Impact of the implementation of electronic guidelines for cardiovascular prevention in primary care: study protocol

Eva Comin, Arantxa Catalan-Ramos, Jose M Verdu, Manuel Iglesias-Rodal, Jose L del Val Garcia, Maria Grau, Ester Amado, Angels Pons, Alicia Consola, Ramon Ciurana, Alicia Franzi, Manel Mata, Josep Davins, Xavier Cos, Eva Frigola, Josep Davins

Abstract


Background The electronic medical records software of the Catalan Institute of Health has recently incorporated an electronic version of clinical practice guidelines (e-CPGs). This study aims to assess the impact of the implementation of e-CPGs on the diagnosis, treatment, control and management of hypercholesterolaemia, diabetes mellitus type 2 and hypertension.

Methods Eligible study participants are those aged 35–74 years assigned to family practitioners (FPs) of the Catalan Institute of Health. Routinely collected data from electronic primary care registries covering 80% of the Catalan population will be analysed using two approaches: (1) a cross-sectional study to describe the characteristics of the sample before e-CPG implementation; (2) a controlled before-and-after study with 1-year follow-up to ascertain the effect of e-CPG implementation. Patients of FPs who regularly use the e-CPGs will constitute the intervention group; the control group will comprise patients assigned to FPs not regularly using the e-CPG. The outcomes are: (1) suspected and confirmed diagnoses, (2) control of clinical variables, (3) requests for tests and (4) proportions of patients with adequate drug prescriptions.

Results This protocol should represent a reproducible process to assess the impact of the implementation of e-CPGs. We anticipate reporting results in late 2013.

Conclusion This project will assess the effectiveness of e-CPGs to improve clinical decisions and healthcare procedures in the three disorders analysed. The results will shed light on the use of evidence-based medicine to improve clinical practice of FPs.


Keywords


electronic health records; physicians; practice guidelines as topic; primary care; primary health care

Full Text:

PDF

References


Evidence-Based Medicine Working Group. Evidence-based medicine. Anew approach to teaching the practice of medicine. JAMA 1992;268:2420–5. http://dx.doi.org/10.1001/jama.1992.03490170092032 PMid:1404801

Richardson G, Godfrey L, Gravelle H and Watt I. Cost-effectiveness of implementing new guidelines for the treatment of hypertension in general practice. British Journal of General Practice 2004;54:765–71. PMid:15469676 PMCid:PMC1324882

Grol R. Successes and failures in the implementation of evidence-based guidelines for clinical practice. Medical Care 2001; 39:8(Suppl 2):II46–54.

Grimshaw JM, Thomas RE, MacLennan G et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment 2004;8:1–72.

Hutchinson A, McIntosh A, Cox S and Gilbert C. Towards efficient guidelines: how to monitor guideline use in primary care. Health Technology Assessment 2003;7:1–97.

Woolf SH, Grol R, Hutchinson A, Eccles M and Grimshaw J. Potential benefits, limitations, and harms of clinical guidelines. BMJ 1999;318:527–30. http://dx.doi.org/10.1136/bmj.318.7182.527

Grimshaw JM and Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. The Lancet 1993;342:1317–22. http://dx.doi.org/10.1016/0140-6736(93)92244-N

Geller JC, Cassens S, Brosz M et al. Achievement of guideline-defined treatment goals in primary care: the German Coronary Risk Management (CoRiMa) study. European Heart Journal 2007;28:3051–8. http://dx.doi.org/10.1093/eurheartj/ehm520 PMid:18029365

Hetlevik I, Holmen J and Kruger Ø. Implementing clinical guidelines in the treatment of hypertension in general practice. Scandinavian Journal of Primary Health Care 1999;17:35–40. http://dx.doi.org/10.1080/028134399750002872

Hetlevik I, Holmen J, Kruger Ø, Kristensen P and Iversen H. Implementing clinical guidelines in the treatment of hypertension in general practice. Blood Pressure 1998;7:270–6. http://dx.doi.org/10.1080/080370598437114

Shiffman RN, Liaw Y, Brandt CA and Corb GJ. Computer-based guideline implementation systems. Journal of the American Medical Informatics Association 1999;6:104–14. http://dx.doi.org/10.1136/jamia.1999.0060104

Hobbs FDR and Erhardt L. Acceptance of guideline recommendations and perceived implementation of coronary heart disease prevention among primary care physicians in five European countries: the Reassessing European Attitudes about Cardiovascular Treatment (REACT) survey. Family Practice 2002;19:596–604. http://dx.doi.org/10.1093/fampra/19.6.596

Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD and Thomson MA on behalf of the Cochrane Effective Practice and Organisation of Care Review Group. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ 1998;317:465–8. http://dx.doi.org/10.1136/bmj.317.7156.465

Cranney M, Warren E, Barton S, Gardner K and Walley T. Why do GPs not implement evidence-based guidelines? A descriptive study. Family Practice 2001;18:359–63. http://dx.doi.org/10.1093/fampra/18.4.359

Green LA, Wyszewianski L, Lowery JC, Kowalski CP and Krein SL. An observational study of the effectiveness of practice guideline implementation strategies examined according to physicians' cognitive styles. Implementation Science 2007;2:41. http://dx.doi.org/10.1186/1748-5908-2-41 PMid:18053156 PMCid:PMC2219964

Grol R and Grimshaw JM. From best evidence to best practice: effective implementation of change in patients' care. The Lancet 2003;362:1225–30. http://dx.doi.org/10.1016/S0140-6736(03)14546-1

Hannes K, Leys M, Vermeire E, Aertgeerts B, Buntinx F and Depoorter AM. Implementing evidence-based medicine in general practice: a focus group based study. BMC Family Practice 2005;6:37. http://dx.doi.org/10.1186/1471-2296-6-37 PMid:16153300 PMCid:PMC1253510

Ramos R, Ballo E, Marrugat J et al. Validity for use in research on vascular diseases of the SIDIAP (information system for the development of research in primary care): the EMMA study. Revista Espanola de Cardiologıa 2012;65:29–37. http://dx.doi.org/10.1016/j.rec.2011.07.016

de Lusignan S and van Weel C. The use of routinely collected computer data for research in primary care: opportunities and challenges. Family Practice 2006;23:253–63. http://dx.doi.org/10.1093/fampra/cmi106 PMid:16368704

Perria C and the IMPLEMEG Study Group. Strategies for the introduction and implementation of a guideline for the treatment of type 2 diabetics by general practitioners (GPs) of the Lazio region of Italy (IMPLEMEG study): protocol for a cluster randomised controlled trial [ISRCTN80116232]. BMC Health Services Research 2004;4:13. http://dx.doi.org/10.1186/1472-6963-4-13 PMid:15196307 PMCid:PMC449719

Alanen SI, Johannala-Kemppainen R, Ijas JI et al. Evaluation of current care effectiveness: a survey of hypertension guidelines implementation in Finnish health centres. Scandinavian Journal of Primary Health Care 2007;25:232–6. http://dx.doi.org/10.1080/02813430701394050 PMid:17852969 PMCid:PMC3379765

Van Bruggen R, Gorter KJ, Stolk RP, Verhoeven RP and Rutten GEHM. Implementation of locally adapted guidelines on type 2 diabetes. Family Practice 2008;25:430–7. http://dx.doi.org/10.1093/fampra/cmn045 PMid:18718886

Young JM and Ward JE. Implementing guidelines for smoking cessation advice in Australian general practice: opinions, current practices, readiness to change and perceived barriers. Family Practice 2001;18:14–20. http://dx.doi.org/10.1093/fampra/18.1.14

Dowie R. A review of research in the United Kingdom to evaluate the implementation of clinical guidelines in general practice. Family Practice 1998;15:462–70. http://dx.doi.org/10.1093/fampra/15.5.462

Nemeth L, Feifer C, Stuart GW and Ornstein SM. Implementing change in primary care practices using electronic medical records: a conceptual framework. Implementation Science 2008;3:3. http://dx.doi.org/10.1186/1748-5908-3-3 PMid:18199330 PMCid:PMC2254645

Pilote L and Tager IB. Outcomes research in the development and evaluation of practice guidelines. BMC Health Services Research 2002;2:7. http://dx.doi.org/10.1186/1472-6963-2-7 PMCid:PMC102335




DOI: http://dx.doi.org/10.14236/jhi.v20i2.33

Refbacks

  • There are currently no refbacks.


This is an open access journal, which means that all content is freely available without charge to the user or their institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal starting from Volume 21 without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open accessFor permission regarding papers published in previous volumes, please contact us.

Privacy statement: The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.

Online ISSN 2058-4563 - Print ISSN 2058-4555. Published by BCS, The Chartered Institute for IT