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

B D Frijling; C M Lobo; M E J L Hulscher; R P Akkermans; B B van Drenth; A Prins; J C van der Wouden; R P T M Grol

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

B D Frijling, C M Lobo, M E J L Hulscher, R P Akkermans, B B van Drenth, A Prins, J C van der Wouden, R P T M Grol

Research output: Contribution to journal › Article › Academic › peer-review

33 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the effects of feedback reports combined with outreach visits from trained non-physicians 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.

Original language	English
Pages (from-to)	181-7
Number of pages	7
Journal	Quality and Safety in Health Care
Volume	12
Issue number	3
Publication status	Published - Jun 2003
Externally published	Yes

Keywords

Adult
Cardiovascular Diseases/complications
Decision Making
Family Practice/education
Feedback
Guideline Adherence/statistics & numerical data
Health Services Research
Humans
Hypercholesterolemia/complications
Middle Aged
Netherlands
Practice Guidelines as Topic
Practice Patterns, Physicians'/statistics & numerical data

Cite this

@article{afd772e3678c470cbea72d256928429d,

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

abstract = "OBJECTIVE: To evaluate the effects of feedback reports combined with outreach visits from trained non-physicians 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.",

keywords = "Adult, Cardiovascular Diseases/complications, Decision Making, Family Practice/education, Feedback, Guideline Adherence/statistics & numerical data, Health Services Research, Humans, Hypercholesterolemia/complications, Middle Aged, Netherlands, Practice Guidelines as Topic, Practice Patterns, Physicians'/statistics & numerical data",

author = "Frijling, {B D} and Lobo, {C M} and Hulscher, {M E J L} and Akkermans, {R P} and {van Drenth}, {B B} and A Prins and {van der Wouden}, {J C} and Grol, {R P T M}",

year = "2003",

month = jun,

language = "English",

volume = "12",

pages = "181--7",

journal = "Quality and Safety in Health Care",

issn = "1475-3898",

publisher = "BMJ Publishing Group",

number = "3",

}

TY - JOUR

T1 - Intensive support to improve clinical decision making in cardiovascular care

T2 - a randomised controlled trial in general practice

AU - Frijling, B D

AU - Lobo, C M

AU - Hulscher, M E J L

AU - Akkermans, R P

AU - van Drenth, B B

AU - Prins, A

AU - van der Wouden, J C

AU - Grol, R P T M

PY - 2003/6

Y1 - 2003/6

N2 - OBJECTIVE: To evaluate the effects of feedback reports combined with outreach visits from trained non-physicians 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.

AB - OBJECTIVE: To evaluate the effects of feedback reports combined with outreach visits from trained non-physicians 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.

KW - Adult

KW - Cardiovascular Diseases/complications

KW - Decision Making

KW - Family Practice/education

KW - Feedback

KW - Guideline Adherence/statistics & numerical data

KW - Health Services Research

KW - Humans

KW - Hypercholesterolemia/complications

KW - Middle Aged

KW - Netherlands

KW - Practice Guidelines as Topic

KW - Practice Patterns, Physicians'/statistics & numerical data

M3 - Article

C2 - 12792007

SN - 1475-3898

VL - 12

SP - 181

EP - 187

JO - Quality and Safety in Health Care

JF - Quality and Safety in Health Care

IS - 3

ER -