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Open Access Study protocol

Preventive evidence into practice (PEP) study: implementation of guidelines to prevent primary vascular disease in general practice protocol for a cluster randomised controlled trial

Mark F Harris1*, Jane Lloyd1, John Litt2, Mieke van Driel3, Danielle Mazza4, Grant Russell4, Jane Smith5, Chris Del Mar5, Elizabeth Denney-Wilson6, Sharon Parker1, Yordanka Krastev7, Upali W Jayasinghe1, Richard Taylor8, Nick Zwar8, Jinty Wilson9, Helen Bolger-Harris10 and Justine Waters11

Author Affiliations

1 Centre for Primary Health Care and Equity, University of New South Wales, Kensington, NSW, 2052, Australia

2 Discipline of General Practice, Flinders University, Adelaide, Australia

3 Discipline of General Practice, University of Queensland, St Lucia, QLD, Australia

4 School of Primary Health Care, Monash University, Melbourne, Australia

5 Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia

6 Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia

7 Ethics Secretariate, University of Technology Sydney, Ultimo, NSW, 2007, Australia

8 School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, 2052, Australia

9 National Heart Foundation of Australia, Melbourne, Australia

10 Royal Australian College of General Practitioners, Melbourne, Australia

11 BUPA Foundation, Sydney, Australia

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Implementation Science 2013, 8:8  doi:10.1186/1748-5908-8-8

Published: 18 January 2013

Abstract

Background

There are significant gaps in the implementation and uptake of evidence-based guideline recommendations for cardiovascular disease (CVD) and diabetes in Australian general practice. This study protocol describes the methodology for a cluster randomised trial to evaluate the effectiveness of a model that aims to improve the implementation of these guidelines in Australian general practice developed by a collaboration between researchers, non-government organisations, and the profession.

Methods

We hypothesise that the intervention will alter the behaviour of clinicians and patients resulting in improvements of recording of lifestyle and physiological risk factors (by 20%) and increased adherence to guideline recommendations for: the management of CVD and diabetes risk factors (by 20%); and lifestyle and physiological risk factors of patients at risk (by 5%). Thirty-two general practices will be randomised in a 1:1 allocation to receive either the intervention or continue with usual care, after stratification by state. The intervention will be delivered through: small group education; audit of patient records to determine preventive care; and practice facilitation visits adapted to the needs of the practices. Outcome data will be extracted from electronic medical records and patient questionnaires, and qualitative evaluation from provider and patient interviews.

Discussion

We plan to disseminate study findings widely and directly inform implementation strategies by governments, professional bodies, and non-government organisations including the partner organisations.

Keywords:
Primary care; Family medicine; Guidelines; Preventive care; Cardiovascular disease