title: Efficacy of case method learning in general practice for secondary prevention in patients with coronary artery disease: randomised controlled study.
abstract: OBJECTIVE
  To study the efficacy of case method learning, for general practitioners, on patients' lipid concentrations in the secondary prevention of coronary artery disease.
  
  
  METHODS
  Prospective controlled trial.
  
  
  METHODS
  Södertälje, Stockholm County, Sweden.
  
  
  METHODS
  255 consecutive patients with coronary artery disease.
  
  
  METHODS
  Guidelines were mailed to all general practitioners (n=54) and presented at a common lecture. General practitioners who were randomised to the intervention group participated in recurrent case method learning dialogues at their primary healthcare centres during a two year period. A locally well known cardiologist served as a facilitator.
  
  
  METHODS
  Concentration of low density lipoprotein cholesterol at baseline and after two years. Analysis according to intention to treat (intervention and control groups (n=88)) was based on group affiliation at baseline.
  
  
  RESULTS
  Low density lipoprotein cholesterol was reduced by 0.5 mmol/l (95% confidence interval 0.2 to 0.8 mmol/l) (9.3% (2.9% to 15.8%)) from baseline in patients in the intervention group and by 0.5 (0.1 to 0.9) mmol/l compared with controls (P<0.05). No change occurred in the control group (0.0 (-0.2 to 0.2) mmol/l). Low density lipoprotein cholesterol decreased by 0.6 (0.4 to 0.8) mmol/l in a group of patients who received specialist care.
  
  
  CONCLUSIONS
  Case method learning resulted in a lowering of low density lipoprotein cholesterol in the primary care patients with coronary artery disease comparable to that achieved at a specialist clinic. Conventional presentation of practice guidelines had no effect.
authors.affiliation: Centre for Clinical Education, Danderyd University Hospital and Karolinska Institute, SE-182 88 Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Kiessling
authors.forename: Peter
authors.initials: P
authors.lastname: Henriksson
mesh_terms: D008078:Cholesterol, LDL / Q000097:blood*; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000097:blood / Q000517:prevention & control*; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000193:education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013548:Sweden
chemical_list: D008078:Cholesterol, LDL