Abstract
BackgroundThere are significant gaps in the implementation and uptake of evidence-based guideline recommendations for cardiovascular disease (CVD) and diabetes in Australian general practice. This study protocol describes the methodology for a cluster randomised trial to evaluate the effectiveness of a model that aims to improve the implementation of these guidelines in Australian general practice developed by a collaboration between researchers, non-government organisations, and the profession.MethodsWe hypothesise that the intervention will alter the behaviour of clinicians and patients resulting in improvements of recording of lifestyle and physiological risk factors (by 20%) and increased adherence to guideline recommendations for: the management of CVD and diabetes risk factors (by 20%); and lifestyle and physiological risk factors of patients at risk (by 5%). Thirty-two general practices will be randomised in a 1:1 allocation to receive either the intervention or continue with usual care, after stratification by state. The intervention will be delivered through: small group education; audit of patient records to determine preventive care; and practice facilitation visits adapted to the needs of the practices. Outcome data will be extracted from electronic medical records and patient questionnaires, and qualitative evaluation from provider and patient interviews.DiscussionWe plan to disseminate study findings widely and directly inform implementation strategies by governments, professional bodies, and non-government organisations including the partner organisations.
Highlights
There are significant gaps in the implementation and uptake of evidence-based guideline recommendations for cardiovascular disease (CVD) and diabetes in Australian general practice
This study aims to evaluate the impact of the Preventive Evidence into Practice (PEP) intervention on: The behaviour of doctors and nurses in general practice in assessing and recording risk factors and providing interventions to address these; and patient behavioural and physiological risk factors
Randomisation Practices will be randomly assigned to intervention and late intervention groups after stratification into blocks by state and practice size—i.e., the number of general practictioners (GPs) in a practice—using a computer-generated randomization list
Summary
There are significant gaps in the implementation and uptake of evidence-based guideline recommendations for cardiovascular disease (CVD) and diabetes in Australian general practice. This study protocol describes the methodology for a cluster randomised trial to evaluate the effectiveness of a model that aims to improve the implementation of these guidelines in Australian general practice developed by a collaboration between researchers, non-government organisations, and the profession. It is estimated that 9 in 10 adult Australians have at least one risk factor for CVD [2]. Behavioural risk factors include smoking, nutrition, alcohol, physical activity, and being overweight or obese. General practitioners provide clinical services to approximately 88% of Australians each year and are in an ideal position to screen for risk factors and provide brief interventions including advice about behavioural risk factors as well as medications [1]. There are numerous barriers to implementation at the patient, practitioner, practice, and system levels [4,5,6,7]
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