title: Quality of secondary prevention of coronary heart disease in Swiss primary care: Lessons learned from a 6-year observational study.
abstract: BACKGROUND
  Across Europe, great variations have been identified in the quality of preventive healthcare services delivered in primary care (PC). We aimed to assess the quality of secondary prevention in Swiss PC patients with coronary heart disease (CHD) and its evolution over six years.
  
  
  METHODS
  In the database of the Swiss «Family Medicine ICPC Research using Electronic Medical Records» (FIRE) project, we identified electronical record data of 2,807 patients with CHD treated for at least 15 months between 2009 and 2014. Primary outcome was the proportion of patients per year meeting four quality indicators of the British Quality and Outcome Framework (QOF): 1) blood pressure (BP) ≤ 150mmHg, 2) total serum cholesterol ≤ 5mmol/L, 3) prescription of anti-platelet therapy, 4) recommended drug prescriptions for patients with previous myocardial infarction (MI). Secondary outcome was the proportion of patients who were ineligible for indicator calculation because of incomplete record data.
  
  
  RESULTS
  From 2009 to 2014, 85.9, 83.1, 82.0, 81.9, 81.5, and 81.0 % of the patients met BP targets and 73.6, 77.0, 69.2, 73.6, 69.4, and 69.1% met cholesterol targets. Anti-platelet therapy was prescribed to 74.8, 76.1, 73.9, 70.2, 72.2, and 72.5 % of the patients. Finally, 83.3, 84.4, 87.5, 75.6, 89.8, and 89.2 % of the patients with previous MI received the recommended drug therapy. Changes over time were not significant. Missing BP records concerned 12.4-15.9 % of the patients, and missing cholesterol records 69.0-75.6 %. Females and patients with less cardiovascular comorbidities were more likely to show missing records.
  
  
  CONCLUSIONS
  Quality of secondary prevention did not improve when measured against QOF indicators in the period under investigation. Missing data in electronic medical records inhibited full quality indicator assessment. Especially in female patients and those with less cardiovascular comorbidity, closer medical documentation should be encouraged in order to facilitate quality of care measurements.
authors.affiliation: Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Scherz
authors.affiliation: Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Fabio
authors.initials: F
authors.lastname: Valeri
authors.affiliation: Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.affiliation: Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland. Electronic address: sima.djalali@usz.ch.
authors.forename: Sima
authors.initials: S
authors.lastname: Djalali
mesh_terms: D003327:Coronary Disease / Q000517:prevention & control*; D006801:Humans; D011320:Primary Health Care; D055502:Secondary Prevention; D013557:Switzerland
keywords: Hausarztmedizin; Kardiovaskuläre Herzkrankheit; Qualitätsindikatoren; Qualitätsmonitoring; Sekundärprevention; cardiovascular disease; electronic medical records; elektronische Krankengeschichte; primary health care; quality indicators; quality monitoring; secondary prevention