title: Management of acute coronary syndromes in secondary care settings in Kerala: impact of a quality improvement programme.
abstract: BACKGROUND
  Evidence-based therapies that have been shown to improve outcomes in acute coronary syndromes (ACS) are often underused in clinically eligible patients. We evaluated the impact, efficacy and acceptability of a quality improvement programme to manage ACS.
  
  
  METHODS
  A well-defined geographical area was identified and a situational analysis done. All physicians in the area, who were actively involved in the detection and management of ACS, were invited to participate in the quality improvement programme. The programme involved the use of a service delivery package which consisted of standard admission orders and patient-directed discharge instructions. Concurrently, health education in the community to promote self-detection, self-administration of aspirin and self-referral were carried out. All participating physicians were asked to register consecutive cases of ACS (20 each) presenting to their clinics before and after the intervention programme. The pre- and post-intervention data were compared.
  
  
  RESULTS
  The use of aspirin at discharge increased from 89.7% to 96.8% (p < 0.05) and that of heparin from 57.6% to 66.3% (p < 0.05). The use of beta-blockers increased from 48.6% to 63.4% (p < 0.05) and that of lipid-lowering therapy from 74.1% to 96.3% (p < 0.05). There was a significant reduction in the use of calcium channel blockers from 21.6% to 8.1% (p < 0.05). The time to thrombolysis decreased significantly (median difference of 54 minutes, p < 0.05) after the intervention programme.
  
  
  CONCLUSIONS
  Structured quality improvement programmes aimed at both patients and providers can be successful in secondary care settings of developing countries.
authors.affiliation: Centre for Chronic Disease Control, New Delhi 110016, India.
authors.forename: D
authors.initials: D
authors.lastname: Prabhakaran
authors.forename: P
authors.initials: P
authors.lastname: Jeemon
authors.forename: P P
authors.initials: PP
authors.lastname: Mohanan
authors.forename: U
authors.initials: U
authors.lastname: Govindan
authors.forename: Z
authors.initials: Z
authors.lastname: Geevar
authors.forename: V
authors.initials: V
authors.lastname: Chaturvedi
authors.forename: K S
authors.initials: KS
authors.lastname: Reddy
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D019317:Evidence-Based Medicine; D005260:Female; D006266:Health Education; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage; D007194:India; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D015912:Thrombolytic Therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D000960:Hypolipidemic Agents; D006493:Heparin; D001241:Aspirin