Auditing secondary prevention of ischaemic heart disease in rural areas of Spain: An opportunity for improvement

Abstract

Aim: To describe the standard of secondary prevention received by individuals with a history of ischaemic heart disease (IHD) in Spanish rural areas, and the factors associated with low standards of quality. Methods: Medical audit of patients with a history of IHD, whose data were provided by 72 rural physicians in 12 autonomous regions (1030 cases). Quality criteria were used based on international guidelines. Multivariate analysis was employed to assess the variables associated with poor-quality attention. Results: 30.9% of patients gave target low-density lipoprotein (LDL) readings, and 68.1% reached target blood pressure (BP). Beta-blockers were taken by 48.5%. Twenty-nine per cent of patients had not visited a specialist within the previous year. The fact that patients had visited a specialist within the previous year was associated with their having followed the types of treatments recommended in the guidelines (p < 0.01) and with obtaining target LDL and BP readings (p < 0.05). Patients from the smallest villages had the lowest probability of having LDL controls and also of receiving hypolipidaemic therapy (p<0.01). Those with a past history of isolated angina had lower probability of being treated with antiaggregants than those who had experienced previous acute myocardial infarction (p < 0.01).

Conclusion: The quality of secondary prevention for these patients shows there is room for improvement. Problems of accessibility exist for some groups, which may be improved with the involvement of rural primary healthcare teams.

• Cardiovascular diseases
• healthcare
• medical audit
• quality assurance
• rural health services
• Spain