Organisational determinants of cardiovascular prevention in general practice

Lobo, Claudia M; Frijling, Bernard D; Hulscher, Marlies; Bernsen, Roos; Braspenning, Jozé; Grol, Richard; Prins, A; Wouden, Johannes C. van der

doi:10.1080/02813430310001707

Cited by 14 publications

(11 citation statements)

References 11 publications

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“…[11][12][13][14][15][16][17][18] A total of 124 practices with 185 GPs participated in this trial. Baseline assessments provided insights into the actual quality of care.…”

Section: Introductionmentioning

confidence: 99%

“…Baseline assessments provided insights into the actual quality of care. [11][12][13][14] The trial also showed the feasibility, effectiveness, and costs of a multifaceted intervention to improve certain elements of the structure, process, and outcome of care. [15][16][17][18] The intervention comprised feedback reports and outreach visits from trained non-physicians.…”

Section: Introductionmentioning

confidence: 99%

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Intensive support to improve clinical decision making in cardiovascular care: a randomised controlled trial in general practice

Frijling

2003

Quality and Safety in Health Care

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Objective: To evaluate the effects of feedback reports combined with outreach visits from trained nonphysicians on the clinical decision making of general practitioners (GPs) in cardiovascular care. Design: Pragmatic cluster controlled trial with randomisation of practices to support (intervention group) or no special attention (control group); analysis after 2 years. Setting: 124 general practices in The Netherlands. Participants: 185 GPs. Main outcome measures: Compliance rates for 12 evidence-based indicators for the management of patients with hypertension, hypercholesterolaemia, angina pectoris, or heart failure. The evaluation relied on the prospective recording of patient encounters by the participating GPs. Results: The GPs reported 30 101 clinical decisions at baseline and 22 454 decisions after the intervention. A significant improvement was seen for five of the 12 indicators: assessment of risk factors in patients with hypercholesterolaemia (odds ratio 2.04; 95% CI 1.44 to 2.88) or angina pectoris (3.07; 1.08 to 8.79), provision of information and advice to patients with hypercholesterolaemia (1.58, 1.17 to 2.13) or hypertension (1.55, 1.35 to 1.77), and checking for clinical signs of deterioration in patients with heart failure (4.11, 2.17 to 7.77). Single handed practices, non-training practices, and practices with older GPs gained particular benefit from the intervention. Conclusions: Intensive support from trained non-physicians can alter certain aspects of the clinical decision making of GPs in cardiovascular care. The effect is small and the strategy needs further development.

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“…[11][12][13][14][15][16][17][18] A total of 124 practices with 185 GPs participated in this trial. Baseline assessments provided insights into the actual quality of care.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intensive support to improve clinical decision making in cardiovascular care: a randomised controlled trial in general practice

Frijling

2003

Quality and Safety in Health Care

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“…Similarly teamwork and structured management were pointed out among organizational determinants in general practice concerning cardiovascular prevention [4]. The most health-promoting potential is supposed to be in the everyday meeting with patients [3].…”

mentioning

confidence: 99%

Low-budget method for lifestyle improvement in primary care Experiences from the Göteborg Health Profile Project

Blomstrand

Lindqvist

Carlsson

et al. 2005

Scandinavian Journal of Primary Health Care

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“…GPs in deprived neighbourhoods have a great deal of information about patients, but – due to their high workload – do not use this information for case-finding and secondary prevention. They lack the time and the organisation to actively invite people for check-ups [9,11-13]. They do not actively assess risk-profiles either.…”

Section: Introductionmentioning

confidence: 99%

Tailoring intervention procedures to routine primary health care practice; an ethnographic process evaluation

Jansen

Bont

Foets

et al. 2007

BMC Health Serv Res

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Background: Tailor-made approaches enable the uptake of interventions as they are seen as a way to overcome the incompatibility of general interventions with local knowledge about the organisation of routine medical practice and the relationship between the patients and the professionals in practice. Our case is the Quattro project which is a prevention programme for cardiovascular diseases in high-risk patients in primary health care centres in deprived neighbourhoods. This programme was implemented as a pragmatic trial and foresaw the importance of local knowledge in primary health care and internal, or locally made, guidelines. The aim of this paper is to show how this prevention programme, which could be tailored to routine care, was implemented in primary care.

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Organisational determinants of cardiovascular prevention in general practice

Cited by 14 publications

References 11 publications

Intensive support to improve clinical decision making in cardiovascular care: a randomised controlled trial in general practice

Intensive support to improve clinical decision making in cardiovascular care: a randomised controlled trial in general practice

Low-budget method for lifestyle improvement in primary care Experiences from the Göteborg Health Profile Project

Tailoring intervention procedures to routine primary health care practice; an ethnographic process evaluation

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