title: The impact of the Polish national Programme of Cardiovascular Disease Prevention on the quality of primary cardiovascular disease prevention in clinical practice.
abstract: BACKGROUND
  Despite a decline since 1991, cardiovascular diseases (CVD) are the major burden on public health in Poland.
  
  
  OBJECTIVE
  To assess the impact of the national Programme of Cardiovascular Disease Prevention (PCVDP) on the quality of primary CVD prevention in clinical practice.
  
  
  METHODS
  Sixty six primary care centres were invited to join the project (2-6 in each province). Half of these centres participated in the PCVDP (in other words, they were 'active' clinics) and the other half was included in the control group. A random sample of 300 patients aged 35-55, free of coronary heart disease, with no history of stroke or peripheral artery disease, and with medical documentation going back at least to 1 January 2005 was selected for the study in each centre. From the total of 3,940 patients in active clinics, 3,162 were judged to be eligible for the study and their medical records were reviewed. All were invited for examination. This was finally attended by 2,314 patients from active clinics and 2,101 from the control group.
  
  
  RESULTS
  Before the introduction of the PCVDP, the percentage of patients with available information on risk factors in medical records was similar in the active and in the control clinics, and varied from more than 40% (hypertension) to less than 5% (weight and waist circumference). After the introduction of the PCVDP, the proportion of subjects with available information on risk factors greatly increased in the clinics which took part in the PCVDP. Knowledge of CVD risk factors was similar in the two studied groups. When asked, about 10% of patients in both groups could not list a single CVD risk factor. Smoking was the most frequently recognised risk factor (named by more than 60% of patients) and diabetes the least (less than 15%). No significant difference was found between the active and control clinics in the frequency of counselling as to smoking, diet, weight reduction or exercise. Only about 40% of smoking patients had received advice on smoking cessation. Counselling on diet had been received by about 40% of patients. Less than 20% of patients had been advised to reduce weight, with about 25% having received advice to increase their physical activity. Control of risk factors was poor and there was no significant difference between the active and control clinics in terms of the proportion of patients who reached prevention targets.
  
  
  CONCLUSIONS
  1. The PCVDP appears to be effective in identifying high risk patients. 2. The effectiveness of the routine management of risk factors in primary care is very low. 3. Addressing via the PCVDP all decisions as to the extent and means of intervention on risk factors to primary care physicians appears to be ineffective. 4. There is a need to introduce an effective structured intervention on risk factors and add it to the PCVDP.
authors.affiliation: Epidemiology and Population Studies Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pająk
authors.forename: Krystyna
authors.initials: K
authors.lastname: Szafraniec
authors.forename: Marianna
authors.initials: M
authors.lastname: Janion
authors.forename: Andrzej
authors.initials: A
authors.lastname: Szpak
authors.forename: Barbara
authors.initials: B
authors.lastname: Wizner
authors.forename: Renata
authors.initials: R
authors.lastname: Wolfshaut-Wolak
authors.forename: Grażyna
authors.initials: G
authors.lastname: Broda
authors.forename: Izabela
authors.initials: I
authors.lastname: Cichocka
authors.forename: Wojciech
authors.initials: W
authors.lastname: Drygas
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Gąsior
authors.forename: Tomasz
authors.initials: T
authors.lastname: Grodzicki
authors.forename: Tomasz
authors.initials: T
authors.lastname: Zdrojewski
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D011044:Poland; D011322:Primary Prevention; D012307:Risk Factors