Multifaceted Implementation of Stroke Prevention Guidelines in Primary Care: Cluster-randomised Evaluation of Clinical and Cost Effectiveness

Overview

Journal Qual Saf Health Care

Specialty Health Services

Date 2007 Feb 16

PMID 17301206

Citations 16

Authors

John Wright

John Bibby

Joe Eastham

Stephen Harrison

Maureen McGeorge

Chris Patterson

Nick Price

Daphne Russell

Ian Russell

Neil Small

Matt Walsh

John Young

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate clinical and cost effectiveness of implementing evidence-based guidelines for the prevention of stroke.

Design: Cluster-randomised trial

Setting: Three primary care organisations in the North of England covering a population of 400,000.

Participants: Seventy six primary care teams in four clusters: North, South & West, City I and City II.

Intervention: Guidelines for the management of patients with atrial fibrillation and transient ischaemic attack (TIA) were developed and implemented using a multifaceted approach including evidence-based recommendations, audit and feedback, interactive educational sessions, patient prompts and outreach visits.

Outcomes: Identification and appropriate treatment of patients with atrial fibrillation or TIA, and cost effectiveness.

Results: Implementation led to 36% increase (95% CI 4% to 78%) in diagnosis of atrial fibrillation, and improved treatment of TIA (odds ratio of complying with guidelines 1.8; 95% CI 1.1 to 2.8). Combined analysis of atrial fibrillation and TIA estimates that compliance was significantly greater (OR 1.46 95% CI 1.10 to 1.94) in the condition for which practices had received the implementation programme. The development and implementation of guidelines cost less than 1500 pounds per practice. The estimated costs per quality-adjusted life year gained by patients with atrial fibrillation or TIA were both less than 2000 pounds, very much less than the usual criterion for cost effectiveness.

Conclusions: Implementation of evidence-based guidelines improved the quality of primary care for atrial fibrillation and TIA. The intervention was feasible and very cost effective. Key components of the model include contextual analysis, strong professional support, clear recommendations based on robust evidence, simplicity of adoption, good communication and use of established networks and opinion leaders.

Citing Articles

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Audit as a Tool for Improving the Quality of Stroke Care: A Review.

Cappadona I, Corallo F, Cardile D, Ielo A, Bramanti P, Lo Buono V Int J Environ Res Public Health. 2023; 20(5).

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Supporting anticoagulant treatment decision making to optimise stroke prevention in complex patients with atrial fibrillation: a cluster randomised trial.

Gattellari M, Hayen A, Leung D, Zwar N, Worthington J BMC Fam Pract. 2020; 21(1):102.

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Estimating Costs of Implementing Stroke Systems of Care and Data-Driven Improvements in the Paul Coverdell National Acute Stroke Program.

Yarnoff B, Khavjou O, Elmi J, Lowe-Beasley K, Bradley C, Amoozegar J Prev Chronic Dis. 2019; 16:E134.

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Local opinion leaders: effects on professional practice and healthcare outcomes.

Flodgren G, OBrien M, Parmelli E, Grimshaw J Cochrane Database Syst Rev. 2019; 6:CD000125.

PMID: 31232458 PMC: 6589938. DOI: 10.1002/14651858.CD000125.pub5.

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