| Project Objectives / Summary:
The focus of this project was the development of a system for improved management of multiple cardiovascular risk factors in general practice. The proposed system has 3 main components: a CVD risk calculator, an Action against Risk Checklist and an Information Management System.
The first aim of the project was to use an approach based on marketing concepts (including a marketing approach to focus group research and piloting) to test and improve the design for the proposed system. The second aim of the project was to test the feasibility of a marketing approach to implementation of that system. The third aim of the project was to test the feasibility of evaluating the system thus developed either with a randomised controlled trial or a time series analysis.
Project Outcomes:
Focus groups of GPs and (separately) older unemployed males were successful in identifying barriers to optimal cardiovascular risk management and possibilities for overcoming those barriers.
From that, it was decided to adopt the New Zealand CVD risk calculator, and proposed Checklist was fine-tuned. The aim was to make it a simple instrument that could be completed by GPs within 10-20 minutes.
The proposed Information Management System was redesigned to become a system for detection and recall of high-risk people. The model that was accepted is to screen high-risk groups to identify people who have multiple risk factors for which they are not receiving optimal management. People thus identified would be encouraged to make appointments with GPs once every three months, specifically for the purpose of filling in the Checklist to prompt optimal management. Completed Checklists would be read by a central computer that would generate individualised reports for the GP and the patient and also generate reminder letters or cue reminder phone calls if required to maintain follow-up. Whilst this design was acceptable to all the stakeholders consulted, there was uncertainty about what percentage of people at high risk would agree to commence and continue using the proposed system without additional motivation.
Two thirds of those who agreed to pilot the Checklist by initiating it with their patients failed to find the time to do so. However, GPs believe that they will fill in the Checklist if patients request it in an appointment specifically made for that purpose as currently occurs for driver's licenses and insurance company reports. The GPs who did pilot the Checklist were very satisfied with it.
A randomised controlled trial comparing the proposed system with routine care would be acceptable to all the stakeholders consulted. This would test the hypothesis that this approach to cardiovascular risk management would be successful at appropriate targeting towards those who would benefit most and thus be cost effective.
Lessons / Assessment:
This project was a feasibility study and the report asserts that the Checklist developed would be effective.
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