Abstract
Current improvement strategies for the control of cardiovascular risk factors (CRFs) in Europe are based on quality management policies. With the aim of understanding the effect of interventions delivered by primary healthcare systems, we evaluated the impact of clinical governance on cardiovascular health after ten years of implementation in Catalonia. A cohort study that included 1878 patients was conducted in 19 primary care centres (PCCs). Audits that comprised 13 cardiovascular health indicators were performed and general practitioners received periodic (annual, biannual or monthly) feedback about their clinical practice. We evaluated improvement in screening, diagnosis and control of the main CRFs and the effects of the feedback on cardiovascular risk (CR), incidence of cardiovascular disease (CVD) and mortality, comparing baseline data with data at the end of the study (after a 10-year follow-up). The impact of the intervention was assessed globally and with respect to feedback frequency. General improvement was observed in screening, percentage of diagnoses and control of CRFs. At the end of the study, few clinically significant differences in CRFs were observed between groups. However, the reduction in CR was greater in the group receiving high frequency feedback, specifically in relation to smoking and control of diabetes and cholesterol (Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL)). A protective effect of having a cardiovascular event (hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.44–0.94) or death (HR = 0.55, 95% CI = 0.35–0.88) was observed in patients from centres where general practitioners received high frequency feedback. Additionally, these PCCs presented improved cardiovascular health indicators and lower incidence and mortality by CVD, illustrating the impact of this intervention.
Highlights
IntroductionIn Europe, 45% of deaths are attributable to cardiovascular disease (CVD) [2], and in Spain, the first specific cause of death is ischaemic heart disease (14.6%) [3]
Cardiovascular disease (CVD) causes one in three deaths worldwide [1]
We evaluated the effect of implementing clinical governance within the context of cardiovascular health and observed the benefits of audits and feedback on the most important modifiable cardiovascular risk factors (CRFs)
Summary
In Europe, 45% of deaths are attributable to CVD [2], and in Spain, the first specific cause of death is ischaemic heart disease (14.6%) [3]. Current improvement strategies for the control of CRFs in Europe are based on quality management policies [8]. Clinical governance has since expanded to other settings, and some factors have been identified as crucial to its effectiveness, especially audits, evidence-based practice, risk management, monitoring the outcomes of medical care, continuing medical education and systems for managing poor performance [10,11,12,13,14,15,16,17,18]
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