Tailored implementation of cardiovascular risk management in general practice: a cluster randomized trial

Abstract

BackgroundCounselling on health-related lifestyles is key to the prevention and management of chronic diseases. After comprehensive study of determinants of its delivery in general practice and strategies to improve, we composed a tailored improvement program, which included communication skills training, online patient information, and a clinical protocol for managing depressive symptoms. Our aim was to assess the effectiveness of this program on professional performance and outcomes in cardiovascular patients.MethodsA two-arm cluster randomized trial in 34 general practices involving 34 nurses was conducted. The primary outcome was an aggregated score of a positive score on lifestyle counselling delivered and an appropriate action on depressive symptoms. Secondary outcomes included the various elements of the primary outcome, vascular risk factors (extracted from patient records), and patient-reported lifestyle behaviors. Data were collected from medical records and a written survey among included patients.ResultsA sample of 1782 patients with recorded cardiovascular disease or high cardiovascular risk was available at follow-up at 6 months. No impact on the primary outcome was found; lifestyle counselling was recorded in a minority of patients (11.4 % in the intervention group and 10.3 % in the control group). An effect was found on a secondary outcome: patients’ physical activity level increased (B 0.18; 95 % CI 0.02–0.35) on a seven-point scale.ConclusionsThe tailored improvement program showed no effect on the primary outcome. This challenges the methodology of tailoring. More involvement of the targeted health care professionals might offer ways to develop more effective implementation programs. Physical activity might be the lifestyle issue that can be more easily changed than smoking or dietary habits.Trial registrationNederlands Trial register NTR4069

Experientially learning how to communicate science effectively: A case study on decoding science

“…Most of the training was related to teaching graduate STEM student trainees how to appeal to their audience. The workshops addressed audience limitations, abilities, biases, and the importance of researching the audience, segmenting, and tailoring the message to audiences (e.g., Chaet et al, ; Dirmaier et al, ; Takla et al, ; van Lieshout et al, ), as the responsibility for message delivery is on the scientist, not the audience.…”

“…Other issues, such as health literacy, affect message reception, as more than one‐third of U.S. Americans are below an intermediate level of health literacy—meaning, they may not be able to read and comprehend a prescription label without assistance (U.S. Department of Health & Human Services, ). Tailoring messages to audiences based on identity and characteristics, and reasons for accessing information (e.g., Chaet, Morshedi, Wells, Barnes, & Valdez, ; Dirmaier, Härter, & Weymann, ; Takla, Velasco, & Benzler, ; van Lieshout, Huntink, Koetsenruijter, & Wensing, ), often is more effective when appealing to an audience than a generic message (Young, Willis, Stemmle, & Rodgers, ). Studies about science communication training programs have echoed the need for these lessons to be included to achieve programmatic success.…”

Process evaluation of a tailored intervention programme of cardiovascular risk management in general practices

“…Despite the fact that we have identified determinants of practice before developing an intervention programme to change healthcare professionals’ behaviour, this process evaluation revealed hardly any change in healthcare professionals’ behaviour [12]. Several process evaluations of randomised trials in which behaviour change was accomplished or wherein determinants were identified have been published.…”

“…The secondary outcomes comprised of cardiovascular risk factors and patient-reported lifestyle behaviours. Data were collected from patients’ medical files and questionnaires aimed at patients [12]. The same group of practice nurses and patients provided us with data for the process evaluation.…”

“…To evaluate the intervention programme, we performed a two arm, cluster randomised trial in seven provinces in the Netherlands in 2013 and 2014. The outcome evaluation showed hardly any improvements in the delivery of CVRM [12]. Parallel to the outcome evaluation, we conducted a process evaluation to explore explanations for the study outcomes.…”