Cardiovascular risk factor documentation and management in primary care electronic medical records among people with schizophrenia in Ontario, Canada: retrospective cohort study

Abstract

Objectives: In order to address the substantial increased risk of cardiovascular disease among people with schizophrenia, it is necessary to identify the factors responsible for some of that increased risk. We analysed the extent to which these risk factors were documented in primary care electronic medical records (EMR), and compared their documentation by patient and provider characteristics.

Design: Retrospective cohort study.

Setting: EMR database of the University of Toronto Practice-Based Research Network Data Safe Haven.

Participants: 197 129 adults between 40 and 75 years of age; 4882 with schizophrenia and 192 427 without.

Primary and secondary outcome measures: Documentation of cardiovascular disease risk factors (age, sex, smoking history, presence of diabetes, blood pressure, whether a patient is currently on medication to reduce blood pressure, total cholesterol and high-density lipoprotein cholesterol).

Results: Documentation of cardiovascular risk factors was more complete among people with schizophrenia (74.5% of whom had blood pressure documented at least once in the last 2 years vs 67.3% of those without, p>0.0001). Smoking status was not documented in 19.8% of those with schizophrenia and 20.8% of those without (p=0.0843). Factors associated with improved documentation included older patients (OR for ages 70-75 vs 45-49=3.51, 95% CI 3.26 to 3.78), male patients (OR=1.39, 95% CI 1.33 to 1.45), patients cared for by a female provider (OR=1.52, 95% CI 1.12 to 2.07) and increased number of encounters (OR for ≥10 visits vs 3-5 visits=1.53, 95% CI 1.46 to 1.60).

Conclusions: Documentation of cardiovascular risk factors was better among people with schizophrenia than without, although overall documentation was inadequate. Efforts to improve documentation of risk factors are warranted in order to facilitate improved management.

Keywords: cardiology; health informatics; mental health; preventive medicine; primary care; schizophrenia & psychotic disorders.