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 .
Recruitment activities for a nationwide, population-based, group-randomized trial: the VA MI-Plus study
Background The Veterans Health Administration ( VHA ) oversees the largest integrated healthcare system in the United States . The feasibility of a large-scale , nationwide , group-r and omized implementation trial of VHA outpatient practice s has not been reported . We describe the recruitment and enrollment of such a trial testing a clinician-directed , Internet-delivered intervention for improving the care of postmyocardial infa rct ion patients with multiple comorbidities . Methods With a recruitment goal of 200 eligible community-based outpatient clinics , parent VHA facilities ( medical centers ) were recruited because they oversee their affiliated clinics and the research conducted there . Eligible facilities had at least four VHA-owned and -operated primary care clinics , an affiliated Institutional Review Board ( IRB ) , and no ongoing , potentially overlapping , quality -improvement study . Between December 2003 and December 2005 , in two consecutive phases , we used initial and then intensified recruitment strategies . Results Overall , 48 of 66 ( 73 % ) eligible facilities were recruited . Of the 219 clinics and 957 clinicians associated with the 48 facilities , 168 ( 78 % ) clinics and 401 ( 42 % ) clinicians participated . The median time from initial facility contact to clinic enrollment was 222 days , which decreased by over one-third from the first to the second recruitment phase ( medians : 323 and 195 days , respectively ; p < .001 ) , when more structured recruitment with physician recruiters was implemented and a dedicated IRB manager was added to the coordinating center staff . Conclusions Large group-r and omized trials benefit from having dedicated physician investigators and IRB personnel involved in recruitment . A large-scale , nationally representative , group-r and omized trial of community-based clinics is feasible within the VHA or a similar national healthcare system
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 .