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Training general practitioners to improve evidence-based drug treatment of patients with heart failure: a cluster randomised controlled trial.

ABSTRACT: AIMS:To assess whether a single training session for general practitioners (GPs) improves the evidence-based drug treatment of heart failure (HF) patients, especially of those with HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS:A cluster randomised controlled trial was performed for which patients with established HF were eligible. Primary care practices (PCPs) were randomised to care-as-usual or to the intervention group in which GPs received a half-day training session on HF management. Changes in HF medication, health status, hospitalisation and survival were compared between the two groups. Fifteen PCPs with 200 HF patients were randomised to the intervention group and 15 PCPs with 198 HF patients to the control group. Mean age was 76.9 (SD 10.8) years; 52.5% were female. On average, the patients had been diagnosed with HF 3.0 (SD 3.0) years previously. In total, 204 had HFrEF and 194 HF with preserved ejection fraction (HFpEF). In participants with HFrEF, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers decreased in 6 months in both groups [5.2%; (95% confidence interval (CI) 2.0-10.0)] and 5.6% (95% CI 2.8-13.4)], respectively [baseline-corrected odds ratio (OR) 1.07 (95% CI 0.55-2.08)], while beta-blocker use increased in both groups by 5.2% (95% CI 2.0-10.0) and 1.1% (95% CI 0.2-6.3), respectively [baseline-corrected OR 0.82 (95% CI 0.42-1.61)]. For health status, hospitalisations or survival after 12-28 months there were no significant differences between the two groups, also not when separately analysed for HFrEF and HFpEF. CONCLUSION:A half-day training session for GPs does not improve drug treatment of HF in patients with established HF.

SUBMITTER: Valk MJM

PROVIDER: S-EPMC7596131 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Training general practitioners to improve evidence-based drug treatment of patients with heart failure: a cluster randomised controlled trial.

Valk M J M MJM Hoes A W AW Mosterd A A Landman M A MA Zuithoff N P A NPA Broekhuizen B D L BDL Rutten F H FH

Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 20201101 11

<h4>Aims</h4>To assess whether a single training session for general practitioners (GPs) improves the evidence-based drug treatment of heart failure (HF) patients, especially of those with HF with reduced ejection fraction (HFrEF).<h4>Methods and results</h4>A cluster randomised controlled trial was performed for which patients with established HF were eligible. Primary care practices (PCPs) were randomised to care-as-usual or to the intervention group in which GPs received a half-day training s ...[more]

PMID: 32997300

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Project description:ObjectiveTo test whether a complex intervention facilitating early cancer rehabilitation by involvement of the general practitioner (GP) soon after diagnosis improves patients' satisfaction with their GPs.DesignA cluster randomised controlled trial. All general practices in Denmark were randomised to an intervention or a control group before the start of the study. Patients included those with cancer who were subsequently allocated to either group based on the randomisation status of their GP.ParticipantsAdult patients with cancer treated for incident cancer at the public regional hospital (Vejle Hospital, Denmark) were included between May 2008 and February 2009. A total of 955 patients registered with 323 practices were included, of which 486 patients were allocated to the intervention group and 469 to the control group.InterventionThe intervention included a patient interview assessing the need for rehabilitation, improved information from the hospital to GPs including information on the patients' current needs along with information about needs of patients with cancer in general. Further, GPs were encouraged to proactively contact the patients and facilitate the patients' rehabilitation course.Outcome measures6 months after inclusion of the patient, patient satisfaction with their GP during the last 12 months in five different dimensions of GP care was assessed using the Danish version of the EuroPEP (European Patients Evaluate General Practice Care) questionnaire (DanPEP). 14 months after inclusion, patient satisfaction with the GP regarding the cancer course and GP's satisfaction with own contribution to the patients' rehabilitation course were assessed using ad hoc questions specifically designed for this study.ResultsNo overall effect of the intervention was observed. Subgroup analysis of the patients with breast cancer showed statistically significant improvement of satisfaction with the GP in two of the five DanPEP dimensions.ConclusionsThis complex intervention aiming at improving GPs' services in cancer rehabilitation had no impact on patient satisfaction.Trial registrationClinicalTrials.gov, registration ID number NCT01021371.

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Training general practitioners to improve evidence-based drug treatment of patients with heart failure: a cluster randomised controlled trial.

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Training general practitioners to improve evidence-based drug treatment of patients with heart failure: a cluster randomised controlled trial.

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