Strategies for guideline implementation in primary care focusing on patients with cardiovascular disease: a systematic review

Unverzagt, Susanne; Oemler, Matthias; Braun, Kristin; Klement, Andreas

doi:10.1093/fampra/cmt080

Cited by 41 publications

(57 citation statements)

References 55 publications

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“…Nineteen [73–91] ( n = 470 studies) evaluated the impact of environmental restructuring including the use of collaborative or shared care practices or the institution of specialized nurses or other allied healthcare professionals [73, 74, 77–83, 85–91], or guideline implementation [75, 76] in primary healthcare settings. Evidence from poor- to high-quality reviews indicate organizational changes to increase collaboration among pharmacists, nurses, prevention coordinators, and other primary healthcare professionals led to increased physicians’ adherence to guidelines [75].…”

Section: Resultsmentioning

confidence: 99%

“…Evidence from poor- to high-quality reviews indicate organizational changes to increase collaboration among pharmacists, nurses, prevention coordinators, and other primary healthcare professionals led to increased physicians’ adherence to guidelines [75]. Nurse-led care was found to be as equally effective as general practitioners in patient satisfaction, asthma, cardiovascular, and diabetes management.…”

Section: Resultsmentioning

confidence: 99%

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Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

et al. 2017

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BackgroundThere is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers.MethodsStudy design: overview of reviews.Data source: MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015).Study selection: two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language.Data extraction and synthesis: two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors’ conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.).ResultsOf 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change.ConclusionsBehavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0538-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

et al. 2017

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“…(15) The implementation of strategies can contribute to its adoption in the PHC, improving the quality of care and patient safety. (16) The advance of risk stratification for children, adults, elderly and chronically ill demonstrates that it is possible to classify risk and plan actions, an important aspect to address the trends of the elderly people and the changes in the epidemiological profile of the communities. The incipient results regarding adolescents suggests greater involvement of the school and parents in order to optimize care.…”

Section: Discussionmentioning

confidence: 99%

Processos organizacionais na Estratégia Saúde da Família: uma análise pelos enfermeiros

2016

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Objective: To analyze the organizational processes of Family Health teams after implementing the Plan Director for Primary Health Care. Methods: This cross-sectional study was conducted in the city of Unai, State of Minas Gerais, Brazil. A Likert questionnaire was used for data collection and the Kruskal-Wallis test was used for analysis, with a 5 % significance level. Results: Better results were identified for the dimensions of maternal and child health, management contract and information systems. Unsatisfactory results were found in the dimensions: principles of primary health care, diagnosis, local programming, welcoming approach, risk classification, family approach, and relationship with the community, health care networks, monitoring, family health medical charts and diagnostic support. A statistically significant difference was identified in the dimensions principles of primary healthcare, local programming, monitoring, women's and child health. Conclusion: Further investment is needed in team organization, particularly regarding organizational processes related to management. ResumoObjetivo: Analisar os processos organizativos das equipes de Saúde da Família após implantação do Plano Diretor da Atenção Primária à Saúde. Métodos: Este estudo transversal foi realizado na cidade de Unaí , no estado de Minas Gerais , Brasil. Um questionário do tipo Likert foi utilizado para coleta de dados e o teste de Kruskal-Wallis foi aplicado para análise, com um nível de significância de 5%. Resultados: Foram identificados melhores resultados para as dimensões saúde da criança, mulher, contrato de gestão e sistemas de informação. Nas dimensões princípios da Atenção Primária à Saúde, diagnóstico, programação local, acolhimento e classificação de risco, abordagem familiar, relacionamento com a comunidade, redes de atenção à saúde, monitoramento, prontuário saúde da família e apoio diagnóstico, os resultados foram insatisfatórios. Nas dimensões princípios da Atenção Primária à Saúde, programação local, monitoramento, saúde da mulher e criança houve diferença estatística. Conclusão: Há necessidade de maiores investimentos na organização das equipes, principalmente com relação aos processos organizativos ligados à gestão.

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“…A study assessing official ACC/AHA guidelines found that significant changes in guidelines are common in updated revisions . Other studies have shown that physicians have hesitancy in following newer guidelines, especially upon initiation . Other reasons as to why clinical practice is not guided by the new recommendations include disagreement with the current recommendations and comfort with previous guidelines, including those by the JNC 7.…”

Section: Discussionmentioning

confidence: 99%

Clinical Diagnosis and Management of Hypertension Compared With the Joint National Committee 8 Panelists' Recommendations

Snipelisky

Waldo

Burton

2015

Clinical Cardiology

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Background The panelists of the Joint National Committee recently published new recommendations for the management of hypertension. Our study aims to evaluate how current practice compares. Hypothesis Current practice likely deviates from the recent JNC 8 panelists' recommendations. Methods A survey was sent to cardiology providers at 3 academic medical centers: Mayo Clinic, Jacksonville, Florida; Mayo Clinic, Scottsdale, Arizona; and Mayo Clinic, Rochester, Minnesota. Providers were asked to select which blood‐pressure goal would be deemed appropriate in various cases based on individual practice in both the maintenance of patients already on therapy as well as threshold of when to initiate therapy. Comparisons with current recommendations were made, as well as geographic location and level of experience. Results A total of 251 survey requests were sent (May 2014), and 77 responses (30.7%) were received. Cardiologists tended not to practice according to the new guidelines, with most variation seen in patients age >60 years without comorbidities on active treatment. Providers' selection of initial pharmacologic agents in non–African American patients, African American patients, and patients with diabetes mellitus reflected congruency with guidelines. Conclusions Our study found that clinical practice does not correlate well with the new blood‐pressure goal recommendations published by the Joint National Committee 8 panelists, particularly in patients age >60 years. Practitioners are likely to follow the recommendations in regard to pharmacologic management.

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Strategies for guideline implementation in primary care focusing on patients with cardiovascular disease: a systematic review

Cited by 41 publications

References 55 publications

Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

Processos organizacionais na Estratégia Saúde da Família: uma análise pelos enfermeiros

Clinical Diagnosis and Management of Hypertension Compared With the Joint National Committee 8 Panelists' Recommendations

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