Implementing guidelines in primary care: can population impact measures help?
BACKGROUND
Primary care organisations are faced with implementing a large number of guideline recommendations. We present methods by which the number of eligible patients requiring treatment, and the relative benefits to the whole population served by a general practice or Primary Care Trust, can be calculated to help prioritise between different guideline recommendations.


METHODS
We have developed measures of population impact, "Number to be Treated in your Population (NTP)" and "Number of Events Prevented in your Population (NEPP)". Using literature-based estimates, we have applied these measures to guidelines for pharmacological methods of secondary prevention of myocardial infarction (MI) for a hypothetical general practice population of 10,000.


RESULTS
Implementation of the NICE guidelines for the secondary prevention of MI will require 176 patients to be treated with aspirin, 147 patients with beta-blockers and with ACE-Inhibitors and 157 patients with statins (NTP). The benefit expressed as NEPP will range from 1.91 to 2.96 deaths prevented per year for aspirin and statins respectively. The drug cost per year varies from euro 1940 for aspirin to euro 60,525 for statins. Assuming incremental changes only (for those not already on treatment), aspirin post MI will be added for 37 patients and produce 0.40 of a death prevented per year at a drug cost of euro 410 and statins will be added for 120 patients and prevent 2.26 deaths per year at a drug cost of euro 46,150. An appropriate policy might be to reserve the use of statins until eligible patients have been established on aspirin, ACE-Inhibitors and beta blockers.


CONCLUSIONS
The use of population impact measures could help the Primary Care Organisation to prioritise resource allocation, although the results will vary according to local conditions which should be taken into account before the measures are used in practice.
Heller
Richard F
RF
Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The Medical School, The University of Manchester, UK. dick.heller@man.ac.uk
Edwards
Richard
R
McElduff
Patrick
P
D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D001241:Aspirin / Q000191:economics / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000191:economics / Q000627:therapeutic use; D006304:Health Status; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D040242:Risk Reduction Behavior; D006113:United Kingdom / Q000453:epidemiology; D026712:Value of Life / Q000191:economics
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin