Abstract
This work describes the methodology used to assess a strategy for implementing clinical practice guidelines (CPG) for cardiovascular risk control in a health area of Madrid.BackgroundThe results on clinical practice of introducing CPGs have been little studied in Spain. The strategy used to implement a CPG is known to influence its final use. Strategies based on the involvement of opinion leaders and that are easily executed appear to be among the most successful.AimThe main aim of the present work was to compare the effectiveness of two strategies for implementing a CPG designed to reduce cardiovascular risk in the primary healthcare setting, measured in terms of improvements in the recording of calculated cardiovascular risk or specific risk factors in patients' medical records, the control of cardiovascular risk factors, and the incidence of cardiovascular events.MethodsThis study involved a controlled, blinded community intervention in which the 21 health centres of the Number 2 Health Area of Madrid were randomly assigned by clusters to be involved in either a proposed CPG implementation strategy to reduce cardiovascular risk, or the normal dissemination strategy. The study subjects were patients ≥ 45 years of age whose health cards showed them to belong to the studied health area. The main variable examined was the proportion of patients whose medical histories included the calculation of their cardiovascular risk or that explicitly mentioned the presence of variables necessary for its calculation. The sample size was calculated for a comparison of proportions with alpha = 0.05 and beta = 0.20, and assuming that the intervention would lead to a 15% increase in the measured variables. Corrections were made for the design effect, assigning a sample size to each cluster proportional to the size of the population served by the corresponding health centre, and assuming losses of 20%. This demanded a final sample size of 620 patients. Data were analysed using summary measures for each cluster, both in making estimates and for hypothesis testing. Analysis of the variables was made on an intention-to-treat basis.Trial RegistrationClinicalTrials.gov: NCT01270022
Highlights
The results on clinical practice of introducing Clinical practice guidelines (CPGs) have been little studied in Spain
A systematic review published in the Lancet in 1993 [8] reported that, of 59 reviewed CPGs, none of which were used in the primary healthcare setting, 55 had improved the health of patients following their implantation
It can be inferred that the use a CPG is related to a number of concatenated factors: it would appear important that health professionals relate to the CPG in question [11], that local adaptations have been made involving people close to the potential end users, and that guidelines are adjusted to the peculiarities of the setting in which they are to be used
Summary
Clinical practice guidelines (CPGs) can be defined as a series of systematically developed recommendations designed to help health professionals and patients take decisions regarding the most appropriate forms of treatment in specific clinical situations [1]. A systematic review published in the Lancet in 1993 [8] reported that, of 59 reviewed CPGs, none of which were used in the primary healthcare setting, 55 had improved the health of patients following their implantation This improvement appeared to be related to the implementation strategy used. It can be inferred that the use a CPG is related to a number of concatenated factors: it would appear important that health professionals relate to the CPG in question [11], that local adaptations have been made involving people close to the potential end users, and that guidelines are adjusted to the peculiarities of the setting in which they are to be used. Aims The main aim of this work was to compare the effectiveness of 1) a proposed strategy based on an educational method involving the participation of opinion leaders with 2) the usual method of dissemination, for implementing a locally adapted CPG for the control of cardiovascular risk among the primary healthcare teams of a health area in Madrid
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