Information exchange networks of health care providers and evidence-based cardiovascular risk management: an observational study

Abstract

BackgroundAlthough a wide range of preventive and clinical interventions has targeted cardiovascular risk management (CVRM), outcomes remain suboptimal. Therefore, the question is what additional determinants of CVRM and outcomes can be identified and addressed to optimize CVRM. In this study, we aimed to identify new perspectives for improving healthcare delivery and explored associations between information exchange networks of health care providers and evidence-based CVRM.MethodsThis observational study was performed parallel to a randomized clinical trial which aimed to improve professional performance of practice nurses in the Netherlands. Information exchange on medical policy for CVRM (“general information networks”) and CVRM for individual patients (“specific information networks”) of 180 health professionals in 31 general practices was measured with personalized questionnaires. Medical record audit was performed concerning 1620 patients in these practices to document quality of care delivery and two risk factors (systolic blood pressure (SBP) and LDL cholesterol level). Hypothesized effects of five network characteristics (density, frequency of contact, centrality of CVRM-coordinators, homophily on positive attitudes for treatment target achievement, and presence of an opinion leader for CVRM) constructed on both general and specific information exchange networks were tested and controlled for practice and patient factors using logistic multilevel analyses.ResultsOdds for adequate performance were enhanced in practices with an opinion leader for CVRM (OR 2.75, p < .05). Odds for achievement of SBP targets were reduced in practices who had networks with low homophily on positive attitudes for SBP and LDL targets (homophily for SBP targets OR 0.57, p < .05 and OR 0.60, p < .05, homophily for LDL targets OR 0.59, p < .05 and OR 0.61, p < .05 in general and specific information networks, respectively). No effects of network characteristics on cholesterol were found.ConclusionsDelivery of evidence-based CVRM is associated with homophily of clinical attitudes and presence of opinion leaders in primary care teams. These results signal the potential of social networks to be taken into account in further attempts to improve the implementation of evidence-based care for CVRM. Future research is needed to identify and formulate optimal strategies for using opinion leaders to improve CVRM. Future interventions may be more effective if they target a common vision on CVRM within practices.

Information Literacy of Nurses in Shaanxi Province, China: A Cross-sectional Descriptive and Multicentre Survey

“…The score of information literacy of primary nurses in these hospitals was far lower than that of the secondary and tertiary hospitals. With the proposal of healthy China strategy; to promote the health level of the whole people [41,42], it is necessary to promote the information construction, improve the electronic medical records of residents, and construct health records and information network in primary hospital [43].…”

Cooperation networks of ambulatory health care providers: exploration of mechanisms that influence coordination and uptake of recommended cardiovascular care (ExKoCare): a mixed-methods study protocol

“…The focus of the questionnaire will be on ambulatory cardiac care (primary care physician, physicians' assistants, cardiologist). Based on previous research of the principal investigator [14], we refrain from measuring networks from the patient relatives' perspectives.…”

“…Additionally, several network characteristics will be calculated from the documented cooperation networks (centrality, density, homogeneity, reciprocity: see section data-analysis), while other network characteristics will be directly measured with questionnaires for providers (opinion leadership, presence of case managers, perceived change of networks). The questionnaire for primary care providers will include questions on the social network and its context: a) presence of opinion leaders for vascular care [14,15] within and outside of general practices as mentioned by health care providers. Furthermore, b) providers' self-perception of opinion leadership [15,16], c) clinical attitudes regarding treatment of vascular patients on which controversy exists, using validated questions with a 5-point Likert scale [14], d) attitudes regarding interprofessional cooperation, using a validated questionnaire [17], e) identification of an appointed case manager for vascular care, if present and f) perceived change in the primary care practice and in the regional network for cardiovascular care (low, moderate, high).…”

“…The questionnaire for primary care providers will include questions on the social network and its context: a) presence of opinion leaders for vascular care [14,15] within and outside of general practices as mentioned by health care providers. Furthermore, b) providers' self-perception of opinion leadership [15,16], c) clinical attitudes regarding treatment of vascular patients on which controversy exists, using validated questions with a 5-point Likert scale [14], d) attitudes regarding interprofessional cooperation, using a validated questionnaire [17], e) identification of an appointed case manager for vascular care, if present and f) perceived change in the primary care practice and in the regional network for cardiovascular care (low, moderate, high). We will also include open questions to identify contextual determinants of cooperation between healthcare providers, including factors related to the functioning of primary care teams, financial reimbursement schemes, information technology systems, and health system characteristics.…”

The new European guideline on cardiovascular disease prevention; how to make progress in general practice?

“…A fundamental question to be answered is who is the problem-owner and who is responsible for orchestrating the process? To take responsibility, but also to explore borders, GPs have to outline a clear vision of their role in CVD prevention [ 3 ]. This vision may be dependent on the organization of healthcare in different countries.…”