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Am Heart J ; 207: 40-48, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30415082


BACKGROUND: Translating evidence into clinical practice in the management of high cardiovascular risk patients is challenging. Few quality improvement interventions have rigorously evaluated their impact on both patient care and clinical outcomes. OBJECTIVES: The main objectives are to evaluate the impact of a multifaceted educational intervention on adherence to local guidelines for the prescription of statins, antiplatelets and angiotensin converting enzyme inhibitors or angiotensin II receptor blockers for high cardiovascular risk patients, as well as on the incidence of major cardiovascular events. DESIGN: We designed a pragmatic two arm cluster randomized trial involving 40 clusters. Clusters are randomized to receive a multifaceted quality improvement intervention or to routine practice (control). The multifaceted intervention includes: reminders, care algorithms, training of a case manager, audit and feedback reports, and distribution of educational materials to health care providers. The primary endpoint is the adherence to combined evidence-based therapies (statins, antiplatelet therapy and angiotensin converting enzyme inhibitors or angiotensin receptor blockers) at 12 months after the intervention period in patients without contra-indications for these medications. All analyses follow the intention-to-treat principle and take the cluster design into account using linear mixed logistic regression modeling. SUMMARY: If proven effective, this multifaceted intervention would have wide utility as a means of promoting optimal usage of evidence-based interventions for the management of high cardiovascular risk patients.

Doenças Cardiovasculares/prevenção & controle , Medicina Baseada em Evidências/estatística & dados numéricos , Adesão à Medicação , Melhoria de Qualidade , Comitês Consultivos/organização & administração , Algoritmos , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Brasil , Doenças Cardiovasculares/tratamento farmacológico , Gerentes de Casos/educação , Causas de Morte , Auditoria Clínica , Retroalimentação , Pessoal de Saúde/educação , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Análise de Intenção de Tratamento , Modelos Logísticos , Inibidores da Agregação de Plaquetas/uso terapêutico , Sistemas de Alerta , Projetos de Pesquisa , Fatores de Risco
Am Heart J ; 207: 49-57, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30415083


BACKGROUND: Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging especially in low- and middle-income countries. OBJECTIVES: The aim of this study is to assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for AIS and TIA patients care. DESIGN: We designed a pragmatic, 2-arm cluster-randomized trial involving 36 clusters and 1624 patients from Brazil, Argentina, and Peru. Hospitals are randomized to receive a multifaceted quality improvement intervention (intervention group) or to routine care (control group). The BRIDGE Stroke multifaceted quality improvement intervention includes case management, reminders, health care providers' educational materials (including treatment algorithms), interactive workshops, and audit and feedback reports. Primary outcome is a composite adherence score to AIS and TIA performance measures. Secondary outcomes include an "all or none" composite end point to performance measures, the individual components of the composite end points, and clinical outcomes at 90 days following admission (stroke recurrence, death, and disability measured by the modified Rankin scale). SUMMARY: The BRIDGE Stroke Trial is an international pragmatic evaluation of a multifaceted quality improvement intervention. If effective, this intervention could be potentially extended widely to improve the quality of care and outcomes of patients with AIS or TIA.

Ataque Isquêmico Transitório/terapia , Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde , Acidente Vascular Cerebral/terapia , Doença Aguda , Comitês Consultivos/organização & administração , Algoritmos , Argentina , Brasil , Administração de Caso/organização & administração , Auditoria Clínica , Medicina Baseada em Evidências , Retroalimentação , Pessoal de Saúde/educação , Hospitais , Humanos , Ataque Isquêmico Transitório/prevenção & controle , Adesão à Medicação , Peru , Guias de Prática Clínica como Assunto , Sistemas de Alerta , Acidente Vascular Cerebral/prevenção & controle , Fatores de Tempo