scholarly journals Mapping De-Implementation Strategies To Identified Determinants of Low-Value Statin Prescription for Primary CVD Prevention in Primary Care

2021 ◽  
Author(s):  
Alvaro Sanchez ◽  
Usue Elizondo-Alzola ◽  
Jose I. Pijoan ◽  
Marta M. Mediavilla ◽  
Susana Pablo ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Primary Prevention ◽  
Healthy Lifestyle ◽  
Implementation Strategies ◽  
Low Risk ◽  
Healthy Lifestyle Promotion ◽  
Risk Patients ◽  
Cvd Prevention ◽  
Primary Care Professionals

Abstract BackgroundDespite clear recommendations supporting healthy lifestyle promotion interventions for the primary prevention of CVD in low-risk patients, a considerable number of these people continue to receive inappropriate statin prescriptions. The present study reports on the structured process based on theory and evidence carried out for the design of de-implementation strategies to reduce the inappropriate prescription of statins and to increase the promotion of healthy lifestyles, in CVD prevention practice of primary care professionals for patients with low cardiovascular risk.MethodsA phase I formative study following a structured theory-informed process combining the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW) was conducted, comprising: semi-structured interviews (n=5) with primary care professionals to delimitate and define the problem in behavioral terms; focus groups (4 groups with 21 physicians; 1 group with 6 patients) to identify the determinants of potentially inappropriate prescribing [PIP] of statins and healthy lifestyle promotion actions; mapping of behavioral change interventions operationalized as de-implementation strategies for addressing identified determinants; and consensus techniques for the prioritization of strategies based on perceived effectiveness, feasibility and acceptability.ResultsNumerous multilevel determinants of both PIP of statins and healthy lifestyle promotion embracing almost all of the TDF dimensions have been identified. Guided by the BCW established procedure, 13 potential de-implementation strategies have been mapped to identified determinants. Those assessed as potentially more feasible, acceptable and potentially effective by the professionals themselves were: 1) Information/knowledge dissemination strategies: a corporate dissemination campaign on “Abandonment of Low-Value Practices”; a Clinical Pathway for the primary prevention of CVD in low-risk patients, accompanied with audiovisual and paper-based training resources; 2) Strategies for presenting relevant information for decision-making: an audit/feedback system regarding CVD prevention practice performance indicators; and 3) Strategies for helping clinical decisions: reminders, alerts, and a decision support tool incorporated into the REGICOR CVD risk calculator in the electronic clinical record.DiscussionThe methodology established by the TDF/BWC for the design of behavior change interventions has been useful for the development of de-implementation strategies targeting the decision-making process of clinicians to favor the uptake of recommended clinical practice for CVD prevention in low-risk patients.TRIAL REGISTRATIONClinicaltrials.gov identifier: NCT04022850. Registered 17 July 2019, https://www.clinicaltrials.gov/ct2/show/NCT04022850

The role of primary care physician and cardiologist follow-up for low-risk patients with chest pain after emergency department assessment

2014 ◽  
Vol 168 (3) ◽  
pp. 289-295 ◽  
Author(s):  
Andrew Czarnecki ◽  
Julie T. Wang ◽  
Jack V. Tu ◽  
Douglas S. Lee ◽  
Michael J. Schull ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Chest Pain ◽  
Primary Care Physician ◽  
Care Physician ◽  
Low Risk ◽  
Risk Patients

Atrial fibrillation detection with a portable device during cardiovascular screening in primary care

Heart ◽  
2020 ◽  
Vol 106 (16) ◽  
pp. 1261-1266 ◽  
Author(s):  
Adriana C Diamantino ◽  
Bruno R Nascimento ◽  
Andrea Z Beaton ◽  
Maria Carmo P Nunes ◽  
Kaciane K B Oliveira ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Heart Disease ◽  
High Risk ◽  
High Sensitivity ◽  
Low Risk ◽  
Intermediate Risk ◽  
Complete Study ◽  
Risk Patients ◽  
Primary Care Patients

IntroductionA novel handheld dual-electrode stick is a portable atrial fibrillation (AF) screening device (AFSD). We evaluated AFSD performance in primary care patients referred for echocardiogram (echo).MethodsThe AFSD has a light indication of irregular rhythm and single-lead ECG recording. Patients were instructed to hold the device for 1 min, and AF indication was recorded. A 12-lead ECG was performed for all AFSD-positive patients and 250 patients with negative AFSD screen. Echos were performed based on a clinical risk score: all high-risk patients and a sampling of low-risk patients underwent complete echo. Intermediate risk patients first had a screening echocardiogram, with a follow-up complete study if abnormality was suspected.ResultsIn 5 days, 1518 patients underwent clinical evaluation and cardiovascular risk stratification: mean age 58±16 years, 66% women. The AFSD was positive in 6.4%: 12.6% high risk, 6.1% intermediate risk and 2.2% low risk. Older age was a risk factor (9.3% vs 4.8% in those more than and less than 65 years, p=0.001). AFSD positive was independently associated with heart disease in echo (OR=3.9, 95% CI 2.1 to 7.2, p<0.001). Compared with 12-lead ECG, the AFSD had sensitivity of 90.2% (95% CI 77.0% to 97.3%) and specificity of 84.0% (95% CI 79.3% to 88.0%) for AF detection.ConclusionAFSD demonstrated high sensitivity for AF detection in primary care patients referred for echo. AF prevalence was substantial and independently associated with structural or functional heart disease, suggesting that AFSD screening could be a useful primary care tool to stratify risk and prioritise echo.

Postmyocardial Infarction Cardiac Rehabilitation in Low Risk Patients. Results With a Coordinated Program of Cardiological and Primary Care

2004 ◽  
Vol 57 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Salvador Espinosa Caliani ◽  
José C. Bravo Navas ◽  
Juan J. Gómez-Doblas ◽  
Ricardo Collantes Rivera ◽  
Belén González Jiménez ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiac Rehabilitation ◽  
Low Risk ◽  
Postmyocardial Infarction ◽  
Risk Patients

scholarly journals North East London coronavirus disease 2019 protocol for diagnostics in two-week wait head and neck cancer patients

2020 ◽  
Vol 134 (8) ◽  
pp. 680-683 ◽  
Author(s):  
E Warner ◽  
D W Scholfield ◽  
A Adams ◽  
P Richards ◽  
S Ali ◽  
...  
Keyword(s):  
Primary Care ◽  
Head And Neck Cancer ◽  
High Risk ◽  
Head And Neck ◽  
Neck Cancer ◽  
Primary Care Physicians ◽  
Management Practices ◽  
Diagnostic Delay ◽  
Low Risk ◽  
Risk Patients

AbstractBackgroundThe coronavirus disease 2019 pandemic requires urgent modification to existing head and neck cancer diagnosis and management practices. A protocol was established that utilises risk stratification, early investigation prior to clinical review and a reduction in aerosol generating procedures to lessen the risk of coronavirus disease 2019 spread.MethodsTwo-week wait referrals were stratified into low, intermediate and high risk. Low risk patients were referred back to primary care with advice; intermediate and high risk patients underwent investigation. Clinical encounters and aerosol generating procedures were minimised. A combined diagnostic and therapeutic surgical approach was undertaken where possible.ResultsForty-one patients were used to assess feasibility. Thirty-one per cent were low risk, 35 per cent were intermediate and 33 per cent were high risk. Thirty-three per cent were discharged with no imaging.ConclusionImplementing this protocol reduces the future burden on tertiary services, by empowering primary care physicians to re-refer low risk patients. The protocol is applicable across the UK and avoids diagnostic delay.

scholarly journals Risk classification in primary prevention of CVD according to QRISK2 and JBS3 ‘heart age’, and prevalence of elevated high-sensitivity C reactive protein in the UK cohort of the EURIKA study

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000849 ◽  
Author(s):  
Ieuan Johns ◽  
Konstantinos E Moschonas ◽  
Jesús Medina ◽  
Nicholas Ossei-Gerning ◽  
George Kassianos ◽  
...  
Keyword(s):  
Primary Prevention ◽  
High Sensitivity ◽  
Low Risk ◽  
Chronological Age ◽  
C Reactive Protein ◽  
Cvd Risk ◽  
Treatment Threshold ◽  
Reactive Protein ◽  
Risk Patients ◽  
Heart Age

ObjectivesThis study assessed cardiovascular disease (CVD) risk classification according to QRISK2, JBS3 ‘heart age’ and the prevalence of elevated high-sensitivity C reactive protein (hsCRP) in UK primary prevention patients.MethodThe European Study on Cardiovascular Prevention and Management in Usual Daily Practice (EURIKA) (NCT00882336) was a cross-sectional study conducted in 12 European countries. 673 UK outpatients aged ≥50 years, without clinical CVD but with at least one conventional CVD risk factor, were recruited. 10-year CVD risk was calculated using QRISK2. JBS3 ‘heart age’ and hsCRP level were assessed according to risk category.ResultsQRISK2 and JBS3 heart age was calculated for 285 of the 305 patients free from diabetes mellitus and not receiving a statin. QRISK2 classified 28%, 39% and 33% of patients as low (<10%), intermediate (10% to <20%) and high (≥20%) risk, respectively. Two-thirds of low-risk patients and half of intermediate-risk patients had a heart age ≥5 years and ≥10 years higher than their chronological age, respectively. Half of low-risk patients had hsCRP levels ≥2 mg/L and approximately 40% had levels ≥3 mg/L. Approximately 80% of low-risk patients had both elevated hsCRP and heart age relative to their chronological age.ConclusionsAlmost 40% more patients in this ‘at risk’ group would be eligible for statin therapy following the lowering of the National Institute for Health and Care Excellence treatment threshold to ≥10% 10-year risk. Of patients falling below this treatment threshold, almost all were at increased lifetime risk as measured by JBS3, and of these, the majority had elevated hsCRP levels. These patients with high absolute risk may benefit from early primary CVD prevention.

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