UNLABELLED: INTRODUCTION AND OBJECTIVES. Clinical practice in unstable angina is not always based on best evidence. Guidelines have the potential to improve quality of health care. There are no randomised trials assessing implementation strategies in the public healthcare system of Spain yet. OBJECTIVE: to compare the effectiveness of a multifaceted strategy (interactive educational meetings, local consensus process) for guideline implementation in unstable angina, with a passive dissemination strategy. Patients and method. SETTING: 10 wards from 3 university hospitals in Sevilla. PARTICIPANTS: 153 specialists (cardiologists, internists) and their patients admitted for an unstable angina episode. DESIGN: a pragmatic, before and after cluster randomized controlled trial. Intervention was delivered from January to April 1998. Retrospective data collection took place in July 1999, of those pre and post-intervention episodes attended from January to October 1997 and from September 1998 to June 1999, respectively. OUTCOMES: compliance with the guideline recommendations for coronary angiography and stress testing, and ejection fraction assessment. RESULTS: The multifaceted strategy compared with the passive one, was associated with an absolute improvement in the appropriateness of use of coronary angiography and stress testing of 11% (95% CI, 0.85-21.1), P=.03. There was no association for the assessment of the ejection fraction: absolute improvement of 1.1% (95% CI, --15.9 to 18.1), P=.88. CONCLUSIONS: Our results show that a combination of interactive educational meetings and local consensus process delivered to wards of physicians may improve the appropriateness of use of coronary angiography and stress testing.
RCT Entities:
UNLABELLED: INTRODUCTION AND OBJECTIVES. Clinical practice in unstable angina is not always based on best evidence. Guidelines have the potential to improve quality of health care. There are no randomised trials assessing implementation strategies in the public healthcare system of Spain yet. OBJECTIVE: to compare the effectiveness of a multifaceted strategy (interactive educational meetings, local consensus process) for guideline implementation in unstable angina, with a passive dissemination strategy. Patients and method. SETTING: 10 wards from 3 university hospitals in Sevilla. PARTICIPANTS: 153 specialists (cardiologists, internists) and their patients admitted for an unstable angina episode. DESIGN: a pragmatic, before and after cluster randomized controlled trial. Intervention was delivered from January to April 1998. Retrospective data collection took place in July 1999, of those pre and post-intervention episodes attended from January to October 1997 and from September 1998 to June 1999, respectively. OUTCOMES: compliance with the guideline recommendations for coronary angiography and stress testing, and ejection fraction assessment. RESULTS: The multifaceted strategy compared with the passive one, was associated with an absolute improvement in the appropriateness of use of coronary angiography and stress testing of 11% (95% CI, 0.85-21.1), P=.03. There was no association for the assessment of the ejection fraction: absolute improvement of 1.1% (95% CI, --15.9 to 18.1), P=.88. CONCLUSIONS: Our results show that a combination of interactive educational meetings and local consensus process delivered to wards of physicians may improve the appropriateness of use of coronary angiography and stress testing.
Authors: Louise Forsetlund; Mary Ann O'Brien; Lisa Forsén; Liv Merete Reinar; Mbah P Okwen; Tanya Horsley; Christopher J Rose Journal: Cochrane Database Syst Rev Date: 2021-09-15
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Authors: Arritxu Etxeberria; Itziar Pérez; Idoia Alcorta; Jose Ignacio Emparanza; Elena Ruiz de Velasco; Maria Teresa Iglesias; Domingo Orozco-Beltrán; Rafael Rotaeche Journal: BMC Health Serv Res Date: 2013-10-24 Impact factor: 2.655
Authors: Emma R Allanson; Özge Tunçalp; Joshua P Vogel; Dina N Khan; Olufemi T Oladapo; Qian Long; Ahmet Metin Gülmezoglu Journal: BMJ Glob Health Date: 2017-07-20