Efficacy of a Strategy for Implementing Guidelines for the Control of Cardiovascular Risk in Primary Healthcare

• 作者: ángela Gallego-Arenas Belén Sierra-García Blanca Novella-Arribas Carmen Suárez-Fernández Francisco Rodríguez-Salvanés Javier López-González Luis María Sánchez-Gómez Maria Jesús Fernández-Luque Marta Ruiz-López Pilar Loeches-Belinchón Rosa Sánchez Alcalde Soledad Mayayo-Vicente Vicente Pastor y Aldeguer
• 来源期刊: 心血管病(英文)
• 学科: 医学
• 关键词: RANDOMIZED Controlled TRIAL Cluster Analysis Clinical Practice GUIDELINES Primary Healthcare Risk Factors CARDIOVASCULAR DISEASES
• 年，卷（期）: 2020,（3）
• 页码范围: 117-130
• 页数: 14页
• 分类号: R73

摘要

Background: A number of strategies exist for the implementation of clinical practice guides (CPGs). Aim: To assess the efficacy of implementing a cardiovascular risk CPG based on an educational method involving opinion leaders, and the habitual method of dissemination among primary healthcare teams. Design and Setting: Controlled, blinded, community intervention trial randomised by clusters. Methods: 21 primary healthcare centres were randomly assigned to either the intervention arm (n = 11) or the control arm (n = 10). The study subjects were patients aged ≥45 years assigned to the centres. The overall impact of the intervention was measured as the difference between the increase in the proportion of patients whose medical records showed the recording of all the variables necessary to calculate cardiovascular risk in both arms. Analyses were performed with Generalized Lineal Model on an intention-to-treat basis. Results: 917 subjects were included at the beginning of the trial (437 in the intervention arm and 480 in the control arm). 826 subjects were included in the final evaluation (436 in the intervention group and 390 in the control arm). At the end of the trial, the recording of the variables necessary for the calculation of the cardiovascular risk in the intervention group had increased more than in the control group (difference between increases 7.49% (95% CI 4.62 - 10.35)) after adjusting for confounding variables. Conclusions: Compared to the habitual method of dissemination, the implementation of this CPG using an educational method involving opinion leaders, improved the recording of the variables needed to calculate patients’ cardiovascular risk.