| Case-based training of evidence-based clinical practice in primary care and decreased mortality in patients with coronary heart disease. | |
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MedLine Citation:
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PMID: 21555748 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Anna Kiessling; Moira Lewitt; Peter Henriksson |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Annals of family medicine Volume: 9 ISSN: 1544-1717 ISO Abbreviation: Ann Fam Med Publication Date: 2011 May-Jun |
Date Detail:
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Created Date: 2011-05-10 Completed Date: 2011-09-08 Revised Date: 2013-05-24 |
Medline Journal Info:
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Nlm Unique ID: 101167762 Medline TA: Ann Fam Med Country: United States |
Other Details:
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Languages: eng Pagination: 211-8 Citation Subset: IM |
Affiliation:
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Department of Clinical Sciences, Karolinska Institutet, Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden. anna.kiessling@ki.se |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anticholesteremic Agents
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therapeutic use Clinical Competence Confidence Intervals Coronary Artery Disease / drug therapy, mortality* Educational Status Evidence-Based Medicine / methods* Female General Practitioners Humans Male Middle Aged Primary Health Care / methods* Problem-Based Learning / methods* Quality of Health Care / standards Statistics as Topic Sweden |
| Chemical | |
Reg. No./Substance:
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0/Anticholesteremic Agents |
| Comments/Corrections | |
Comment In:
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Ann Fam Med. 2011 May-Jun;9(3):198-200
[PMID:
21555746
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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