Effect of tailored practice and patient care plans on secondary prevention of heart disease in general practice: cluster randomised controlled trial
Open accessAbstract
OBJECTIVE: To test the effectiveness of a complex intervention designed, within a theoretical framework, to improve outcomes for patients with coronary heart disease. DESIGN: Cluster randomised controlled multicentre trial. SETTING: General practices in Northern Ireland and the Republic of Ireland, regions with different healthcare systems. PARTICIPANTS: 903 patients with established coronary heart disease registered with one of 48 practices. INTERVENTION: Tailored care plans for practices (practice based training in prescribing and behaviour change, administrative support, quarterly newsletter), and tailored care plans for patients (motivational interviewing, goal identification, and target setting for lifestyle change) with reviews every four months at the practices. Control practices provided usual care. MAIN OUTCOME MEASURES: The proportion of patients at 18 month follow-up above target levels for blood pressure and total cholesterol concentration, and those admitted to hospital, and changes in physical and mental health status (SF-12). RESULTS: At baseline the numbers (proportions) of patients above the recommended limits were: systolic blood pressure greater than 140 mm Hg (305/899; 33.9%, 95% confidence interval 30.8% to 33.9%), diastolic blood pressure greater than 90 mm Hg (111/901; 12.3%, 10.2% to 14.5%), and total cholesterol concentration greater than 5 mmol/l (188/860; 20.8%, 19.1% to 24.6%). At the 18 month follow-up there were no significant differences between intervention and control groups in the numbers (proportions) of patients above the recommended limits: systolic blood pressure, intervention 98/360 (27.2%) v control, 133/405 (32.8%), odds ratio 1.51 (95% confidence interval 0.99 to 2.30; P=0.06); diastolic blood pressure, intervention 32/360 (8.9%) v control, 40/405 (9.9%), 1.40 (0.75 to 2.64; P=0.29); and total cholesterol concentration, intervention 52/342 (15.2%) v control, 64/391 (16.4%), 1.13 (0.63 to 2.03; P=0.65). The number of patients admitted to hospital over the 18 month study period significantly decreased in the intervention group compared with the control group: 107/415 (25.8%) v 148/435 (34.0%), 1.56 (1.53 to 2.60; P=0.03). CONCLUSIONS: Admissions to hospital were significantly reduced after an intensive 18 month intervention to improve outcomes for patients with coronary heart disease, but no other clinical benefits were shown, possibly because of a ceiling effect related to improved management of the disease. TRIAL REGISTRATION: Current Controlled Trials ISRCTN24081411.
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In Murphy 2009, contamination was at low risk of bias.
“Contamination Low risk Randomisation at general practice level”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Murphy 2009
In Murphy 2009, blinding of outcome assessment was at unclear risk of bias.
“Blinding of outcome assessment (detection bias) All outcomes Unclear risk Data were collected from patient records by a research nurse”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Murphy 2009
In Murphy 2009, overall risk of bias was unclear.
“Risk of bias overall Unclear risk 3 unclear risk criteria”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Murphy 2009
In Murphy 2009, baseline characteristics were at low risk of bias.
“Baseline characteristics Low risk Intervention and control groups comparable”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Murphy 2009
In Murphy 2009, other bias was at low risk of bias.
“Other bias Low risk Baseline characteristics similar; low likelihood of contamination”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Murphy 2009
In Murphy 2009, baseline outcomes were at low risk of bias.
“Baseline outcomes Low risk Baseline outcomes comparable”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Murphy 2009
In Murphy 2009, incomplete outcome data was at low risk of bias.
“Incomplete outcome data (attrition bias) All outcomes Low risk”
From Tailored interventions to address determinants of practice (2015) · cites this paper as Murphy 2009
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- Authors
- Murphy, A. W., Cupples, M. E., Smith, S. M., Byrne, M., Byrne, M. C., Newell, J., & for the SPHERE study team
- Affiliations
- Ollscoil na Gaillimhe – University of Galway (IE)
- Queen's University Belfast (GB)
- Corresponding author
- Murphy, A W
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2009-10-29
- Volume
- 339
- Issue
- oct29 4
- Pages
- b4220-b4220
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2770592
- OpenAlex
- W2164123703
- Cited by
- 99
- References
- 42
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 9 · 2017: 5 · 2016: 11 · 2015: 9 · 2014: 6 · 2013: 9 · 2012: 12
- FWCI
- 10.27
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Portal (Queen's University Belfast) (acceptedVersion, cc-by-nc)
- Arrow@dit (Dublin Institute of Technology) (acceptedVersion)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (acceptedVersion, cc-by-nc-nd)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by-nc-nd)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (submittedVersion, cc-by-nc-nd)
- Funders
- Economic and Social Research Council (ES/G007438/1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- secondary prevention, coronary artery disease, motivational interviewing, goal setting, lifestyle modification, blood pressure control, cholesterol management, drug prescribing, behavior change, general practice, complex interventions, hospitalization, quality of life, healthcare system differences, Northern Ireland, Republic of Ireland, primary care quality improvement, patient-centered care
- MeSH terms
- Aged, Blood Pressure, Cholesterol, Coronary Disease, Family Practice, Female, Health Status, Hospitalization, Humans, Hypercholesterolemia, Hypertension, Ireland, Life Style, Male, Mental Health, Northern Ireland, Patient Care Planning
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