Innovative strategy for implementing chronic heart failure guidelines among family physicians in different healthcare settings in Berlin

Abstract

AimsThe aim of this study was to improve drug therapy for chronic heart failure (CHF) patients. Methods and resultsThis prospective interventional pilot study was performed with cross-sectional comparative analysis before and after the intervention. Usual pharmacotherapy was observed for 8 months in two different outpatient healthcare settings in Berlin [11 family physicians from individual GP (IGP) practices and 12 working in a medical care centre (MCC)]. Medical care centres provide a novel structure for outpatient care and have recently been introduced in Germany. The subsequent intervention entailed implementation of heart failure guidelines via a computer-based reminder system, followed by renewed cross-sectional observation of prescription behaviour for 1 year. Family physicians recruited patients, assessed CHF severity according to the NYHA class, and referred patients for echocardiography. The study included 190 patients in the baseline phase and 209 in the intervention phase. Longitudinal follow-up was performed in 172 cases. Echocardiography was ordered by 94.6% of MCC-physicians and 79.9% of IGP's. Undermedication was observed in both settings. Guideline-based beta-blocker therapy was prescribed for 46.3% of patients (44.8% of IGPs and 48.5% of MCC-GPs). Prescription improved by 12.3% after the intervention. There were marked deficiencies in the prescription of aldosterone antagonists (35%) for severe heart failure, which improved to 44.2% after the intervention. ConclusionThe problem of inadequate implementation of evidence-based therapy for CHF was partially overcome by using the reminder system, which provided participating physicians with short guideline recommendations during the intervention phase.--

Patient adherence to evidence‐based pharmacotherapy in systolic heart failure and the transition of follow‐up from specialized heart failure outpatient clinics to primary care

“…A German study from 2011 investigated whether a computer‐based pop‐up reminder system could increase the use of RAS inhibitors, beta‐blockers, and spironolactone in a setting of individual GPs or Medical Care Centres (with GPs and specialists working in the same setting). It was found that beta‐blocker treatment increased significantly by 12.3% to 58.6% and spironolactone by 9.2% to 44.2%.…”

Overdiagnosis of heart failure in primary care: a cross-sectional study

“…16,[19][20][21] However, patients in these studies could also have been referred for analysis of a heart murmur, or for other cardiac causes of breathlessness.…”

Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care

“…(continued) applied educational meetings supported by diverse additional methods such as reminders,29,48 networking 33 or distribution55 ; or performed the educational component in the form of an outreach visit, extended by distribution 24 or audit.…”