• Mark Fort Harris, Sharon M Parker, John Litt, Mieke van Driel, Grant Russell, Danielle Mazza, Upali W Jayasinghe, Chris Del Mar, Jane Lloyd, Jane Smith, Nicholas Zwar, Richard Taylor, Gawaine Powell Davies, and Preventive Evidence into Practice Partnership Group.
• Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia.
• BMJ Open. 2015 Dec 11; 5 (12): e009397.

ObjectiveTo evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease.Setting32 urban general practices in 4 Australian states.RandomisationStratified randomisation of practices.Participants122 general practitioners (GPs) and practice nurses (PNs) were recruited at baseline and 97 continued to 12 months. 21,848 patient records were audited for those aged 40-69 years who attended the practice in the previous 12 months without heart disease, stroke, diabetes, chronic renal disease, cognitive impairment or severe mental illness.InterventionThe practice level intervention over 6 months included small group training of practice staff, feedback on audited performance, practice facilitation visits and provision of patient education and referral information.Outcome MeasuresPrimary: 1. Change in proportion of patients aged 40-69 years with smoking status, alcohol intake, body mass index (BMI), waist circumference (WC), blood pressure (BP) recorded and for those aged 45-69 years with lipids, fasting blood glucose and cardiovascular risk in the medical record. 2. Change in the level of risk for each factor.Secondarychange in self-reported frequency and confidence of GPs and PNs in assessment.ResultsRisk recording improved in the intervention but not the control group for WC (OR 2.52 (95% CI 1.30 to 4.91)), alcohol consumption (OR 2.19 (CI 1.04 to 4.64)), smoking status (OR 2.24 (1.17 to 4.29)) and cardiovascular risk (OR 1.50 (1.04 to 2.18)). There was no change in recording of BP, lipids, glucose or BMI and no significant change in the level of risk factors based on audit data. The confidence but not reported practices of GPs and PNs in the intervention group improved in the assessment of some risk factors.ConclusionsThis intervention was associated with improved recording of some risk factors but no change in the level of risk at the follow-up audit.Trial Registration NumberAustralian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000578808, results.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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