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.Objec-tive. To determine the factors influencing GPs decisions to pre-scribe cardiovascular prevention drugs. Design of Study. Secondary analysis of data collected on patients whose cardio-vascular risk factors weremeasured 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 theWestMidlands, 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 logis-tic regression models investigated the relationship between pre-scription of preventive treatments and cardiovascular risk factors.Results.Among patients assessed by their GP, statin pre-scribing was significantly associated only with a total cholesterol concentration7mmol/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 andwith 10-year cardiovascular risk. Limitations.Generaliz-ability 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 deter-mined by elevation of a single risk factor. When patients were assessed by the project nurse, prescribing was much more con-sistent with established guidelines. Key words: Prescribing; nurse assessment; cardiovascular disease; general practice, risk factors, cardiovascular risk (Med Decis Makin