Improving quality of organizing cardiovascular preventive care in general practice by outreach visitors: a randomized controlled trial

Claudia M Lobo, Bernard D Frijling, Marlies E J L Hulscher, Roos M D Bernsen, Jozé C Braspenning, Richard P T M Grol, Ad Prins, Johannes C van der Wouden

Research output: Contribution to journalArticleAcademicpeer-review

35 Citations (Scopus)


BACKGROUND: Adequate care for patients with cardiovascular risks requires an adequate practice organization. Educational outreach visits are a promising approach to modifying professional behavior. We aimed to assess whether the quality of cardiovascular preventive care in general practice can be improved through a comprehensive intervention implemented by an educational outreach visitor.

METHODS: After baseline measurements, general practices (n = 124) in the southern half of The Netherlands were randomly allocated to either intervention or control group. The intervention, based on the educational outreach model, comprised 15 practice visits over a period of 21 months and addressed a large number of issues around task delegation, availability of instruments and patient leaflets, record-keeping, and follow-up routines. Twenty-one months after the start of the intervention, postintervention measurements were performed. The difference between ideal and actual practice in each aspect of organizing preventive care was defined as a deficiency score. Primary outcome measure was the difference in deficiency scores before and after the intervention.

RESULTS: All practices completed both baseline and postintervention measurements. The difference in change between intervention and control group adjusted for baseline was statistically significant (P < 0.001) for each aspect of organizing preventive care. The largest absolute improvement was found for the number of preventive tasks performed by the practice assistant.

CONCLUSIONS: This study showed that a comprehensive intervention implemented by outreach visitors was effective in improving organization of cardiovascular preventive care in general practice.

Original languageEnglish
Pages (from-to)422-9
Number of pages8
JournalPreventive medicine
Issue number5
Publication statusPublished - Nov 2002
Externally publishedYes


  • Adult
  • Cardiovascular Diseases/prevention & control
  • Disease Management
  • Education, Medical, Continuing/methods
  • Family Practice/education
  • Female
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Netherlands
  • Organizational Innovation
  • Practice Patterns, Physicians'
  • Preventive Health Services/organization & administration
  • Quality Assurance, Health Care
  • Statistics, Nonparametric

Cite this