Document Detail

Case-based training of evidence-based clinical practice in primary care and decreased mortality in patients with coronary heart disease.
MedLine Citation:
PMID:  21555748     Owner:  NLM     Status:  MEDLINE    
PURPOSE: We investigated the 10-year mortality rates in a trial that tested a case-based intervention in primary care aimed at reducing the gap between evidence-based goals and clinical practice in patients with coronary heart disease (CHD).
METHODS: A prospective randomized controlled pragmatic trial was undertaken in a primary care setting. New evidence-based guidelines, with intensified lipid-lowering recommendations in CHD, were mailed to all general practitioners in the region and presented at a lecture in 1995. General practitioners (n = 54) and patients with CHD (n = 88) were assigned according to their primary health care center to 2 balanced groups and randomly allocated to usual care as a control or to an active intervention. General practitioners in the intervention group participated in repeated case-based training during a 2-year period. Patients whose CHD was treated by specialists (n = 167) served as an internal specialist comparison group. Altogether, 255 consecutive patients were included. Cox regression analysis was used to detect any survival benefit of the intervention.
RESULTS: At 10 years, 22% of the patients in the intervention group had died as compared with 44% in the control group (P = .02), with a hazard ratio of 0.45 (95% confidence interval, 0.20-0.95). This difference was mainly due to reduced cardiovascular mortality in the intervention group (P = .01). In addition, the mortality rate of 22% in the intervention group was comparable to the rate of 23% seen in patients treated by a specialist.
CONCLUSIONS: Use of case-based training to implement evidence-based practice in primary care was associated with decreased mortality at 10 years in patients with CHD.
Anna Kiessling; Moira Lewitt; Peter Henriksson
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of family medicine     Volume:  9     ISSN:  1544-1717     ISO Abbreviation:  Ann Fam Med     Publication Date:    2011 May-Jun
Date Detail:
Created Date:  2011-05-10     Completed Date:  2011-09-08     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  101167762     Medline TA:  Ann Fam Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  211-8     Citation Subset:  IM    
Department of Clinical Sciences, Karolinska Institutet, Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden.
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MeSH Terms
Anticholesteremic Agents / therapeutic use
Clinical Competence
Confidence Intervals
Coronary Artery Disease / drug therapy,  mortality*
Educational Status
Evidence-Based Medicine / methods*
General Practitioners
Middle Aged
Primary Health Care / methods*
Problem-Based Learning / methods*
Quality of Health Care / standards
Statistics as Topic
Reg. No./Substance:
0/Anticholesteremic Agents
Comment In:
Ann Fam Med. 2011 May-Jun;9(3):198-200   [PMID:  21555746 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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