title: Audit-based education to reduce suboptimal management of cholesterol in primary care: a before and after study.
abstract: BACKGROUND
  Statins are recommended for the secondary prevention of cardiovascular disease, although they are often used in suboptimal doses and some patients may not receive lipid-lowering therapy. The Primary Care Data Quality (PCDQ) programme is an audit-based educational intervention.
  
  
  OBJECTIVE
  To report the PCDQ programme's effect on the cholesterol management in cardiovascular disease. Subjects and methods Anonymized general practice data from 99 practices; 5% (n = 29 915) had cardiovascular diagnoses.
  
  
  RESULTS
  Mean cholesterol fell from 4.75 to 4.64 mmol l(-1); patients achieving cholesterol target (< 5 mmol l(-1)) rose from 45.3 to 53.2%. Coronary heart disease patients achieved better control (mean 4.57 mmol l(-1)) than those with stroke (4.87 mmol l(-1)) or peripheral vascular disease (4.93 mmol l(-1)). Statin prescribing increased from 57.5 to 62.7%. Patients with diabetes [odds ratio (OR) 2.06, 95% confidence interval (95% CI) 1.91-2.21], prior myocardial infarction (MI) (OR 1.93, 95% CI 1.80-2.07), revascularization (OR 1.52, 95% CI 1.33-1.73) and smokers (OR 1.31, 95% CI 1.23-1.39) were more likely to receive statins, whereas people aged 75+ (OR 0.48, 95% CI 0.45-0.50), females (OR 0.90, 95% CI 0.86-0.94) and non-CHD-diagnosed (OR 0.36, 95% CI 0.34-0.38) were less likely.
  
  
  CONCLUSIONS
  Diagnostic coding and number of patients who had their cholesterol measured and treated increased. There was no significant change in dosage used or inequity between the different groups prescribed statins.
authors.affiliation: Primary Care Informatics, Division of Community Health Sciences, St George's - University of London, London SW17 ORE, UK. slusigna@sgul.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: de Lusignan
authors.forename: J
authors.initials: J
authors.lastname: Belsey
authors.forename: N
authors.initials: N
authors.lastname: Hague
authors.forename: N
authors.initials: N
authors.lastname: Dhoul
authors.forename: J
authors.initials: J
authors.lastname: van Vlymen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005194:Family Practice / Q000193:education / Q000592:standards*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D007223:Infant; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D013997:Time Factors; D006113:United Kingdom
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol