title: Evaluating quality and its determinants in lipid control for secondary prevention of heart disease and stroke in primary care: a study in an inner London Borough.
abstract: OBJECTIVE
  To assess quality of management and determinants in lipid control for secondary prevention of cardiovascular disease (CVD) using multilevel regression models.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Inner London borough, with a primary care registered population of 378,000 (2013).
  
  
  METHODS
  48/49 participating general practices with 7869 patients on heart disease/stroke registers were included.
  
  
  METHODS
  (1) Recording of current total cholesterol levels and lipid control according to national evidence-based standards. (2) Assessment of quality by age, sex, ethnicity, deprivation, presence of other risks or comorbidity in meeting both lipid measurement and control standards.
  
  
  RESULTS
  Some process standards were not met. Patients with a current cholesterol measurement >5 mmol/L were less likely to have a current statin prescription (adjusted OR=3.10; 95% CI 2.70 to 3.56). They were more likely to have clustering of other CVD risk factors. Women were significantly more likely to have raised cholesterol after adjustment for other factors (adjusted OR=1.74; 95% CI 1.53 to 1.98).
  
  
  CONCLUSIONS
  In this study, the key factor that explained poor lipid control in people with CVD was having no current prescription record of a statin. Women were more likely to have poorly controlled cholesterol (independent of comorbid risk factors and after adjusting for age, ethnicity, deprivation index and practice-level variation). Women with CVD should be offered statin prescription and may require higher statin dosage for improved control.
authors.affiliation: Lambeth & Southwark Councils, Public Health, London, UK.
authors.forename: Hiten
authors.initials: H
authors.lastname: Dodhia
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK.
authors.forename: Liu
authors.initials: L
authors.lastname: Kun
authors.affiliation: Kings College NHS Foundation Trust, F2 Doctor, London, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: Logan Ellis
authors.affiliation: Lambeth & Southwark Councils, Public Health, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Crompton
authors.affiliation: Department of Chemical Pathology, St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Wierzbicki
authors.affiliation: NHS Southwark Clinical Commissioning Group, Medicines Management Team, London UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Williams
authors.affiliation: NHS Lambeth Clinical Commissioning Group, Medicines Management Team, London, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Hodgkinson
authors.affiliation: NHS Lambeth Clinical Commissioning Group, Governing Body Member, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Balazs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002784:Cholesterol / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016015:Logistic Models; D008131:London; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012042:Registries; D055502:Secondary Prevention / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D020521:Stroke / Q000097:blood / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol
keywords: AUDIT; PRIMARY CARE; health care equity