Improving guideline adherence: A randomized trial evaluating strategies to increase β-blocker use in heart failure
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. This was a randomized controll...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2003-06, Vol.107 (22), p.2799-2804 |
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| container_title | Circulation (New York, N.Y.) |
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| creator | ANSARI, Maria SHLIPAK, Michael G HEIDENREICH, Paul A VAN OSTAEYEN, Denise POHL, Elizabeth C BROWNER, Warren S MASSIE, Barry M |
| description | 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.
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 |
| doi_str_mv | 10.1161/01.CIR.0000070952.08969.5B |
| format | Article |
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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.
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.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.0000070952.08969.5B</identifier><identifier>PMID: 12756157</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adrenergic beta-Antagonists - therapeutic use ; Biological and medical sciences ; Cardiovascular system ; Cohort Studies ; Drug Utilization - statistics & numerical data ; Guideline Adherence - statistics & numerical data ; Health Personnel - education ; Health Personnel - standards ; Heart Failure - drug therapy ; Humans ; Information Dissemination ; Medical sciences ; Nurse Practitioners - standards ; Outcome and Process Assessment (Health Care) - statistics & numerical data ; Patient Education as Topic - methods ; Patient Education as Topic - standards ; Pharmacology. Drug treatments ; Practice Patterns, Physicians' - statistics & numerical data ; Reminder Systems ; Vasodilator agents. Cerebral vasodilators</subject><ispartof>Circulation (New York, N.Y.), 2003-06, Vol.107 (22), p.2799-2804</ispartof><rights>2003 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Jun 10 2003</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c315t-23b8363b0a17f0d6ff1bd15982cdc73e3ebeaa22869d80b1a28f21bb435a14883</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14898307$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12756157$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>ANSARI, Maria</creatorcontrib><creatorcontrib>SHLIPAK, Michael G</creatorcontrib><creatorcontrib>HEIDENREICH, Paul A</creatorcontrib><creatorcontrib>VAN OSTAEYEN, Denise</creatorcontrib><creatorcontrib>POHL, Elizabeth C</creatorcontrib><creatorcontrib>BROWNER, Warren S</creatorcontrib><creatorcontrib>MASSIE, Barry M</creatorcontrib><title>Improving guideline adherence: A randomized trial evaluating strategies to increase β-blocker use in heart failure</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>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.
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.
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.</description><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular system</subject><subject>Cohort Studies</subject><subject>Drug Utilization - statistics & numerical data</subject><subject>Guideline Adherence - statistics & numerical data</subject><subject>Health Personnel - education</subject><subject>Health Personnel - standards</subject><subject>Heart Failure - drug therapy</subject><subject>Humans</subject><subject>Information Dissemination</subject><subject>Medical sciences</subject><subject>Nurse Practitioners - standards</subject><subject>Outcome and Process Assessment (Health Care) - statistics & numerical data</subject><subject>Patient Education as Topic - methods</subject><subject>Patient Education as Topic - standards</subject><subject>Pharmacology. Drug treatments</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Reminder Systems</subject><subject>Vasodilator agents. Cerebral vasodilators</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkd1qFDEUx4Modq2-goSC3s2Yj8nH9K5d_FgoCKLX4UzmzDY1M1OTmYI-lg_iM5m1CwvmJhzy--ck50fIBWc155q_Y7ze7r7U7LAMa5WomW11W6vrJ2TDlWiqRsn2KdmU87YyUogz8iLnu1JqadRzcsaFUZorsyF5N96n-SFMe7pfQ48xTEihv8WEk8dLekUTTP08hl_Y0yUFiBQfIK6wHCJ5SbDgPmCmy0zD5BNCRvrnd9XF2X_HRNdShoneIqSFDhDimvAleTZAzPjquJ-Tbx_ef91-qm4-f9xtr24qL7laKiE7K7XsGHAzsF4PA-96rlorfO-NRIkdAghhddtb1nEQdhC86xqpgDfWynPy9vHe8sMfK-bFjSF7jBEmnNfsjJStYUIX8OI_8G5e01Te5gQXWpeRsgJdPkI-zTknHNx9CiOkn44zd_DiGHfFizt5cf-8OHVdwq-PHdZuxP4UPYoowJsjANlDHMrUfcgnrrGtlczIvxxdmBI</recordid><startdate>20030610</startdate><enddate>20030610</enddate><creator>ANSARI, Maria</creator><creator>SHLIPAK, Michael G</creator><creator>HEIDENREICH, Paul A</creator><creator>VAN OSTAEYEN, Denise</creator><creator>POHL, Elizabeth C</creator><creator>BROWNER, Warren S</creator><creator>MASSIE, Barry M</creator><general>Lippincott Williams & Wilkins</general><general>American Heart Association, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20030610</creationdate><title>Improving guideline adherence: A randomized trial evaluating strategies to increase β-blocker use in heart failure</title><author>ANSARI, Maria ; SHLIPAK, Michael G ; HEIDENREICH, Paul A ; VAN OSTAEYEN, Denise ; POHL, Elizabeth C ; BROWNER, Warren S ; MASSIE, Barry M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c315t-23b8363b0a17f0d6ff1bd15982cdc73e3ebeaa22869d80b1a28f21bb435a14883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Cardiovascular system</topic><topic>Cohort Studies</topic><topic>Drug Utilization - statistics & numerical data</topic><topic>Guideline Adherence - statistics & numerical data</topic><topic>Health Personnel - education</topic><topic>Health Personnel - standards</topic><topic>Heart Failure - drug therapy</topic><topic>Humans</topic><topic>Information Dissemination</topic><topic>Medical sciences</topic><topic>Nurse Practitioners - standards</topic><topic>Outcome and Process Assessment (Health Care) - statistics & numerical data</topic><topic>Patient Education as Topic - methods</topic><topic>Patient Education as Topic - standards</topic><topic>Pharmacology. Drug treatments</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Reminder Systems</topic><topic>Vasodilator agents. Cerebral vasodilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>ANSARI, Maria</creatorcontrib><creatorcontrib>SHLIPAK, Michael G</creatorcontrib><creatorcontrib>HEIDENREICH, Paul A</creatorcontrib><creatorcontrib>VAN OSTAEYEN, Denise</creatorcontrib><creatorcontrib>POHL, Elizabeth C</creatorcontrib><creatorcontrib>BROWNER, Warren S</creatorcontrib><creatorcontrib>MASSIE, Barry M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>ANSARI, Maria</au><au>SHLIPAK, Michael G</au><au>HEIDENREICH, Paul A</au><au>VAN OSTAEYEN, Denise</au><au>POHL, Elizabeth C</au><au>BROWNER, Warren S</au><au>MASSIE, Barry M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improving guideline adherence: A randomized trial evaluating strategies to increase β-blocker use in heart failure</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2003-06-10</date><risdate>2003</risdate><volume>107</volume><issue>22</issue><spage>2799</spage><epage>2804</epage><pages>2799-2804</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>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.
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.
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.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>12756157</pmid><doi>10.1161/01.CIR.0000070952.08969.5B</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0009-7322 |
| ispartof | Circulation (New York, N.Y.), 2003-06, Vol.107 (22), p.2799-2804 |
| issn | 0009-7322 1524-4539 |
| language | eng |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
| subjects | Adrenergic beta-Antagonists - therapeutic use Biological and medical sciences Cardiovascular system Cohort Studies Drug Utilization - statistics & numerical data Guideline Adherence - statistics & numerical data Health Personnel - education Health Personnel - standards Heart Failure - drug therapy Humans Information Dissemination Medical sciences Nurse Practitioners - standards Outcome and Process Assessment (Health Care) - statistics & numerical data Patient Education as Topic - methods Patient Education as Topic - standards Pharmacology. Drug treatments Practice Patterns, Physicians' - statistics & numerical data Reminder Systems Vasodilator agents. Cerebral vasodilators |
| title | Improving guideline adherence: A randomized trial evaluating strategies to increase β-blocker use in heart failure |
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