Article type
Year
Abstract
Background: Various evidence-based guidelines on prevention and treatment of cardiovascular diseases (CVD) are published each year. Patients treated according to the present recommendations show improved prognosis, but effective modalities cannot be fully transferred into the care of patients in daily clinical practice.
Objectives: The main aim of this study is to explain statistical heterogeneity in two systematic reviews of the efficacy of implementation strategies to improve guideline adherence of physicians and patients to evidence-based treatment of CVD.
Methods: We used a random-effects meta-regression model to assess the influence of multimodal implementation strategies on adherence and add effect modifiers simultaneously. Modifiers on physician adherence included clinical sources of heterogeneity because of the different categories of implementation strategies, staff responsible for implementation, level of prevention and duration of follow-up. We will explore the relationship of different categories of implementation strategies, the complexity of recommended therapies and organizational environment on the efficiency of implementation strategies on patient adherence.
Results: This study is based on an analysis of 75 trials to improve physician’s adherence and more than 50 trials to improve patient’s adherence. Physician adherence was improved by 62% (95% confidence interval (95% CI) 29 to 104%) or 29% (95% CI 5 to 60%) in trials where other non-medical professionals or nurses were included in the implementation process. Improvement of physician adherence was more successful in primary and secondary prevention of CVD compared to tertiary prevention. Results of the investigation of heterogeneity on the efficacy of strategies to improve patient adherence will be presented at the Colloquium.
Conclusions: The co-operation of different health professionals in primary care practices might, especially, increase physician adherence; guideline implementation seems to be more difficult in tertiary prevention of CVD. We hope to identify appropriate strategies for long-lasting, successful patient participation in the therapeutic process.
Objectives: The main aim of this study is to explain statistical heterogeneity in two systematic reviews of the efficacy of implementation strategies to improve guideline adherence of physicians and patients to evidence-based treatment of CVD.
Methods: We used a random-effects meta-regression model to assess the influence of multimodal implementation strategies on adherence and add effect modifiers simultaneously. Modifiers on physician adherence included clinical sources of heterogeneity because of the different categories of implementation strategies, staff responsible for implementation, level of prevention and duration of follow-up. We will explore the relationship of different categories of implementation strategies, the complexity of recommended therapies and organizational environment on the efficiency of implementation strategies on patient adherence.
Results: This study is based on an analysis of 75 trials to improve physician’s adherence and more than 50 trials to improve patient’s adherence. Physician adherence was improved by 62% (95% confidence interval (95% CI) 29 to 104%) or 29% (95% CI 5 to 60%) in trials where other non-medical professionals or nurses were included in the implementation process. Improvement of physician adherence was more successful in primary and secondary prevention of CVD compared to tertiary prevention. Results of the investigation of heterogeneity on the efficacy of strategies to improve patient adherence will be presented at the Colloquium.
Conclusions: The co-operation of different health professionals in primary care practices might, especially, increase physician adherence; guideline implementation seems to be more difficult in tertiary prevention of CVD. We hope to identify appropriate strategies for long-lasting, successful patient participation in the therapeutic process.