| Improving guideline adherence: a randomized trial evaluating strategies to increase beta-blocker use in heart failure. | |
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MedLine Citation:
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PMID: 12756157 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The dissemination of clinical practice guidelines often has not been accompanied by desired improvements in guideline adherence. This study evaluated interventions for implementing a new practice guideline advocating the use of beta-blockers for heart failure patients. METHODS AND RESULTS: This was a randomized controlled trial involving heart failure patients (n=169) with an ejection fraction < or =45% and no contraindications to beta-blockers. Patients' primary providers were randomized in a stratified design to 1 of 3 interventions: (1) control: provider education; (2) provider and patient notification: computerized provider reminders and patient letters advocating beta-blockers; and (3) nurse facilitator: supervised nurse to initiate and titrate beta-blockers. The primary outcome, the proportion of patients who were initiated or uptitrated and maintained on beta-blockers, analyzed by intention to treat, was achieved in 67% (36 of 54) of patients in the nurse facilitator group compared with 16% (10 of 64) in the provider/patient notification and 27% (14 of 51) in the control groups (P<0.001 for the comparisons between the nurse facilitator group and both other groups). The proportion of patients on target beta-blocker doses at the study end (median follow-up, 12 months) was also highest in the nurse facilitator group (43%) compared with the control (10%) and provider/patient notification groups (2%) (P<0.001). There were no differences in adverse events among groups. CONCLUSIONS: The use of a nurse facilitator was a successful approach for implementing a beta-blocker guideline in heart failure patients. The use of provider education, clinical reminders, and patient education was of limited value in this setting. |
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Authors:
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Maria Ansari; Michael G Shlipak; Paul A Heidenreich; Denise Van Ostaeyen; Elizabeth C Pohl; Warren S Browner; Barry M Massie |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, Non-P.H.S. Date: 2003-05-19 |
Journal Detail:
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Title: Circulation Volume: 107 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2003 Jun |
Date Detail:
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Created Date: 2003-06-10 Completed Date: 2003-06-25 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 2799-804 Citation Subset: AIM; IM |
Affiliation:
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Cardiology Division, San Francisco VA Medical Center, 4150 Clement St, San Francisco, Calif 94121, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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therapeutic use* Cohort Studies Drug Utilization / statistics & numerical data* Guideline Adherence / statistics & numerical data* Health Personnel / education, standards Heart Failure / drug therapy* Humans Information Dissemination Nurse Practitioners / standards Outcome and Process Assessment (Health Care) / statistics & numerical data* Patient Education as Topic / methods, standards Physician's Practice Patterns / statistics & numerical data* Reminder Systems |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists |
| Comments/Corrections | |
Comment In:
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ACP J Club. 2004 Jan-Feb;140(1):22
[PMID:
14711293
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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