title: [The PROPRESE trial: results of a new health care organizational model in primary care for patients with chronic coronary heart disease based on a multifactorial intervention].
abstract: OBJECTIVE
  Comparison of the results from the EUROASPIRE I to the EUROASPIRE III, in patients with coronary heart disease, shows that the prevalence of uncontrolled risk factors remains high. The aim of the study was to evaluate the effectiveness of a new multifactorial intervention in order to improve health care for chronic coronary heart disease patients in primary care.
  
  
  METHODS
  In this randomized clinical trial with a 1-year follow-up period, we recruited patients with a diagnosis of coronary heart disease (145 for the intervention group and 1461 for the control group). An organizational intervention on the patient-professional relationship (centered on the Chronic Care Model, the Stanford Expert Patient Programme and the Kaiser Permanente model) and formative strategy for professionals were carried out. The main outcomes were smoking control, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP). A multivariate analysis was performed.
  
  
  RESULTS
  The characteristics of patients were: age (68.4±11.8 years), male (71.6%), having diabetes mellitus (51.3%), dyslipidemia (68.5%), arterial hypertension (76.7%), non-smokers (76.1%); LDL-C < 100mg/dL (46.9%); SBP < 140mmHg (64.5%); DBP < 90 (91.2%). The multivariable analysis showed the risk of good control for intervention group to be: smoking, adjusted relative risk (aRR): 15.70 (95% confidence interval [95%CI], 4.2-58.7); P < .001; LDL-C, aRR: 2.98 (95%CI, 1.48-6.02); P < .002; SPB, aRR: 1.97 (95%CI, 1.21-3.23); P < .007, and DBP: aRR: 1.51 (95%CI, 0.65-3.50); P < .342.
  
  
  CONCLUSIONS
  An intervention based on models for chronic patients focused in primary care and involving patients in medical decision making improves cardiovascular risk factors control (smoking, LDL-C and SBP). Chronic care strategies may be an efficacy tool to help clinicians to involve the patients with a diagnosis of CHD to reach better outcomes.
authors.affiliation: Unidad de docencia e investigación, Hospital Universitario de Sant Joan d'Alacant, Alicante, España.
authors.forename: Esther
authors.initials: E
authors.lastname: Ruescas-Escolano
authors.affiliation: Unidad de docencia e investigación, Hospital Universitario de Sant Joan d'Alacant, Alicante, España; Cátedra de Medicina de Familia, Departamento Medicina Clínica, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, España; Centro de Salud Cabo Huertas, Alicante, España. Electronic address: dorozcobeltran@gmail.com.
authors.forename: Domingo
authors.initials: D
authors.lastname: Orozco-Beltran
authors.affiliation: Unidad de docencia e investigación, Hospital Universitario de Sant Joan d'Alacant, Alicante, España.
authors.forename: María
authors.initials: M
authors.lastname: Gaubert-Tortosa
authors.affiliation: Centro de Salud Doctor Sapena, Elche, Alicante, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Navarro-Palazón
authors.affiliation: Servicio de Cardiología, Hospital Universitario de Sant Joan d'Alacant, Alicante, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cordero-Fort
authors.affiliation: Centro de Salud Salvador Pau, Valencia, España. Universitat de València/CIBERESP, Valencia, España.
authors.forename: Jorge
authors.initials: J
authors.lastname: Navarro-Pérez
authors.affiliation: Cátedra de Medicina de Familia, Departamento Medicina Clínica, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, España.
authors.forename: Concepción
authors.initials: C
authors.lastname: Carratalá-Munuera
authors.affiliation: Centro de Salud Cabo Huertas, Alicante, España.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pertusa-Martínez
authors.affiliation: Centro de Salud Dolores Cano Royo, Castellón, España.
authors.forename: Enrique
authors.initials: E
authors.lastname: Soler-Bahilo
authors.affiliation: Centro de Salud Carinyena, Vila-Real, Castellón, España.
authors.forename: Francisco
authors.initials: F
authors.lastname: Brotons-Muntó
authors.affiliation: Centro de Salud Carinyena, Vila-Real, Castellón, España.
authors.forename: Jose
authors.initials: J
authors.lastname: Bort-Cubero
authors.affiliation: Unidad de docencia e investigación, Hospital Universitario de Sant Joan d'Alacant, Alicante, España.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Núñez-Martínez
authors.affiliation: Servicio de Cardiología, Hospital Universitario de Sant Joan d'Alacant, Alicante, España.
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-Martínez
authors.affiliation: Cátedra de Medicina de Familia, Departamento Medicina Clínica, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, España.
authors.forename: Adriana
authors.initials: A
authors.lastname: López-Pineda
authors.affiliation: Cátedra de Medicina de Familia, Departamento Medicina Clínica, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, España.
authors.forename: Vicente F
authors.initials: VF
authors.lastname: Gil-Guillén
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D017146:Models, Organizational; D011320:Primary Health Care / Q000458:organization & administration*; D012307:Risk Factors; D055502:Secondary Prevention
keywords: Atención primaria; Cardiovascular diseases; Enfermedades cardiovasculares; Health services research; Investigación en servicios sanitarios; Prevención secundaria; Primary care; Secondary prevention