Implementing guidelines to routinely prevent chronic vascular disease in primary care: The preventive evidence into practice cluster randomised controlled trial

Mark Fort Harris, Sharon M. Parker, John Litt, Mieke Van Driel, Grant Russell, Danielle Mazza, Upali W. Jayasinghe, Chris Del Mar, Jane Lloyd, Jane Smith, Nicholas Zwar, Richard Taylor, Gawaine Powell Davies, Elizabeth Denney-Wilson, Rachel Laws, Teri Snowdon, Helen Bolger-Harris, Stephan Groombridge, Stan Goldstein, Teresa Howarth & 2 others Nancy Huang, Jinty Wilson

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Abstract

Objective: To evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease. Setting: 32 urban general practices in 4 Australian states. Randomisation: Stratified randomisation of practices. Participants: 122 general practitioners (GPS) and practice nurses (PNs) were recruited at baseline and 97 continued to 12 months. 21 848 patient records were audited for those aged 40-69 years who attended the practice in the previous 12 months without heart disease, stroke, diabetes, chronic renal disease, cognitive impairment or severe mental illness. Intervention: The practice level intervention over 6 months included small group training of practice staff, feedback on audited performance, practice facilitation visits and provision of patient education and referral information. Outcome measures: Primary: 1. Change in proportion of patients aged 40-69 years with smoking status, alcohol intake, body mass index (BMI), waist circumference (WC), blood pressure (BP) recorded and for those aged 45-69 years with lipids, fasting blood glucose and cardiovascular risk in the medical record. 2. Change in the level of risk for each factor. Secondary: change in self-reported frequency and confidence of GPS and PNs in assessment. Results: Risk recording improved in the intervention but not the control group for WC (OR 2.52 (95% CI 1.30 to 4.91)), alcohol consumption (OR 2.19 (CI 1.04 to 4.64)), smoking status (OR 2.24 (1.17 to 4.29)) and cardiovascular risk (OR 1.50 (1.04 to 2.18)). There was no change in recording of BP, lipids, glucose or BMI and no significant change in the level of risk factors based on audit data. The confidence but not reported practices of GPS and PNs in the intervention group improved in the assessment of some risk factors. Conclusions: This intervention was associated with improved recording of some risk factors but no change in the level of risk at the follow-up audit. Trial registration number: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000578808, results.

Original languageEnglish
Article numbere009397
JournalBMJ Open
Volume5
Issue number12
DOIs
Publication statusPublished - 2015

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Vascular Diseases
General Practice
Primary Health Care
Chronic Disease
Randomized Controlled Trials
Guidelines
General Practitioners
Nurses
Waist Circumference
Random Allocation
Body Mass Index
Smoking
Blood Pressure
Lipids
Patient Education
Chronic Renal Insufficiency
New Zealand
Alcohol Drinking
Medical Records
Blood Glucose

Cite this

Harris, Mark Fort ; Parker, Sharon M. ; Litt, John ; Van Driel, Mieke ; Russell, Grant ; Mazza, Danielle ; Jayasinghe, Upali W. ; Del Mar, Chris ; Lloyd, Jane ; Smith, Jane ; Zwar, Nicholas ; Taylor, Richard ; Davies, Gawaine Powell ; Denney-Wilson, Elizabeth ; Laws, Rachel ; Snowdon, Teri ; Bolger-Harris, Helen ; Groombridge, Stephan ; Goldstein, Stan ; Howarth, Teresa ; Huang, Nancy ; Wilson, Jinty. / Implementing guidelines to routinely prevent chronic vascular disease in primary care : The preventive evidence into practice cluster randomised controlled trial. In: BMJ Open. 2015 ; Vol. 5, No. 12.
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title = "Implementing guidelines to routinely prevent chronic vascular disease in primary care: The preventive evidence into practice cluster randomised controlled trial",
abstract = "Objective: To evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease. Setting: 32 urban general practices in 4 Australian states. Randomisation: Stratified randomisation of practices. Participants: 122 general practitioners (GPS) and practice nurses (PNs) were recruited at baseline and 97 continued to 12 months. 21 848 patient records were audited for those aged 40-69 years who attended the practice in the previous 12 months without heart disease, stroke, diabetes, chronic renal disease, cognitive impairment or severe mental illness. Intervention: The practice level intervention over 6 months included small group training of practice staff, feedback on audited performance, practice facilitation visits and provision of patient education and referral information. Outcome measures: Primary: 1. Change in proportion of patients aged 40-69 years with smoking status, alcohol intake, body mass index (BMI), waist circumference (WC), blood pressure (BP) recorded and for those aged 45-69 years with lipids, fasting blood glucose and cardiovascular risk in the medical record. 2. Change in the level of risk for each factor. Secondary: change in self-reported frequency and confidence of GPS and PNs in assessment. Results: Risk recording improved in the intervention but not the control group for WC (OR 2.52 (95{\%} CI 1.30 to 4.91)), alcohol consumption (OR 2.19 (CI 1.04 to 4.64)), smoking status (OR 2.24 (1.17 to 4.29)) and cardiovascular risk (OR 1.50 (1.04 to 2.18)). There was no change in recording of BP, lipids, glucose or BMI and no significant change in the level of risk factors based on audit data. The confidence but not reported practices of GPS and PNs in the intervention group improved in the assessment of some risk factors. Conclusions: This intervention was associated with improved recording of some risk factors but no change in the level of risk at the follow-up audit. Trial registration number: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000578808, results.",
author = "Harris, {Mark Fort} and Parker, {Sharon M.} and John Litt and {Van Driel}, Mieke and Grant Russell and Danielle Mazza and Jayasinghe, {Upali W.} and {Del Mar}, Chris and Jane Lloyd and Jane Smith and Nicholas Zwar and Richard Taylor and Davies, {Gawaine Powell} and Elizabeth Denney-Wilson and Rachel Laws and Teri Snowdon and Helen Bolger-Harris and Stephan Groombridge and Stan Goldstein and Teresa Howarth and Nancy Huang and Jinty Wilson",
year = "2015",
doi = "10.1136/bmjopen-2015-009397",
language = "English",
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Harris, MF, Parker, SM, Litt, J, Van Driel, M, Russell, G, Mazza, D, Jayasinghe, UW, Del Mar, C, Lloyd, J, Smith, J, Zwar, N, Taylor, R, Davies, GP, Denney-Wilson, E, Laws, R, Snowdon, T, Bolger-Harris, H, Groombridge, S, Goldstein, S, Howarth, T, Huang, N & Wilson, J 2015, 'Implementing guidelines to routinely prevent chronic vascular disease in primary care: The preventive evidence into practice cluster randomised controlled trial' BMJ Open, vol. 5, no. 12, e009397. https://doi.org/10.1136/bmjopen-2015-009397

Implementing guidelines to routinely prevent chronic vascular disease in primary care : The preventive evidence into practice cluster randomised controlled trial. / Harris, Mark Fort; Parker, Sharon M.; Litt, John; Van Driel, Mieke; Russell, Grant; Mazza, Danielle; Jayasinghe, Upali W.; Del Mar, Chris; Lloyd, Jane; Smith, Jane; Zwar, Nicholas; Taylor, Richard; Davies, Gawaine Powell; Denney-Wilson, Elizabeth; Laws, Rachel; Snowdon, Teri; Bolger-Harris, Helen; Groombridge, Stephan; Goldstein, Stan; Howarth, Teresa; Huang, Nancy; Wilson, Jinty.

In: BMJ Open, Vol. 5, No. 12, e009397, 2015.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Implementing guidelines to routinely prevent chronic vascular disease in primary care

T2 - The preventive evidence into practice cluster randomised controlled trial

AU - Harris, Mark Fort

AU - Parker, Sharon M.

AU - Litt, John

AU - Van Driel, Mieke

AU - Russell, Grant

AU - Mazza, Danielle

AU - Jayasinghe, Upali W.

AU - Del Mar, Chris

AU - Lloyd, Jane

AU - Smith, Jane

AU - Zwar, Nicholas

AU - Taylor, Richard

AU - Davies, Gawaine Powell

AU - Denney-Wilson, Elizabeth

AU - Laws, Rachel

AU - Snowdon, Teri

AU - Bolger-Harris, Helen

AU - Groombridge, Stephan

AU - Goldstein, Stan

AU - Howarth, Teresa

AU - Huang, Nancy

AU - Wilson, Jinty

PY - 2015

Y1 - 2015

N2 - Objective: To evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease. Setting: 32 urban general practices in 4 Australian states. Randomisation: Stratified randomisation of practices. Participants: 122 general practitioners (GPS) and practice nurses (PNs) were recruited at baseline and 97 continued to 12 months. 21 848 patient records were audited for those aged 40-69 years who attended the practice in the previous 12 months without heart disease, stroke, diabetes, chronic renal disease, cognitive impairment or severe mental illness. Intervention: The practice level intervention over 6 months included small group training of practice staff, feedback on audited performance, practice facilitation visits and provision of patient education and referral information. Outcome measures: Primary: 1. Change in proportion of patients aged 40-69 years with smoking status, alcohol intake, body mass index (BMI), waist circumference (WC), blood pressure (BP) recorded and for those aged 45-69 years with lipids, fasting blood glucose and cardiovascular risk in the medical record. 2. Change in the level of risk for each factor. Secondary: change in self-reported frequency and confidence of GPS and PNs in assessment. Results: Risk recording improved in the intervention but not the control group for WC (OR 2.52 (95% CI 1.30 to 4.91)), alcohol consumption (OR 2.19 (CI 1.04 to 4.64)), smoking status (OR 2.24 (1.17 to 4.29)) and cardiovascular risk (OR 1.50 (1.04 to 2.18)). There was no change in recording of BP, lipids, glucose or BMI and no significant change in the level of risk factors based on audit data. The confidence but not reported practices of GPS and PNs in the intervention group improved in the assessment of some risk factors. Conclusions: This intervention was associated with improved recording of some risk factors but no change in the level of risk at the follow-up audit. Trial registration number: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000578808, results.

AB - Objective: To evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease. Setting: 32 urban general practices in 4 Australian states. Randomisation: Stratified randomisation of practices. Participants: 122 general practitioners (GPS) and practice nurses (PNs) were recruited at baseline and 97 continued to 12 months. 21 848 patient records were audited for those aged 40-69 years who attended the practice in the previous 12 months without heart disease, stroke, diabetes, chronic renal disease, cognitive impairment or severe mental illness. Intervention: The practice level intervention over 6 months included small group training of practice staff, feedback on audited performance, practice facilitation visits and provision of patient education and referral information. Outcome measures: Primary: 1. Change in proportion of patients aged 40-69 years with smoking status, alcohol intake, body mass index (BMI), waist circumference (WC), blood pressure (BP) recorded and for those aged 45-69 years with lipids, fasting blood glucose and cardiovascular risk in the medical record. 2. Change in the level of risk for each factor. Secondary: change in self-reported frequency and confidence of GPS and PNs in assessment. Results: Risk recording improved in the intervention but not the control group for WC (OR 2.52 (95% CI 1.30 to 4.91)), alcohol consumption (OR 2.19 (CI 1.04 to 4.64)), smoking status (OR 2.24 (1.17 to 4.29)) and cardiovascular risk (OR 1.50 (1.04 to 2.18)). There was no change in recording of BP, lipids, glucose or BMI and no significant change in the level of risk factors based on audit data. The confidence but not reported practices of GPS and PNs in the intervention group improved in the assessment of some risk factors. Conclusions: This intervention was associated with improved recording of some risk factors but no change in the level of risk at the follow-up audit. Trial registration number: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000578808, results.

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