Introduction

Coronary heart disease kills over 110,000 people in England each year. It also accounts for 3% of all hospital admissions. The use of 3-hydroxy-3 methylglutaryl coenzyme A reductase inhibitors (statins) have shown a relative risk reduction for major cardiovascular events of between 25-40%. Cardiovascular therapeutics is known locally to cause problems across the interface between primary and secondary care. The types of problems that general practitioners (GP's) and hospital consultants regularly report are lack of communication of treatment plans, and lack of clarity over monitoring and follow up responsibilities. The aim of this study is to identify where the problems occur in statin prescribing across the interface and to suggest models to improve prescribing practices.

Methods

Patients initiated on statin therapy during a hospital admission who consented to the study were interviewed to assess how much information they had been given about their new prescription, and their attitudes to medicines in general. Information about baseline cholesterol levels, liver function tests, diagnoses and CHD risk estimation was collected from hospital notes and follow up test results from the GP notes. Information about diagnoses and treatment plans given on discharge was also collected.

Preliminary results

We have conducted a preliminary analysis of results to date and hope to present more data and discussion by April 2003.

To date there have been 40 patients recruited, of which 55% are male, with an average age of 69 years. Atorvastatin was prescribed in 77.5%, and simvastatin in 22.5% of the patients. The initial daily doses of the statin were 10mg in 72.5% of patients and 20mg in 27.5%. Hospital guidance suggests a target for total cholesterol level below 5.2mmol/L. Data was obtained on cholesterol levels for 34 patients, the mean cholesterol level was 5.67 mmol/L before starting treatment. Nine patients (26.5%) had a cholesterol level below 5.2 mmol/L. For 5 patients cholesterol levels were taking either after treatment was started or were from a previous admission. One patient did not have his cholesterol measured. 70% of all patients knew what the new medicine was prescribed for, but only 22.5% knew how long the medication had to be continued. All patients knew how to get further supplies of the medicine, while no one knew whether they would need any follow-up tests. 70% of patients expressed a desire for information about their medicines in general while 30% did not. There is a normal distribution of how the patients perceive the benefits of medicine, with most of them (85%) tending to be more positive. Neither gender nor age seems to be a significant influence on how much the patient knows about the new medicine, the desire of information, or the perception of the benefits of medicine in general.