Stepwise implementation of a cardiovascular risk management care program in primary care

Abstract

Background Primary care plays a pivotal role in sustainable cardiovascular risk management (CVRM) but little is known about the organizational process of implementing the guidelines. The aim of the study was to describe the approach taken by a primary care group to implement the CVRM guideline. Methods Stepwise introduction and implementation of a programmatic CVRM care program was organized and facilitated by the care group between April 2010 and January 2013 in 137 affiliated general practices with 188 general practitioners (GPs), in the vicinity of Eindhoven, Netherlands. Care group support comprised sufficient staff, support with data extraction based on ICPC and ATC codes and with identification of eligible patients by scrutinizing patient health records and adequate coding of disease conditions. Results Patient selection based on availability of structured information on ICPC codes and risk factor levels from the electronic health records, led to 38,675 eligible patients in 2013. December 2019, the CVRM program was still running in 151 practices with 51,416 patients receiving programmatic CVRM care. Linking problems between 8 different electronic health record systems and the multidisciplinary information system for integrated care delayed adequate data collection until the beginning of 2013. Conclusion Commitment of affiliated GPs, a structured approach with adequate coding of diagnoses and risk factors, central data registration and additional funding for sufficient staff support are important conditions for the introduction and implementation of successful and sustainable programmatic CVRM care. This approach constitutes the basis for long-term follow up and annual evaluation.

Patient characteristics and reasons for discontinuation in a cardiovascular risk management programme in The Netherlands

“…PoZoB is a primary care group in and around Eindhoven, southeast of the Netherlands, that supports affiliated GPs with the organization of 5 chronic care programmes: diabetes type 2 (DM2), chronic obstructive pulmonary diseases (COPD), cardiovascular risk management (CVRM), psychiatric diseases and fragile elderly. The care group started with the implementation of a nurse-led integrated CVRM care programme on April 1 st, 2010, which has been described in detail elsewhere [ 9 ]. Practices affiliated with the care group are located in rural, semirural and urban settings comparable with other regions in the Netherlands and therefore can be considered representative.…”

Patient characteristics and reasons for discontinuation in a cardiovascular risk management programme in The Netherlands

“…Setting PoZoB is a primary care group in and around Eindhoven, southeast of the Netherlands, that supports a liated GPs with the organization of 5 chronic care programmes: diabetes type 2 (DM2), chronic obstructive pulmonary diseases (COPD), cardiovascular risk management (CVRM), psychiatric diseases and fragile elderly. The care group started with the implementation of a nurse-led integrated CVRM care programme on April 1 st, 2010, which has been described in detail elsewhere (10). Practices a liated with the care group are located in rural, semirural and urban settings comparable with other regions in the Netherlands and therefore can be considered representative.…”

Practice visitations in primary care to improve performance of cardiovascular risk management: an observational study

“…In 2016 data was collected from 48,258 patients eligible for integrated CVRM care. Conditions for eligibility for the CVRM care programme were based on the National CVRM guideline 2012 and have been described in detail elsewhere (9,10). Patient data was collected in the care groups' multidisciplinary registration (Care2U: C2U).…”

“…Fourth, prescriptions of BPL and LM medication were used as performance indicator, without knowing whether medication was indicated which could have led to some overestimation. Fifth, PoZoB supported affiliated practices for several years in various ways which have been described in detail, resulting in annual improvements of performance (9). This might have contributed to the lack of effect on performance of additional practice visitations.…”