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 journalArticleAcademicpeer-review

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 languageEnglish
Pages (from-to)181-7
Number of pages7
JournalQuality and Safety in Health Care
Volume12
Issue number3
Publication statusPublished - Jun 2003

Cite this

Frijling, B. D., Lobo, C. M., Hulscher, M. E. J. L., Akkermans, R. P., van Drenth, B. B., Prins, A., ... Grol, R. P. T. M. (2003). Intensive support to improve clinical decision making in cardiovascular care: a randomised controlled trial in general practice. Quality and Safety in Health Care, 12(3), 181-7.
Frijling, B D ; Lobo, C M ; Hulscher, M E J L ; Akkermans, R P ; van Drenth, B B ; Prins, A ; van der Wouden, J C ; Grol, R P T M. / Intensive support to improve clinical decision making in cardiovascular care : a randomised controlled trial in general practice. In: Quality and Safety in Health Care. 2003 ; Vol. 12, No. 3. pp. 181-7.
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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.",
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Frijling, BD, Lobo, CM, Hulscher, MEJL, Akkermans, RP, van Drenth, BB, Prins, A, van der Wouden, JC & Grol, RPTM 2003, 'Intensive support to improve clinical decision making in cardiovascular care: a randomised controlled trial in general practice' Quality and Safety in Health Care, vol. 12, no. 3, pp. 181-7.

Intensive support to improve clinical decision making in cardiovascular care : a randomised controlled trial in general practice. / Frijling, B D; Lobo, C M; Hulscher, M E J L; Akkermans, R P; van Drenth, B B; Prins, A; van der Wouden, J C; Grol, R P T M.

In: Quality and Safety in Health Care, Vol. 12, No. 3, 06.2003, p. 181-7.

Research output: Contribution to journalArticleAcademicpeer-review

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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

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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

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JO - Quality and Safety in Health Care

JF - Quality and Safety in Health Care

SN - 1475-3898

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ER -