Coronary heart disease risk factors: effectiveness of their control by primary health doctors (survey data)

The survey focused on municipal out-patient clinic internists' involvement into modified coronary heart disease risk factor (CHD RF) control, as well as on RF control effectiveness reported by the patients. Up to 73 % of the doctors confirmed clinical effectiveness of the intervention, and 53 % regarded it equally important as antianginal therapy. Nevertheless, there were numerous barriers for successful realization of CHD RF control measures. Delivering RF control advice was linked to doctors' working pressure in 50, 5 % of cases, to patients' cultural level in 78,8 %, to patients' interest and initiative in 33,3 %, and to personal patient-doctor relations in 21,2 %. Only brief advice was given by 44,9 % of the doctors, and no more than 18 % of the respondents were ready to forward their patient to the relevant specialist. Therefore, 26 % of the doctors reported providing lifestyle modification advice «never», «rarely», or «occasionally». Unsatisfactory follow-up on fulfillment of such advice was confirmed by 49 % of the doctors. According to patient-provided data, the majority of the patients were unable to recollect receiving any relevant advice from their doctors. Most doctors reported advising on lipid-lowering diet, body weight control and smoking cessation (94 % in each case), or physical training (77,5 %), but only 46,1 %, 32,3 %, 75,3 % and 23,8 % of their patients, respectively, confirmed receiving such recommendations. Moreover, even for smoking cessation advice, where doctor-patient reporting gap was minimal, only 13, 4 % of the patients confirmed being offered some cessation plan. Expectedly, the majority of quitters (68,85 %) were sure that cessation was their own accomplishment.

Coronary heart disease, modified risk factors, effectiveness of the intervention

1. Albright C.L., Cohen S., Gibbons L., et al. Incorporating physical activity advice into primary care: physician-delivered advice within the activity counseling trial. Am. J. Prev. Med. 2000 Apr; 18(3): 225-34.

2. Anda R., Remington P.L., Sienko D.G., et al. Are physicians advising smokers to quit? The patient's perspective. JAMA 1987 Apr 10; 257(14): 1916-9.

3. Bansal M.A., Cummings K.M., Hyland A., et al. Stop-smoking medications: who uses them, who misuses them, and who is misinformed about them? Nicotine Tob. Res. 2004; 6 Suppl 3: S303-10.

4. Bjerrum L., Larsen J., Kragstrup J. Increased use of lipid-lowering agents after implementation of clinical guidelines in general practice. Ugeskr. Laeger. 2003 Jan 6; 165(2): 120-3.

5. Brady A.J.В., Norrie J., Ford I. Statin Prescribing: Is the Reality Meeting the Expectations of Primary Care? Br. J. Cardiol. 2005; 12(5): 397-400.

6. Bull F.C., Schipper E.C., Jamrozik K., et al. How can and do Australian doctors promote physical activity? Prev. Med. 1997 Nov-Dec; 26(6): 866-73.

7. Cummings S.R., Rubin S.M., Oster G. The cost-effectiveness of counseling smokers to quit. JAMA 1989 Jan 6; 261(l): 75-9.

8. EUROASPIRE I and II Group. Clinical realty of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. The Lancet 2001 Mar; 357: 995-1001.

9. EUROASPIRE II Group. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries: principal results from EUROASPIRE II. Eur. Heart. J. 2001; 22: 554-72.

10. EUROASPIRE Study Group. EUROASPIRE: a European Society of Cardiology survey of secondary prevention of coronary heart disease, principal results. Eur. Heart. J. 1997; 18: 1569-82.

11. Frolkis J.P., Zyzanski S.J., Schwartz J.M., et al. Physician noncompliance with the 1993 National Cholesterol Education Program (NCEP-ATP II) guidelines. Circulation. 1998 Sep l; 98(9): 851-5.

12. Gibbons R.J., Abrams J. et al. ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina. A Report of the American College of Cardiology/Am. Heart. Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for the Management of Patients With Chronic Stable Angina)//http://www.acc.org

13. Gibbons R.J., Chatterjee K., Daley J., et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 1999; 33: 2092-2097.

14. Gill J.M., Diamond J.J., Leone F.T., et al. Do physicians in Delaware follow national guidelines for tobacco counseling? Del. Med. J. 2004 Aug; 76(8): 297-308.

15. Glanz K., Tziraki C., Albright C.L., et al. Nutrition assessment and counseling practices: attitudes and interests of primary care physicians. J. Gen. Intern. Med. 1995 Feb; 10(2): 89-92.

16. Hiddink G.J., Hautvast J.G., van Woerkum C.M., et al. Nutrition guidance by primary-care physicians: perceived barriers and low involvement. Eur. J. Clin. Nutr. 1995 Nov; 49(ll): 842-51.

17. Hobbs F.D., Erhardt L. Acceptance of guideline recommendations and perceived implementation of coronary heart disease prevention among primary care physicians in five European countries: the Reassessing European Attitudes about Cardiovascular Treatment (REACT) survey. Fam. Pract. 2002 Dec; 19(6): 596-604.

18. Hyman D.J., Maibach E.W., Flora J.A., et al. Cholesterol treatment practices of primary care physicians. Public Health Rep. 1992 Jul-Aug; 107(4): 441-8.

19. Kaplan C.P., Perez-Stable E.J., Fuentes-Afflick E., et al. Smoking cessation counseling with young patients: the practices of family physicians and pediatricians. Arch. Pediatr. Adolesc. Med. 2004 Jan; 158(1): 83-90.

20. Larsen J., Andersen M., Bjerrum L., et al. Insufficient use of lipid-lowering drugs and measurement of serum cholesterol among patients with a history of myocardial infarction. J. Cardiovasc. Risk. 2003 Feb; 10(1): 61-4.

21. Majumdar S.R., Gurwitz J.H., Soumerai S.B. Undertreatment of hyperlipidemia in the secondary prevention of coronary artery disease. J. Gen. Intern. Med. 1999; Dec; 14(12): 711-7.

22. McIlvain H.E., Crabtree B.F., Gilbert C., et al. Current trends in tobacco prevention and cessation in Nebraska physicians' offices. J. Fam. Pract. 1997 Feb; 44(2): 193-202

23. Pearson Т.А. The undertreatment of LDL-cholesterol: adressing the challenge. Int. J. Cardiol. 200 Jun 30; 74 Suppl 1: S23-8.

24. Saddlemire A.E., Denny C.H., Greenlund K.J., et al. Trends in Cholesterol Screening and Awareness of High Blood Cholesterol. United States, 1991-2003 MMWR 2005; 54(35): 865-870. ©2005 Centers for Disease Control and Prevention (CDC).

25. Schucker В., Wittes J.T., Santanello N.C., et al. Change in cholesterol awareness and action. Results from national physician and public surveys. Arch Intern Med 1991 Apr. 151(4): 666-73.

26. Soltesz K.S., Price J.H., Johnson L.W., et al. Family physicians' views of the preventive services task force recommendations regarding nutritional counseling. Arch. Fam. Med. 1995. Jul. 4(7): 589-93.

27. Sueta C.A., Chowdhury M., Boccuzzi S.J., et al. Analysis of the degree of undertreatment of hyperlipidemia and congestive heart failure secondary to coronary artery disease. Am. J. Cardiol. 1999 May 1; 83(9): 1303-7.

28. Summerskill W.S., Pope C. An exploratory qualitative study of the barriers to secondary prevention in the management of coronary heart disease. Fam Pract 2002 Dec. 19(6): 605-10.

29. Ujita K., Ohno K., Hashiguchi M., et al. Drug use evaluation of anti-dyslipidemic agents at a community hospital in Japan. Yakugaku Zasshi. 2002 Jul; 122(7): 499-506.

30. Wells K.B., Lewis C.E., Leake B., et al. The practices of general and subspecialty internists in counseling about smoking and exercise. Am. J. Public. Health. 1986 Aug; 76(8): 1009-13.

31. Гафаров В.В., Пак В.А., Гагулин И.В. и др. Эпидемиология и профилактика хронических неинфекционных заболеваний в течение двух десятилетий и в период социально-экономического кризиса в России. Новосибирск, 2000. С. 227-233.