Process evaluation of an intensified preventive intervention to reduce cardiovascular risk in general practices in deprived neighbourhoods.
BACKGROUND
A RCT, conducted to examine the effectiveness of a structured collaboration in general practice to provide intensified preventive care in patients at high cardiovascular risk yielded no effect in the total group but differences across healthcare centres and ethnic groups become apparent. We conducted a process evaluation to explain these differences.


METHODS
We assessed the reach of the target group and whether key intervention components (individual educational sessions, structured team meetings, and risk assessments) were performed as planned (maximum score for protocol completion is 11).


RESULTS
The reach was initially 91%, but only a minority of patients completed the intervention activities as planned. The average score of the number of intervention components was low (5.66 out of 11 (sd 2.8)) and varied between centres (4.84 to 7.40) and ethnic groups (4.89 to 7.38), with team meetings as the least implemented activity conform plan.


CONCLUSIONS
This study indicates that adding a practice nurse and a peer health educator to the general practice did not seem to result in the desired collaboration between the healthcare personnel. Further research is needed to investigate the reasons behind the low participation rate of the patients in the intervention.
El Fakiri
Fatima
F
Department of Health Policy and Management, Erasmus Medical Centre Rotterdam, Netherlands. fatima.el.fakiri@rivm.nl
Hoes
Arno W
AW
Uitewaal
Paul J M
PJ
Frenken
Rianne A A
RA
Bruijnzeels
Marc A
MA
D000704:Analysis of Variance; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D003150:Community Health Workers / Q000458:organization & administration; D003299:Cooperative Behavior; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006266:Health Education / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009426:Netherlands / Q000453:epidemiology; D009722:Nurse Practitioners / Q000458:organization & administration; D015403:Nursing Evaluation Research; D010043:Outcome and Process Assessment, Health Care; D011204:Poverty Areas; D011320:Primary Health Care / Q000458:organization & administration; D011322:Primary Prevention / Q000458:organization & administration*; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment / Q000458:organization & administration; D040242:Risk Reduction Behavior