RATIONALE AND AIMS: Clinical practice guidelines (CPG) reflect the evidence of effective pharmacotherapy of chronic (systolic) heart failure (CHF) which needs to be implemented. This study aimed to evaluate the effect of a new, multifaceted intervention (educational train-the-trainer course plus pharmacotherapy feedback = TTT) compared with standard education on guideline adherence (GA) in general practice. METHOD: Thirty-seven participating general practitioners (GPs) were randomized (18 vs. 19) and included 168 patients with ascertained symptomatic CHF [New York Heart Association (NYHA) II-IV]. Groups received CPG, the TTT intervention consisted of four interactive educational meetings and a pharmacotherapy feedback, while the control group received a usual lecture (Standard). Outcome measure was GA assessed by prescription rates and target dosing of angiotensin converting enzyme (ACE) inhibitors (ACE-I) or angiotensin receptor blockers (ARB), beta-blockers (BB) and aldosterone antagonists (AA) at baseline and 7-month follow-up. Group comparisons at follow-up were adjusted to GA, sex, age and NYHA stage at baseline. RESULTS:Prescription rates at baseline (n = 168) were high (ACE-I/ARB 90, BB 79 and AA 29%) in both groups. At follow up (n = 146), TTT improved compared with Standard regarding AA (43% vs. 23%, P = 0.04) and the rates of reached target doses of ACE-I/ARB (28% vs. 15%, P = 0.04). TTT group achieved significantly higher mean percentages of daily target dose (52% vs. 42%, mean difference 10.3%, 95% CI 0.84-19.8, P = 0.03). CONCLUSION: Despite of pre-existing high GA in both groups and an active control group, the multifaceted intervention was effective in quality of care measured by GA. Further research is needed on the choice of interventions in different provider populations.
RCT Entities:
RATIONALE AND AIMS: Clinical practice guidelines (CPG) reflect the evidence of effective pharmacotherapy of chronic (systolic) heart failure (CHF) which needs to be implemented. This study aimed to evaluate the effect of a new, multifaceted intervention (educational train-the-trainer course plus pharmacotherapy feedback = TTT) compared with standard education on guideline adherence (GA) in general practice. METHOD: Thirty-seven participating general practitioners (GPs) were randomized (18 vs. 19) and included 168 patients with ascertained symptomatic CHF [New York Heart Association (NYHA) II-IV]. Groups received CPG, the TTT intervention consisted of four interactive educational meetings and a pharmacotherapy feedback, while the control group received a usual lecture (Standard). Outcome measure was GA assessed by prescription rates and target dosing of angiotensin converting enzyme (ACE) inhibitors (ACE-I) or angiotensin receptor blockers (ARB), beta-blockers (BB) and aldosterone antagonists (AA) at baseline and 7-month follow-up. Group comparisons at follow-up were adjusted to GA, sex, age and NYHA stage at baseline. RESULTS: Prescription rates at baseline (n = 168) were high (ACE-I/ARB 90, BB 79 and AA 29%) in both groups. At follow up (n = 146), TTT improved compared with Standard regarding AA (43% vs. 23%, P = 0.04) and the rates of reached target doses of ACE-I/ARB (28% vs. 15%, P = 0.04). TTT group achieved significantly higher mean percentages of daily target dose (52% vs. 42%, mean difference 10.3%, 95% CI 0.84-19.8, P = 0.03). CONCLUSION: Despite of pre-existing high GA in both groups and an active control group, the multifaceted intervention was effective in quality of care measured by GA. Further research is needed on the choice of interventions in different provider populations.
Authors: Kirkwood F Adams; G Michael Felker; Ghassan Fraij; J Herbert Patterson; Christopher M O'Connor Journal: Heart Fail Rev Date: 2010-07 Impact factor: 4.214
Authors: Jonathan G Howlett; Robert S McKelvie; Jeannine Costigan; Anique Ducharme; Estrellita Estrella-Holder; Justin A Ezekowitz; Nadia Giannetti; Haissam Haddad; George A Heckman; Anthony M Herd; Debra Isaac; Simon Kouz; Kori Leblanc; Peter Liu; Elizabeth Mann; Gordon W Moe; Eileen O'Meara; Miroslav Rajda; Samuel Siu; Paul Stolee; Elizabeth Swiggum; Shelley Zeiroth Journal: Can J Cardiol Date: 2010-04 Impact factor: 5.223
Authors: M L A Luttik; M Brons; T Jaarsma; H L Hillege; A Hoes; R de Jong; G Linssen; D J Lok; M Berger; D J van Veldhuisen Journal: Neth Heart J Date: 2012-08 Impact factor: 2.380
Authors: Frank Peters-Klimm; Stephen Campbell; Katja Hermann; Cornelia U Kunz; Thomas Müller-Tasch; Joachim Szecsenyi Journal: Trials Date: 2010-05-17 Impact factor: 2.279
Authors: Mark J Valk; Arend Mosterd; Berna Dl Broekhuizen; Nicolaas Pa Zuithoff; Marcel Aj Landman; Arno W Hoes; Frans H Rutten Journal: Br J Gen Pract Date: 2016-06-06 Impact factor: 5.386
Authors: Frank Peters-Klimm; Rebecca Olbort; Stephen Campbell; Cornelia Mahler; Antje Miksch; Annika Baldauf; Joachim Szecsenyi Journal: Int J Qual Health Care Date: 2009-08-14 Impact factor: 2.038
Authors: Frank Peters-Klimm; Stephen Campbell; Thomas Müller-Tasch; Dieter Schellberg; Goetz Gelbrich; Wolfgang Herzog; Joachim Szecsenyi Journal: Trials Date: 2009-08-13 Impact factor: 2.279