Rationale and design for a cluster randomized quality improvement trial to increase the uptake of evidence based therapies for patients at high cardiovascular risk: The bridge cardiovascular prevention trial
Am. heart j
; (207): 40-48, Jan. 2019. graf, ilus
Artigo
em Inglês
| Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1023779
Biblioteca responsável:
BR79.1
ABSTRACT
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. (AU)
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Coleções:
Bases de dados nacionais
/
Brasil
Contexto em Saúde:
Agenda de Saúde Sustentável para as Américas
Problema de saúde:
Objetivo 7: Evidência e conhecimento em matéria de saúde
Base de dados:
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Assunto principal:
Inibidores da Agregação Plaquetária
/
Medicina Baseada em Evidências
Tipo de estudo:
Ensaio clínico controlado
/
Estudo de etiologia
/
Guia de prática clínica
/
Fatores de risco
Limite:
Humanos
Idioma:
Inglês
Revista:
Am. heart j
Ano de publicação:
2019
Tipo de documento:
Artigo
Instituição/País de afiliação:
Duke University School of Medicine/US
/
Faculdade de Medicina de Ribeirão Preto/BR
/
HCor Hospital do Coração/BR
/
Insituto Dante Pazzanese de Cardiologia/BR
/
Universidade Federal de Ciências da Saúde de Porto Alegre/BR
/
Universidade Federal de São Paulo/BR