There were no significant effects of organisational  interventions on lipid profile , HbA1c , medication adherence or recurrent cardiovascular events .
Pooled results indicated that educational interventions were not associated with clear differences in any of the review outcomes .
The estimated effects of organisational interventions were compatible with improvements and no differences in several modifiable risk factors .
BACKGROUND People with stroke or transient ischaemic attack ( TIA ) are at increased risk of future stroke and other cardiovascular events .
Evidence -based strategies for secondary stroke prevention have been established .
However , the implementation of prevention strategies could be improved .
OBJECTIVES To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control , including patient adherence to prescribed medications , and the occurrence of secondary cardiovascular events .
Cluster randomized trials utilizing primary care electronic health records: methodological issues in design, conduct, and analysis (eCRT Study)
Background There is growing interest in conducting clinical and cluster r and omized trials through electronic health records . This paper reports on the method ological issues identified during the implementation of two cluster r and omized trials using the electronic health records of the Clinical Practice Research Data link ( CPRD ) . Methods Two trials were completed in primary care : one aim ed to reduce inappropriate antibiotic prescribing for acute respiratory infection ; the other aim ed to increase physician adherence with secondary prevention interventions after first stroke . The paper draws on documentary records and trial data sets to report on the method ological experience with respect to research ethics and research governance approval , general practice recruitment and allocation , sample size calculation and power , intervention implementation , and trial analysis . Results We obtained research governance approvals from more than 150 primary care organizations in Engl and , Wales , and Scotl and . There were 104 CPRD general practice s recruited to the antibiotic trial and 106 to the stroke trial , with the target number of practice s being recruited within six months . Interventions were installed into practice information systems remotely over the internet . The mean number of participants per practice was 5,588 in the antibiotic trial and 110 in the stroke trial , with the coefficient of variation of practice sizes being 0.53 and 0.56 respectively . Outcome measures showed substantial correlations between the 12 months before , and after intervention , with coefficients ranging from 0.42 for diastolic blood pressure to 0.91 for proportion of consultations with antibiotics prescribed , defining practice and participant eligibility for analysis requires careful consideration . Conclusions Cluster r and omized trials may be performed efficiently in large sample s from UK general practice s using the electronic health records of a primary care data base . The geographical dispersal of trial sites presents a difficulty for research governance approval and intervention implementation . Pretrial data analyses should inform trial design and analysis plans . Trial registration Current Controlled Trials IS RCT N47558792 and IS RCT N35701810 ( both registered on 17 March 2010 )
There were no significant effects of organisational  interventions on lipid profile , HbA1c , medication adherence or recurrent cardiovascular events .
Pooled results indicated that educational interventions were not associated with clear differences in any of the review outcomes .
The estimated effects of organisational interventions were compatible with improvements and no differences in several modifiable risk factors .
BACKGROUND People with stroke or transient ischaemic attack ( TIA ) are at increased risk of future stroke and other cardiovascular events .
Evidence -based strategies for secondary stroke prevention have been established .
However , the implementation of prevention strategies could be improved .
OBJECTIVES To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control , including patient adherence to prescribed medications , and the occurrence of secondary cardiovascular events .