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Multicenter Study
. 2009 May;41(5):240-5.
doi: 10.1016/j.aprim.2008.09.006. Epub 2009 Apr 8.

[Improved effectiveness in the management of cardiovascular risk among type 2 diabetic patients in primary health care]

[Article in Spanish]
Antonio Hormigo Pozo  1 , María Angeles Viciana López, Leonor Gómez Jiménez, María Dolores Gallego Parrilla, Javier Orellana Lozano, José Miguel Morales Asencio
Affiliations
Multicenter Study

[Improved effectiveness in the management of cardiovascular risk among type 2 diabetic patients in primary health care]

[Article in Spanish]
Antonio Hormigo Pozo et al. Aten Primaria. 2009 May.

Abstract
in English, Spanish

Objectives: To determine the impact of the implementation of a guidelines in the assessment of cardiovascular risk in high-risk patients (type 2 diabetes) in health centres, and to analyse the appropriateness of antihypertensive and antiplatelet treatment in diabetic patients.

Design: Quasi-experimental, non-randomised, prospective study with concurrent control group. PLACEMENT: Two health centres in Málaga.

Participants: General practitioners of the two centres.

Interventions: The guideline was implemented through a multifaceted intervention in family physicians in the experimental centre.

Main outcomes: Rate of cardiovascular risk assessment in high risk population. Secondary: appropriateness of antihypertensive and antiplatelet treatment.

Results: Large differences were detected in the cardiovascular risk assessment, improving in the experimental group (74.36% vs. 7.63%; RR = 9.74; 95% CI, 5.15-18.43; P = .0001). Similarly, the antiplatelet use was more in line with the guidelines recommendations in the intervention group (51.28% vs. 36.44%; RR = 1.407; 95% CI, 1.04-1.89; P = .026), and in antihypertensive drugs, although with no statistical significance (80% vs. 66.27%; RR = 1.207; 95% CI, 0.99-1.46).

Conclusions: A multifaceted intervention for the implementation of a guideline for the management of high risk cardiovascular patients, improves the adherence to effective interventions by family physicians.

Objetivos: Determinar el impacto de la implementación de una guía en la valoración del riesgo cardiovascular de pacientes en alto riesgo (diabéticos tipo 2), y en la adecuación del tratamiento antihipertensivo y antiagregante.

Diseño: Estudio semiexperimental, no aleatorizado, prospectivo, con grupo control concurrente.

Emplazamiento: Dos centros de salud de Málaga.

Participantes: Médicos de familia.

Intervenciones: Implementación de la guía mediante intervenciones multicomponentes sobre los médicos de familia del centro experimental.

Mediciones principales: Variable principal de resultado: grado de estimación del riesgo cardiovascular en población con elevado riesgo (diabéticos). Variables secundarias: adecuación del tratamiento antihipertensivo y antiagregante.

Resultados: Se detectaron importantes diferencias en la estimación del riesgo cardiovascular a favor del grupo experimental (el 74,36 frente al 7,63%; riesgo relativo [RR]=9,74; intervalo de confianza [IC] del 95%, 5,15–18,43; p=0,0001). Las pautas de antiagregación se ajustaron más a las recomendaciones de la evidencia en el grupo intervención (el 51,28 frente al 36,44%; RR=1,407; IC del 95%, 1,04–1,89; p=0,026), al igual que en antihipertensivos, aunque sin significación (el 80 frente al 66,27%; RR=1,207; IC del 95%, 0,99–1,46.

Conclusiones: Una estrategia de implementación multicomponente de una guía para el manejo de pacientes con elevado riesgo cardiovascular mejora la adherencia a intervenciones efectivas por parte de médicos de familia.

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