title: [Effectiveness of a multifactorial strategy for implementing clinical guidelines on unstable angina: cluster randomized trial].
abstract: INTRODUCTION AND OBJECTIVES. Clinical practice in unstable angina is not always based on best evidence. Guidelines have the potential to improve quality of health care. There are no randomised trials assessing implementation strategies in the public healthcare system of Spain yet.
  
  
  OBJECTIVE
  to compare the effectiveness of a multifaceted strategy (interactive educational meetings, local consensus process) for guideline implementation in unstable angina, with a passive dissemination strategy. Patients and method.
  
  
  METHODS
  10 wards from 3 university hospitals in Sevilla.
  
  
  METHODS
  153 specialists (cardiologists, internists) and their patients admitted for an unstable angina episode.
  
  
  METHODS
  a pragmatic, before and after cluster randomized controlled trial. Intervention was delivered from January to April 1998. Retrospective data collection took place in July 1999, of those pre and post-intervention episodes attended from January to October 1997 and from September 1998 to June 1999, respectively.
  
  
  RESULTS
  compliance with the guideline recommendations for coronary angiography and stress testing, and ejection fraction assessment.
  
  
  RESULTS
  The multifaceted strategy compared with the passive one, was associated with an absolute improvement in the appropriateness of use of coronary angiography and stress testing of 11% (95% CI, 0.85-21.1), P=.03. There was no association for the assessment of the ejection fraction: absolute improvement of 1.1% (95% CI, --15.9 to 18.1), P=.88.
  
  
  CONCLUSIONS
  Our results show that a combination of interactive educational meetings and local consensus process delivered to wards of physicians may improve the appropriateness of use of coronary angiography and stress testing.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario de Valme, Sevilla, Spain. albertoromeroalonso@hotmail.com
authors.forename: Alberto
authors.initials: A
authors.lastname: Romero
authors.forename: Carlos
authors.initials: C
authors.lastname: Alonso
authors.forename: Ignacio
authors.initials: I
authors.lastname: Marín
authors.forename: Jeremy
authors.initials: J
authors.lastname: Grimshaw
authors.forename: Ernesto de
authors.initials: Ed
authors.lastname: Villar
authors.forename: Manuel
authors.initials: M
authors.lastname: Rincón
authors.forename: Antonio
authors.initials: A
authors.lastname: Reyes
authors.forename: Eduardo
authors.initials: E
authors.lastname: Briones
authors.forename: Enrique
authors.initials: E
authors.lastname: Calderón
authors.forename: Juan Ramón
authors.initials: JR
authors.lastname: Lacalle
authors.forename: James
authors.initials: J
authors.lastname: Jaffey
mesh_terms: D000368:Aged; D000465:Algorithms; D000789:Angina, Unstable / Q000175:diagnosis; D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003627:Data Interpretation, Statistical; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012307:Risk Factors; D013030:Spain; D013318:Stroke Volume