Multifaceted implementation of stroke prevention guidelines in primary care: cluster-randomised evaluation of clinical and cost effectiveness
- 1 February 2007
- journal article
- research article
- Published by BMJ in Quality and Safety in Health Care
- Vol. 16 (1) , 51-59
- https://doi.org/10.1136/qshc.2006.019778
Abstract
Objective: To evaluate clinical and cost effectiveness of implementing evidence-based guidelines for the prevention of stroke. Design: Cluster-randomised trial Setting: Three primary care organisations in the North of England covering a population of 400 000. Participants: Seventy six primary care teams in four clusters: North, South & West, City I and City II. Intervention: Guidelines for the management of patients with atrial fibrillation and transient ischaemic attack (TIA) were developed and implemented using a multifaceted approach including evidence-based recommendations, audit and feedback, interactive educational sessions, patient prompts and outreach visits. Outcomes: Identification and appropriate treatment of patients with atrial fibrillation or TIA, and cost effectiveness. Results: Implementation led to 36% increase (95% CI 4% to 78%) in diagnosis of atrial fibrillation, and improved treatment of TIA (odds ratio of complying with guidelines 1.8; 95% CI 1.1 to 2.8). Combined analysis of atrial fibrillation and TIA estimates that compliance was significantly greater (OR 1.46 95% CI 1.10 to 1.94) in the condition for which practices had received the implementation programme. The development and implementation of guidelines cost less than £1500 per practice. The estimated costs per quality-adjusted life year gained by patients with atrial fibrillation or TIA were both less than £2000, very much less than the usual criterion for cost effectiveness. Conclusions: Implementation of evidence-based guidelines improved the quality of primary care for atrial fibrillation and TIA. The intervention was feasible and very cost effective. Key components of the model include contextual analysis, strong professional support, clear recommendations based on robust evidence, simplicity of adoption, good communication and use of established networks and opinion leaders.Keywords
This publication has 24 references indexed in Scilit:
- Improving the management and referral of patients with transient ischaemic attacks: a change strategy for a health communityQuality and Safety in Health Care, 2006
- Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomesPublished by Wiley ,2005
- What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviewsBMJ, 2004
- Does NICE have a cost‐effectiveness threshold and what other factors influence its decisions? A binary choice analysisHealth Economics, 2004
- Changing physicians' behavior: What works and thoughts on getting more things to workJournal of Continuing Education in the Health Professions, 2002
- Making Decisions About Antithrombotic Therapy in Heart Disease: Decision Analytic and Costeffectiveness IssuesChest, 1998
- Royal College of Physicians of Edinburgh Consensus Conference on Medical Management of Stroke, 26–27 May 1998Age and Ageing, 1998
- Management of transient ischaemic attacks and strokePostgraduate Medical Journal, 1995
- Changing physician performance. A systematic review of the effect of continuing medical education strategiesJAMA, 1995
- Medical audit in general practice. I: Effects on doctors' clinical behaviour for common childhood conditions. North of England Study of Standards and Performance in General Practice.BMJ, 1992