Comparing the effectiveness of two cardiovascular prevention programmes for highly educated professionals in general practice : a randomised clinical trial

Background: Cardiovascular disease is a major cause of mortality and morbidity and its prevalence is set to increase. While the benefits of medical and lifestyle interventions are established, the effectiveness of interventions which seek to improve the way preventive care is delivered in general practice is less so. The aim was to study and to compare the effectiveness of 2 intervention programmes for reducing cardiovascular risk factors within general practice. Methods: A randomised controlled trial was conducted in Belgium between 2007-2010 with 314 highly educated and mainly healthy professionals allocated to a medical (MP) or a medical + lifestyle (MLP) programme. The MP consisted of medical assessments (screening and follow-up) and the MLP added a tailored lifestyle change programme (web-based and individual coaching) to the MP. Primary outcomes were total cholesterol, blood pressure, and body mass index (BMI). The secondary outcomes were smoking status, fitness-score, and total cardiovascular risk. Results: The mean age was 41 years, 95 (32%) participants were female, 7 had a personal cardiovascular event in their medical history and 3 had diabetes. There were no significant differences found between MP and MLP in primary or secondary outcomes. In both study conditions decreases of cholesterol, systolic blood pressure, and diastolic blood pressure were found. Unfavourable increases were found for BMI (p < .05). A significant decrease of the overall cardiovascular risk was reported (p < .001). Conclusions: Both interventions are effective in reducing cardiovascular risk. In our population the combined medical and lifestyle programme was not superior to the medical programme

Estimating the Cost-Effectiveness of Quality-Improving Interventions in Oral Anticoagulation Management within General Practice

AbstractObjectivesA clinical trial, “Belgian Improvement Study on Oral Anticoagulation Therapy (BISOAT),” significantly improved the quality after implementing four different quality-improving interventions in four randomly divided groups of general practitioners (GPs). The quality-improving interventions consisted of multifaceted education with or without feedback reports on their performance, international normalized ratio (INR) testing by the GP with a CoaguChek device or computer-assisted advice for adapting oral anticoagulation therapy. The quality improvement in INR control versus baseline was similar in the four groups. The aim of the current study was to calculate the cost-effectiveness and influencing factors of the four quality-improving interventions compared with usual care.MethodsActivity-based costing techniques with questionnaires were used to determine the global costs per patient per month in the different intervention groups. Effectiveness data were obtained from the BISOAT study. Cost-effectiveness was expressed as cost per additional day within a 0.5 range from INR target.ResultsThe one-time cost of multifaceted education was €49,997 for the whole study. Monthly continuous costs per intervention ranged between €37 and €54 per patient. Using the CoaguChek in combination with the multifaceted education was associated with net savings and quality improvement, hence dominated usual care. Sensitivity analyses showed improved cost-effectiveness with extended duration and with increased program size.ConclusionImplementation of the combination multifaceted education with the use of the CoaguChek is a cost-effective new organizational model of oral anticoagulation management in general practice

The PreCardio-study protocol – a randomized clinical trial of a multidisciplinary electronic cardiovascular prevention programme

<p>Abstract</p> <p>Background</p> <p>Cardiovascular diseases (CVD) are the leading cause of death and the third cause of disability in Europe. Prevention programmes should include interventions aimed at a reduction of medical risk factors (hypertension, hypercholesterol, hyperglycemia, overweight and obesity) as well as behavioural risk factors (sedentary lifestyle, high fat intake and low fruit and vegetable intake, smoking). The aim of this study is to investigate the effects of a multifaceted, multidisciplinary electronic prevention programme on cardiovascular risk factors.</p> <p>Methods/Design</p> <p>In a randomized controlled trial, one group will receive a maximal intervention (= intervention group). The intervention group will be compared to the control group receiving a minimal intervention. An inclusion of 350 patients in total, with a follow-up of 3 years is foreseen. The inclusion criteria are age between 25–65 and insured by the Onderlinge Ziekenkas, insuring for guaranteed income in case of illness for self-employed. The maximal intervention group receives several prevention consultations by their general practitioner (GP) using a new type of cardiovascular risk calculator with personalised feedback on behavioural risk factors. These patients receive a follow-up with intensive support of health behaviour change via different methods, i.e. a tailored website and personal advice of a multidisciplinary team (psychologist, physiotherapist and dietician). The aim of this strategy is to reduce cardiovascular risk factors according to the guidelines. The primary outcome measures will be cardiovascular risk factors. The secondary outcome measures are cardiovascular events, quality of life, costs and incremental cost effectiveness ratios. The control group receives prevention consultations using a new type of cardiovascular risk calculator and general feedback.</p> <p>Discussion</p> <p>This trial incorporates interventions by GPs and other health professionals aiming at a reduction of medical and behavioural cardiovascular risk factors. An assessment of clinical, psychological and economical outcome measures will be performed.</p> <p>Trial registration</p> <p>ISRCTN23940498</p

Quality improvement of the management of oral anticoagulation by Belgian general practitioners

Kwaliteitsverbetering van het orale ontstollingsbeleid door de Belgis che huisarts Het doel van dit proefschrift is vanuit de Belgische huisartsen setting trachten modellen of ondersteuning te ontwikkelen die op maat van de hui sarts zijn en hem een steun bieden in zijn dagelijks klinisch handelen. Het voorwerp van onderzoek is de orale ontstollingtherapie door de huisa rts. In de eerste plaats hebben we de kwaliteit van de opvolging van ora le antistollingstherapie bij de huisarts onderzocht om nadien het effect van interventies hierop te kunnen onderzoeken. Vervolgens hebben we het effect van verschillende kwaliteitsbevorderende interventies onderzocht . De ervaringen van de huisartsen over deze kwaliteitsbevorderende inter venties werden bevraagd. Om te eindigen werd de kosteneffectiviteit van de verschillende interventies onderzocht. Hoofdstuk 1 geeft een globaal overzicht van de literatuur betreffe nde de fysiologie van de bloedstolling en thrombofilie en diens behandel ing met orale anticoagulantia. In het derde deel van dit hoofdstuk worden theoretische modellen voor implementatieon derzoek samengevat. In het vierde deel worden verschillende mogelijke kw aliteitsbevorderende interventies in de huisartsenpraktijk (meerzijdige opleiding, feedback, controle van de INR door de huisarts met het CoaguC hek toestel of computer geleide dosisaanpassing) besproken. In hoofdstuk 2 geven we de resultaten van een kwaliteitsanaly se van het orale antistollingsbeleid door de huisarts. Van de 66 deelnem ende huisartsenpraktijken werden de INRs van de afgelopen 6 maanden opge vraagd bij één klinisch laboratorium. Van de overeenkomstige patiën ten hebben de huisartsen bijkomende medische informatie verstrekt. In he t totaal werden 737 patiënten onder orale antistollingstherapie geïnclud eerd. De conclusie van deze studie was dat de kwaliteit van orale ontsto lling bij de huisarts suboptimaal was. Hoofdstuk 3 beschrijft de resultaten van de implementatiestud ie met name een cluster gerandomiseerde interventiestudie (BISOAT-studie ). De 66 huisartsenpraktijken werden at random verdeeld over 4 verschill ende interventiegroepen. Alle groepen kregen als basisinterventie meerzi jdige opleiding met richtlijnen, specifieke anticoagulatiedossiers en pa tiënt informatieboekjes al dan niet aangevuld met feedback (groep B), co ntrole van de INR door de huisarts met het CoaguChek toestel (groep C) o f computer geleide dosisaanpassing (groep D). De kwaliteit van het orale anticoagulatiebeleid verbeterde significant na implementatie van de 4 v erschillende kwaliteitsbevorderende interventies zonder significant vers chil in kwaliteit tussen de 4 groepen. De resultaten van een evaluatiestudie zijn samengevat in hoofdst uk 4. Het doel van deze studie was na te gaan op welke manier de ze kwaliteitsbevorderende interventies aanvaard werden door de deelnemen de huisarts-praktijken (HA-praktijken) van de BISOAT-studie. Hiervoor werd een schriftelijke vragenlijst opgestuurd naar de 66 H A-praktijken. De HA waren positief over de richtlijnen en de anticoagulatiedossiers. D e HA gebruikten de patiënt informatieboekjes om de patiënten bewust te m aken van hun orale anticoagulatie behandeling. De helft van de HA was ni et overtuigd dat de patiënten deze boekjes lazen of dat ze de informatie begrepen. De groep met de CoaguChek toestellen was het meest tevreden w at betreft de bruikbaarheid in de dagelijkse praktijk en de meerwaarde v oor het huisartsgeneeskundig handelen. Ze vonden dat de interventie moet geïmplementeerd worden in hun dagelijkse praktijk. In Hoofdstuk 5 worden de kosten en de kostenefficiëntie ratio van de verschillende interventies onderzocht en vergeleken met het gebruikelijke zorgmodel alwaar de bloedstalen afgenomen worden door de huisarts, geanalyseerd worden in het labo en de behandeling vervolgens w ordt aangepast door de huisarts op basis van deze INR. De resultaten van deze economische studie tonen aan dat de implementatie van de meerzijdi ge opleiding samen met het gebruik van de CoaguChek een kostenefficiënt zorgmodel is in de huisartsenpraktijk. Hoofdstuk 6 ten slotte bespreekt de belangrijkste resultaten van d e verschillende studies. Conclusies uit de kwaliteitsanalyse, het interv entieonderzoek van de verschillende kwaliteitsbevorderende interventies, het evaluatieonderzoek naar de appreciatie van de huisartsen en kostene ffectiviteitonderzoek worden kritisch beschouwd. Onderzoek in deze thesi s heeft aangetoond dat er nood is aan meerzijdige opleiding en ondersteu ning in het orale anticoagulatiebeleid van de huisarts. Vervolgens is de implementatie van meerzijdige opleiding samen met het gebruik van het C oaguChek toestel een kostenefficiënt en gebruiker-vriendelijk nieuw zorg model, uitgewerkt in volledige samenwerking met het klinisch laboratoriu m. Ten derde is het belang van betrokkenheid van de huisarts bij het org aniseren van nieuwe zorgmodellen met het gebruik van computeradvies aan het licht gekomen.Table of Contents Chapter 1 Introduction 7 Chapter 2 Quality assessment of oral anticoagulation in Belgium, as practiced by a group of GPs 41 Chapter 3 The Belgian Improvement Study on Oral Anticoagulation Therapy (BISOAT-study): a randomized clinical trial 57 Chapter 4 Appreciation of interventions to improve oral anticoagulant monitoring by GPs (the BISOAT-study) 79 Chapter 5 Cost-effectiveness of quality improving interventions in oral anticoagulation management within the general practice 93 Chapter 6 General discussion 115 Summary 141 Samenvatting 145 Dankwoord 149 Curriculum Vitae 159status: publishe

The PreCardio-study protocol – a randomized clinical trial of a multidisciplinary electronic cardiovascular prevention programme-0

<p><b>Copyright information:</b></p><p>Taken from "The PreCardio-study protocol – a randomized clinical trial of a multidisciplinary electronic cardiovascular prevention programme"</p><p>http://www.biomedcentral.com/1471-2261/7/27</p><p>BMC Cardiovascular Disorders 2007;7():27-27.</p><p>Published online 4 Sep 2007</p><p>PMCID:PMC2045658.</p><p></p

Surfing depth on a behaviour change website: predictors and effects on behaviour

The primary objectives of the present study were to gain insight into website use and to predict the surfing depth on a behaviour change website and its effect on behaviour. Two hundred eight highly educated adults from the intervention condition of a randomised trial received access to a medical intervention, individual coaching (by e-mail, post, telephone or face-to-face) and a behaviour change website. Website use (e.g. surfing depth, page view duration) was registered. Online questionnaires for physical activity and fat intake were filled out at baseline and after 6 months. Hierarchical linear regression was used to predict surfing depth and its effect on behaviour. Seventy-five per cent of the participants visited the website. Fifty-one and fifty-six per cent consulted the physical activity and fat intake feedback, respectively. The median surfing depth was 2. The total duration of interventions by e-mail predicted deeper surfing (beta=0.36; p<0.001). Surfing depth did not predict changes in fat intake (beta=-0.07; p=0.45) or physical activity (beta=-0.03; p=0.72). Consulting the physical activity feedback led to more physical activity (beta=0.23; p=0.01). The findings from the present study can be used to guide future website development and improve the information architecture of behaviour change websites

Personality of Belgian physicians in a clinical leadership program

Abstract Background Physician and non-physician leadership development programs aim to improve organizational performance. Although a significant, positive relation between physicians’ leadership skills and patient outcomes, staff satisfaction and staff retention has been found, physicians are not formally trained in clinical leadership skills during their physician training. A lot of current healthcare leaders were chosen to take on leadership because of their productivity, published research, solid clinical skills, or because they were great educators, Heifetz RA. Leadership Without Easy Answers; 1994 although they often do not have the skills to build a team, resulting in dysfunctional teams and having to deal with conflicts and chaos. The first steps of a Clinical Leadership Program is to gain insight in one’s personality, one’s personal skills and one’s leadership growth potential, because this gives information on one’s natural leadership style. The aim of our research is to gain insight in the personality traits of healthcare professionals who are leading teams and to check (a) whether Belgian physicians with leadership ambition, share certain preferences, (b) whether physicians differ from other healthcare staff in terms of personality, (c) whether our sample of Belgian physicians differs from a population of physicians in the United States of America. Methods In-hospital physicians and non-physicians enrolled in a Clinical Leadership Program consented to participate. They explored their personal preferences across four dimensions, based on the Myers-Briggs Type Indicator (MBTI). Their most suitable MBTI profile was determined with a self-assessment and a complementary guidance of an MBTI-coach. Chi-squared tests and logistic regression were performed to check distributions across different MBTI-dimensions and to assess the relation with profession and location. Results Among participating physicians significantly more preferences for ‘Thinking’ then for ‘Feeling’ were found. Non-physicians were found to be significantly more ‘Sensing’ and ‘Judging’ compared with physicians. No significant differences were found between physicians from our (Belgian) and the USA dataset. Conclusion Preferences of physicians proved to be different from those of non-physicians. ‘ISTJ’ is the most frequent personality profile both in Belgian and USA physicians