INVOLVEMENT OF THE PRIMARY HEALTH-CARE TEAM IN CORONARY HEART-DISEASEPREVENTION

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.