title: Effect of a comprehensive intervention program targeting general practice staff on quality of life in patients at high cardiovascular risk: a randomized controlled trial.
abstract: BACKGROUND
  We implemented a comprehensive intervention program targeting general practice staff, that proved successful in optimizing practice organization and clinical decision-making. In this paper, health-related quality of life (HRQL) is investigated as a clinical outcome.
  
  
  OBJECTIVE
  To evaluate the effect of the implementation of an intervention program on the HRQL in patients at high cardiovascular risk.
  
  
  METHODS
  Randomized controlled trial. Intervention practices (n = 62) received a comprehensive intervention program (by means of outreach visitors) lasting 21 months. HRQL of patients at high cardiovascular risk was assessed by the MOS 36-Item Short-Form Health Survey (SF-36), at baseline and after intervention. Three patient categories were distinguished: diabetes mellitus, cardiovascular disease and hypertension.
  
  
  RESULTS
  HRQL deteriorated in all respondents, but more pronounced in the control group. In diabetes patients the differences between intervention and control group were significant for the Vitality and Mental Health scales, with mean difference in change of 3.93 (95% CI: 1.08-6.78) and 3.71 (95% CI: 0.73-6.68), respectively. Patients with cardiovascular disease had significantly different changes on three scales: physical functioning (3.57, 95% CI: 0.71-6.43), vitality (3.01, 95% CI: 0.72-5.30) and social functioning (3.96, 95% CI: 0.50-7.42). In patients with hypertension, there were no differences between the intervention and control group.
  
  
  CONCLUSIONS
  Our comprehensive intervention program resulted in changes in HRQL on several domains, particularly in patients with diabetes and cardiovascular disease.
authors.affiliation: Department of General Practice, Erasmus MC--University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: Lobo
authors.forename: B D
authors.initials: BD
authors.lastname: Frijling
authors.forename: M E J L
authors.initials: ME
authors.lastname: Hulscher
authors.forename: R M D
authors.initials: RM
authors.lastname: Bernsen
authors.forename: R P T M
authors.initials: RP
authors.lastname: Grol
authors.forename: A
authors.initials: A
authors.lastname: Prins
authors.forename: J C
authors.initials: JC
authors.lastname: van der Wouden
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control / Q000523:psychology*; D003159:Community-Institutional Relations; D003191:Comprehensive Health Care / Q000592:standards*; D003920:Diabetes Mellitus / Q000517:prevention & control / Q000523:psychology*; D005194:Family Practice / Q000193:education / Q000592:standards*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000517:prevention & control / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015397:Program Evaluation; D011788:Quality of Life; D018570:Risk Assessment; D012647:Self-Assessment; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires