Care manager to control cardiovascular risk factors in primary care: the Raffaello cluster randomized trial.

Autor: Deales A; Clinical Governance Area, Regional Healthcare Agency of Marche Region, Ancona, Italy., Fratini M; Clinical Governance Area, Regional Healthcare Agency of Marche Region, Ancona, Italy., Romano S; Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila, Italy., Rappelli A; Polytechnic University of Marche, Ancona, Italy., Penco M; Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila, Italy., Perna GP; Department of Cardiovascular Diseases, University Hospital Umberto I, Ancona, Italy., Beccaceci G; Health District of Jesi, Italy., Borgia R; Health District of Francavilla, Chieti, Italy., Palumbo W; Primary Care Practice of L'Aquila, Italy., Magi M; Primary Care Practice of Ancona, Italy., Vespasiani G; Diabetes Care Center Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy., Bronzini M; Polytechnic University of Marche, Ancona, Italy., Musilli A; Alliance Development & Health Solutions Manager, Pfizer, Italy., Nocciolini M; Department of Medicine and Aging Sciences, University 'G. d'Annunzio' of Chieti, Italy., Mezzetti A; Department of Medicine and Aging Sciences, University 'G. d'Annunzio' of Chieti, Italy; Clinical Research Center, Ce.S.I., University 'G. d'Annunzio' Foundation, Chieti, Italy., Manzoli L; Department of Medicine and Aging Sciences, University 'G. d'Annunzio' of Chieti, Italy. Electronic address: lmanzoli@post.harvard.edu.
Jazyk: angličtina
Zdroj: Nutrition, metabolism, and cardiovascular diseases : NMCD [Nutr Metab Cardiovasc Dis] 2014 May; Vol. 24 (5), pp. 563-71. Date of Electronic Publication: 2013 Dec 24.
DOI: 10.1016/j.numecd.2013.11.008
Abstrakt: Background and Aim: This cluster randomized trial evaluated the efficacy of a disease and care management (D&CM) model in cardiovascular (CVD) prevention in primary care.
Methods and Results: Eligible subjects had ≥ 1 among: blood pressure ≥ 140/90 mmHg; glycated hemoglobin ≥ 7%; LDL-cholesterol ≥ 160 or ≥ 100 mg/dL (primary or secondary prevention, respectively); BMI ≥ 30; current smoking. The D&CM intervention included a teamwork including nurses as care managers for the implementation of tailored care plans. Control group was allocated to usual-care. The main outcome was the proportion of subjects achieving recommended clinical targets for ≥ 1 of uncontrolled CVD risk factors at 12-month. During 2008-2009 we enrolled 920 subjects in the Abruzzo/Marche regions, Italy. Following the exclusion of L'Aquila due to 2009 earthquake, final analyses included 762 subjects. The primary outcome was achieved by 39.1% (95%CI: 34.2-44.2) and 25.2% (95%CI: 20.9-29.9) of subjects in the intervention and usual-care group, respectively (p < 0.001). The D&CM intervention significantly increased the proportion of subjects who achieved clinical targets for both diabetes and hypertension, with no differences in hypercholesterolemia, smoking status and obesity.
Conclusions: The D&CM intervention was effective in controlling cardiovascular risk factors, in particular hypertension and diabetes. Numbers needed to treat were small. Such intervention may deserve further consideration in clinical practice.
Registration Number: ACTRN12611000813987.
(Copyright © 2013 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: