[Effectiveness of a multifactorial strategy for implementing clinical guidelines on unstable angina: cluster randomized trial].
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.
Romero
Alberto
A
Servicio de Medicina Interna, Hospital Universitario de Valme, Sevilla, Spain. albertoromeroalonso@hotmail.com
Alonso
Carlos
C
Marín
Ignacio
I
Grimshaw
Jeremy
J
Villar
Ernesto de
Ed
Rincón
Manuel
M
Reyes
Antonio
A
Briones
Eduardo
E
Calderón
Enrique
E
Lacalle
Juan Ramón
JR
Jaffey
James
J
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