Study on the effect of comprehensive intervention in the management of cardiovascular disease risk factors for general practitioners

Abstract

Objective To evaluate the effect of interventions for improving the management of cardiovascular risk factors in general practitioners. Methods Interventions were conducted in thirty-five community health service centers in Chaoyang District of Beijing using simplified clinical pathways, clinical decision support systems, service quality evaluation index and feedback mechanism, and quality-related motivation system. The research was divided into three periods, which were indicated as before the interventions (2014.1-6), after the first intervention (2014.8-10), and after the second intervention (2014.12-2015.2), according to the community service center outpatient clinic, the computer randomly selected 2 100, 2 089 and 2 052 subjects. With the method of retrospective case review, historical case records of each selected case were extracted, and the changes in KPIs before and after interventions were evaluated. Results After two cycles of intervention, compared with before the interventions, the capability of general practitioners to record hypertension (99.9% vs. 70.5%, χ2=708.9), diabetes (99.6% vs. 41.5%, χ2=1691.1), hyperlipidemia (99.5% vs. 37.0%, χ2=1854.9), coronary atherosclerotic heart disease (CHD) (99.6% vs. 54.3%, χ2=1190.9), and cerebral hemorrhagic stroke (99.4% vs. 39.7%, χ2=1736.2) had significantly increased (P<0.001). Records of other risk factors, for instance, height and weight (81.4% vs. 72.2%, χ2=50.3), smoking (70.0% vs. 0.1%, χ2=2 179.2), and health education including recommended physical activity (75.0% vs. 68.2%, χ2=24.0) and weight control (75.4% vs. 16.2%, χ2=1 467.1) significantly increased (P<0.001). The proportion of patients with hypertension who did not use antihypertensive drugs was 31.6% before the intervention; in the first period of intervention, it reduced to 20.2%, and in the second period after the intervention it was 25.8%. Cases of CHD, stroke, diabetes, patients taking aspirin, beta blockers, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in proportion to the class of drugs, and statins increased (P<0.05); the coronary atherosclerosis heart disease patients with beta-blockers utility ratio was 20.2% before the intervention, and in the second cycle it was up to 27.9% after the intervention; for patients with diabetes statins utility ratio was 32.1% before the intervention, and in the second cycle it was up to 40.9% after the intervention. Conclusion Adoption and implementation of a series of interventions such as simplified clinical pathways, clinical decision support systems, service quality evaluation index and feedback mechanism, and quality-related motivation system will be beneficial to improve the capability of general practitioners to manage the cardiovascular disease risk factors, which are implied to be effective methods for managing chronic diseases. Key words: Quality of health care; Cardiovascular diseases; Implementation