Improving cardiovascular risk management: a randomized, controlled trial on the effect of a decision support tool for patients and physicians

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Abstract
There is nonoptimal adherence of general practitioners (GPs) and patients to cardiovascular risk reducing interventions. GPs find it difficult to assimilate multiple risk factors into an accurate assessment of cardiovascular risk. In addition, communicating cardiovascular risk to patients has proved to be difficult. Improving primary prevention of cardiovascular disease (CVD) in primary care by enhancing patient involvement in the use of a decision support tool. Design Cluster randomized trial. Thirty-four GPs included patients (40-75 years old) without CVD. In an interactive, small group training session lasting 4h, the GPs in the intervention group were trained to use the guidelines on cardiovascular risk and a decision support tool. The control group received educational materials about the guidelines on paper. GPs’ clinical performance and patients’ risk perception and self-reported lifestyles were measured at baseline and after 6 months. Results Thirty-four GPs recorded 490 consultations, 276 in the intervention and 214 in the control group. After 6 months, no significant effect of the intervention on the GPs’ performance or the patients’ risk perception was found. There was only an effect on self-reported lifestyle, in that more men in the intervention group than in the control group increased their physical activity (odds ratio 3.8, 95% confidence interval 1.7–8.7). The 4-h interactive, small group training did not guarantee correct application of the decision support tool and as such failed to improve GPs’ performance or correct patients’ risk perception. The positive effect on physical activity justifies further research on patient involvement. Eur J Cardiovasc Prev Rehabil 14: 44-50 © 2007 The European Society of Cardiology