Effectiveness of a new health care organization model in primary care for chronic cardiovascular disease patients based on a multifactorial intervention: the PROPRESE randomized controlled trial
1 Unidad de docencia e investigación, Hospital Universitario de Sant Joan d’Alacant, Ctra. Nnal. 332 Alicante, Valencia s/n, Sant Joan d’Alacant Alicante 03550, Spain
2 Servicio de Cardiología, Hospital Universitario de Sant Joan d’ Alacant, Ctra. Nnal. 332 Alicante, Valencia s/n, Sant Joan d’Alacant Alicante 03550, Spain
3 CS Salvador Pau, c/ Salvador Pau, Nº 42, Valencia 46021, Spain
4 Cátedra de Medicina de Familia. Departamento Medicina Clínica, Universidad Miguel Hernández, Ctra. Nnal. 332 Alicante-Valencia s/n, Sant Joan d’Alacant Alicante 03550, Spain
5 CS Cabo Huertas, c/Arpón s/n, Alicante 03540, Spain
6 CS Dolores Cano Royo, c/Martí l’Humá, 13, Vila-RealCastellón, Spain
7 CS Carinyena c/Illes Columbretes, s/n 12540, Vila-Real, Castellon, Spain
BMC Health Services Research 2013, 13:293 doi:10.1186/1472-6963-13-293Published: 2 August 2013
To evaluate the effectiveness of a new multifactorial intervention to improve health care for chronic ischemic heart disease patients in primary care. The strategy has two components: a) organizational for the patient/professional relationship and b) training for professionals.
Experimental study. Randomized clinical trial. Follow-up period: one year. Study setting: primary care, multicenter (15 health centers). For the intervention group 15 health centers are selected from those participating in ESCARVAL study. Once the center agreed to participate patients are randomly selected from the total amount of patients with ischemic heart disease registered in the electronic health records. For the control group a random sample of patients with ischemic heart disease is selected from all 72 health centers electronic records.
Intervention components: a) Organizational intervention on the patient/professional relationship. Centered on the Chronic Care Model, the Stanford Expert Patient Program and the Kaiser Permanente model: Teamwork, informed and active patient, decision making shared with the patient, recommendations based on clinical guidelines, single electronic medical history per patient that allows the use of indicators for risk monitoring and stratification. b) Formative strategy for professionals: 4 face-to-face training workshops (one every 3 months), monthly update clinical sessions, online tutorial by a cardiologist, availability through the intranet of the action protocol and related documents.
Measurements: Blood pressure, blood glucose, HbA1c, lipid profile and smoking. Frequent health care visits. Number of hospitalizations related to vascular disease. Therapeutic compliance. Drug use.
This study aims to evaluate the efficacy of a multifactorial intervention strategy involving patients with ischemic heart disease for the improvement of the degree of control of the cardiovascular risk factors and of the quality of life, number of visits, and number of hospitalizations.