PMID- 19018915
OWN - NLM
STAT- MEDLINE
DCOM- 20090220
LR  - 20220309
IS  - 1365-2753 (Electronic)
IS  - 1356-1294 (Linking)
VI  - 14
IP  - 5
DP  - 2008 Oct
TI  - Improved guideline adherence to pharmacotherapy of chronic systolic heart failure 
      in general practice--results from a cluster-randomized controlled trial of 
      implementation of a clinical practice guideline.
PG  - 823-9
LID - 10.1111/j.1365-2753.2008.01060.x [doi]
AB  - RATIONALE AND AIMS: Clinical practice guidelines (CPG) reflect the evidence of 
      effective pharmacotherapy of chronic (systolic) heart failure (CHF) which needs 
      to be implemented. This study aimed to evaluate the effect of a new, multifaceted 
      intervention (educational train-the-trainer course plus pharmacotherapy feedback 
      = TTT) compared with standard education on guideline adherence (GA) in general 
      practice. METHOD: Thirty-seven participating general practitioners (GPs) were 
      randomized (18 vs. 19) and included 168 patients with ascertained symptomatic CHF 
      [New York Heart Association (NYHA) II-IV]. Groups received CPG, the TTT 
      intervention consisted of four interactive educational meetings and a 
      pharmacotherapy feedback, while the control group received a usual lecture 
      (Standard). Outcome measure was GA assessed by prescription rates and target 
      dosing of angiotensin converting enzyme (ACE) inhibitors (ACE-I) or angiotensin 
      receptor blockers (ARB), beta-blockers (BB) and aldosterone antagonists (AA) at 
      baseline and 7-month follow-up. Group comparisons at follow-up were adjusted to 
      GA, sex, age and NYHA stage at baseline. RESULTS: Prescription rates at baseline 
      (n = 168) were high (ACE-I/ARB 90, BB 79 and AA 29%) in both groups. At follow up 
      (n = 146), TTT improved compared with Standard regarding AA (43% vs. 23%, P = 
      0.04) and the rates of reached target doses of ACE-I/ARB (28% vs. 15%, P = 0.04). 
      TTT group achieved significantly higher mean percentages of daily target dose 
      (52% vs. 42%, mean difference 10.3%, 95% CI 0.84-19.8, P = 0.03). CONCLUSION: 
      Despite of pre-existing high GA in both groups and an active control group, the 
      multifaceted intervention was effective in quality of care measured by GA. 
      Further research is needed on the choice of interventions in different provider 
      populations.
FAU - Peters-Klimm, Frank
AU  - Peters-Klimm F
AD  - Department of Genral Practice and Health Services Research, University Hospital 
      Heidelberg, Germany. frank.peters@med.uni-heidelberg.de
FAU - Muller-Tasch, Thomas
AU  - Muller-Tasch T
FAU - Remppis, Andrew
AU  - Remppis A
FAU - Szecsenyi, Joachim
AU  - Szecsenyi J
FAU - Schellberg, Dieter
AU  - Schellberg D
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - J Eval Clin Pract
JT  - Journal of evaluation in clinical practice
JID - 9609066
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Angiotensin II Type 1 Receptor Blockers)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Mineralocorticoid Receptor Antagonists)
SB  - IM
MH  - Adrenergic beta-Antagonists/therapeutic use
MH  - Aged
MH  - Angiotensin II Type 1 Receptor Blockers/therapeutic use
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Cluster Analysis
MH  - Drug Prescriptions/standards/statistics & numerical data
MH  - Drug Utilization/standards/statistics & numerical data
MH  - Education, Medical, Continuing/*organization & administration
MH  - Evidence-Based Medicine/education/organization & administration
MH  - Female
MH  - Follow-Up Studies
MH  - Germany
MH  - Guideline Adherence/*organization & administration
MH  - Heart Failure, Systolic/*drug therapy
MH  - Humans
MH  - Linear Models
MH  - Male
MH  - Middle Aged
MH  - Mineralocorticoid Receptor Antagonists/therapeutic use
MH  - Physicians, Family/*education/organization & administration/psychology
MH  - *Practice Guidelines as Topic
MH  - Practice Patterns, Physicians'/organization & administration
MH  - Program Evaluation
MH  - Quality of Health Care/organization & administration
EDAT- 2008/11/21 09:00
MHDA- 2009/02/21 09:00
CRDT- 2008/11/21 09:00
PHST- 2008/11/21 09:00 [pubmed]
PHST- 2009/02/21 09:00 [medline]
PHST- 2008/11/21 09:00 [entrez]
AID - JEP1060 [pii]
AID - 10.1111/j.1365-2753.2008.01060.x [doi]
PST - ppublish
SO  - J Eval Clin Pract. 2008 Oct;14(5):823-9. doi: 10.1111/j.1365-2753.2008.01060.x.