HEART DISEASE PREVENTION IN PRIMARY CARE

初级保健中的心脏病预防

基本信息

批准号：
2223752
负责人：
PATRICK E MCBRIDE
金额：
$ 96.57万
依托单位：
UNIVERSITY OF WISCONSIN-MADISON
依托单位国家：
美国
项目类别：
财政年份：
1992
资助国家：
美国
起止时间：
1992-08-01 至 1997-07-31
项目状态：
已结题

项目摘要

The systematizing of primary care prevention services has the potential of improving physicians' implementation of national guidelines for coronary heart disease (CHD) prevention. this five-year study, to be conducted in community practices in three Midwestern states, will provide extensive descriptive information regarding current prevention practices of primary care physicians and will evaluate two interventions designed to improve recognition and management of patients who have high blood cholesterol, hypertension, history of smoking, or family history of premature CHD. The study's interventions are: (1) PRACTICE CONSULTATION, and (2) introduction of a project-trained PREVENTION COORDINATOR into a practice. The first intervention uses a series of meetings between study consultants and practice personnel to identify and evaluate a practice's current systems of preventive care delivery, provide feedback from baseline audits, develop plans for detection and management of patients at risk of CHD, and reinforce positive changes instituted by the practice during the study. The second intervention involves adding a grant-funded Prevention Coordinator to a practice's staff to organize systematic delivery of preventive and patient education services. The two interventions are developed from educational and organizational theory, a successful feasibility project, and experience from pilot practice research. Our prior research found that: (1) detection, assessment, and management of CHD risk factors in primary care are not optimal; (2) practice organization for delivery of preventive and patient education services is irregular and idiosyncratic; and (3) barriers to adequate preventive care such as limited clinical time, inadequate physician and staff training, patients' reluctance to accept preventive services, practice inefficiency, and lack of practice support can be assessed objectively and addressed realistically. The pilot project which we conducted demonstrated that the proposed interventions can be implemented successfully in typical primary care practices. The study's factorial design tests these two interventions separately and in combination to establish the level of support required to ensure adequate delivery of preventive services in primary care practices. The study will utilize medical record audits, practice organization audits, physician and staff surveys, Prevention Coordinator activity logs, patient reports of practice and personal behaviors, and financial analyses of Prevention Coordinators' productivity to quantify the effectiveness and feasibility of these interventions for improving heart disease prevention services in primary care.

初级保健预防服务的系统化具有以下潜力：改善医生对国家冠心病指南的实施预防心脏病（CHD）。这项为期五年的研究将于中西部三个州的社区实践将提供广泛的有关当前初级预防实践的描述性信息护理医生并将评估两项旨在改善的干预措施识别和管理高胆固醇患者，高血压、吸烟史或早发冠心病家族史。该研究的干预措施是：(1) 实践咨询，以及 (2) 将经过项目培训的预防协调员引入实践中。第一个干预措施是研究顾问之间举行一系列会议和实践人员识别和评估实践的当前预防性护理提供系统，提供基线审计的反馈，制定检测和管理有冠心病风险的患者的计划，以及强化研究期间实践所带来的积极变化。第二项干预措施涉及增加一项由赠款资助的预防措施诊所工作人员的协调员，组织系统性的交付预防和患者教育服务。这两种干预措施是从教育和组织方面发展起来的理论、成功的可行性项目以及试点经验实践研究。我们之前的研究发现：（1）检测，初级保健中对 CHD 危险因素的评估和管理最佳的; (2) 提供预防和病人的实践组织教育服务不规范且特殊； (3) 障碍充分的预防性护理，例如有限的临床时间、不充分的预防性护理医生和工作人员培训，患者不愿意接受预防服务、实践效率低下和缺乏实践支持可能是客观评价，切实解决。该试点项目我们的研究表明，拟议的干预措施可以在典型的初级保健实践中成功实施。该研究的因子设计分别测试了这两种干预措施，并结合起来确定所需的支持水平，以确保在初级保健实践中提供充分的预防服务。这研究将利用医疗记录审计、实践组织审计、医生和工作人员调查、预防协调员活动日志、患者实践和个人行为报告以及财务分析预防协调员的生产力，以量化有效性和这些干预措施改善心脏病预防的可行性初级保健服务。