Abstract
BackgroundA pilot project cardiovascular prevention was implemented in Sandwell (West Midlands, UK). This used electronic primary care records to identify untreated patients at high risk of cardiovascular disease then invited these high risk patients for assessment by a nurse in their own general practice. Those found to be eligible for treatment were offered treatment. During the pilot a higher proportion of high risk patients were started on treatment in the intervention practices than in control practices. Following the apparent success of the prevention project, it was intended to extend the service to all practices across the Sandwell area. However the pilot project was not a robust evaluation. There was a need for an efficient evaluation that would not disrupt the planned rollout of the project.Methods/designProject nurses will sequentially implement targeted cardiovascular case finding in a phased way across all general practices, with the sequence of general practices determined randomly. This is a stepped wedge randomised controlled trial design. The target population is patients aged 35 to 74, without diabetes or cardiovascular disease whose ten-year cardiovascular risk, (determined from data in their electronic records) is ≥20%. The primary outcome is the number of high risk patients started on treatment, because these data could be efficiently obtained from electronic primary care records. From this we can determine the effects of the case finding programme on the proportion of high risk patients started on treatment in practices before and after implementation of targeted case finding. Cost-effectiveness will be modelled from the predicted effects of treatments on cardiovascular events and associated health service costs. Alongside the implementation it is intended to interview clinical staff and patients who participated in the programme in order to determine acceptability to patients and clinicians. Practical considerations meant that 26 practices in Sandwell could be randomised, including about 6,250 patients at high risk of cardiovascular disease. This gives sufficient power for evaluation.DiscussionIt is possible to design a stepped wedge randomised controlled trial using routine data to determine the primary outcome to evaluate implementation of a cardiovascular prevention programme.
Highlights
A pilot project cardiovascular prevention was implemented in Sandwell (West Midlands, UK)
This paper presents the protocol for a stepped wedged cluster randomised controlled trial that aims to quantify the benefits of targeted case finding of patients at high risk of Cardiovascular disease (CVD) over opportunistic assessment and overcome the challenges of evaluation
The total population registered with these practices was approximately 125,000 and from the pilot study it was anticipated that 5% would be untreated high risk patients
Summary
A pilot project cardiovascular prevention was implemented in Sandwell (West Midlands, UK) This used electronic primary care records to identify untreated patients at high risk of cardiovascular disease invited these high risk patients for assessment by a nurse in their own general practice. Those found to be eligible for treatment were offered treatment. GPs do not always follow guidelines in routine clinical practice [7] They may not fully recognise the clinical importance of statin prescribing and when eligible patients consult, physicians commonly delay prescribing decisions until the visit [8,9]. In 2009, 29% of adults were hypertensive of whom 51% were untreated and the figures have changed little since 2005 [16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
