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Open AccessArticle

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

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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
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Unitat d’Avaluació, Direcció d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
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Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L‘Ebre, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
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Sector de Biologia Molecular i Recerca, Hospital de Tortosa Verge de la Cinta, 43500 Tortosa, Tarragona, Spain
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Equip d’Atenció Primària Tortosa Oest, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
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Equip d’Atenció Primària Tortosa Est, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
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Fundació Institut Català de Farmacologia, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
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Equip d’Atenció Primària l’Aldea, Institut Català de la Salut, 43896 Aldea, Tarragona, Spain
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Equip d’Atenció Primària Horts de Miró, Institut Català de la Salut, 43204 Reus, Tarragona, Spain
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Author to whom correspondence should be addressed.
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Int. J. Environ. Res. Public Health 2019, 16(21), 4299; https://doi.org/10.3390/ijerph16214299
Received: 14 October 2019 / Revised: 2 November 2019 / Accepted: 4 November 2019 / Published: 5 November 2019
(This article belongs to the Section Health Care Sciences & Services)
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. View Full-Text
Keywords: cardiovascular diseases; primary health care; clinical audit; feedback; clinical governance; incidence; mortality cardiovascular diseases; primary health care; clinical audit; feedback; clinical governance; incidence; mortality
MDPI and ACS Style

Aguilar Martín, C.; Gonçalves, A.Q.; López-Pablo, C.; Fernández-Sáez, J.; Forcadell Drago, E.; Hernández Rojas, Z.; Pepió Vilaubí, J.M.; Rodríguez Cumplido, D.; Piñol, J.L.; Bladé-Creixenti, J.; Dalmau Llorca, M.R. Ten-Year Follow-Up of Clinical Governance Implementation in Primary Care: Improving Screening, Diagnosis and Control of Cardiovascular Risk Factors. Int. J. Environ. Res. Public Health 2019, 16, 4299.

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