Patient and other factors influencing the prescribing of cardiovascular prevention therapy in the general practice setting with and without nurse assessment.

BACKGROUND: Although guidelines indicate when patients are eligible for antihypertensives and statins, little is known about whether general practitioners (GPs) follow this guidance.

OBJECTIVE: To determine the factors influencing GPs decisions to prescribe cardiovascular prevention drugs.

DESIGN OF STUDY: Secondary analysis of data collected on patients whose cardiovascular risk factors were measured as part of a controlled study comparing nurse-led risk assessment (four practices) with GP-led risk assessment (two practices).

SETTING: Six general practices in the West Midlands, England.

PATIENTS: Five hundred patients: 297 assessed by the project nurse, 203 assessed by their GP.

MEASUREMENTS: Cardiovascular risk factor data and whether statins or antihypertensives were prescribed. Multivariable logistic regression models investigated the relationship between prescription of preventive treatments and cardiovascular risk factors.

RESULTS: Among patients assessed by their GP, statin prescribing was significantly associated only with a total cholesterol concentration ≥ 7 mmol/L and antihypertensive prescribing only with blood pressure ≥ 160/100 mm Hg. Patients prescribed an antihypertensive by their GP were five times more likely to be prescribed a statin. Among patients assessed by the project nurse, statin prescribing was significantly associated with age, sex, and all major cardiovascular risk factors. Antihypertensive prescribing was associated with blood pressures ≥ 140/90 mm Hg and with 10-year cardiovascular risk.

LIMITATIONS: Generalizability is limited, as this is a small analysis in the context of a specific cardiovascular prevention program.

CONCLUSIONS: GP prescribing of preventive treatments appears to be largely determined by elevation of a single risk factor. When patients were assessed by the project nurse, prescribing was much more consistent with established guidelines.