The Sandwell Project: a controlled evaluation of a programme of targeted screening for prevention of cardiovascular disease in primary care.
BACKGROUND
A pilot cardiovascular disease prevention project was implemented in the inner-city West Midlands. It was evaluated by comparing its effectiveness to a control group where full implementation was delayed by a year.


METHODS
Cardiovascular risk factor data were extracted on all untreated patients 35 to 74 years old from electronic medical databases in six general practices. A best estimate of ten-year CVD risk cardiovascular risk was calculated on all patients using the extracted risk factor data. Default risk-factor values were used for all missing risk factor data. High risk patients were thus identified. In four practices a project nurse systematically invited, assessed and referred high risk patients for treatment. Two control practices were provided with a list of their high risk patients. The outcomes were the proportions of untreated high-risk patients who were assessed, identified as eligible for treatment and treated under two strategies for identifying and treating such patients in primary care.


RESULTS
Of all high-risk patients suitable for inclusion in the project, 40.6% (95% CI: 36.7 to 45.7%) of patients in intervention practices were started on treatment were started on at least one treatment, compared to 12.7% (95% CI: 9.8% to 16.1%) in control practices.


CONCLUSIONS
A strategy using electronic primary care records to identify high risk patients for CVD prevention works best with a process for acting on information, ensuring patients are invited, assessed and treated.
Marshall
Tom
T
Department of Public Health & Epidemiology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. T.P.Marshall@bham.ac.uk
Westerby
Paul
P
Chen
Jenny
J
Fairfield
Mary
M
Harding
Jenny
J
Westerby
Ruth
R
Ahmad
Rajai
R
Middleton
John
J
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D003327:Coronary Disease / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011314:Preventive Health Services / Q000379:methods*; D011320:Primary Health Care; D015397:Program Evaluation; D018570:Risk Assessment; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology