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Background: The underlying reasons for differences between clinical practice
and systematically developed guidelines vary from one clinical problem to
another. It is therefore logical to tailor strategies to support the implementation
of guidelines to address identified barriers to change. The objective of
this trial is to evaluate the effects of a tailored intervention to support
the implementation of systematically developed guidelines for the use of
antihypertensive and cholesterol-lowering drugs for the primary prevention
of cardiovascular disease.
Methods/Design: Unblinded, cluster-randomised trial. 150 general practices
will be recruited from two geographical areas in Norway, and randomised to
the intervention or control group (passive dissemination of guidelines).
Outcomes will be measured for all eligible patients seen in the participating
practices during one year after the intervention. A multifaceted intervention
has been tailored to address identified barriers to change. Key components
are an educational outreach visit with audit and feedback, and computerised
reminders. Pharmacists will conduct the visits. During the outreach visit
the main recommendations will be presented and software will be installed
that links to the electronic medical record systems used in the participating
practices. The software will perform an audit that will be fed back during
the visit, present pop-up reminders for patients with high blood pressure
or cholesterol, and provide a cardiovascular risk calculator and patient
education material. The main outcomes are the proportions of 1) first time
prescriptions for hypertension where thiazides are not prescribed, 2) patients
not assessed for cardiovascular risk before prescribing antihypertensive
or cholesterol-lowering drugs, and 3) patients treated for hypertension or
high cholesterol for three months or more who have not achieved recommended
treatment goals.
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