An integrated general practice and pharmacy-based intervention to promote the use of appropriate preventive medications among individuals at high cardiovascular disease risk: protocol for a cluster randomized controlled trial

被引:8
作者
Hayek, Adina [1 ,2 ]
Joshi, Rohina [1 ,2 ]
Usherwood, Tim [1 ,2 ,3 ]
Webster, Ruth [1 ,2 ]
Kaur, Baldeep [1 ,2 ]
Saini, Bandana [4 ,5 ]
Armour, Carol [4 ,5 ]
Krass, Ines [5 ]
Laba, Tracey-Lea [1 ,2 ]
Reid, Christopher [6 ,7 ]
Shiel, Louise [8 ]
Hespe, Charlotte [9 ]
Hersch, Fred [10 ]
Jan, Stephen [1 ,2 ]
Lo, Serigne [1 ,2 ]
Peiris, David [1 ,2 ]
Rodgers, Anthony [1 ,2 ]
Patel, Anushka [1 ,2 ]
机构
[1] George Inst Global Hlth, Sydney, NSW, Australia
[2] Univ Sydney, Sydney, NSW, Australia
[3] Univ Sydney, Sydney Med Sch Westmead, Sydney, NSW, Australia
[4] Woolcock Inst, Sydney, NSW, Australia
[5] Univ Sydney, Sch Pharm, Sydney, NSW, Australia
[6] Monash Univ, Melbourne, Vic, Australia
[7] Curtin Univ, Bentley, WA, Australia
[8] Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia
[9] Univ Notre Dame, Sydney, NSW, Australia
[10] Univ Sydney, Sydney Med Sch, Sch Publ Hlth, Menzies Ctr Hlth Policy, Sydney, NSW, Australia
来源
IMPLEMENTATION SCIENCE | 2016年 / 11卷
基金
英国医学研究理事会; 澳大利亚国家健康与医学研究理事会;
关键词
Cardiovascular disease; General practitioners; Pharmacists; Clinical decision support system; Polypill; Primary health care; BLOOD-PRESSURE CONTROL; ELECTRONIC DECISION-SUPPORT; PRIMARY-HEALTH-CARE; ADHERENCE; MANAGEMENT; METAANALYSIS; PROGRAM; CHOLESTEROL; GAPS;
D O I
10.1186/s13012-016-0488-1
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Cardiovascular diseases (CVD) are responsible for significant morbidity, premature mortality, and economic burden. Despite established evidence that supports the use of preventive medications among patients at high CVD risk, treatment gaps remain. Building on prior evidence and a theoretical framework, a complex intervention has been designed to address these gaps among high-risk, under-treated patients in the Australian primary care setting. This intervention comprises a general practice quality improvement tool incorporating clinical decision support and audit/feedback capabilities; availability of a range of CVD polypills (fixed-dose combinations of two blood pressure lowering agents, a statin +/- aspirin) for prescription when appropriate; and access to a pharmacy-based program to support long-term medication adherence and lifestyle modification. Methods: Following a systematic development process, the intervention will be evaluated in a pragmatic cluster randomized controlled trial including 70 general practices for a median period of 18 months. The 35 general practices in the intervention group will work with a nominated partner pharmacy, whereas those in the control group will provide usual care without access to the intervention tools. The primary outcome is the proportion of patients at high CVD risk who were inadequately treated at baseline who achieve target blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels at the study end. The outcomes will be analyzed using data from electronic medical records, utilizing a validated extraction tool. Detailed process and economic evaluations will also be performed. Discussion: The study intends to establish evidence about an intervention that combines technological innovation with team collaboration between patients, pharmacists, and general practitioners (GPs) for CVD prevention.
引用
收藏
页数:9
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