E Anne Lacey D, GS Kalsi, Mike J Macintosh
Secondary prevention of coronary heart disease (CHD) is high on the primary care agenda, but the evidence base for targeted interventions to improve the quality of services in this area is patchy. This article reports an evaluation of an innovative project aiming to improve secondary prevention in an area of social deprivation. The innovation was based in one primary care trust (PCT), and funded by the voluntary sector. Three distinct approaches to the evaluation are reported: a before and after audit of services, a survey of patient-reported uptake of services, and qualitative data from staff interviews. Taken together, the evaluation showed a picture of improved services in intervention practices compared with controls. Against a background of increasing quality of systematic care for CHD, following the introduction of the National Service Framework, intervention practices showed greater gains than control practices. Furthermore, two-thirds of practices that benefited from the innovation reported offering some form of cardiac rehabilitation service locally. Patients in intervention practices were more likely to report appropriate monitoring and treatment for cholesterol management, and were more likely to receive lifestyle advice. Staff interviews revealed the mechanisms by which such improvements had been facilitated. This evaluation suggests that interventions base at PCT level can facilitate changes in a number of practices in a locality. This model of service delivery might be particularly beneficial in areas of social deprivation where staff are dealing with high levels of disease, and improvements can lead to reductions in health inequalities. The conclusions are qualified, however, by the difficulty in conducting rigorous evaluations of complex innovations against a background of constant change and national and local initiatives.
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