title: Implementing guidelines to routinely prevent chronic vascular disease in primary care: the Preventive Evidence into Practice cluster randomised controlled trial.
abstract: OBJECTIVE
  To evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease.
  
  
  METHODS
  32 urban general practices in 4 Australian states.
  
  
  METHODS
  Stratified randomisation of practices.
  
  
  METHODS
  122 general practitioners (GPs) and practice nurses (PNs) were recruited at baseline and 97 continued to 12 months. 21,848 patient records were audited for those aged 40-69 years who attended the practice in the previous 12 months without heart disease, stroke, diabetes, chronic renal disease, cognitive impairment or severe mental illness.
  
  
  METHODS
  The practice level intervention over 6 months included small group training of practice staff, feedback on audited performance, practice facilitation visits and provision of patient education and referral information.
  
  
  METHODS
  Primary: 1. Change in proportion of patients aged 40-69 years with smoking status, alcohol intake, body mass index (BMI), waist circumference (WC), blood pressure (BP) recorded and for those aged 45-69 years with lipids, fasting blood glucose and cardiovascular risk in the medical record. 2. Change in the level of risk for each factor.
  change in self-reported frequency and confidence of GPs and PNs in assessment.
  
  
  RESULTS
  Risk recording improved in the intervention but not the control group for WC (OR 2.52 (95% CI 1.30 to 4.91)), alcohol consumption (OR 2.19 (CI 1.04 to 4.64)), smoking status (OR 2.24 (1.17 to 4.29)) and cardiovascular risk (OR 1.50 (1.04 to 2.18)). There was no change in recording of BP, lipids, glucose or BMI and no significant change in the level of risk factors based on audit data. The confidence but not reported practices of GPs and PNs in the intervention group improved in the assessment of some risk factors.
  
  
  CONCLUSIONS
  This intervention was associated with improved recording of some risk factors but no change in the level of risk at the follow-up audit.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000578808, results.
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia.
authors.forename: Mark Fort
authors.identifier: http://orcid.org/0000-0002-0705-8913
authors.initials: MF
authors.lastname: Harris
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Parker
authors.affiliation: Discipline of General Practice, School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Litt
authors.affiliation: Academic Discipline of General Practice, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Mieke
authors.initials: M
authors.lastname: van Driel
authors.affiliation: Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Russell
authors.affiliation: Department of General Practice, Monash University, Notting Hill, Victoria, Australia.
authors.forename: Danielle
authors.initials: D
authors.lastname: Mazza
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia.
authors.forename: Upali W
authors.initials: UW
authors.lastname: Jayasinghe
authors.affiliation: Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Del Mar
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Lloyd
authors.affiliation: Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Smith
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Zwar
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Taylor
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia.
authors.forename: Gawaine
authors.initials: G
authors.lastname: Powell Davies
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D058006:General Practice; D058005:General Practitioners; D006801:Humans; D008019:Life Style; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009726:Nurses; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014505:Urban Population
chemical_list: D015415:Biomarkers
keywords: PREVENTIVE MEDICINE; PRIMARY CARE; chronic disease; practice facilitation; quality improvement