Abstract
BackgroundThe appropriate care for people with cardiovascular risk factors can reduce morbidity and mortality. One strategy for improving the care for these patients involves the implementation of evidence-based guidelines. To date, little research concerning the impact of such implementation strategies in our setting has been published. Aims. To evaluate the effectiveness of a multifaceted tailored intervention in the implementation of three cardiovascular risk-related guidelines (hypertension, type 2 diabetes and dyslipidemia) in primary care in the Basque Health Service compared with usual implementation.Methods/DesignA two-year cluster randomized clinical trial in primary care in two districts in the Basque Health Service. All primary care units are randomized. Data from all patients with diabetes, hypertension and those susceptible to coronary risk screening will be analyzed.Interventions. The control group will receive standard implementation. The experimental group will receive a multifaceted tailored implementation strategy, including a specific web page and workshops for family physicians and nurses.Endpoints. Primary endpoints: annual request for glycosylated hemoglobin, basic laboratory tests for hypertension, cardiovascular risk screening (women between 45–74 and men between 40–74 years old). Secondary endpoints: other process and clinical guideline indicators.Analysis: Data will be extracted from centralized computerized medical records. Analysis will be performed at a primary care unit level weighted by cluster size.DiscussionThe main contribution of our study is that it seeks to identify an effective strategy for cardiovascular guideline implementation in primary care in our setting.Trial registrationCurrent Controlled Trials, ISRCTN88876909
Highlights
The appropriate care for people with cardiovascular risk factors can reduce morbidity and mortality
The main contribution of our study is that it seeks to identify an effective strategy for cardiovascular guideline implementation in primary care in our setting
Main endpoint To evaluate the effectiveness of a multifaceted tailored intervention in the implementation of three cardiovascular risk-related Clinical Practice Guideline (CPG) in primary care in the Basque Health Service compared with usual implementation
Summary
The appropriate care for people with cardiovascular risk factors can reduce morbidity and mortality. One strategy for improving the care for these patients involves the implementation of evidence-based guidelines. Current data suggest that there remains significant room for improvement in cardiovascular risk factor and diabetes care in our setting. According to data from the Provider Agreement in 2008 only 41.3% of diabetic patients in the Autonomous Community of the Basque Country had a glycosylated hemoglobin (HbA1c) level of less than 7.5%, basic analysis was performed in 44.9% of patients and only 27% had a blood pressure of less than 140/80 mm Hg. The almost anecdotal use of tools to calculate cardiovascular risk at that time suggests that statin treatment in primary prevention is chosen on the basis of cholesterol level rather than overall cardiovascular risk [3]
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