Abstract
Background: A number of strategies exist for the implementation of clinical practice guides (CPGs). Aim: To assess the efficacy of implementing a cardiovascular risk CPG based on an educational method involving opinion leaders, and the habitual method of dissemination among primary healthcare teams. Design and Setting: Controlled, blinded, community intervention trial randomised by clusters. Methods: 21 primary healthcare centres were randomly assigned to either the intervention arm (n = 11) or the control arm (n = 10). The study subjects were patients aged ≥45 years assigned to the centres. The overall impact of the intervention was measured as the difference between the increase in the proportion of patients whose medical records showed the recording of all the variables necessary to calculate cardiovascular risk in both arms. Analyses were performed with Generalized Lineal Model on an intention-to-treat basis. Results: 917 subjects were included at the beginning of the trial (437 in the intervention arm and 480 in the control arm). 826 subjects were included in the final evaluation (436 in the intervention group and 390 in the control arm). At the end of the trial, the recording of the variables necessary for the calculation of the cardiovascular risk in the intervention group had increased more than in the control group (difference between increases 7.49% (95% CI 4.62 - 10.35)) after adjusting for confounding variables. Conclusions: Compared to the habitual method of dissemination, the implementation of this CPG using an educational method involving opinion leaders, improved the recording of the variables needed to calculate patients’ cardiovascular risk.
Highlights
A number of strategies exist for the implementation of clinical practice guides (CPGs)
In one of the centres assigned to the intervention arm, only the four planned meetings could be attended by all health professionals
Since the intervention was analysed with intention to treat, the results from this centre were included in the analysis within the intervention arm
Summary
A number of strategies exist for the implementation of clinical practice guides (CPGs). At the end of the trial, the recording of the variables necessary for the calculation of the cardiovascular risk in the intervention group had increased more than in the control group 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]. They can improve the consistency of care [2] and they have been shown at least capable of changing clinical practice [3]. Choosing the right one for a particular setting, and planning is paramount [11]
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