P80– Quality of care in the management of cardiovascular risk factors in primary care of the Basque Country before the implementation of three clinical practice guidelines

PRIMARY TRACK

Guideline implementation

SECONDARY TRACK

Implementing guidelines in developing countries

BACKGROUND (INTRODUCTION)

The Basque Health Service has focused on the improvement of care for cardiovascular risk factors through a program of implementation of three clinical practice guidelines (diabetes, hypertension, and dyslipemia) in primary care. A cluster randomized clinical trial is being performed to evaluate its impact.

LEARNING OBJECTIVES (TRAINING GOALS)

1

To describe the management of cardiovascular risk factors before the implementation of the guidelines.

METHODS

Type of study: a cross-sectional study. Study population: Patients with hypertension, type 2 diabetes mellitus, and general population; Basque Country (Gipuzkoa East and Bilbao districts). Data sour central computerized medical record, period 2008. Variables: Process and outcome indicators proposed in the guidelines.

RESULTS

Diabetes (N = 40,604): annual request for HbA1c, 71.38%; annual cardiovascular risk assessment, 7.02%; HbA1c less than 7%, 41.44%; annual foot examination, 39.81%; new diagnoses treated with metformin, 65.17%. Hypertension (N = 89,164): annual request for laboratory testing, 17.18%; adequate control of blood pressure, 29.62%; annual cardiovascular risk assessment, 6.93%. General population (N = 389,471): cardiovascular risk assessment in women aged 45 years and men aged 40 years: 17.27% and 14.36%, respectively. No statistically significant differences were found in baseline characteristics of patients between the intervention and control groups, with the exception of the indicator “annual request for HbA1c” (P < 0.05), although the magnitude of the difference was very small (1.6%).

DISCUSSION (CONCLUSION)

There is considerable scope for improvement in cardiovascular risk factors care. An impact assessment of different interventions is needed to improve the management of cardiovascular risk factors.

TARGET AUDIENCE(S)

1

Clinical researcher