Computerised systematic secondary prevention in ischaemic heart disease: astudy in one practice

Background. One of the most effective interventions that the primary health care team can make is that of secondary prevention in ischaemic heart dise ase (IHD). There is still a need to improve the uptake of effective interve ntions such as aspirin and statins in these patients. General Practice in t he UK is 95% computerised, but many functions an underutilised. In the majo rity of cases primary care clinicians use the keyboard rather than mouse fo r data entry. Methods of data entry using the keyboard or CKUI (Character U ser Interface) can be cumbersome and time consuming. This can limit data co llection and its assimilation for patient care. The object of this study wa s to assess the feasibility and effectiveness of a new software programme, which provides computerised support to primary care staff in their preventi ve care of IHD patients. Aim. To demonstrate that a systematic computer facilitated secondary preven tion programme for IHD was effective, feasible, and acceptable to patients and improved patient care. Method: Evidence-based guidelines and intervention levels for secondary pre vention of LHD were agreed at practice level and embedded in the software. Patients aged SO and under were identified by the use of Read codes and rep eat prescribing. The nurse-run programme consisted of a detailed review of electronic and written records and then the clinical review of 141 patients . At follow-up patients were issued with a questionnaire to assess their sa tisfaction with the process. Results. From a general practice computer search for ischaemic heart diseas e Read Code (G3) and/or nitrate prescription an initial cohort of 242 patie nts was established. 90 were excluded on clinical grounds (not IHD, decease d, over-riding other clinical problems), and eleven patients could not be r ecruited (eight declined and three had moved away). The final cohort consis ted of 141 patients, of whom 101 patients suffered angina, 67 had a previou s history of myocardial infarction, and 28 had had coronary artery bypass g rafting. Hypertension had been diagnosed in 80 and hyperlipidaemia in 43. A s a result of the study new diagnoses included: hyperlipidaemia where stati ns were indicated (38), congestive cardiac failure requiring treatment with ACE (Angiotensin Converting Enzyme) inhibitors (2) and carotid bruits requ iring referral (4). In addition diabetes was diagnosed in three patients. T he programme proved acceptable to patients, doctors and practice staff; fol low-up continues. Conclusion: The use of this methodology, in a single practice, has improved the care of patients well beyond that achieved with established template-b ased secondary prevention programmes. The outcome has been measured in term s of increased diagnosis and active management of hyperlipidaemia and other risk factors.