Implementing guidelines to routinely prevent chronic vascular disease in primary care: The Preventive Evidence into Practice cluster randomised controlled trial

Harris, MF; Parker, SM; Litt, J; Van Driel, M; Russell, G; Mazza, D; Jayasinghe, UW; Del Mar, C; Lloyd, J; Smith, J; Zwar, N; Taylor, R; Davies, GP; Denney-Wilson, E; Laws, R; Snowdon, T; Bolger-Harris, H; Groombridge, S; Goldstein, S; Howarth, T; Huang, N; Wilson, J

Implementing guidelines to routinely prevent chronic vascular disease in primary care: The Preventive Evidence into Practice cluster randomised controlled trial

Harris, MF Parker, SM Litt, J Van Driel, M Russell, G Mazza, D Jayasinghe, UW Del Mar, C Lloyd, J Smith, J Zwar, N Taylor, R Davies, GP Denney-Wilson, E

Laws, R Snowdon, T Bolger-Harris, H Groombridge, S Goldstein, S Howarth, T Huang, N Wilson, J

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Publication Type:: Journal Article
Citation:: BMJ Open, 2015, 5 (12)
Issue Date:: 2015-01-01

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Field	Value	Language
dc.contributor.author	Harris, MF	en_US
dc.contributor.author	Parker, SM	en_US
dc.contributor.author	Litt, J	en_US
dc.contributor.author	Van Driel, M	en_US
dc.contributor.author	Russell, G	en_US
dc.contributor.author	Mazza, D	en_US
dc.contributor.author	Jayasinghe, UW	en_US
dc.contributor.author	Del Mar, C	en_US
dc.contributor.author	Lloyd, J	en_US
dc.contributor.author	Smith, J	en_US
dc.contributor.author	Zwar, N	en_US
dc.contributor.author	Taylor, R	en_US
dc.contributor.author	Davies, GP	en_US
dc.contributor.author	Denney-Wilson, E https://orcid.org/0000-0001-9879-4969	en_US
dc.contributor.author	Laws, R	en_US
dc.contributor.author	Snowdon, T	en_US
dc.contributor.author	Bolger-Harris, H	en_US
dc.contributor.author	Groombridge, S	en_US
dc.contributor.author	Goldstein, S	en_US
dc.contributor.author	Howarth, T	en_US
dc.contributor.author	Huang, N	en_US
dc.contributor.author	Wilson, J	en_US
dc.date.issued	2015-01-01	en_US
dc.identifier.citation	BMJ Open, 2015, 5 (12)	en_US
dc.identifier.uri	http://hdl.handle.net/10453/43532
dc.description.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.	en_US
dc.relation	http://purl.org/au-research/grants/nhmrc/GNT568979
dc.relation.ispartof	BMJ Open	en_US
dc.relation.isbasedon	10.1136/bmjopen-2015-009397	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Cardiovascular Diseases	en_US
dc.subject.mesh	Treatment Outcome	en_US
dc.subject.mesh	Risk Assessment	en_US
dc.subject.mesh	Risk Factors	en_US
dc.subject.mesh	Life Style	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Nurses	en_US
dc.subject.mesh	Urban Population	en_US
dc.subject.mesh	Primary Health Care	en_US
dc.subject.mesh	Medical Audit	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Practice Guidelines as Topic	en_US
dc.subject.mesh	General Practitioners	en_US
dc.subject.mesh	General Practice	en_US
dc.subject.mesh	Biomarkers	en_US
dc.title	Implementing guidelines to routinely prevent chronic vascular disease in primary care: The Preventive Evidence into Practice cluster randomised controlled trial	en_US
dc.type	Journal Article
utslib.citation.volume	12	en_US
utslib.citation.volume	5	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1199 Other 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 Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	open_access
pubs.issue	12	en_US
pubs.publication-status	Published	en_US
pubs.volume	5	en_US

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.

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