Title

Implementing guidelines to routinely prevent chronic vascular disease in primary care: The preventive evidence into practice cluster randomised controlled trial

Date of this Version

12-11-2015

Document Type

Journal Article

Grant Number

NHMRC of Australia under a Partnership Grant (grant number 568979). Funding was also provided from the RACGP, the Heart Foundation and Bupa Health Foundation

Publication Details

Published version

Harris, M. F., Parker, S., Litt, J., van Driel, M., Russell, G., Mazza, D., Jayasinghe, U. W., del Mar, C., Lloyd, J., Smith, J., Zwar, N., Taylor, R., & Davies, G. P. (2015). Implementing guidelines to routinely prevent chronic vascular disease in primary care: The preventive evidence into practice cluster randomised controlled trial. BMJ Group,5 (12), e009397.

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© Copyright, The Authors, 2015

Distribution License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN

2044-6055

Abstract

Objective

To evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease.

Setting

32 urban general practices in 4 Australian states.

Randomisation

Stratified randomisation of practices.

Participants

122 general practitioners (GPs) and practice nurses (PNs) were recruited at baseline and 97 continued to 12 months. 21 848 patient records were audited for those aged 40–69 years who attended the practice in the previous 12 months without heart disease, stroke, diabetes, chronic renal disease, cognitive impairment or severe mental illness.

Intervention

The practice level intervention over 6 months included small group training of practice staff, feedback on audited performance, practice facilitation visits and provision of patient education and referral information.

Outcome measures

Primary: 1. Change in proportion of patients aged 40–69 years with smoking status, alcohol intake, body mass index (BMI), waist circumference (WC), blood pressure (BP) recorded and for those aged 45–69 years with lipids, fasting blood glucose and cardiovascular risk in the medical record. 2. Change in the level of risk for each factor.

Secondary change in self-reported frequency and confidence of GPs and PNs in assessment.

Results

Risk recording improved in the intervention but not the control group for WC (OR 2.52 (95% CI 1.30 to 4.91)), alcohol consumption (OR 2.19 (CI 1.04 to 4.64)), smoking status (OR 2.24 (1.17 to 4.29)) and cardiovascular risk (OR 1.50 (1.04 to 2.18)). There was no change in recording of BP, lipids, glucose or BMI and no significant change in the level of risk factors based on audit data. The confidence but not reported practices of GPs and PNs in the intervention group improved in the assessment of some risk factors.

Conclusions

This intervention was associated with improved recording of some risk factors but no change in the level of risk at the follow-up audit.

 

This document has been peer reviewed.