Ten-year follow-up of clinical governance implementation in primary care : Improving screening, diagnosis and control of cardiovascular risk factors
Aguilar Martín, Carina (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Gonçalves, A. Q. (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
López-Pablo, C. (Hospital de Tortosa Verge de la Cinta)
Fernández-Sáez, José (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Forcadell Drago, Emma (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Hernández Rojas, Zojaina (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Vilaubí, J. M. P. (Institut Català de la Salut)
Rodríguez, Dolores (Fundació Institut Català de Farmacologia)
Piñol, Josep Lluís (Institut Català de la Salut)
Bladé Creixenti, Juan (Institut Català de la Salut)
Dalmau Llorca, M. Rosa (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Universitat Autònoma de Barcelona

Date:	2019
Abstract:	protective effect of having a cardiovascular event (hazard ratio (HR) = 0. 64, 95% confidence interval (CI) = 0. 44-0. 94) or death (HR = 0. 55, 95% CI = 0. 35-0. 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. 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.
Grants:	Instituto de Salud Carlos III PI021060
Note:	Altres ajuts: CAM was awarded a predoctoral scholarship from the Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol) (http: //www.idiapjordigol.com/index.php/ca/) (7Z06/003).
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Cardiovascular diseases ; Clinical audit ; Clinical governance ; Feedback ; Incidence ; Mortality ; Primary health care
Published in:	International journal of environmental research and public health, Vol. 16 Núm. 21 (november 2019) , p. 4299, ISSN 1660-4601

DOI: 10.3390/ijerph16214299
PMID: 31694294

11 p, 330.4 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Articles > Research articles
Articles > Published articles