An integrated general practice and pharmacy-based intervention to promote the use of appropriate preventive medications among individuals at high cardiovascular disease risk: Protocol for a cluster randomized controlled trial

Hayek, A; Joshi, R; Usherwood, T; Webster, R; Kaur, B; Saini, B; Armour, C; Krass, I; Laba, TL; Reid, C; Shiel, L; Hespe, C; Hersch, F; Jan, S; Lo, S; Peiris, D; Rodgers, A; Patel, A

An integrated general practice and pharmacy-based intervention to promote the use of appropriate preventive medications among individuals at high cardiovascular disease risk: Protocol for a cluster randomized controlled trial

Hayek, A Joshi, R Usherwood, T Webster, R Kaur, B Saini, B Armour, C Krass, I Laba, TL

Reid, C Shiel, L Hespe, C Hersch, F Jan, S Lo, S Peiris, D Rodgers, A Patel, A

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Publication Type:: Journal Article
Citation:: Implementation Science, 2016, 11 (1)
Issue Date:: 2016-09-23

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Field	Value	Language
dc.contributor.author	Hayek, A	en_US
dc.contributor.author	Joshi, R	en_US
dc.contributor.author	Usherwood, T	en_US
dc.contributor.author	Webster, R	en_US
dc.contributor.author	Kaur, B	en_US
dc.contributor.author	Saini, B	en_US
dc.contributor.author	Armour, C	en_US
dc.contributor.author	Krass, I	en_US
dc.contributor.author	Laba, TL https://orcid.org/0000-0002-5182-9092	en_US
dc.contributor.author	Reid, C	en_US
dc.contributor.author	Shiel, L	en_US
dc.contributor.author	Hespe, C	en_US
dc.contributor.author	Hersch, F	en_US
dc.contributor.author	Jan, S	en_US
dc.contributor.author	Lo, S	en_US
dc.contributor.author	Peiris, D	en_US
dc.contributor.author	Rodgers, A	en_US
dc.contributor.author	Patel, A	en_US
dc.date.available	2016-09-01	en_US
dc.date.issued	2016-09-23	en_US
dc.identifier.citation	Implementation Science, 2016, 11 (1)	en_US
dc.identifier.uri	http://hdl.handle.net/10453/135172
dc.description.abstract	© 2016 The Author(s). Background: Cardiovascular diseases (CVD) are responsible for significant morbidity, premature mortality, and economic burden. Despite established evidence that supports the use of preventive medications among patients at high CVD risk, treatment gaps remain. Building on prior evidence and a theoretical framework, a complex intervention has been designed to address these gaps among high-risk, under-treated patients in the Australian primary care setting. This intervention comprises a general practice quality improvement tool incorporating clinical decision support and audit/feedback capabilities; availability of a range of CVD polypills (fixed-dose combinations of two blood pressure lowering agents, a statin ± aspirin) for prescription when appropriate; and access to a pharmacy-based program to support long-term medication adherence and lifestyle modification. Methods: Following a systematic development process, the intervention will be evaluated in a pragmatic cluster randomized controlled trial including 70 general practices for a median period of 18months. The 35 general practices in the intervention group will work with a nominated partner pharmacy, whereas those in the control group will provide usual care without access to the intervention tools. The primary outcome is the proportion of patients at high CVD risk who were inadequately treated at baseline who achieve target blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels at the study end. The outcomes will be analyzed using data from electronic medical records, utilizing a validated extraction tool. Detailed process and economic evaluations will also be performed. Discussion: The study intends to establish evidence about an intervention that combines technological innovation with team collaboration between patients, pharmacists, and general practitioners (GPs) for CVD prevention. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12616000233426	en_US
dc.relation.ispartof	Implementation Science	en_US
dc.relation.isbasedon	10.1186/s13012-016-0488-1	en_US
dc.subject.classification	Health Policy & Services	en_US
dc.title	An integrated general practice and pharmacy-based intervention to promote the use of appropriate preventive medications among individuals at high cardiovascular disease risk: Protocol for a cluster randomized controlled trial	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	11	en_US
utslib.for	08 Information and Computing Sciences	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
utslib.copyright.status	open_access
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	11	en_US

Abstract:

© 2016 The Author(s). Background: Cardiovascular diseases (CVD) are responsible for significant morbidity, premature mortality, and economic burden. Despite established evidence that supports the use of preventive medications among patients at high CVD risk, treatment gaps remain. Building on prior evidence and a theoretical framework, a complex intervention has been designed to address these gaps among high-risk, under-treated patients in the Australian primary care setting. This intervention comprises a general practice quality improvement tool incorporating clinical decision support and audit/feedback capabilities; availability of a range of CVD polypills (fixed-dose combinations of two blood pressure lowering agents, a statin ± aspirin) for prescription when appropriate; and access to a pharmacy-based program to support long-term medication adherence and lifestyle modification. Methods: Following a systematic development process, the intervention will be evaluated in a pragmatic cluster randomized controlled trial including 70 general practices for a median period of 18months. The 35 general practices in the intervention group will work with a nominated partner pharmacy, whereas those in the control group will provide usual care without access to the intervention tools. The primary outcome is the proportion of patients at high CVD risk who were inadequately treated at baseline who achieve target blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels at the study end. The outcomes will be analyzed using data from electronic medical records, utilizing a validated extraction tool. Detailed process and economic evaluations will also be performed. Discussion: The study intends to establish evidence about an intervention that combines technological innovation with team collaboration between patients, pharmacists, and general practitioners (GPs) for CVD prevention. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12616000233426

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http://hdl.handle.net/10453/135172