title: Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: the treatment of cardiovascular risk using electronic decision support cluster-randomized trial.
abstract: Despite effective treatments to reduce cardiovascular disease risk, their translation into practice is limited.
  
  
  
  Using a parallel arm cluster-randomized controlled trial in 60 Australian primary healthcare centers, we tested whether a multifaceted quality improvement intervention comprising computerized decision support, audit/feedback tools, and staff training improved (1) guideline-indicated risk factor measurements and (2) guideline-indicated medications for those at high cardiovascular disease risk. Centers had to use a compatible software system, and eligible patients were regular attendees (Aboriginal and Torres Strait Islander people aged ≥ 35 years and others aged ≥ 45 years). Patient-level analyses were conducted using generalized estimating equations to account for clustering. Median follow-up for 38,725 patients (mean age, 61.0 years; 42% men) was 17.5 months. Mean monthly staff support was <1 hour/site. For the coprimary outcomes, the intervention was associated with improved overall risk factor measurements (62.8% versus 53.4% risk ratio; 1.25; 95% confidence interval, 1.04-1.50; P=0.02), but there was no significant differences in recommended prescriptions for the high-risk cohort (n=10,308; 56.8% versus 51.2%; P=0.12). There were significant treatment escalations (new prescriptions or increased numbers of medicines) for antiplatelet (4.3% versus 2.7%; P=0.01), and BP lowering (18.2% versus 11.0%; P=0.02) but not lipid-lowering medications.
  
  
  
  In Australian primary healthcare settings, a computer-guided quality improvement intervention, requiring minimal support, improved cardiovascular disease risk measurement but did not increase prescription rates in the high-risk group. Computerized quality improvement tools offer an important, albeit partial, solution to improving primary healthcare system capacity for cardiovascular disease risk management.
  
  
  
  https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336630. Australian New Zealand Clinical Trials Registry No. 12611000478910.
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.). dpeiris@georgeinstitute.org.
authors.forename: David
authors.initials: D
authors.lastname: Peiris
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Tim
authors.initials: T
authors.lastname: Usherwood
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Kathryn
authors.initials: K
authors.lastname: Panaretto
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Mark
authors.initials: M
authors.lastname: Harris
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hunt
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Julie
authors.initials: J
authors.lastname: Redfern
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Nicholas
authors.initials: N
authors.lastname: Zwar
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Stephen
authors.initials: S
authors.lastname: Colagiuri
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Noel
authors.initials: N
authors.lastname: Hayman
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Serigne
authors.initials: S
authors.lastname: Lo
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Bindu
authors.initials: B
authors.lastname: Patel
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Marilyn
authors.initials: M
authors.lastname: Lyford
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Stephen
authors.initials: S
authors.lastname: MacMahon
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: David
authors.initials: D
authors.lastname: Sullivan
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Rod
authors.initials: R
authors.lastname: Jackson
authors.affiliation: From The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia (D.P., J.R., S.L., B.P., M.L., S.M., B.N., A.P.); Westmead Clinical School (T.U.), The Boden Institute (S.C.), and Sydney Medical School (D.S.) University of Sydney, New South Wales, Sydney, Australia; Queensland Aboriginal and Islander Health Council, Brisbane, Queensland, Australia (K.P.); Centre for Primary Health Care and Equity (M.H.) and School of Public Health and Community Medicine (N.Z.) University of New South Wales, Sydney, New South Wales, Australia; Aboriginal Health and Medical Research Council, Sydney, New South Wales, Australia (J.H.); Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia (N.H.); Menzies School of Health Research, Darwin, Northern Territory, Australia (A.C.); and School of Population Health, University of Auckland, Auckland, New Zealand (R.J.).
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D003661:Decision Support Techniques; D011307:Drug Prescriptions / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D011314:Preventive Health Services / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D013813:Therapy, Computer-Assisted / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome
keywords: cardiovascular diseases; primary health care; quality improvement