Limited data suggest that systematic risk assessment for CVD has no statistically significant effects on clinical endpoints .
There is limited evidence to suggest that CVD systematic risk assessment may have some favourable effects on cardiovascular risk factors .
BACKGROUND Screening programmes can potentially identify people at high cardiovascular risk and reduce cardiovascular disease ( CVD ) morbidity and mortality .
However , there is currently not enough evidence showing clear clinical or economic benefits of systematic screening-like programmes over the widely practised opportunistic risk assessment of CVD in primary care setting s. OBJECTIVES The primary objective of this review was to assess the effectiveness , costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD .
An open cluster-randomized, 18-month trial to compare the effectiveness of educational outreach visits with usual guideline dissemination to improve family physician prescribing
Background The Portuguese National Health Directorate has issued clinical practice guidelines on prescription of anti-inflammatory drugs , acid suppressive therapy , and antiplatelets . However , their effectiveness in changing actual practice is unknown . Methods The study will compare the effectiveness of educational outreach visits regarding the improvement of compliance with clinical guidelines in primary care against usual dissemination strategies . A cost-benefit analysis will also be conducted . We will carry out a parallel , open , superiority , r and omized trial directed to primary care physicians . Physicians will be recruited and allocated at a cluster-level ( primary care unit ) by minimization . Data will be analyzed at the physician level . Primary care units will be eligible if they use electronic prescribing and have at least four physicians willing to participate . Physicians in intervention units will be offered individual educational outreach visits ( one for each guideline ) at their workplace during a six-month period . Physicians in the control group will be offered a single unrelated group training session . Primary outcomes will be the proportion of cyclooxygenase-2 inhibitors prescribed in the anti-inflammatory class , and the proportion of omeprazole in the proton pump inhibitors class at 18 months post-intervention . Prescription data will be collected from the regional pharmacy cl aims data base . We estimated a sample size of 110 physicians in each group , corresponding to 19 clusters with a mean size of 6 physicians . Outcome collection and data analysis will be blinded to allocation , but due to the nature of the intervention , physicians and detailers can not be blinded . Discussion This trial will attempt to address unresolved issues in the literature , namely , long term persistence of effect , the importance of sequential visits in an outreach program , and cost issues . If successful , this trial may be the cornerstone for deploying large scale educational outreach programs within the Portuguese National Health Service . Trial registration Clinical Trials.gov number NCT01984034
Limited data suggest that systematic risk assessment for CVD has no statistically significant effects on clinical endpoints .
There is limited evidence to suggest that CVD systematic risk assessment may have some favourable effects on cardiovascular risk factors .
BACKGROUND Screening programmes can potentially identify people at high cardiovascular risk and reduce cardiovascular disease ( CVD ) morbidity and mortality .
However , there is currently not enough evidence showing clear clinical or economic benefits of systematic screening-like programmes over the widely practised opportunistic risk assessment of CVD in primary care setting s. OBJECTIVES The primary objective of this review was to assess the effectiveness , costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD .