a1 Department of Family Medicine, Clalit Health Services, Haifa and Western Galilee District, The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Israel
Background In many countries there is a gap between the clinical evidence for cardiovascular disease (CVD) prevention and implementation in clinical practice. Inadequate control of cardiovascular risk factors and underutilization of aspirin, statins, angiotensin converting enzyme inhibitors and β-blockers are well-established examples. The optimal approach to implementation of CVD prevention in clinical practice is still under debate. The screening and monitoring (SaM) approach is based on cyclic monitoring and individual treatment of patients with cardiovascular risk factors in the primary care setting. After achieving improvements in risk factor levels and in the use of preventive medications in a pilot study, it was decided to test the efficacy of this approach in a larger population at risk.
Methods Five primary care clinics adopted the SaM approach. A total of 1622 patients with established CVD, diabetes mellitus or hypertension were assessed by their family physicians for cardiovascular risk factors and use of medications for cardiovascular risk reduction. Interventions were made according to accepted clinical guidelines. Cardiovascular risk factor levels and the use of medications for CVD prevention were retrospectively analyzed.
Results The results demonstrated significant reductions in blood pressure, hemoglobin A1c and low-density lipoprotein-cholesterol levels, as well as significant increases in the use of medications for CVD prevention.
Conclusion A systematic approach to CVD reduction, with an emphasis on multiple risk factor assessment and use of preventive medications in patients at cardiovascular risk, yielded significant improvements in measures of the quality of preventive care.
(Received March 31 2009)
(Accepted November 01 2009)
(Online publication December 10 2009)