title: Process evaluation of a multifaceted intervention to improve cardiovascular disease prevention in general practice.
abstract: OBJECTIVE
  To perform a process evaluation of a multifaceted intervention to improve cardiovascular and diabetes care in general practice.
  
  
  METHODS
  The feasibility of the intervention, carried out by outreach visitors in 62 practices, was addressed by evaluating whether the intervention programme was performed as planned and the extent to which it was accepted by the practice team. In addition, the costs of the programme were determined.
  
  
  RESULTS
  The intervention was largely carried out as planned, although the intervention period had to be extended by three months. Of the 18 topics that could be addressed during the intervention period, 12 (mean) were addressed. The number of outreach visits per practice was 15.2 (mean), each visit lasted about one hour. Most practice members endorsed both the key recommendations for clinical decision-making and cardiovascular risk profiling. The majority of GPs (range 63-98%) agreed with the guidelines for clinical decision-making, and 29-97% had a positive opinion about the guidelines for practice organisation. According to practice staff members, the outreach visitor had sufficient knowledge and skills to support them in changing the practice organisation. GPs were less positive about the outreach visitor's knowledge and skills in optimising clinical decision-making; however 78% believed that the outreach visitor contributed to effecting change in their clinical decision-making. The total costs of the intervention per practice were Euro 4317.
  
  
  CONCLUSIONS
  This process evaluation demonstrated that the intervention was usually carried out as planned and achieved a high satisfaction rating from the participating practice members.
authors.affiliation: Department of General Practice, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Lobo
authors.forename: Lya
authors.initials: L
authors.lastname: Euser
authors.forename: Jeanine
authors.initials: J
authors.lastname: Kamp
authors.forename: Bernard D
authors.initials: BD
authors.lastname: Frijling
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
authors.forename: Marlies E J L
authors.initials: ME
authors.lastname: Hulscher
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
authors.forename: Ad
authors.initials: A
authors.lastname: Prins
authors.forename: Johannes C
authors.initials: JC
authors.lastname: van der Wouden
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003657:Decision Making; D019468:Disease Management; D005194:Family Practice / Q000458:organization & administration*; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000458:organization & administration*; D017064:Process Assessment, Health Care