title: Quality of cardiovascular disease care in Ontario, Canada: missed opportunities for prevention - a cross sectional study.
abstract: BACKGROUND
  Primary care plays a key role in the prevention and management of cardiovascular disease (CVD). We examined primary care practice adherence to recommended care guidelines associated with the prevention and management of CVD for high risk patients.
  
  
  METHODS
  We conducted a secondary analysis of cross-sectional baseline data collected from 84 primary care practices participating in a large quality improvement initiative in Eastern Ontario from 2008 to 2010. We collected medical chart data from 4,931 patients who either had, or were at high risk of developing CVD to study adherence rates to recommended guidelines for CVD care and to examine the proportion of patients at target for clinical markers such as blood pressure, lipid levels and hemoglobin A1c.
  
  
  RESULTS
  Adherence to preventive care recommendations was poor. Less than 10% of high risk patients received a waistline measurement, half of the smokers received cessation advice, and 7.7% were referred to a smoking cessation program. Gaps in care exist for diabetes and kidney disease as 54.9% of patients with diabetes received recommended hemoglobin-A1c screenings, and only 55.8% received an albumin excretion test. Adherence rates to recommended guidelines for coronary artery disease, hypertension, and dyslipidemia were high (>75%); however <50% of patients were at target for blood pressure or LDL-cholesterol levels (37.1% and 49.7% respectively), and only 59.3% of patients with diabetes were at target for hemoglobin-A1c.
  
  
  CONCLUSIONS
  There remain significant opportunities for primary care providers to engage high risk patients in prevention activities such as weight management and smoking cessation. Despite high adherence rates for hypertension, dyslipidemia, and coronary artery disease, a significant proportion of patients failed to meet treatment targets, highlighting the complexity of caring for people with multiple chronic conditions.
authors.affiliation: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada. cliddy@bruyere.org
authors.forename: Clare
authors.initials: C
authors.lastname: Liddy
authors.forename: Jatinderpreet
authors.initials: J
authors.lastname: Singh
authors.forename: William
authors.initials: W
authors.lastname: Hogg
authors.forename: Simone
authors.initials: S
authors.lastname: Dahrouge
authors.forename: Catherine
authors.initials: C
authors.lastname: Deri-Armstrong
authors.forename: Grant
authors.initials: G
authors.lastname: Russell
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.forename: Ayub
authors.initials: A
authors.lastname: Akbari
authors.forename: George
authors.initials: G
authors.lastname: Wells
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy*; D016000:Cluster Analysis; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior