Findings from a clinical audit in regional general practice of management of patients following acute coronary syndrome

Abstract

Patients with acute coronary syndrome (ACS) require ongoing treatment and support from their primary care provider to modify cardiovascular risk factors (including diet, exercise and mood), to receive evidence-based pharmacotherapies and be properly monitored and to ensure their take-up and completion of cardiac rehabilitation (CR). This study assesses adherence to National Heart Foundation guidelines for ACS in primary care in a regional centre in Western Australia. Patients discharged from hospital after a coronary event (unstable angina or myocardial infarction) or a coronary procedure (stent or coronary artery bypass graft) were identified through general practice electronic medical records. Patient data was extracted using a data form based on National Heart Foundation guidelines. Summary statistics were calculated and reported. Our study included 22 GPs and 44 patients in a regional centre. In total, 90% (n=39) of discharge summaries recorded medications. Assessment of pharmacological management showed that 53% (n=23) of patients received four or more classes of pharmacotherapy and that GPs often augmented medication beyond that prescribed at discharge. Of 15 smokers, 13 (87%) had advice to quit documented. Minimal advice for other risk-factor modification was documented in care plans. Patients with type 2 diabetes (n=20) were 70% more likely to receive allied health referral (P=0.02) and 60% more likely to receive advice regarding diet and exercise (P=0.007). However, overall, only 30% (n=13) of those eligible were referred to a dietician, and only 25% were referred to CR (n=10) with six completing CR. Although most GPs did not use standardised tools for mood assessment, 18 (41%) patients were diagnosed as depressed, of which 88% (n=16) were started on antidepressants and 28% (n=6) were referred to a psychologist. Although pharmacotherapy, mood management and smoking cessation management generally followed recommended guidelines, risk factor management relating to diet and exercise by GPs require improvement. Detailed care plans and referral to CR and allied health staff for patient support is recommended.

Audit of the quality of medical care as a way to improve the efficiency of medical organizations

“…Клинические аудиты часто проводятся не только в стационарах, но также и в сфере деятельности врачей общей практики и в амбулаторных учреждениях [26].…”

Perceived Facilitators of Physical Activity Following Coronary Artery Bypass Graft Surgery: A Qualitative Study

“…[8][9][10] However, there can be a gap of weeks to months between hospital discharge and commencement of outpatient (phase 2) cardiac rehabilitation. 11 This gap has led to calls for a more seamless transition between hospital discharge and phase 2 cardiac rehabilitation. 12 In addition, a variety of both programrelated and person-related factors means that access to and uptake of cardiac rehabilitation is limited.…”

“…A previous systematic review identified 11 studies that had explored ways to facilitate physical activity engagement during the first few months following CABG surgery outside of the supervised cardiac rehabilitation setting. 14 Strategies identified in this review that are shown to increase physical activity levels post-CABG surgery were as follows: the provision of written information, 15 verbal information provided by health professionals, 16 one-onone peer support, 17 and videos modeling other patients coping with challenges.…”