Can general practitioners provide effective cardiovascular disease (CVD) prevention? Dreams and realities of CVD prevention.

AIMS: This study explores how the New Zealand (NZ) population experiences approaches to cardiovascular disease (CVD) risk management: (1) the Primary Health Organisation (PHO) CVD risk performance indicator programme in Akaroa, Canterbury NZ and (2) consumer use of community services that promote healthier lifestyles. METHODS: An audit identified patients enrolled at the Akaroa Health Centre eligible for CVD risk assessments and the portion with completed formal assessments. This was compared with the standard PHO performance tool for assessing CVD. An exploratory survey identified awareness of and barriers to use of local lifestyle resources that may directly or indirectly reduce CVD risk, in respondents over the age of 45 years. RESULTS: Distinguishing the eligible population who had not already had their CVD risk calculated required complex database analysis. As of April 2009 11.8% of the eligible population had a CVD risk calculated using the PHO performance tool. However, another 10.1% had had these risks assessed through other tools. The combined total of 21.9% meets the minimum target of 21.7% for the year ending June 30th 2009. The community survey found around a third (36%) of lifestyle promoting resources available were recognised with about half (56.9%) of respondents participating in the activities. Barriers to use included lack of time and perceived need of the service. CONCLUSIONS: The current performance indicator approach is not practical, subject to error and may have significant opportunity costs. Furthermore, barriers exist in engaging the population identified as at risk in health-promoting activities.