Clinical InvestigationAcute Ischemic Heart DiseaseImpact of opinion leader–endorsed evidence summaries on the quality of prescribing for patients with cardiovascular disease: A randomized controlled trial
Section snippets
Methods
The study's rationale and design have been published1 and are thus only summarized in this article. It was approved by the University of Alberta Ethics Board.
Results
The study was conducted from January 2002 through June 2005. The flow of participant selection is illustrated in Figure 1. We screened 2897 patients (1279 with HF and 1147 with IHD) to recruit 171 patients. The primary reason for exclusion was current or previous use of study medications, noted in more than 75% of the screened patients. For HF, 884 (69%) patients were already taking an ACE inhibitor or an ARB and 119 (9%) had previously been dispensed one of these agents and then discontinued
Discussion
The quality of care for patients with cardiovascular diseases remains suboptimal, and innovative strategies need to be developed—and tested in controlled studies—if quality is to improve. In a randomized controlled trial conducted in a fee-for-service setting, we tested the hypothesis that local opinion leaders could accelerate the adoption of cardiovascular evidence by primary care physicians. Overall, our intervention led to a small and statistically nonsignificant 6% absolute improvement in
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2012, American Journal of MedicineCitation Excerpt :We have previously used these methods in studies of osteoporosis, ischemic heart disease, and heart failure.19,21-23 The opinion leaders were nominated by surveying all physicians in the region using validated sociometric instruments.19,21-23 The evidence summaries were brief and emphasized 3 points (see Appendix, online): 1) patients with a vertebral fracture and osteoporosis are at 20-fold increased risk of future fracture compared with those with no vertebral fractures and normal bones; 2) this patients' risk of another fracture is as high as 20% over the next year; and 3) evidence-based treatments can reduce risk of fracture by 50%.
Case-based training of evidence-based clinical practice in primary care and decreased mortality in patients with coronary heart disease
2011, Annals of Family MedicineCitation Excerpt :Emphasis on acute rather than preventive tasks and lack of reimbursement may represent further barriers. Known facilitators include audits and feedback, real-time reminders, and academic detailing, whereby prescribing health professionals are trained face to face by experts.4–7 It is well known that this gap also exists in secondary prevention among patients with coronary heart disease (CHD).8
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This study was supported by grants from the AHFMR (Alberta Heritage Foundation for Medical Research; Edmonton, Alberta, Canada) and the Institute of Health Economics. Drs Majumdar and McAlister received salary awards from the AHFMR and the Canadian Institutes of Health Research (Ottawa, Ontario, Canada). Drs McAlister and Tsuyuki are supported by the Merck Frosst/Aventis Chair in Patient Health Management.
Trial Registry: ISRCTN26365328 and NCT00175279.