There were no significant effects of interventions on mean blood pressure or cholesterol levels , prescribing , smoking status or body mass index .
There was some suggestion of a " ceiling effect " whereby interventions have a diminishing beneficial effect once certain levels of risk factor management are reached .
There is weak evidence that regular planned recall of patients for appointments , structured monitoring of risk factors and prescribing , and education for patients can be effective in increasing the proportions of patients within target levels for cholesterol control and blood pressure .
BACKGROUND Ischaemic heart disease ( IHD ) is a major cause of mortality and morbidity and its prevalence is set to increase .
Secondary prevention aims to prevent subsequent acute events in people with established IHD .
While the benefits of individual medical and lifestyle interventions is established , the effectiveness of interventions which seek to improve the way secondary preventive care is delivered in primary care or community setting s is less so .
OBJECTIVES To assess the effectiveness of service organisation interventions , identifying which types and elements of service change are associated with most improvement in clinician and patient adherence to secondary prevention recommendations relating to risk factor levels and monitoring ( blood pressure , cholesterol and lifestyle factors such as diet , exercise , smoking and obesity ) and appropriate prophylactic medication .
Impact of opinion leader-endorsed evidence summaries on the quality of prescribing for patients with cardiovascular disease: a randomized controlled trial.
BACKGROUND Local opinion leaders are educationally and socially influential physicians . Although they can accelerate the adoption of new evidence in hospitals , their impact on the quality of prescribing for out patients has only been examined by a few studies . We hypothesized that an intervention consisting of patient-specific one-page evidence summaries , generated and endorsed by local opinion leaders , would improve prescribing of angiotensin-converting enzyme ( ACE ) inhibitors or angiotensin receptor blockers ( ARBs ) in heart failure ( HF ) and that of statins in ischemic heart disease ( IHD ) . METHODS We conducted a community-based r and omized controlled trial in patients with HF ( not receiving ACE inhibitors or ARBs ) and those with IHD ( not receiving statins ) who were recruited from 40 pharmacies and allocated either to the opinion leader intervention or to usual care based on r and omization of their primary care physician . The primary outcome was an increase in the use of efficacious therapies ( ACE inhibitors or ARBs in HF and statins in IHD ) within 6 months ; the secondary outcomes were prescribing changes for HF or IHD . RESULTS A total of 171 patients participated in the study ; 87 were allocated to the intervention , whereas 84 were assigned to the  control group .  The median age of the participants was 75 years ; 103 ( 60 % ) were female , 54 ( 32 % ) had HF , and 117 ( 68 % ) had IHD . Overall , 21 ( 24 % ) intervention patients started receiving an efficacious medication within 6 months , as compared with 15 ( 18 % ) control subjects ( relative risk of improvement 1.32 , 95 % CI 0.73 - 2.40 , P = .31 ) . In the HF subgroup , 38 % of the intervention patients started receiving an ACE inhibitor or ARB therapy , as compared with 20 % of control subjects ( relative risk of improvement 1.90 , 95 % CI 0.76 - 4.72 , P = .15 ) . In the IHD subgroup , 17 % of the intervention patients and 17 % of the control subjects started receiving  statin therapy  ( P = .97 ) . CONCLUSIONS The influence of local opinion leaders may be useful for improving the quality of cardiovascular prescribing in the community , but the benefits are likely modest and may be disease specific . Further studies on this method are warranted
There were no significant effects of interventions on mean blood pressure or cholesterol levels , prescribing , smoking status or body mass index .
There was some suggestion of a " ceiling effect " whereby interventions have a diminishing beneficial effect once certain levels of risk factor management are reached .
There is weak evidence that regular planned recall of patients for appointments , structured monitoring of risk factors and prescribing , and education for patients can be effective in increasing the proportions of patients within target levels for cholesterol control and blood pressure .
BACKGROUND Ischaemic heart disease ( IHD ) is a major cause of mortality and morbidity and its prevalence is set to increase .
Secondary prevention aims to prevent subsequent acute events in people with established IHD .
While the benefits of individual medical and lifestyle interventions is established , the effectiveness of interventions which seek to improve the way secondary preventive care is delivered in primary care or community setting s is less so .
OBJECTIVES To assess the effectiveness of service organisation interventions , identifying which types and elements of service change are associated with most improvement in clinician and patient adherence to secondary prevention recommendations relating to risk factor levels and monitoring ( blood pressure , cholesterol and lifestyle factors such as diet , exercise , smoking and obesity ) and appropriate prophylactic medication .