Abstract
BackgroundTo evaluate the effectiveness of a new multifactorial intervention to improve health care for chronic ischemic heart disease patients in primary care. The strategy has two components: a) organizational for the patient/professional relationship and b) training for professionals.Methods/designExperimental study. Randomized clinical trial. Follow-up period: one year. Study setting: primary care, multicenter (15 health centers). For the intervention group 15 health centers are selected from those participating in ESCARVAL study. Once the center agreed to participate patients are randomly selected from the total amount of patients with ischemic heart disease registered in the electronic health records. For the control group a random sample of patients with ischemic heart disease is selected from all 72 health centers electronic records.Intervention components: a) Organizational intervention on the patient/professional relationship. Centered on the Chronic Care Model, the Stanford Expert Patient Program and the Kaiser Permanente model: Teamwork, informed and active patient, decision making shared with the patient, recommendations based on clinical guidelines, single electronic medical history per patient that allows the use of indicators for risk monitoring and stratification. b) Formative strategy for professionals: 4 face-to-face training workshops (one every 3 months), monthly update clinical sessions, online tutorial by a cardiologist, availability through the intranet of the action protocol and related documents.Measurements: Blood pressure, blood glucose, HbA1c, lipid profile and smoking. Frequent health care visits. Number of hospitalizations related to vascular disease. Therapeutic compliance. Drug use.DiscussionThis study aims to evaluate the efficacy of a multifactorial intervention strategy involving patients with ischemic heart disease for the improvement of the degree of control of the cardiovascular risk factors and of the quality of life, number of visits, and number of hospitalizations.Trial registrationNCT01826929
Highlights
To evaluate the effectiveness of a new multifactorial intervention to improve health care for chronic ischemic heart disease patients in primary care
This study aims to evaluate the efficacy of a multifactorial intervention strategy involving patients with ischemic heart disease for the improvement of the degree of control of the cardiovascular risk factors and of the quality of life, number of visits, and number of hospitalizations
Therapeutic educational interventions, such as the Chronic Care Model (CCM) that includes educational, organizational and community participation interventions; the Stanford Expert Patient Program (EPP); and the Kaiser Permanente model [12,13] have all shown their benefit in patients with a high Cardiovascular disease (CVD) risk and their effect on clinical measures and health care use
Summary
IHD is one of the main causes of death despite the great capacity for prevention that is available. The present study involved an organizational intervention based on CCM together with an educational intervention, integrating cardiology service professionals and primary care professionals (general practitioners and nurses), in an attempt to improve the degree of control of CVRF and decrease the number of hospitalizations. Our study has some different aspects that can be mentioned: we use an unique electronic health record for primary and secondary care improving communication between professionals, we implement CCM strategies involving patients with self-care, sharing decisions about the level of control to be reached and objective based treatments, involving all primary care team (physicians and nurses) and cardiologists. All authors have critically read the final manuscript draft, to make contributions, and have approved the final version
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