title: Adherence to a guideline on cardiovascular prevention: a comparison between general practitioners and practice nurses.
abstract: BACKGROUND
  Patient non-compliance with prescribed treatment is an important factor in the lack of success in cardiovascular prevention. Another important cause is non-adherence of caregivers to the guidelines. It is not known how doctors and nurses differ in the application of guidelines. Patient compliance to treatment may vary according to the type of caregiver.
  
  
  OBJECTIVE
  To compare adherence to cardiovascular prevention delivered by practice nurses and by general practitioners.
  
  
  METHODS
  Six primary health care centres in the Netherlands (25 general practitioners, six practice nurses).
  
  
  METHODS
  701 high risk patients were included in a randomised trial. Half of the patients received nurse-delivered care and half received care by general practitioners. For 91% of the patients treatment concerned secondary prevention. The Dutch guideline on cardiovascular prevention was used as protocol. A structured self-administered questionnaire was sent by post to patients. Data were extracted from the practice database and the questionnaire.
  
  
  RESULTS
  Intervention was received by 77% of respondents who visited the practice nurse compared to 57% from the general practitioner group (OR = 2.56, p < 0.01). More lifestyle intervention was given by the practice nurse; 46% of patients received at least one lifestyle intervention (weight, diet, exercise, and smoking) compared to 13% in general practitioner group (OR = 3.24, p < 0.001). In addition, after one year more patients from the practice nurse group used cardiovascular drugs (OR = 1.9, p = 0.03). Nurses inquired more frequently about patient compliance to medical treatment (OR = 2.1, p < 0.01). Regarding patient compliance, no statistical difference between study groups in this trial was found.
  
  
  CONCLUSIONS
  Practice nurses adhered better to the Dutch guideline on cardiovascular prevention than general practitioners did. Lifestyle intervention advice was more frequently given by practice nurses. Improvement of cardiovascular prevention is still necessary. Both caregivers should inquire about patient adherence on a regular basis.
authors.affiliation: Department of Integrated Care, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, The Netherlands. hrvoogdt@gmail.com
authors.forename: Helene R
authors.initials: HR
authors.lastname: Voogdt-Pruis
authors.forename: Jan W
authors.initials: JW
authors.lastname: Van Ree
authors.forename: Anton P M
authors.initials: AP
authors.lastname: Gorgels
authors.forename: George H M I
authors.initials: GH
authors.lastname: Beusmans
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009726:Nurses; D011320:Primary Health Care; D011795:Surveys and Questionnaires