TITLE

Implementing guidelines in primary care: can population impact measures help?

AUTHOR(S)
Heller, Richard F.; Edwards, Richard; McElduff, Patrick
PUB. DATE
January 2003
SOURCE
BMC Public Health;2003, Vol. 3, p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Primary care organisations are faced with implementing a large number of guideline recommendations. We present methods by which the number of eligible patients requiring treatment, and the relative benefits to the whole population served by a general practice or Primary Care Trust, can be calculated to help prioritise between different guideline recommendations. Methods: We have developed measures of population impact, "Number to be Treated in your Population (NTP)" and "Number of Events Prevented in your Population (NEPP)". Using literature-based estimates, we have applied these measures to guidelines for pharmacological methods of secondary prevention of myocardial infarction (MI) for a hypothetical general practice population of 10,000. Results: Implementation of the NICE guidelines for the secondary prevention of MI will require 176 patients to be treated with aspirin, 147 patients with beta-blockers and with ACE-Inhibitors and 157 patients with statins (NTP). The benefit expressed as NEPP will range from 1.91 to 2.96 deaths prevented per year for aspirin and statins respectively. The drug cost per year varies from €1940 for aspirin to €60,525 for statins. Assuming incremental changes only (for those not already on treatment), aspirin post MI will be added for 37 patients and produce 0.40 of a death prevented per year at a drug cost of €410 and statins will be added for 120 patients and prevent 2.26 deaths per year at a drug cost of €46,150. An appropriate policy might be to reserve the use of statins until eligible patients have been established on aspirin, ACE-Inhibitors and beta blockers. Conclusions: The use of population impact measures could help the Primary Care Organisation to prioritise resource allocation, although the results will vary according to local conditions which should be taken into account before the measures are used in practice.
ACCESSION #
29973736

 

Related Articles

  • Experts call upon MDs to embrace guidance for post-MI.  // Medical Device Daily;8/29/2009, p2 

    The article reports on a call from experts from the Primary Care Cardiovascular Society and Heart UK for primary care clinicians to adopt a new guidance designed to support optimal care and treatment of post-myocardial infarction (MI) patients. The guidance, which was published in the "British...

  • Looking more closely for MI signals in the office.  // Cortlandt Forum;Jan2007, Vol. 20 Issue 1, p12 

    The article presents a study conducted by Harvard which revealed that primary-care physicians missing signs of impending heart attack for some in-office patients. The researchers found that almost 1,000 patients with no history of coronary heart disease admitted to the hospital with acute...

  • One-stop shop for the heart. Hlotyak, Elizabeth // Westchester County Business Journal;12/30/2002, Vol. 41 Issue 52, p1 

    Reports on the formation of Primary Care and Cardiovascular Associates of Westchester in New York City. Services offered; Focus on the provision of care related to myocardial infarctions; Efforts of the company to offer nuclear cardiac stress imaging.

  • Features of High Quality Discharge Planning for Patients Following Acute Myocardial Infarction. Cherlin, Emily; Curry, Leslie; Thompson, Jennifer; Greysen, S.; Spatz, Erica; Krumholz, Harlan; Bradley, Elizabeth // JGIM: Journal of General Internal Medicine;Mar2013, Vol. 28 Issue 3, p436 

    BACKGROUND: Hospital discharge planning is required as a Medicare Condition of Participation (CoP), and is essential to the health and safety for all patients. However, there have been no studies examining specific hospital discharge processes, such as patient education and communication with...

  • Atrial Electromechanical Delay and Diastolic Dysfunction in Primary Sjögren Syndrome. Akyel, Ahmet; Tavil, Yusuf; Tufan, Abdurrahman; Yayla, Cagri; Kaya, Arif; Tezcan, Mehmet Engin; Ozturk, Mehmet Akif; Boyaci, Bulent // Clinical & Investigative Medicine;2012, Vol. 35 Issue 5, pE303 

    Purpose: In this study we aimed to investigate myocardial function and atrial electromechanical properties by conventional and tissue doppler echocardiography in patients with primary Sjögren syndrome. Methods: Forty patients with Sjögren syndrome (SS) and 25 age- and sex-matched healthy...

  • Is there a clinically significant gender bias in post-myocardial infarction pharmacological management in the older (>60) population of a primary care practice? Cecco, Romolo Di; Patel, Umesh; Upshur, Ross E. G. // BMC Family Practice;2002, Vol. 3, p1 

    Background: Differences in the management of coronary artery disease between men and women have been reported in the literature. There are few studies of potential inequalities of treatment that arise from a primary care context. This study investigated the existence of such inequalities in the...

  • An audit of secondary prevention of coronary heart disease in post acute myocardial infarction patients in primary care. Dunkley, Alison; Stone, Margaret; Squire, Iain; Johnson, Tracy; Farooqi, Azhar; Khunti, Kamlesh // Quality in Primary Care;2006, Vol. 14 Issue 1, p15 

    Introduction The National Service Framework for Coronary Heart Disease (CHD) defines national standards for delivering care after acute myocardial infarction (AMI). Objectives To improve appropriate use of secondary prevention measures and investigations after an AMI at the interface of primary...

  • Aspirin's Absence. Siegfried, Donna Rae // Arthritis Today;Mar/Apr2006, Vol. 20 Issue 2, p72 

    Discusses the findings of a study on patients with rheumatoid arthritis (RA) at high risk of heart attack, conducted by researchers from Wake Forest University in Winston-Salem, North Carolina. Percentage of patients who took aspirin to prevent a heart attack; Lack of awareness of the...

  • Comparative outcome of patients undergoing percutaneous coronary intervention (PCI) following fibrinolysis or primary PCI for ST-elevation myocardial infarction. Rankin, K.; Brennan, A.; Andrianopoulos, N.; Sebastian, M.; Freeman, M.; Yip, T.; Ajani, A.; Clark, D.; Reid, C.; O’Brien, J.; Oqueli, E.; Duffy, S. // Heart, Lung & Circulation;2015 Supplement 3, Vol. 24, pS268 

    No abstract available.

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics