Hypertension Clinical Trial
— TRANSITOfficial title:
A Program to TRANSform InTerprofessional Clinical Practices to Improve Cardiovascular Prevention in Primary Care
Verified date | February 2017 |
Source | Fonds de la Recherche en Santé du Québec |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The TRANSIT program is a program to TRANSform InTerprofessional clinical practices to
improve cardiovascular prevention in primary care. It addresses priorities in primary care
relevant to the Chronic Care Model (Wagner 2001): self-management support, delivery-system
design, and management of clinical information.
The program includes :
- a case manager to coordinate and provide care and follow up;
- clinical protocols and tools to support interprofessional and systematic follow up;
- training for clinicians;
- patient's personalized cardiovascular health booklet;
- tools to promote group sessions for patient education on cholesterol, hypertension, and
diabetes.
The general OBJECTIVE of this trial is to evaluate and compare two STRATEGIES for
implementing the TRANSIT program in Family Medicine Groups (FMGs):
1. facilitation, and
2. passive diffusion.
Passive diffusion is the usual strategy where clinicians implement an intervention program
by themselves. Facilitation is a strategy whereby a facilitator provides support to a team
of clinicians to help them introduce the changes required to implement the program into
practice.
The hypothesis is that facilitation will be more efficacious to implement the program than
passive diffusion:
- it will enhance the provision of cardiovascular preventive care;
- it will enhance interprofessional collaboration;
- it will enable more efficaciously the implementation of new clinical processes;
- it will improve patient clinical outcomes;
- it will cost more in the short term, but will have positive economic impact in the long
term;
- there will be less "undesired effects" of all types related to implementation.
To test the hypothesis, we assess the efficacy of the implementation strategies to enhance
interprofessional collaboration and better support patients in the management of their
conditions. Impact on provision of care, interprofessional collaboration, clinical
processes, and patient clinical outcomes (values, therapeutic targets, and lifestyle habits)
will be evaluated. Moreover, the implementation cost related to each strategy will be
estimated.
We complement the trial with qualitative methods to document the perceptions of clinicians,
facilitators, patients and members of the family regarding the TRANSIT program, the
implementation strategies and the observed changes in the clinical practices and outcomes.
Status | Completed |
Enrollment | 759 |
Est. completion date | October 2016 |
Est. primary completion date | October 2013 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - patient is registered in a Family Medicine Group; - 10-year Framingham risk score (FRS) moderate (11-19%) to high (= 20%); - at least one of the following condition uncontrolled: - Diabetes: HbA1C > 7% OR fasting blood glucose > 7 mmol/L OR 2-hour postprandial blood glucose > 10 mmol/L (OR > 8 mmol/L if HbA1C target is not acheived)(Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Canadian Journal of Diabetes, 2008) - Dyslipidemia: C-LDL = 2 mmol/L in moderate to high risk patients OR less than 50% reduction of C-LDL compared to initial value OR Apo-B = 0,8 g/L (Genest, McPherson et al. 2009) - Hypertension: blood pressure = 140/90 ou = 130/80 in diabetic patients or with chronic kidney disease (TFG < 60mL/min/1,73m2; (Cloutier & Poirier 2011) - Patient with at least two chronic disease or chronic health problem other than type II diabetes, dyslipidemia, hypertension, or cardiovascular disease (e.g. : angina, previous history of myocard infarct, stroke, and intermittent claudication). Exclusion Criteria: - Patient followed for a cardiovascular disease in a specialized clinic in secondary care (ex.: cardiology, endocrinology etc). |
Country | Name | City | State |
---|---|---|---|
Canada | Centre de santé et de services sociaux de Laval | Laval | Quebec |
Lead Sponsor | Collaborator |
---|---|
Fonds de la Recherche en Santé du Québec | Université de Montréal |
Canada,
Dogherty EJ, Harrison MB, Graham ID. Facilitation as a role and process in achieving evidence-based practice in nursing: a focused review of concept and meaning. Worldviews Evid Based Nurs. 2010 Jun 1;7(2):76-89. doi: 10.1111/j.1741-6787.2010.00186.x. Review. — View Citation
Fortin M, Soubhi H, Hudon C, Bayliss EA, van den Akker M. Multimorbidity's many challenges. BMJ. 2007 May 19;334(7602):1016-7. — View Citation
Genest J, McPherson R, Frohlich J, Anderson T, Campbell N, Carpentier A, Couture P, Dufour R, Fodor G, Francis GA, Grover S, Gupta M, Hegele RA, Lau DC, Leiter L, Lewis GF, Lonn E, Mancini GB, Ng D, Pearson GJ, Sniderman A, Stone JA, Ur E. 2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult - 2009 recommendations. Can J Cardiol. 2009 Oct;25(10):567-79. Review. — View Citation
Hackam DG, Khan NA, Hemmelgarn BR, Rabkin SW, Touyz RM, Campbell NR, Padwal R, Campbell TS, Lindsay MP, Hill MD, Quinn RR, Mahon JL, Herman RJ, Schiffrin EL, Ruzicka M, Larochelle P, Feldman RD, Lebel M, Poirier L, Arnold JM, Moe GW, Howlett JG, Trudeau L, Bacon SL, Petrella RJ, Milot A, Stone JA, Drouin D, Boulanger JM, Sharma M, Hamet P, Fodor G, Dresser GK, Carruthers SG, Pylypchuk G, Burgess ED, Burns KD, Vallée M, Prasad GV, Gilbert RE, Leiter LA, Jones C, Ogilvie RI, Woo V, McFarlane PA, Hegele RA, Tobe SW; Canadian Hypertension Education Program.. The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2 - therapy. Can J Cardiol. 2010 May;26(5):249-58. Review. — View Citation
Lalonde L, Goudreau J, Hudon É, Lussier MT, Bareil C, Duhamel F, Lévesque L, Turcotte A, Lalonde G; Group for TRANSIT to Best Practices in Cardiovascular Disease Prevention in Primary Care.. Development of an interprofessional program for cardiovascular prevention in primary care: A participatory research approach. SAGE Open Med. 2014 Feb 17;2:2050312114522788. doi: 10.1177/2050312114522788. — View Citation
Lalonde L, Goudreau J, Hudon É, Lussier MT, Duhamel F, Bélanger D, Lévesque L, Martin É; Group for TRANSIT to Best Practices in Cardiovascular Disease Prevention in Primary Care.. Priorities for action to improve cardiovascular preventive care of patients with multimorbid conditions in primary care--a participatory action research project. Fam Pract. 2012 Dec;29(6):733-41. doi: 10.1093/fampra/cms021. — View Citation
Nagykaldi Z, Mold JW, Robinson A, Niebauer L, Ford A. Practice facilitators and practice-based research networks. J Am Board Fam Med. 2006 Sep-Oct;19(5):506-10. Review. — View Citation
Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001 Nov-Dec;20(6):64-78. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Quality of the cardiovascular preventive care | Mean change in the composite score of the quality of the cardiovascular preventive care | Baseline and 12 months after randomization | |
Secondary | Organisational outcomes | Impact of implementation strategy on: clinicians' and patients' perception of health service delivery (questionnaires: ACIC and PACIC); team work (questionnaire: TCI - short version); clinicians' perception of achievement of change (questionnaires: Herscovitch and Meyer's Affective Engagement, Bandura's Self Efficacy, and clinician's perception of achievement of the TRANSIT program [after 12 months only]); direct costs (clinician time and compensations for participation in facilitation activities, salary and training of the external facilitator). |
Baseline and 12 months after randomization | |
Secondary | Blood pressure | Mean change in the systolic/diastolic blood pressure | Baseline and 12 months after randomization | |
Secondary | c-LDL | Mean change in change in the c-LDL | Baseline and 12 months after randomization | |
Secondary | Glycosylated hemoglobine (HgA1c) | Mean change in the HgA1c | Baseline and 12 months after randomization | |
Secondary | Achieved therapeutic targets | Mean change in percentage of achieved therapeutic targets | Baseline and 12 months after randomization | |
Secondary | Lifestyle habits | Mean change in lifestyle habits as measured using self-administered questionnaires to patients : Hopkin's food frequency questionnaire, International Physical Activity Questionnaire (IPAQ), smoking status | Baseline and 12 months after randomization | |
Secondary | Use of public programs | Mean change in percentage of patients using the education programs and in mean frequency of use. Programs are education to patients on diabetes, cholesterol, hypertension, and healthy weight control | Baseline and 12 months after randomization |
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