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      An Assessment of Specialist Physician Referral Practices for Long-Term Cardiovascular Risk Reduction in the Community: Are We Using Our Available Resources?

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      Canadian Journal of General Internal Medicine
      Dougmar Publishing Group, Inc.

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          Abstract

          Background: Our aim was to evaluate specialist physicians’ referral patterns for cardiovascular risk reduction (CRR) while identifying existing CRR programs in a large Canadian city. Methods: This was a cross-sectional study involving an electronic survey of cardiologists and internists in Calgary, Alberta, to assess CRR referral patterns. A concurrent online search for programs addressing CRR was undertaken. Results: Twenty-four CRR programs were identified. Nine (37.5%, 95% CI: 21.2–57.2) required physician referral. Half (50.0%, 95% CI: 31.4–68.6) had no direct patient cost. A majority of surveyed physicians estimated that more than half of their patients have at least one modifiable risk factor. However, 75.0% (95% CI: 61.2–85.1) had referred less than half of these patients for CRR. Conclusion: Our study demonstrates a gap in specialist physician referral practices for CRR. Patients with modifiable risk factors may not be accessing valuable CRR resources. Résumé Contexte : Notre but consistait à évaluer les habitudes d’orientation des médecins spécialistes en ce qui a trait à la réduction du risque cardiovasculaire (RRCV) et à recenser les programmes de RRCV présents à l’intérieur d’une grande ville canadienne. Méthodologie: Une étude de prévalence a été menée par sondage électronique auprès des cardiologues et des internistes de la ville de Calgary, Alberta, dans le but d’évaluer les habitudes d’orientation en ce qui a trait à la réduction du risque cardiovasculaire (RRCV). Parallèlement, une recherche sur les programmes de RRCV a été entreprise, en ligne également. Résultats: On a répertorié 24 programmes de RRCV. Neuf (37,5 %; IC de 95 % : 21,2–57,2) nécessitent que le patient soit recommandé par un médecin. La moitié (50,0 %; IC de 95 % : 31,4–68,6) n’engendre aucun coût direct pour le patient. La plupart des médecins interrogés évaluent que plus de la moitié de leurs patients présente au moins un facteur de risque modifiable. Cependant, 75,0 % (IC de 95 % : 61,2–85,1) ont orienté moins de la moitié de ces patients vers un programme de RRCV. Conclusion : Notre étude montre qu’il y a une lacune dans les pratiques d’orientation des médecins spécialistes relativement aux programmes de RRCV. Ainsi, des patients ayant des facteurs de risque modifiables n’ont pas accès à des ressources précieuses en matière de RRCV.    

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          Most cited references11

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          Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association.

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            Time and the patient-physician relationship

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              Effectiveness and cost effectiveness of cardiovascular disease prevention in whole populations: modelling study

              Objective To estimate the potential cost effectiveness of a population-wide risk factor reduction programme aimed at preventing cardiovascular disease. Design Economic modelling analysis. Setting England and Wales. Population Entire population. Model Spreadsheet model to quantify the reduction in cardiovascular disease over a decade, assuming the benefits apply consistently for men and women across age and risk groups. Main outcome measures Cardiovascular events avoided, quality adjusted life years gained, and savings in healthcare costs for a given effectiveness; estimates of how much it would be worth spending to achieve a specific outcome. Results A programme across the entire population of England and Wales (about 50 million people) that reduced cardiovascular events by just 1% would result in savings to the health service worth at least £30m (€34m; $48m) a year compared with no additional intervention. Reducing mean cholesterol concentrations or blood pressure levels in the population by 5% (as already achieved by similar interventions in some other countries) would result in annual savings worth at least £80m to £100m. Legislation or other measures to reduce dietary salt intake by 3 g/day (current mean intake approximately 8.5 g/day) would prevent approximately 30 000 cardiovascular events, with savings worth at least £40m a year. Legislation to reduce intake of industrial trans fatty acid by approximately 0.5% of total energy content might gain around 570 000 life years and generate NHS savings worth at least £230m a year. Conclusions Any intervention that achieved even a modest population-wide reduction in any major cardiovascular risk factor would produce a net cost saving to the NHS, as well as improving health. Given the conservative assumptions used in this model, the true benefits would probably be greater.
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                Author and article information

                Journal
                Canadian Journal of General Internal Medicine
                Can Journ Gen Int Med
                Dougmar Publishing Group, Inc.
                2369-1778
                1911-1606
                January 02 2018
                January 02 2018
                : 12
                : 4
                Article
                10.22374/cjgim.v12i4.219
                e2979512-6e07-4f87-8048-1a61977ccc36
                © 2018

                Copyright of articles published in all DPG titles is retained by the author. The author grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any non-commercial third party the rights to use the article freely provided original author(s) and citation details are cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/


                General medicine,Geriatric medicine,Neurology,Internal medicine
                General medicine, Geriatric medicine, Neurology, Internal medicine

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