Quality indicators for the primary prevention of cardiovascular disease in primary care: A systematic review

Abstract

Background Primary care is usually the entry point for preventing cardiovascular disease (CVD). Quality indicators can be used to assess and monitor the quality of care provided in a primary care setting. In this systematic review, we aimed to identify, summarise, and assess the methodological quality of indicators reported in the articles for the primary prevention of CVD in primary care. Methods We searched Ovid MEDLINE, Ovid EMBASE, CINAHL Plus, SCOPUS, and grey literature for articles containing quality indicators published in English language. Quality indicators were categorised using the Donabedian framework: Structure (organisation of care), Process (assessment of metabolic risk factors, global risk assessment, lifestyle management, prescription of medications, risk communication/advice, referral), and Outcome (attainment of risk factor targets). Articles were reviewed by two authors, using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument, where a score of ≥50% for each domain indicated strong methodological quality (e.g., stakeholder involvement). Results We identified 282 articles for full-text review; 57 articles were included for extraction. A total of 726 (681 unique) quality indicators were extracted. Three out of four (76%) were process indicators (56 articles), followed by 15% outcome indicators (40 articles), and 9% structure indicators (12 articles). One-third of process indicators were related to the assessment of metabolic risk factors (222/726 indicators, 41 articles), followed by lifestyle management (153/726 indicators, 39 articles), prescription of medications (122/726 indicators, 37 articles), and global risk assessment (27/726, 14 articles). Few indicators were related to risk communication/advice (20/726 indicators, 7 articles) and referral (9/726 indicators, 6 articles). Only 26/57 (46%) articles were found to have strong methodological quality. Conclusion We summarised and appraised the methodological quality of indicators for the primary prevention of CVD. The next step requires prioritising a minimum set of quality indicators to encourage standardised collection and monitoring across countries.