Ten-Year Follow-Up of Clinical Governance Implementation in Primary Care: Improving Screening, Diagnosis and Control of Cardiovascular Risk Factors

Carina Aguilar Martín, Alessandra Queiroga Gonçalves, Carlos López-Pablo, José Fernández-Sáez, Emma Forcadell Drago, Zojaina Hernández Rojas, Josep Maria Pepió Vilaubí, Dolores Rodríguez Cumplido, Josep Lluis Piñol, Jordi Bladé-Creixenti and Maria Rosa Dalmau Llorca
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Carina Aguilar Martín: Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
Alessandra Queiroga Gonçalves: Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
Carlos López-Pablo: Sector de Biologia Molecular i Recerca, Hospital de Tortosa Verge de la Cinta, 43500 Tortosa, Tarragona, Spain
José Fernández-Sáez: Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
Emma Forcadell Drago: Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
Zojaina Hernández Rojas: Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
Josep Maria Pepió Vilaubí: Equip d’Atenció Primària Tortosa Oest, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
Dolores Rodríguez Cumplido: Fundació Institut Català de Farmacologia, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
Josep Lluis Piñol: Equip d’Atenció Primària l’Aldea, Institut Català de la Salut, 43896 Aldea, Tarragona, Spain
Jordi Bladé-Creixenti: Equip d’Atenció Primària Horts de Miró, Institut Català de la Salut, 43204 Reus, Tarragona, Spain
Maria Rosa Dalmau Llorca: Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain

IJERPH, 2019, vol. 16, issue 21, 1-11

Abstract: Current improvement strategies for the control of cardiovascular risk factors (CRFs) in Europe are based on quality management policies. With the aim of understanding the effect of interventions delivered by primary healthcare systems, we evaluated the impact of clinical governance on cardiovascular health after ten years of implementation in Catalonia. A cohort study that included 1878 patients was conducted in 19 primary care centres (PCCs). Audits that comprised 13 cardiovascular health indicators were performed and general practitioners received periodic (annual, biannual or monthly) feedback about their clinical practice. We evaluated improvement in screening, diagnosis and control of the main CRFs and the effects of the feedback on cardiovascular risk (CR), incidence of cardiovascular disease (CVD) and mortality, comparing baseline data with data at the end of the study (after a 10-year follow-up). The impact of the intervention was assessed globally and with respect to feedback frequency. General improvement was observed in screening, percentage of diagnoses and control of CRFs. At the end of the study, few clinically significant differences in CRFs were observed between groups. However, the reduction in CR was greater in the group receiving high frequency feedback, specifically in relation to smoking and control of diabetes and cholesterol (Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL)). A protective effect of having a cardiovascular event (hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.44–0.94) or death (HR = 0.55, 95% CI = 0.35–0.88) was observed in patients from centres where general practitioners received high frequency feedback. Additionally, these PCCs presented improved cardiovascular health indicators and lower incidence and mortality by CVD, illustrating the impact of this intervention.

Keywords: cardiovascular diseases; primary health care; clinical audit; feedback; clinical governance; incidence; mortality (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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