Introduction
Chronic kidney disease (CKD), type 2 diabetes (T2D) and cardiovascular disease (CVD) (including ischaemic heart disease (IHD), heart failure (HF), ischaemic stroke (IS) and peripheral vascular disease (PVD)) are common interrelated chronic vascular diseases sharing multiple risk factors as well as preventive and management strategies.1 Effective detection and management of the rising numbers of affected individuals presents a considerable challenge. In 2012, over one in four Australian adults had at least one of these diseases2 and they were the principal or associated cause of over 60% of all deaths in Australia.3 The increasing prevalence of chronic disease together with an ageing population is causing considerable pressure on the Australian healthcare system.4
In order to reduce this high disease burden and associated expenditure, detection and management of these diseases and their risk factors needs to be optimised. The interrelated chronic vascular diseases share risk factors, and in some cases, the presence of one of these diseases can lead to another. Early detection and management of risk factors and diseases offers the possibility of preventing this cascade of events. This is especially important in high-risk groups, such as those with familial hypercholesterolaemia (FH), atrial fibrillation (AF) and in Aboriginal and Torres Strait Islander peoples. FH is the most common autosomal dominant condition which leads to premature CVD if untreated.5 AF greatly increases the risk of stroke, with this risk able to be reduced with anticoagulants in those at higher risk.6 Aboriginal and Torres Strait Islander peoples have 2.2 times the risk of CKD, 3.6 times the risk of diabetes and 1.3 times the risk of CVD compared with non-Indigenous Australians.7 Recommendations addressing these interrelated chronic vascular diseases advise targeted testing to identify and appropriately manage individuals with, and at risk of, these conditions in general practice (GP).8 9 However, previous studies have demonstrated that the interrelated chronic vascular diseases and their risk factors may be under-recognised and undertreated in the community10–12 reflecting the challenges of guideline implementation.
Primary care provides the best setting to translate the national recommendations for management of these chronic diseases. Around 85% of Australians attend GP each year.4 In Australia, patients do not need to register to attend a GP and are able to attend multiple different practices, with 28% attending more than one practice in a year.13 Over 95% of Australian general practitioners use computers for clinical purposes and of these, more than two-thirds use electronic medical records (EMRs) exclusively.14 A previous study from our centre suggested that GP EMR data could be used to inform quality improvement in the translation of guidelines and recommendations in the setting of CKD.15 Research from Western Australia has shown the potential for GP EMR data to detect patients with undiagnosed FH.16 A large Australian study using GP EMR data from 6.6% of Australian GPs with participants from all states and territories, showed prevalence of hypertension at 16.9%, T2D at 5.3%, CKD at 1.2%, HF at 1.2%, AF at 2.3% and CVD (including IHD, PVD, IS and transient ischaemic attack) at 5%.17 This study included all patients with at least one general practitioner clinical encounter within a 12-month period, whereas our study required patients to have had ≥3 GP attendances within a 24-month period. There is a paucity of published data from Australian GP EMRs regarding the prevalence and management of IHD, IS and PVD as individual conditions instead of being reported together as CVD and our study addresses these issues. The aim of this cross-sectional analysis was to evaluate the capacity of EMR data from Victorian GPs to assess the recording of risk factors, disease diagnostic testing, diagnosis, monitoring and pharmacotherapy for the interrelated chronic vascular diseases by reporting baseline data from the Chronic Disease IMPACT (Chronic Disease early detection and Improved Management in PrimAry Care ProjecT) study.