Year: 2015
Type: dissertation
Study design: Observational Study
Abstract: This thesis aims to identify features of primary care associated with improved health\noutcomes using premature coronary heart disease (CHD) mortality as an example.\nImpacts of different modelling approaches are also explored.\nA cross-sectional study of 229 general practices in the East Midlands was undertaken.\nThe main outcome measure was numbers of premature CHD deaths in patients registered\nat the practices (April 2006 to March 2009). Publicly available data describing\nboth population characteristics and aspects of primary care were utilised. A novel\nmethod of estimating smoking prevalence in practice populations was described and\ndiffering methods of describing the performance of primary care in detecting hypertension\nwere evaluated.\nPopulation characteristics and markers of quality of primary care were associated with\nvariations in premature CHD mortality. Increases in: the percentage of practice populations\non practice diabetes registers, the proportion who were over 65, the proportion\nwho were male, and the estimated smoking prevalence in patients with chronic conditions\nwere all associated with increasing levels of premature CHD mortality. Control\nof serum cholesterol levels in those with CHD and the percentage of patients recalling\naccess to their preferred general practitioner, a measure of continuity of care, were both\nassociated with decreased counts of premature CHD mortality. Increasing levels of undiagnosed\nhypertension prevalence were associated with increased levels of premature\nCHD mortality. Similar results were found for all-age mortality; there is less evidence\nthat continuity of care is associated with all-age CHD mortality.\nHigh-quality primary care, including aspects of access to and continuity of care, disease\ndetection and management, appear to be associated with reduced CHD mortality. Data\ngathered as part of the Health Checks initiative has the potential to improve studies of\nthis type, particularly if published by age group. Determining the most useful measures\nof quality of primary care needs further consideration.
Author: Catherine Eliza Honeyford
Language: English
Subfield: Family Practice
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W572376689