Conclusions Organisational and professional interventions improved prescribing of statins/lipid-lowering agents and target blood pressure in patients with IHDs but there was little evidence of change in other outcomes .
Objectives Ischaemic heart diseases ( IHDs ) are a leading cause of death worldwide .
Although prescribing according to guidelines improves health outcomes , it remains suboptimal .
We determined whether interventions targeted at healthcare professionals are effective to enhance prescribing and health outcomes in patients with IHDs .
A randomized trial to assess the impact of opinion leader endorsed evidence summaries on the use of secondary prevention strategies in patients with coronary artery disease: the ESP-CAD trial protocol [NCT00175240]
Background Although numerous therapies have been shown to be beneficial in the prevention of myocardial infa rct ion and /or death in patients with coronary disease , these therapies are under-used and this gap contributes to sub-optimal patient outcomes . To increase the uptake of proven efficacious therapies in patients with coronary disease , we design ed a multifaceted quality improvement intervention employing patient-specific reminders delivered at the point-of-care , with one-page treatment guidelines endorsed by local opinion leaders ( " Local Opinion Leader Statement " ) . This trial is design ed to evaluate the impact of these Local Opinion Leader Statements on the practice s of primary care physicians caring for patients with coronary disease . In order to isolate the effects of the messenger ( the local opinion leader ) from the message , we will also test an identical quality improvement intervention that is not signed by a local opinion leader ( " Unsigned Evidence Statement " ) in this trial . Methods R and omized trial testing three different interventions in patients with coronary disease : ( 1 ) usual care versus ( 2 ) Local Opinion Leader Statement versus ( 3 ) Unsigned Evidence Statement .  Patients diagnosed with coronary artery disease after cardiac catheterization ( but without acute coronary syndromes ) will be r and omly allocated to one of the three interventions by cluster r and omization ( at the level of their primary care physician ) , if they are not on optimal statin therapy at baseline . The primary outcome is the proportion of patients demonstrating improvement in their statin management in the first six months post-catheterization . Secondary outcomes include examinations of the use of ACE inhibitors , anti-platelet agents , beta-blockers , non-statin lipid lowering drugs , and provision of smoking cessation advice in the first six months post-catheterization in the three treatment arms . Although r and omization will be clustered at the level of the primary care physician , the design effect is anticipated to be negligible and the unit of analysis will be the patient . Discussion If either the Local Opinion Leader Statement or the Unsigned Evidence Statement improves secondary prevention in patients with coronary disease , they can be easily modified and applied in other communities and for other target conditions
Conclusions Organisational and professional interventions improved prescribing of statins/lipid-lowering agents and target blood pressure in patients with IHDs but there was little evidence of change in other outcomes .
Objectives Ischaemic heart diseases ( IHDs ) are a leading cause of death worldwide .
Although prescribing according to guidelines improves health outcomes , it remains suboptimal .
We determined whether interventions targeted at healthcare professionals are effective to enhance prescribing and health outcomes in patients with IHDs .