posted on 2015-03-06, 16:14authored byCatherine Eliza Honeyford
This thesis aims to identify features of primary care associated with improved health
outcomes using premature coronary heart disease (CHD) mortality as an example.
Impacts of different modelling approaches are also explored.
A cross-sectional study of 229 general practices in the East Midlands was undertaken.
The main outcome measure was numbers of premature CHD deaths in patients registered
at the practices (April 2006 to March 2009). Publicly available data describing
both population characteristics and aspects of primary care were utilised. A novel
method of estimating smoking prevalence in practice populations was described and
differing methods of describing the performance of primary care in detecting hypertension
were evaluated.
Population characteristics and markers of quality of primary care were associated with
variations in premature CHD mortality. Increases in: the percentage of practice populations
on practice diabetes registers, the proportion who were over 65, the proportion
who were male, and the estimated smoking prevalence in patients with chronic conditions
were all associated with increasing levels of premature CHD mortality. Control
of serum cholesterol levels in those with CHD and the percentage of patients recalling
access to their preferred general practitioner, a measure of continuity of care, were both
associated with decreased counts of premature CHD mortality. Increasing levels of undiagnosed
hypertension prevalence were associated with increased levels of premature
CHD mortality. Similar results were found for all-age mortality; there is less evidence
that continuity of care is associated with all-age CHD mortality.
High-quality primary care, including aspects of access to and continuity of care, disease
detection and management, appear to be associated with reduced CHD mortality. Data
gathered as part of the Health Checks initiative has the potential to improve studies of
this type, particularly if published by age group. Determining the most useful measures
of quality of primary care needs further consideration.