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General practice / Family practice
Research
Implementing guidelines to routinely prevent chronic vascular disease in primary care: the Preventive Evidence into Practice cluster randomised controlled trial
  1. Mark Fort Harris1,
  2. Sharon M Parker1,
  3. John Litt2,
  4. Mieke van Driel3,
  5. Grant Russell4,
  6. Danielle Mazza5,
  7. Upali W Jayasinghe1,
  8. Chris Del Mar6,
  9. Jane Lloyd1,
  10. Jane Smith6,
  11. Nicholas Zwar7,
  12. Richard Taylor7,
  13. Gawaine Powell Davies1
  14. On behalf of the Preventive Evidence into Practice (PEP) Partnership Group
    1. 1Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia
    2. 2Discipline of General Practice, School of Medicine, Flinders University, Adelaide, South Australia, Australia
    3. 3Academic Discipline of General Practice, University of Queensland, Brisbane, Queensland, Australia
    4. 4Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia
    5. 5Department of General Practice, Monash University, Notting Hill, Victoria, Australia
    6. 6Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
    7. 7School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
    1. Correspondence to Professor Mark Fort Harris; m.f.harris{at}unsw.edu.au

    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.

    Trial registration number Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000578808, results.

    • PRIMARY CARE
    • PREVENTIVE MEDICINE
    • practice facilitation
    • chronic disease
    • quality improvement

    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

    https://doi.org/10.1136/bmjopen-2015-009397

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