Effects of treatment recommendations and specialist intervention on care provided by primary care physicians to patients with myocardial infarction or heart failure.

Guadagnoli E, Normand SL, DiSalvo TG, Palmer RH, McNeil BJ
Am J Med. 2004 117 (6): 371-9

PMID: 15380493 · DOI:10.1016/j.amjmed.2004.04.013

PURPOSE - To assess the effects of an intervention involving dissemination of treatment recommendations to primary care physicians treating outpatients with acute myocardial infarction or heart failure.

METHODS - The study comprised 509 patients with myocardial infarction and 323 patients with heart failure who were discharged from hospital. The primary care physicians caring for these patients were assigned randomly to either the intervention or control group; the intervention group was mailed practice guidelines immediately after patient discharge, and patients were cited by name. During a 6-month assessment period, the records of primary care physicians (and cardiologists, if any) were reviewed to assess mean conformance with the guidelines, using seven measures of care for myocardial infarction and eight measures of care for heart failure.

RESULTS - After adjusting for demographic and clinical characteristics of patients, and the number of eligible measures per patient, we observed no effect of the intervention on care of patients with myocardial infarction (odds ratio [OR] = 0.98; 95% confidence interval [CI]: 0.81 to 1.17) or heart failure (OR = 1.25; 95% CI: 0.96 to 1.59). However, there was a higher likelihood of conformance with measures for patients with infarction (OR = 1.56; 95% CI: 1.29 to 1.87) or heart failure (OR = 1.71; 95% CI: 1.29 to 2.23) who had also been seen by a cardiologist during the 6-month assessment period.

CONCLUSION - Mailing treatment recommendations did not improve the quality of care of recently discharged patients with myocardial infarction or heart failure. However, efforts to include cardiologists in the care of these patients might be worthwhile.

Copyright 2004 Elsevier Inc.

MeSH Terms (24)

Adrenergic beta-Antagonists Adult Aged Aged, 80 and over Angiotensin-Converting Enzyme Inhibitors Cardiology Female Follow-Up Studies Heart Block Heart Failure Humans Male Middle Aged Myocardial Infarction Outcome Assessment, Health Care Physicians, Family Practice Guidelines as Topic Psychomotor Performance Quality Assurance, Health Care Sickness Impact Profile Stroke Volume Survival Analysis Treatment Outcome United States

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