Impact of implementing electronic clinical practice guidelines for the diagnosis, control and treatment of cardiovascular risk factors: A pre-post controlled study

Comín, E.; Catalán-Ramos, Arantxa; Iglesias-Rodal, Manuel; Grau, María; Val, José Luís del; Consola, Alicia; Amado, Ester; Pons, Angels; Mata-Cases, Manel; Franzi, Alicia; Ciurana, Ramon; Frigola, Eva; Cos, Xavier; Davins, Josep; Verdú-Rotellar, José María

doi:10.1016/j.aprim.2016.11.007

Cited by 9 publications

(8 citation statements)

References 18 publications

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“…A synthesis of systematic reviews of the effectiveness of guideline implementation strategies suggested that effective methods to improve guideline adherence include; interactive education, clinical reminder systems, audit and feedback, benchmarking, and multifaceted interventions. [65][66][67] The Anglo-Danish-Dutch Study of Intensive Treatment In People with Screen-Detected Diabetes in Primary Care (ADDITION)-Denmark trial has recently demonstrated that training general practitioners to provide target-driven intensive management of glycaemic control and cardiovascular risk can improve cardiovascular outcomes long term. 68 The universal implementation of these effective methods is required to improve target attainment in people with T2DM.…”

Section: Discussionmentioning

confidence: 99%

Achievement of guideline targets for blood pressure, lipid, and glycaemic control in type 2 diabetes: A meta-analysis

Khunti

Ceriello²,

Cos

et al. 2018

Diabetes Research and Clinical Practice

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136

100

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We assessed global achievement of targets recommended by the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and National Institute of Health and Care Excellence (NICE) for type 2 diabetes. We searched Medline, Embase, and The Cochrane Library for observational studies reporting target attainment (2006 to 2017 inclusive) for HbA1c, blood pressure, or lipids (low density lipoprotein cholesterol [LDL-C], high density lipoprotein cholesterol [HDL-C], or triglycerides). Rates were pooled using a random-effects meta-analysis. Study quality and risk of small study of bias was assessed. From 2491 screened records, 24 studies were included reporting on 369,251 people from 20 countries. The pooled target achievement rates were; 42.8% (95% CI 38.1-47.5%) for glycaemic control, 29.0% (22.9-35.9%) for blood pressure, 49.2% (39.0-59.4%) for LDL-C, 58.2% (51.7-64.4%) for HDL-C, and 61.9% (55.2-68.2%) for triglyceride control. A higher proportion of people achieved HbA1c targets within Europe and North America than the rest of the world. A higher proportion of people achieved blood pressure targets in North America than Europe or the rest of the world. Meta regression showed no significant improvement in rates by year for any target. The achievement of evidence-based targets is markedly suboptimal globally and not improving.

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Section: Discussionmentioning

confidence: 99%

Achievement of guideline targets for blood pressure, lipid, and glycaemic control in type 2 diabetes: A meta-analysis

Khunti

Ceriello²,

Cos

et al. 2018

Diabetes Research and Clinical Practice

Self Cite

136

100

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“…Type : Education and counseling Domain : Lifestyle The authors did not justify why an RCT was not undertaken to evaluate the effectiveness of the intervention. All participants: Treatment group hypertension prevalence in the beginning: 37.3% Treatment group hypertension prevalence at the end: 33.7%; P -value beginning vs. end: 0.1 Control group hypertension prevalence in the beginning: 31.1% Control group hypertension prevalence at the end: 33.4%; P -value beginning vs. end: 0.28 Among participants younger than 40 years old: Treatment group hypertension prevalence in the beginning: 22.8% Treatment group hypertension prevalence at the end: 16.2%; P -value beginning vs. end: 0.01 Control group hypertension prevalence in the beginning: 14.0% Control group hypertension prevalence at the end: 15.1%; P -value beginning vs. end: 0.52 Among nonobese participants: Treatment group hypertension prevalence in the beginning: 31.4% Treatment group hypertension prevalence at the end: 26.2%; P -value beginning vs. end: 0.03 Control group hypertension prevalence in the beginning: 21.9% Control group hypertension prevalence at the end: 25.1%; P -value beginning vs. end: 0.17 Comin, 2017 [ 18 ] • N = 189,067 • Design: PPCG • Duration: 30 months • Data Source: Primary • Region: Europe • Subpopulation: all genders and racial/ethnic groups, aged 35–74 years • Participants: Patients with hypertension and diabetes and hypercholesterolemia Health center Computerized clinical practice guidelines: General practitioners had General practitioners accessed the computerized clinical practice guidelines at least twice a day Type : Management Domain : Care The authors did not justify why an RCT was not undertaken to evaluate the effectiveness of the intervention. In hypertension patients: Women: Treatment group percentage of improved BP control: 9.8% Control group percentage of improved BP control: 6.7% Treatment group vs. Control group percentage of improved BP control: P -value < 0.001 Men: Treatment group percentage of improved BP control: 11.8% Control group percentage of improved BP control: 7.9% Treatment group vs. Control group_ percentage of improved BP control: P -value < 0.001 Fikri-Benbrahim, 2012 [ 26 ] • N = 177 • Design: PPCG • Duration: 5 months • Data Source: Primary • Region: Europe • Subpopulation: all genders and racial/ethni...…”

Section: Methodsmentioning

confidence: 99%

Interventions in hypertension: systematic review and meta-analysis of natural and quasi-experiments

2022

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Background Hypertension is an urgent public health problem. Consistent summary from natural and quasi-experiments employed to evaluate interventions that aim at preventing or controlling hypertension is lacking in the current literature. This study aims to summarize the evidence from natural and quasi-experiments that evaluated interventions used to prevent or control hypertension. Methods We searched PubMed, Embase and Web of Science for natural and quasi-experiments evaluating interventions used to prevent hypertension, improve blood pressure control or reduce blood pressure levels from January 2008 to November 2018. Descriptions of studies and interventions were systematically summarized, and a meta-analysis was conducted. Results Thirty studies were identified, and all used quasi-experimental designs including a difference-in-difference, a pre-post with a control group or a propensity score matching design. Education and counseling on lifestyle modifications such as promoting physical activity (PA), promoting a healthy diet and smoking cessation consultations could help prevent hypertension in healthy people. The use of computerized clinical practice guidelines by general practitioners, education and management of hypertension, the screening for cardiovascular disease (CVD) goals and referral could help improve hypertension control in patients with hypertension. The educating and counseling on PA and diet, the monitoring of patients’ metabolic factors and chronic diseases, the combination of education on lifestyles with management of hypertension, the screening for economic risk factors, medical needs, and CVD risk factors and referral all could help reduce blood pressure. In the meta-analysis, the largest reduction in blood pressure was seen for interventions which combined education, counseling and management strategies: weighted mean difference in systolic blood pressure was − 5.34 mmHg (95% confidence interval [CI], − 7.35 to − 3.33) and in diastolic blood pressure was − 3.23 mmHg (95% CI, − 5.51 to − 0.96). Conclusions Interventions that used education and counseling strategies; those that used management strategies; those that used combined education, counseling and management strategies and those that used screening and referral strategies were beneficial in preventing, controlling hypertension and reducing blood pressure levels. The combination of education, counseling and management strategies appeared to be the most beneficial intervention to reduce blood pressure levels.

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“…Health care quality indicators have been used in recent years to monitorize and quantify improvements in the follow-up and control of different chronic diseases, including T2DM [16] , [17] , [18] . In Catalonia, the Healthcare quality standard (EQA, the Catalan acronym for Estàndard de Qualitat Assistencial) has been calculated for>10 years and includes>60 clinical indicators, some related to the follow-up, screening and control of patients with T2DM [19] .…”

Section: Introductionmentioning

confidence: 99%

Association between the reduction of face-to-face appointments and the control of patients with type 2 diabetes mellitus during the Covid-19 pandemic in Catalonia

Coma¹,

Miró²,

Medina³

et al. 2021

Diabetes Research and Clinical Practice

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Impact of implementing electronic clinical practice guidelines for the diagnosis, control and treatment of cardiovascular risk factors: A pre-post controlled study

Cited by 9 publications

References 18 publications

Achievement of guideline targets for blood pressure, lipid, and glycaemic control in type 2 diabetes: A meta-analysis

Achievement of guideline targets for blood pressure, lipid, and glycaemic control in type 2 diabetes: A meta-analysis

Interventions in hypertension: systematic review and meta-analysis of natural and quasi-experiments

Association between the reduction of face-to-face appointments and the control of patients with type 2 diabetes mellitus during the Covid-19 pandemic in Catalonia

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