title: Collaborative care intervention for stable ischemic heart disease.
abstract: BACKGROUND
  Accumulating evidence suggests that collaborative models of care enhance communication among primary care providers, improving quality of care and outcomes for patients with chronic conditions. We sought to determine whether a multifaceted intervention that used a collaborative care model and was directed through primary care providers would improve symptoms of angina, self-perceived health, and concordance with practice guidelines for managing chronic stable angina.
  
  
  METHODS
  We conducted a prospective trial, cluster randomized by provider, involving patients with symptomatic ischemic heart disease recruited from primary care clinics at 4 academically affiliated Department of Veterans Affairs health care systems. Primary end points were changes over 12 months in symptoms on the Seattle Angina Questionnaire, self-perceived health, and concordance with practice guidelines.
  
  
  RESULTS
  In total, 183 primary care providers and 703 patients participated in the study. Providers accepted and implemented 91.6% of 701 recommendations made by collaborative care teams. Almost half were related to medications, including adjustments to β-blockers, long-acting nitrates, and statins. The intervention did not significantly improve symptoms of angina or self-perceived health, although end points favored collaborative care for 10 of 13 prespecified measures. While concordance with practice guidelines improved 4.5% more among patients receiving collaborative care than among those receiving usual care (P < .01), this was mainly because of increased use of diagnostic testing rather than increased use of recommended medications.
  
  
  CONCLUSIONS
  A collaborative care intervention was well accepted by primary care providers and modestly improved receipt of guideline-concordant care but not symptoms or self-perceived health in patients with stable angina.
authors.affiliation: Departments of Medicine, University of Washington, Seattle, USA. stephan.fihn@va.gov
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
authors.forename: Joy B
authors.initials: JB
authors.lastname: Bucher
authors.forename: Mary
authors.initials: M
authors.lastname: McDonell
authors.forename: Paula
authors.initials: P
authors.lastname: Diehr
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.forename: Melanie
authors.initials: M
authors.lastname: Doak
authors.forename: Cynthia
authors.initials: C
authors.lastname: Dougherty
authors.forename: Martha
authors.initials: M
authors.lastname: Gerrity
authors.forename: Paul
authors.initials: P
authors.lastname: Heidenreich
authors.forename: Greg
authors.initials: G
authors.lastname: Larsen
authors.forename: Peter I
authors.initials: PI
authors.lastname: Lee
authors.forename: Linda
authors.initials: L
authors.lastname: Lucas
authors.forename: Connor
authors.initials: C
authors.lastname: McBryde
authors.forename: Karin
authors.initials: K
authors.lastname: Nelson
authors.forename: Mary E
authors.initials: ME
authors.lastname: Plomondon
authors.forename: Michael
authors.initials: M
authors.lastname: Stadius
authors.forename: Christopher
authors.initials: C
authors.lastname: Bryson
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D002908:Chronic Disease; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D009566:Nitrates / Q000627:therapeutic use; D010349:Patient Compliance / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D009566:Nitrates