Ten-year follow-up of clinical governance implementation in primary care : Improving screening, diagnosis and control of cardiovascular risk factors
Autor: | Aguilar Martín, Carina, Gonçalves, A. Q., López-Pablo, C., Fernández-Sáez, José, Forcadell Drago, Emma, Hernández Rojas, Zojaina, Vilaubí, J. M. P., Rodríguez, Dolores, Piñol, J. L., Bladé-Creixenti, J., Dalmau Llorca, M. Rosa, Universitat Autònoma de Barcelona |
---|---|
Rok vydání: | 2019 |
Předmět: |
Adult
Male Clinical audit medicine.medical_specialty Health Toxicology and Mutagenesis Psychological intervention lcsh:Medicine feedback Disease 030204 cardiovascular system & hematology Article Feedback Cohort Studies clinical governance 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans Mass Screening 030212 general & internal medicine Mortality Aged Primary health care Clinical governance business.industry Incidence (epidemiology) Incidence lcsh:R Hazard ratio clinical audit Public Health Environmental and Occupational Health Middle Aged mortality Confidence interval cardiovascular diseases primary health care Cardiovascular diseases Spain Emergency medicine incidence Female business Follow-Up Studies Cohort study |
Zdroj: | Dipòsit Digital de Documents de la UAB Universitat Autònoma de Barcelona International Journal of Environmental Research and Public Health Volume 16 Issue 21 International Journal of Environmental Research and Public Health, Vol 16, Iss 21, p 4299 (2019) |
Popis: | Current improvement strategies for the control of cardiovascular risk factors (CRFs) in Europe are based on quality management policies. With the aim of understanding the effect of interventions delivered by primary healthcare systems, we evaluated the impact of clinical governance on cardiovascular health after ten years of implementation in Catalonia. A cohort study that included 1878 patients was conducted in 19 primary care centres (PCCs). Audits that comprised 13 cardiovascular health indicators were performed and general practitioners received periodic (annual, biannual or monthly) feedback about their clinical practice. We evaluated improvement in screening, diagnosis and control of the main CRFs and the effects of the feedback on cardiovascular risk (CR), incidence of cardiovascular disease (CVD) and mortality, comparing baseline data with data at the end of the study (after a 10-year follow-up). The impact of the intervention was assessed globally and with respect to feedback frequency. General improvement was observed in screening, percentage of diagnoses and control of CRFs. At the end of the study, few clinically significant differences in CRFs were observed between groups. However, the reduction in CR was greater in the group receiving high frequency feedback, specifically in relation to smoking and control of diabetes and cholesterol (Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL)). A protective effect of having a cardiovascular event (hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.44&ndash 0.94) or death (HR = 0.55, 95% CI = 0.35&ndash 0.88) was observed in patients from centres where general practitioners received high frequency feedback. Additionally, these PCCs presented improved cardiovascular health indicators and lower incidence and mortality by CVD, illustrating the impact of this intervention. |
Databáze: | OpenAIRE |
Externí odkaz: |