Improving cardiovascular risk management: a randomized, controlled trial on the effect of a decision support tool for patients and physicians.
BACKGROUND
There is nonoptimal adherence of general practitioners (GPs) and patients to cardiovascular risk reducing interventions. GPs find it difficult to assimilate multiple risk factors into an accurate assessment of cardiovascular risk. In addition, communicating cardiovascular risk to patients has proved to be difficult.


OBJECTIVE
Improving primary prevention of cardiovascular disease (CVD) in primary care by enhancing patient involvement in the use of a decision support tool.


METHODS
Cluster randomized trial.


METHODS
Thirty-four GPs included patients (40-75 years old) without CVD. In an interactive, small group training session lasting 4 h, the GPs in the intervention group were trained to use the guidelines on cardiovascular risk and a decision support tool. The control group received educational materials about the guidelines on paper. GPs' clinical performance and patients' risk perception and self-reported lifestyles were measured at baseline and after 6 months.


RESULTS
Thirty-four GPs recorded 490 consultations, 276 in the intervention and 214 in the control group. After 6 months, no significant effect of the intervention on the GPs' performance or the patients' risk perception was found. There was only an effect on self-reported lifestyle, in that more men in the intervention group than in the control group increased their physical activity (odds ratio 3.8, 95% confidence interval 1.7-8.7).


CONCLUSIONS
The 4-h interactive, small group training did not guarantee correct application of the decision support tool and as such failed to improve GPs' performance or correct patients' risk perception. The positive effect on physical activity justifies further research on patient involvement.
van Steenkiste
Ben
B
Department of General Practice, Centre for Quality of Care Research, Care and Public Health Research Institute (CAPHRI), the Netherlands. Ben.vanSteenkiste@hag.unimaas.nl
van der Weijden
Trudy
T
Stoffers
Henri E J H
HE
Kester
Arnold D M
AD
Timmermans
Daniëlle R M
DR
Grol
Richard
R
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D001294:Attitude to Health; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D010358:Patient Participation; D010821:Physicians, Family / Q000592:standards*; D011364:Professional Practice / Q000592:standards*; D018570:Risk Assessment / Q000379:methods; D040242:Risk Reduction Behavior