Findings from a clinical audit in regional general practice of management of patients following acute coronary syndrome
Mithilesh Dronavalli A B J , Manavi M. Bhagwat A C , Sandy Hamilton A , Marisa Gilles D E , Jacquie Garton-Smith F G H I and Sandra C. Thompson AA Western Australian Centre for Rural Health, University of Western Australia, 167 Fitzgerald Street, Geraldton, WA 6530, Australia.
B School of Mathematics and Statistics, University of New South Wales, The Red Centre, Centre Wing, Kensington, NSW 2052, Australia.
C Georgetown University, 3700 O Street NW, Washington, DC 20057, USA.
D Research School of Public Health, Australian National University, Building 62, Mills Road, Acton, ACT 2601, Australia.
E WA Country Health Service, 189 Wellington Street, Perth, WA 6000, Australia.
F Cardiovascular Health Network, Department of Health WA, 189 Royal Street, East Perth, WA 6004, Australia.
G Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia.
H WA Primary Health Alliance, 2–7/7 Tanunda Drive, Rivervale, WA 6103, Australia.
I Wembley Family Medical Practice, 272 Cambridge Street, Wembley, WA 6014, Australia.
J Corresponding author. Email: dr.mit@me.com
Australian Journal of Primary Health 23(2) 170-177 https://doi.org/10.1071/PY15191
Submitted: 31 December 2015 Accepted: 29 August 2016 Published: 20 September 2016
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.
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