Effect of postal prompts to patients and general practitioners on the quality of primary care after a coronary event (POST): randomised controlled trial

Objectives To determine whether postal prompts to patients who have Survive d an acute coronary event and to their general practitioners improve second ary prevention of coronary heart disease. Design Randomised controlled trial. Setting 52 general practices in east London, 44 of which had received facil itation of local guidelines for coronary heart disease. Participants 328 patients admitted to hospital for myocardial infarctionor unstable angina. Interventions Postal prompts sent 2 weeks and 3 months after discharge from hospital. The prompts contained recommendations for lowering the risk of a nother coronary event, including changes to lifestyle, drug treatment, and making an appointment to discuss these issues with the general practitioner or practice nurse. Main outcome measures Proportion of patients: in whom serum cholesterol con centrations were measured; proportion of patients prescribed beta blockers (6 months after discharge); and proportion of patients prescribed cholester ol lowering drugs (1 year after discharge). Results Prescribing of beta bockers (odds ratio 1.7, 95% confidence interva l 0.8 to 3.0, P > 0.05) and cholesterol lowering drugs (1.7., 0.8 to 3.4, P > 0.05) did not differ between intervention and control groups: A higher p roportion of patients in the intervention group (64%) than in the control g roup (38%) had their serum cholesterol concentrations measured (2.9, 1.5 to 5.5, P < 0.001). Secondary outcomes were significantly improved for consul tations for coronary heart disease, the recording of risk factors, and advi ce given. There were no significant differences in patients' self reported changes to lifestyle: or to the belief that it is possible to modify the ri sk of another coronary event Conclusions,Postal prompts to patients who had had acute coronary events an d to their general practitioners in a locality where guidelines for coronar y heart disease had been disseminated did not improve prescribing of effect ive drugs for secondary prevention or self reported changes to lifestyle. T he prompts did increase consultation,rates related to. 1 coronary heart dis ease and the recording of risk factors in the practices. Effective secondar y prevention of coronary heart disease requires more than postal prompts an d the dissemination of guidelines.