M. Calnan et al., INVOLVEMENT OF THE PRIMARY HEALTH-CARE TEAM IN CORONARY HEART-DISEASEPREVENTION, British journal of general practice, 44(382), 1994, pp. 224-228
Background Recent years have seen a vast increase in the amount of hea
lth promotion activity undertaken in general practice. Aim. This study
set out to identify the level of general practitioner and nurse invol
vement in activities aimed at coronary heart disease prevention and to
examine variations in involvement. Method. A questionnaire survey was
undertaken of a sample of general practitioners across England and th
e nurses who worked in their practices. Results. Of 1696 randomly sele
cted general practitioners 64% completed a questionnaire, of 928 pract
ice nurses 71% responded and of 682 health visitors and 679 district n
urses 52% and 40% responded, respectively. Of the general practitioner
s 94% reported that they were involved in assessing lifestyle risk fac
tors in the routine consultation and regular assessments most commonly
involved blood pressure testing and inquiry about smoking status. Eig
hty six per cent of practices were reported by the practice nurse as h
aving well person clinics; these clinics were usually run by the pract
ice nurse. Clinics for the management of specific lifestyle risk facto
rs were also usually run by practice nurses, although many doctors wer
e involved in hypertension clinics and cholesterol clinics. Health vis
itors and district nurses had a low level of involvement in this pract
ice based clinic activity. Involvement of general practitioners and pr
actice nurses in coronary heart disease prevention was associated with
training in health promotion and positive attitudes towards preventio
n and health promotion. The level of involvement of practice nurses in
health promotion was associated with the support received from primar
y health care facilitators, family health services authorities and dis
trict health authorities. Conclusion. Members of the primary health ca
re team appeared to have their own distinct area of preventive activit
y. However, this division did not appear to be a result of organized t
eamwork and deployment of skills and expertise according to a clearly
defined management protocol Instead it seemed to be a product of gener
al practitioner contract and management arrangements which tended to e
ncourage an approach to general practice health promotion which revolv
ed around the practice nurse and which hindered the development of a b
roader team based approach to planning and delivery of health promotio
n in relation to the needs of the practice population.