Mixed methods evaluation of targeted case finding for cardiovascular disease prevention using a stepped wedged cluster RCT

BMC Public Health

Kate Jolly¹  Nicola Gale¹  Paramjit Gill¹  Karla Hemming¹  Michael Caley²  Tom Marshall¹ 

[1] School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK;Warwickshire Primary Care Trust, Westgate House, Market Street, Warwick, CV34 4DE, UK

关键词: Cluster randomised controlled trial;    Risk factors;    Prevention;    Cardiovascular diseases;    Statinsm;   

Others  :  1162927
DOI  :  10.1186/1471-2458-12-908

 received in 2012-10-10, accepted in 2012-10-24,  发布年份 2012

【 摘 要 】

Background

A pilot project cardiovascular prevention was implemented in Sandwell (West Midlands, UK). This used electronic primary care records to identify untreated patients at high risk of cardiovascular disease then invited these high risk patients for assessment by a nurse in their own general practice. Those found to be eligible for treatment were offered treatment. During the pilot a higher proportion of high risk patients were started on treatment in the intervention practices than in control practices. Following the apparent success of the prevention project, it was intended to extend the service to all practices across the Sandwell area. However the pilot project was not a robust evaluation. There was a need for an efficient evaluation that would not disrupt the planned rollout of the project.

Methods/design

Project nurses will sequentially implement targeted cardiovascular case finding in a phased way across all general practices, with the sequence of general practices determined randomly. This is a stepped wedge randomised controlled trial design. The target population is patients aged 35 to 74, without diabetes or cardiovascular disease whose ten-year cardiovascular risk, (determined from data in their electronic records) is ≥20%. The primary outcome is the number of high risk patients started on treatment, because these data could be efficiently obtained from electronic primary care records. From this we can determine the effects of the case finding programme on the proportion of high risk patients started on treatment in practices before and after implementation of targeted case finding. Cost-effectiveness will be modelled from the predicted effects of treatments on cardiovascular events and associated health service costs. Alongside the implementation it is intended to interview clinical staff and patients who participated in the programme in order to determine acceptability to patients and clinicians. Practical considerations meant that 26 practices in Sandwell could be randomised, including about 6,250 patients at high risk of cardiovascular disease. This gives sufficient power for evaluation.

Discussion

It is possible to design a stepped wedge randomised controlled trial using routine data to determine the primary outcome to evaluate implementation of a cardiovascular prevention programme.

【 授权许可】

   
2012 Marshall et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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