Peer facilitation and multifaceted intervention in guideline implementation : enhancing care of cardiovascular diseases in primary care
Year: 2012
Type: dissertation
Abstract: Clinical practices are not sufficiently in line with current evidence compiled in evidence based guidelines. Changing practice behaviour is challenging. Therefore active, tailored and often local interventions are needed to lead these changes. ---- The aims of the present study were to describe a local, practical and comprehensive multifaceted guideline implementation intervention, assess the feasibility of the intervention and its effects on care processes. The second aim was to approximate the time resources needed for preventive activities. The third aim was at patient level to evaluate long-term effects of an individualised lifestyle intervention on cardiovascular risk factor levels. ---- The key components of the two-year intervention were internal pair facilitation, education and consensus meetings, local guideline development, audit and feedback, and marketing. The feasibility of the intervention, and structure and process changes were measured with questionnaires and clinical audit recordings during appointments (BP measurements, diabetes and dyslipidaemia patients). National Prescription register data was used to evaluate changes in antihypertensive drug prescribing and chart audits to assess long-term clinical outcomes. ---- For different patient groups changes in the division of tasks had been made at 22 29 of 31 practices, different local guidelines were adopted at 22 31 practices and self-measurement sites were set up for all practices. BP measurements were reduced and targeted at those with poor treatment balance. Using modelling the time allocations by nurses for BP measurements and lifestyle counselling were reduced from 11.9% to 6.3% of their total working time. No statistical changes between intervention and control GPs were detected in time in antihypertensive prescribing. The main advantages of the intervention were mutual clinical practices and clarified professional roles. The main barrier to change was time constrains. ---- In conclusion, internal facilitation is a feasible way of promoting changes in care processes in primary care. However, support and leadership are needed to adopt systematic and sustained quality improvement (QI). Multiprofessionality is important in QI initiatives in primary care, but some practices, such as prescribing, need more individualised interventions.
Source: Työväentutkimus Vuosikirja
Author: Raija Sipilä
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2219279658