Impact of implementing electronic clinical practice guidelines for the diagnosis, control and treatment of cardiovascular risk factors: A pre-post controlled study / Impacto de la implementación de las guías de práctica clínica electrónicas en el diagnóstico, control y tratamiento de los factores de riesgo cardiovascular: un estudio pre-post controlado

Objective: To evaluate the impact of computerized clinical practice guidelines on the management, diagnosis, treatment, control, and follow-up of the main cardiovascular risk factors: hypertension, hypercholesterolaemia, and type 2 diabetes mellitus. Design: Pre-post controlled study. Setting: Catalonia, autonomous community located in north-eastern Spain. Participants: Individuals aged 35-74 years assigned to general practitioners of the Catalan Health Institute. Intervention: The intervention group consisted of individuals whose general practitioners had accessed the computerized clinical practice guidelines at least twice a day, while the control group consisted of individuals whose general practitioner had never accessed the computerized clinical practice guidelines platform Main outcomes: The Chi-squared test was used to detect significant differences in the follow-up, control, and treatment variables for all three disorders (hypertension, hypercholesterolaemia, and type 2 diabetes mellitus) between individuals assigned to users and non-users of the computerized clinical practice guidelines, respectively. Results: A total of 189,067 patients were included in this study, with a mean age of 56 years (standard deviation 12), and 55.5% of whom were women. Significant differences were observed in hypertension management, treatment and control; type 2 diabetes mellitus management, treatment and diagnoses, and the management and control of hypercholesterolaemia in both sexes. Conclusions: Computerized clinical practice guidelines are an effective tool for the control and follow-up of patients diagnosed with hypertension, type 2 diabetes mellitus, and hypercholesterolaemia. The usefulness of computerized clinical practice guidelines to diagnose and adequately treat individuals with these disorders remains unclear (AU)

Objetivo: Evaluar el impacto de las guías de práctica clínica electrónicas en el manejo, diagnóstico, tratamiento, control y seguimiento de los factores de riesgo cardiovascular mayores: hipertensión, hipercolesterolemia, diabetes mellitus tipo 2. Diseño: Estudio pre-post controlado. Emplazamiento: Cataluña, comunidad autónoma situada al noreste de España. Participantes: Individuos de 35-74 años asignados a médicos de familia del Institut Català de la Salut. Intervención: El grupo de intervención estaba formado por pacientes asignados a médicos de familia que accedían al menos 2 veces al día a las guías de práctica clínica electrónicas. El grupo de control estaba formado por las personas asignadas a médicos de familia que nunca habían accedido. Medidas de resultado: Se realizaron pruebas de ji al cuadrado para detectar diferencias significativas en el seguimiento, control y tratamiento de la hipertensión, hipercolesterolemia y diabetes mellitus tipo 2 entre los individuos asignados al grupo de usuarios y los no usuarios de las guías. Resultados: Se incluyeron 189.067 individuos, con una edad media de 56 años (desviación estándar 12), de los cuales el 55,5% eran mujeres. Se encontraron diferencias estadísticamente significativas en el manejo, tratamiento y control de la hipertensión; en el manejo, tratamiento y diagnóstico de la diabetes mellitus tipo 2, y en el manejo y control de la hipercolesterolemia en ambos sexos. Conclusiones: Las guías de práctica clínica electrónicas son una herramienta efectiva para el control y seguimiento de los pacientes con hipertensión, hipercolesterolemia y diabetes mellitus tipo 2. La utilidad de las guías de práctica clínica electrónicas en el diagnóstico y adecuación del tratamiento sigue en discusión (AU)

Impact of implementing electronic clinical practice guidelines for the diagnosis, control and treatment of cardiovascular risk factors: A pre-post controlled study.

OBJECTIVE: To evaluate the impact of computerized clinical practice guidelines on the management, diagnosis, treatment, control, and follow-up of the main cardiovascular risk factors: hypertension, hypercholesterolaemia, and type 2 diabetes mellitus. DESIGN: Pre-post controlled study. SETTING: Catalonia, autonomous community located in north-eastern Spain. PARTICIPANTS: Individuals aged 35-74 years assigned to general practitioners of the Catalan Health Institute. INTERVENTION: The intervention group consisted of individuals whose general practitioners had accessed the computerized clinical practice guidelines at least twice a day, while the control group consisted of individuals whose general practitioner had never accessed the computerized clinical practice guidelines platform. MAIN OUTCOMES: The Chi-squared test was used to detect significant differences in the follow-up, control, and treatment variables for all three disorders (hypertension, hypercholesterolaemia, and type 2 diabetes mellitus) between individuals assigned to users and non-users of the computerized clinical practice guidelines, respectively. RESULTS: A total of 189,067 patients were included in this study, with a mean age of 56 years (standard deviation 12), and 55.5% of whom were women. Significant differences were observed in hypertension management, treatment and control; type 2 diabetes mellitus management, treatment and diagnoses, and the management and control of hypercholesterolaemia in both sexes. CONCLUSIONS: Computerized clinical practice guidelines are an effective tool for the control and follow-up of patients diagnosed with hypertension, type 2 diabetes mellitus, and hypercholesterolaemia. The usefulness of computerized clinical practice guidelines to diagnose and adequately treat individuals with these disorders remains unclear.

Population prevalence and control of cardiovascular risk factors: What electronic medical records tell us / Prevalencia y control de factores de riesgo cardiovascular en la población general: ¿qué nos dice la historia clínica electrónica?

OBJETIVOS: Analizar la prevalencia, control y manejo de la hipertensión arterial, hipercolesterolemia y diabetes mellitus tipo 2. DISEÑO: Análisis transversal de todos los individuos atendidos en centros de atención primaria entre 2006 y 2009.Emplazamiento: Se extrajo de la historia clínica electrónica los antecedentes de enfermedad cardiovascular, el diagnóstico y tratamiento de la hipertensión arterial, hipercolesterolemia, diabetes mellitus tipo 2, el perfil lipídico, la glicemia y la presión arterial. Las prevalencias ylas variables de manejo y control se estandarizaron por edad. Participantes: Individuos de 35 a 74 años registrados en las bases de datos de atención primaria. Mediciones principales: Se analizaron registros de 2.174.515 de individuos (47% hombres, edad media 52 años (DE 11)). RESULTADOS: La hipertensión arterial fue el factor de riesgo más prevalente (39% en mujeres y 41% en hombres), seguido de la hipercolesterolemia (38% y 40%) y la diabetes mellitus tipo 2 (12% y 16%), respectivamente. Los diuréticos y los inhibidores de la enzima convertidora de angiotensina fueron los fármacos más frecuentemente recetados para el control de la presión arterial (68% de hombres y 60% de mujeres presentaron valores <140/90 mmHg). Sólo el 31% de los hombres y el 26% de las mujeres sin antecedentes de enfermedad cardiovascular presentaron hipercolesterolemia controlada (colesterol de las lipoproteínas de baja densidad <130 mg/dl),a pesar del porcentaje de tratamiento con estatinas (90%). EL porcentaje de mujeres y hombres con diabetes mellitus tipo 2 y hemoglobina glicada <7% era de 64.7% y 59.2%, respectivamente; el tratamiento se realizó predominantemente con antidiabéticos orales únicamente (70%) o asociados con insulina (15%). CONCLUSIONES: La hipertensión arterial fue el factor de riesgo cardiovascular más prevalente en población catalana atendida en centros de atención primaria. Alrededor de dos tercios de los individuos con hipertensión arterial o diabetes mellitus tipo 2 estaban adecuadamente controlados; mientras que el control de la hipercolesterolemia fue especialmente bajo

OBJECTIVE: To analyze the prevalence, control, and management of hypertension, hypercholesterolemia, and diabetes mellitus type 2 (DM2). DESIGN: Cross-sectional analysis of all individuals attended in the Catalan primary care centers between 2006 and 2009.LocationHistory of cardiovascular diseases, diagnosis and treatment of hypertension, hypercholesterolemia, DM2, lipid profile, glycemia and blood pressure data were extracted from electronic medical records. Age-standardized prevalence and levels of management and control were estimated. Participants: Individuals aged 35-74 years using primary care databases. Main measures: A total of 2,174,515 individuals were included (mean age 52 years [SD 11], 47% men). RESULTS: Hypertension was the most prevalent cardiovascular risk factor (39% in women, 41% in men) followed by hypercholesterolemia (38% and 40%) and DM2 (12% and 16%), respectively. Diuretics and angiotensin-converting enzyme inhibitors were most often prescribed for hypertension control (<140/90 mmHg, achieved in 68% of men and 60% of women treated). Hypercholesterolemia was controlled (low-density lipoprotein cholesterol <130 mg/dl) in just 31% of men and 26% of women with no history of cardiovascular disease, despite lipid-lowering treatment, primarily (90%) with statins. The percentage of women and men with DM2 and with glycated hemoglobin <7% was 64.7% and 59.2%, respectively; treatment was predominantly with oral hypoglycemic agents alone (70%), or combined with insulin (15%). CONCLUSIONS: Hypertension was the most prevalent cardiovascular risk factor in the Catalan population attended at primary care centers. About two thirds of individuals with hypertension or DM2 were adequately controlled; hypercholesterolemia control was particularly low

Population prevalence and control of cardiovascular risk factors: what electronic medical records tell us.

OBJECTIVE: To analyze the prevalence, control, and management of hypertension, hypercholesterolemia, and diabetes mellitus type 2 (DM2). DESIGN: Cross-sectional analysis of all individuals attended in the Catalan primary care centers between 2006 and 2009. LOCATION: History of cardiovascular diseases, diagnosis and treatment of hypertension, hypercholesterolemia, DM2, lipid profile, glycemia and blood pressure data were extracted from electronic medical records. Age-standardized prevalence and levels of management and control were estimated. PARTICIPANTS: Individuals aged 35-74 years using primary care databases. MAIN MEASURES: A total of 2,174,515 individuals were included (mean age 52 years [SD 11], 47% men). RESULTS: Hypertension was the most prevalent cardiovascular risk factor (39% in women, 41% in men) followed by hypercholesterolemia (38% and 40%) and DM2 (12% and 16%), respectively. Diuretics and angiotensin-converting enzyme inhibitors were most often prescribed for hypertension control (<140/90mmHg, achieved in 68% of men and 60% of women treated). Hypercholesterolemia was controlled (low-density lipoprotein cholesterol <130mg/dl) in just 31% of men and 26% of women with no history of cardiovascular disease, despite lipid-lowering treatment, primarily (90%) with statins. The percentage of women and men with DM2 and with glycated hemoglobin <7% was 64.7% and 59.2%, respectively; treatment was predominantly with oral hypoglycemic agents alone (70%), or combined with insulin (15%). CONCLUSIONS: Hypertension was the most prevalent cardiovascular risk factor in the Catalan population attended at primary care centers. About two thirds of individuals with hypertension or DM2 were adequately controlled; hypercholesterolemia control was particularly low.

Impact of the implementation of electronic guidelines for cardiovascular prevention in primary care: study protocol.

BACKGROUND: The electronic medical records software of the Catalan Institute of Health has recently incorporated an electronic version of clinical practice guidelines (e-CPGs). This study aims to assess the impact of the implementation of e-CPGs on the diagnosis, treatment, control and management of hypercholesterolaemia, diabetes mellitus type 2 and hypertension. METHODS: Eligible study participants are those aged 35-74 years assigned to family practitioners (FPs) of the Catalan Institute of Health. Routinely collected data from electronic primary care registries covering 80% of the Catalan population will be analysed using two approaches: (1) a cross-sectional study to describe the characteristics of the sample before e-CPG implementation; (2) a controlled before-and-after study with 1-year follow-up to ascertain the effect of e-CPG implementation. Patients of FPs who regularly use the e-CPGs will constitute the intervention group; the control group will comprise patients assigned to FPs not regularly using the e-CPG. The outcomes are: (1) suspected and confirmed diagnoses, (2) control of clinical variables, (3) requests for tests and (4) proportions of patients with adequate drug prescriptions. RESULTS: This protocol should represent a reproducible process to assess the impact of the implementation of e-CPGs. We anticipate reporting results in late 2013. CONCLUSION: This project will assess the effectiveness of e-CPGs to improve clinical decisions and healthcare procedures in the three disorders analysed. The results will shed light on the use of evidence-based medicine to improve clinical practice of FPs.

Population and primary health-care team characteristics explain the quality of the service.

OBJECTIVES: To identify the characteristics of the primary health-care (PHC) team's structure and of the assigned population affecting service quality dimensions, and to check whether the PHC team's performance varies when assessing the service quality using crude values or those adjusted by the structural factors that affect it. RESEARCH DESIGN: Cross-sectional descriptive study. SUBJECTS: 213 Catalan PHC teams. MEASUREMENTS: Service quality indicators measured in three dimensions: (1) access and physician-patient relationship; (2) team coordination and (3) evidence-based practice. The PHC team structural factors studied are: experience, setting (urban or rural), geographical dispersion, teaching activities and managerial structure. The catchment population characteristics analysed are: age, socio-economic level, mortality, and the proportion of the population that are immigrants. RESULTS: Access and physician-patient relationship dimension were not affected by the studied structural factors. Team coordination improved in rural teams and in those providing care for older populations. Evidence-based practice was found to be higher in teaching teams, in more experienced teams and in those attending populations with a lower socio-economic level. Adjusted service quality indicator values substantially modify the PHC team quality ranking carried out on the basis of its crude values, especially in the team coordination and evidence-based practice dimensions. CONCLUSIONS: A fair evaluation of PHC team performance must be based on its health-care service quality indicators adjusted for setting, age and socio-economic level of the catchment population and for the team's experience and teaching activities.

Personalised care, access, quality and team coordination are the main dimensions of family medicine output

BACKGROUND: Health organisations continually seek good output indicators of family medicine health care provision because they are accountable to society, they need to compare services, and need to evaluate the impact of organisational reforms. OBJECTIVES: Using the sources of information routinely available in health-service management, we sought to assess the groups of components of primary health care output that best serve to define the outcome of family medicine services. DESIGN: Cross-sectional descriptive study. SITE: Primary health care in Catalunya. PARTICIPANTS: 213 primary health care teams. MEASUREMENTS: Information was collected on team structure, user satisfaction, quality-of-professional-life of the health care professionals, and physicians' drug prescription. Confirmatory Factor Analysis was used to assess the number of dimensions that best explained the family medicine outcome. RESULTS: The model that best fits the structure of the data (AGFI=0.778) is that which consists of three dimensions i.e. (1) the individual accessibility to the services and professional-patient relationship; (2) the coordination within the health care team; (3) the scientific-technical quality of the service. The first two of these dimensions were correlated between themselves, but the third was totally independent of the other two. CONCLUSIONS: Using sources of information that are routinely employed in primary health care services management, the model enables the measurement of the output of family medicine by considering the dimensions such as inter-personnel relationships, internal coordination of the team and the scientific-technical quality of the service. Despite its simplicity, this measure of the output incorporates the views not only of the users but of the health care professionals, as well. (AU)

Personalised care, access, quality and team coordination are the main dimensions of family medicine output.

BACKGROUND: Health organisations continually seek good output indicators of family medicine health care provision because they are accountable to society, they need to compare services, and need to evaluate the impact of organisational reforms. OBJECTIVES: Using the sources of information routinely available in health-service management, we sought to assess the groups of components of primary health care output that best serve to define the outcome of family medicine services. DESIGN: Cross-sectional descriptive study. SITE: Primary health care in Catalunya. PARTICIPANTS: 213 primary health care teams. MEASUREMENTS: Information was collected on team structure, user satisfaction, quality-of-professional-life of the health care professionals, and physicians' drug prescription. Confirmatory Factor Analysis was used to assess the number of dimensions that best explained the family medicine outcome. RESULTS: The model that best fits the structure of the data (AGFI=0.778) is that which consists of three dimensions i.e. (1) the individual accessibility to the services and professional-patient relationship; (2) the coordination within the health care team; (3) the scientific-technical quality of the service. The first two of these dimensions were correlated between themselves, but the third was totally independent of the other two. CONCLUSIONS: Using sources of information that are routinely employed in primary health care services management, the model enables the measurement of the output of family medicine by considering the dimensions such as inter-personnel relationships, internal coordination of the team and the scientific-technical quality of the service. Despite its simplicity, this measure of the output incorporates the views not only of the users but of the health care professionals, as well.