CHANGING PREVENTIVE PRACTICE - A CONTROLLED TRIAL ON THE EFFECTS OF OUTREACH VISITS TO ORGANIZE PREVENTION OF CARDIOVASCULAR-DISEASE

Objectives-To assess the effects outreach visits by trained nurse faci litators on the organisation of services used to prevent cardiovascula r disease. To identify the characteristics of general practices that d etermined success. Design-A non-randomised controlled trial of two met hods of implementing guidelines to organise prevention of cardiovascul ar disease: an innovative outreach visit method compared with a feedba ck method. The results in both groups were compared with data from a c ontrol group. Setting and subjects-95 general practices in two regions in The Netherlands. Interventions-Trained nurse facilitators visited practices, focusing on solving problems in the organisation of prevent ion. They applied a four step model in each practice. The number of vi sits depended on the needs of the practice team. The feedback method c onsisted of the provision of a feedback report with advice specific to each practice and standardised instructions. Main outcome measures-Th e proportion of practices adhering to 10 different guidelines. Guideli nes were on the detection of patients at risk, their follow up, the re gistration of preventive activities, and teamwork within the practice. Results-Outreach visits were more effective than feedback in implement ing guidelines to organise prevention. Within the group with outreach visits, the increase in the number of practices adhering to the guidel ines was significant for six out of 10 guidelines. Within the feedback group, a comparison of data before and after intervention showed no s ignificant differences. Partnerships and practices with a computer cha nged more. Conclusion-Outreach visits by trained nurse facilitators pr oved to be effective in implementing guidelines within general practic es, probably because their help was practical and designed for the ind ividual practice, guided by the wishes and capabilities of the practic e team.