Effect of a Multifaceted Quality Improvement Intervention on the Prescription of Evidence-Based Treatment in Patients at High Cardiovascular Risk in Brazil The BRIDGE Cardiovascular Prevention Cluster Randomized Clinical Trial

被引：25

作者：

Machline-Carrion, M. Julia ^{[1
]}

Soares, Rafael Marques ^{[1
]}

Damiani, Lucas Petri ^{[1
]}

Campos, Viviane Bezerra ^{[1
]}

Sampaio, Bruna ^{[1
]}

Fonseca, Francisco H. ^{[2
]}

Izar, Maria Cristina ^{[2
]}

Amodeo, Celso ^{[3
,11
]}

Pontes-Neto, Octavio Marques ^{[4
]}

Santos, Juliana Yamashita ^{[1
]}

Gomes, Samara Pinheiro do Carmo ^{[1
]}

Saraiva, Jose Francisco Kerr ^{[5
]}

Ramacciotti, Eduardo ^{[6
]}

Barros e Silva, Pedro Gabriel de Melo ^{[1
,7
]}

Lopes, Renato D. ^{[7
,8
]}

da Silva, Nilton Brandao ^{[9
,35
]}

Guimaraes, Helio Penna ^{[1
]}

Piegas, Leopoldo ^{[10
]}

Stein, Airton T. ^{[9
]}

Berwanger, Otavio ^{[1
]}

Julia Machline-Carrion, M.

Berwanger, Otavio ^{[1
]}

Stein, Airton

Fonseca, Francisco H. ^{[2
]}

Izar, Maria Cristina ^{[2
]}

Pontes-Neto, Octavio Marques ^{[4
]}

Amodeo, Celso ^{[3
,11
]}

Piegas, Leopoldo ^{[10
]}

Guimaraes, Helio Penna ^{[1
]}

Lopes, Renato Delascio

da Silva, Nilton Brandao ^{[9
,35
]}

Soares, Rafael Marques ^{[1
]}

Campos, Viviane Bezerra ^{[1
]}

Sampaio, Bruna ^{[1
]}

Gonzales, Beatriz Pacheco

Santos, Juliana Yamashita ^{[1
]}

Kodama, Alessandra

Sampaio, Bruna ^{[1
]}

Guimaraes, Helio Penna ^{[1
]}

de Melo Barros e Silva, Pedro Gabriel

Pinheiro, Samara

Damiani, Lucas Petri ^{[1
]}

Nakagawa, Renato Hideo

Ribas Fortes, Jose Augusto ^{[12
]}

Woehl, Juliane ^{[12
]}

do Carmo, Juliana Barbosa ^{[12
]}

Leaes, Paulo Ernesto ^{[13
]}

Baldissera, Vanessa ^{[13
]}

Luiz, Raquel Osorio ^{[13
]}

Goncalves, Marcelo Rodrigues ^{[14
]}

机构：

[1] Hosp Coracao, HCor Res Inst, 250 Abilio Soares St, BR-04005909 Sao Paulo, SP, Brazil

[2] Univ Fed Sao Paulo, Sao Paulo, SP, Brazil

[3] Inst Dante Pazzanese Cardiol, Sao Paulo, SP, Brazil

[4] Univ Sao Paulo, Ribeirao Preto Med Sch, Sao Paulo, SP, Brazil

[5] Hosp & Maternidade Celso Pierro, Campinas, SP, Brazil

[6] Hosp & Maternidade Christovao Gama, Santo Andre, SP, Brazil

[7] Brazilian Clin Res Inst, Sao Paulo, SP, Brazil

[8] Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA

[9] Univ Fed Ciencias Saude Porto Alegre, Porto Alegre, RS, Brazil

[10] Hosp Coracao, Sao Paulo, SP, Brazil

[11] Inst Dante Pazzanese Cardiol, Sao Paulo, SP, Brazil

[12] Hosp Santa Casa Curitiba, Curitiba, Parana, Brazil

[13] Santa Casa Misericordia Porto Alegre, Porto Alegre, RS, Brazil

[14] Univ Fed Rio Grande do Sul, Unidade Basica Saude Santa Cecilia, Porto Alegre, RS, Brazil

[15] Grp Hosp Conceicao, Porto Alegre, RS, Brazil

[16] Hosp Sao Jose, Antonio Prado, RS, Brazil

[17] Univ Santa Cruz do Sul, Santa Cruz, RS, Brazil

[18] Secretaria Municipal Saude Montenegro, Montenegro, RS, Brazil

[19] Hosp Celso Ramos, Florianopolis, SC, Brazil

[20] Univ Estado Rio De Janeiro, Clin Hipertensao Arterial & Doencas Metabol Assoc, Rio De Janeiro, RJ, Brazil

[21] Hosp & Maternidade Santa Lucia Pocos De Caldas, Pocos De Caldas, MG, Brazil

[22] Hosp Reg Sao Sebastiao, Lavras, MG, Brazil

[23] CARDIOPED, Colatina, ES, Brazil

[24] Univ Fed Goias, Hosp Clin, Goiania, Go, Brazil

[25] Fundacao Univ Fed Sergipe, Aracaju, Sergipe, Brazil

[26] Ctr Pesquisa Clin Coracao, Aracaju, Sergipe, Brazil

[27] Hosp Agamenon Magalhaes, Recife, PE, Brazil

[28] Hosp & Maternidade Celso Pierro, Campinas, SP, Brazil

[29] Inst Cardiol Valle Paraiba, Sao Jose Dos Campos, SP, Brazil

[30] Clin Villela Martin, Sao Jose Do Rio Preto, SP, Brazil

[31] Luiz Phellipe Aquila Hosp Sao Francisco Ribeirao, Ribeirao Preto, SP, Brazil

[32] Univ Fed Maranhao, Hosp Clin Hosp Univ, Sao Luis, Maranhao, Brazil

[33] Clin Familia Teewald, Santa Maria Herval, RS, Brazil

[34] Inst Municipal Estrategia Saude Familia, Porto Alegre, RS, Brazil

[35] Ambulatorio Clin Med Santa Casa Porto Alegre, Porto Alegre, RS, Brazil

[36] Inst Pesquisas Ensinos Med Itajai, Itajai, SC, Brazil

[37] Soc Hosp Angelina Caron, Campina Grande Do Sul, Parana, Brazil

[38] Inst Molestias Cardiovasc, Sao Jose Do Rio Preto, SP, Brazil

[39] Univ Oeste Paulista, Hosp Reg Presidente Prudente, Presidente Prudente, SP, Brazil

[40] Hosp Naval Marcilio Dias, Inst Pesquisa Biomed, Rio De Janeiro, RJ, Brazil

[41] Hosp Lifecenter, Belo Horizonte, MG, Brazil

[42] Escola Super Ciencias Santa Casa Misericor Vitoria, Vitoria, ES, Brazil

[43] Hosp Bahia, Salvador, BA, Brazil

[44] Hosp Coracao Aracaju, Aracaju, Sergipe, Brazil

[45] Pronto Socorro Cardiol Univ Pernambuco Prof Luiz, Recife, PE, Brazil

[46] CARDIOLIMA, Teresina, Piaui, Brazil

[47] Univ Fed Sao Paulo, Hosp Sao Paulo, Sao Paulo, SP, Brazil

来源：

JAMA CARDIOLOGY | 2019年 / 4卷 / 05期

关键词：

INCOME COUNTRIES; MIDDLE-INCOME; HEALTH-CARE; DISEASE; PARTICIPANTS; METAANALYSIS; TELMISARTAN; CHOLESTEROL; STRATEGIES; MANAGEMENT;

D O I：

10.1001/jamacardio.2019.0649

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

IMPORTANCE Studies have found that patients at high cardiovascular risk often fail to receive evidence-based therapies in community practice. OBJECTIVE To evaluate whether a multifaceted quality improvement intervention can improve the prescription of evidence-based therapies. DESIGN, SETTING, AND PARTICIPANTS In this 2-arm cluster randomized clinical trial, patients with established atherothrombotic disease from 40 public and private outpatient clinics (clusters) in Brazil were studied. Patients were recruited from August 2016 to August 2017, with follow-up to August 2018. Data were analyzed in September 2018. INTERVENTIONS Case management, audit and feedback reports, and distribution of educational materials (to health care professionals and patients) vs routine practice. MAIN OUTCOMES AND MEASURES The primary end point was prescription of evidence-based therapies (ie, statins, antiplatelet therapy, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) using the all-or-none approach at 12 months after the intervention period in patients without contraindications. RESULTS Of the 1619 included patients, 1029(63.6%) were male, 1327(82.0%) hadcoronary artery disease (843 [52.1%] with prior acute myocardial infarction), 355 (21.9%) had prior ischemic stroke or transient ischemic attack, and 197(12.2%) had peripheral vascular disease, and the mean(SD) age was 65.6 (10.5) years. Among randomized clusters, 30 (75%) were cardiology sites, 6 (15%) were primary care units, and 26(65%) were teaching institutions. Among eligible patients, those in intervention clusters were more likely to receive a prescription of evidence-based therapies than those in control clusters (73.5% [515 of 701] vs 58.7% [493 of 840]; odds ratio, 2.30; 95% CI, 1.14-4.65). There were no differences between the intervention and control groups with regards to risk factor control(ie, hyperlipidemia, hypertension, or diabetes). Rates of education for smoking cessation were higher among current smokers in the intervention group than in the control group(51.9% [364 of 701] vs 18.2%[153 of 840]; odds ratio, 11.24; 95% CI, 2.20-57.43). The rate of cardiovascular mortality, acute myocardial infarction, and stroke was 2.6% for patients from intervention clusters and 3.4% for those in the control group (hazard ratio, 0.76; 95% CI, 0.43-1.34). CONCLUSIONS AND RELEVANCE Among Brazilian patients at high cardiovascular risk, a quality improvement intervention resulted in improved prescription of evidence-based therapies.

引用

页码：408 / 417

页数：10

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