Kwaliteitsverbetering: over heilige huisjes en voortschrijdend inzicht.

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Systematic review of implementation strategies for risk tables in the prevention of cardiovascular diseases.

Contains fulltext : 70894.pdf (publisher's version ) (Open Access)BACKGROUND: Cardiovascular disease prevention is guided by so-called risk tables for calculating individual's risk numbers. However, they are not widely used in routine practice and it is important to understand the conditions for their use. OBJECTIVES: Systematic review of the literature on professionals' performance regarding cardiovascular risk tables, in order to develop effective implementation strategies. SELECTION CRITERIA: Studies were eligible for inclusion if they reported quantitative empirical data on the effect of professional, financial, organizational or regulatory strategies on the implementation of cardiovascular risk tables. Participants were physicians or nurses. OUTCOME MEASURE: Primary: professionals' self-reported performance related to actual use of cardiovascular risk tables. Secondary: patients' cardiovascular risk reduction. DATA COLLECTION AND ANALYSIS: An extensive strategy was used to search MEDLINE, EMBASE, CINAHL, and PSYCHINFO from database inception to February 2007. MAIN RESULTS: The review included 9 studies, covering 3 types of implementation strategies (or combinations). Reported effects were moderate, sometimes conflicting and contradictory. Although no clear relation was observed between a particular type of strategy and success or failure of the implementation, promising strategies for patient selection and risk assessment seem to be teamwork, nurse led-clinics and integrated IT support. CONCLUSIONS: Implementation strategies for cardiovascular risk tables have been sparsely studied. Future research on implementation of cardiovascular risk tables needs better embedding in the systematic and problem-based approaches developed in implementation science

Preventing recurrent coronary heart disease

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Primary care patients' recognition of their own risk for cardiovascular disease: implications for risk communication in practice.

Item does not contain fulltextPURPOSE OF REVIEW: Guidelines on primary prevention of cardiovascular disease emphasize identifying high-risk patients for intensive risk-reducing management. These guidelines recommend the identification of individuals with high risk using risk score sheets or risk tables. Patients' misperceptions of risk seem to hamper implementation of the high-risk approach. How appropriate are the risk perceptions of patients? What is known about effective ways of risk communication? RECENT FINDINGS: Cardiovascular risk is often perceived inappropriately in primary care populations; by nearly four in five high-risk patients (incorrect optimism), and by one in five low-risk patients (incorrect pessimism). Communicating cardiovascular risk by means of natural frequencies seems effective to correct inappropriate risk perception, though effects are small. SUMMARY: In communicating cardiovascular disease risk, primary care physicians must be aware that they mostly encounter low-risk patients and that the perceived risk does not necessarily correspond with the actual risk. Professionals should be skilled in the use of effective formats for risk communication that are ideally integrated within patient decision aids for cardiovascular risk management

“Dus alles is goed dokter” Hoe informeer ik mijn patiënten over grote en kleine risico’s.

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Feasibility of a national cholesterol guideline in daily practice. A randomized controlled trial in 20 general practices.

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WITHDRAWN: Interventions to implement prevention in primary care.

Contains fulltext : 53125.pdf (publisher's version ) (Open Access)BACKGROUND: Primary care physicians hold a strategic position in delivering preventive services. However discrepancies exist between evidence based guidelines and practice. OBJECTIVES: To assess the effects of interventions to improve the delivery of preventive services in primary care. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register (November 1995; August 1999), MEDLINE (1980 to 1995) and hand searched relevant journals. SELECTION CRITERIA: Randomised trials, controlled before and after studies, and interrupted time series analyses of interventions to improve preventive services by primary care professionals responsible for patient care. DATA COLLECTION AND ANALYSIS: Two researchers independently extracted data and assessed study quality. MAIN RESULTS: Fifty-five studies were included, involving more than 2000 health professionals and 99,000 people, with 83 comparisons between intervention and control groups. Post intervention differences between intervention and control groups varied widely within and across categories of interventions. Most interventions were found to be effective in some studies, but not in others. Five comparisons of group education versus no intervention showed absolute change of preventive services varying between -4% and +31%. Nine comparisons of physician reminders versus no intervention showed absolute change of preventive services varying between 5% and 24%. Fourteen comparisons of multifaceted interventions versus no intervention showed absolute change of preventive services varying between -3% and +64%. Six comparisons of multifaceted interventions versus group education reported absolute changes varying between -31% and +28%. All these comparisons used randomised groups. Ten comparisons of multifaceted interventions versus no intervention used non-randomised groups and showed absolute change of preventive services varying between -5% and +21%. The remaining planned comparisons within categories of interventions contained less than five comparisons. AUTHORS' CONCLUSIONS: There is currently no solid basis for assuming that a particular intervention or package of interventions will work. Effective interventions to increase preventive activities in primary care exist, but there is considerable variation in the level of change achieved, with effect sizes usually small or moderate. Tailoring interventions to address specific barriers to change in a particular setting is probably important. Multifaceted interventions may be more effective than single interventions, because more barriers to change can be addressed. Future research should analyse barriers to change and interventions to implement preventive services in more detail, to clarify how interventions relate to specific barriers. Since more complex interventions are likely to be more effective but also more costly, economic evaluations should also be included