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Rational and aims In recent years, guidelines for treatment of patients with chronic heart failure (CHF) have been updated. Insight in current pharmacological and non-pharmacological treatment of CHF in primary care, which was non-optimal in earlier studies, is limited. We aim to describe current pharmacological and non-pharmacological treatment of CHF in primary care. Methods In this cross-sectional observational study, we included a representative sample of 357 patients diagnosed with CHF from 42 primary care practices in the Netherlands. We combined medical record data with data from patient and doctor questionnaires. Results Mean age of patients was 75.7 years (SD 10.2), 53% were male, and 73% of patients had mild heart failure (New York Heart Association class I or II). 76.5% of patients received diuretics. Angiotensin-converting enzyme inhibitors were prescribed in 40.6% and angiotensin-II receptor blockers in 20.7%; β-blockers were prescribed to 54.6%, while 24.9% received spironolactone. Patients with more severe heart failure had a lower probability of being treated according to guideline recommendations. Relevant lifestyle advice was given to 40–60% of the patients, depending on the specific lifestyle advice. Conclusions Implementation of evidence-based pharmacotherapy for heart failure in primary care has improved since clinical guidelines have been updated; especially with respect to prescription of β-blockers. However, there still seems ample room for improvement, as in the case for providing lifestyle advice. [ABSTRACT FROM AUTHOR]

A consistent finding in articles on quality improvement in health care is that change is difficult to achieve. According to the research literature, the majority of interventions are targeted at health care professionals. But success in achieving change may be influenced by factors other than those relating to individual professionals, and theories may help explain whether change is possible. This article argues for a more systematic use of theories in planning and evaluating quality-improvement interventions in clinical practice. It demonstrates how different theories can be used to generate testable hypotheses regarding factors that influence the implementation of change, and it shows how different theoretical assumptions lead to different quality-improvement strategies. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to compare four methods for assessing the preferences of the dental profession for topics to be considered for the development of clinical practice guidelines. Methods: The methods were: (1) a survey among dentists, (2) an analysis of topics discussed in dental peer groups, and (3) screening of dental journals. A fourth method was obtained from method number 3. The frequencies of the reported topics were calculated for each of the methods. For the fourth method, the number of publications per topic were plotted against the year of publication, and the slope of the linear regression line was uscd as an indicator. Within each of the four methods, the topics were ranked according to the frequency in which they were reported, and to the slope value. The reliability of the methods was tested by the "item-rest sum correlation", which is the correlation of the rank positions of one method with the sum of the rank positions obtained by the remaining three methods. Results: In using all methods, a total of 1027 topics were obtained. Reclassification resulted in 34 topics. Moderate item-rest sum correlations ranging from 0.34 to 0.48 were found for all methods, indicating that the rank order of every method moderately predicts the sum of the rank orders obtained by all other methods. The topic 'prevention of cross-infection' had the highest overall rank position. Conclusion: It is concluded that the four applied methods appeared to provide a consistent ranking ofpotential topics. In view of the fact that the questionnaire method is generally applicable, this method should be preferred for assessing dentists' preferences for topics to be considered for the development of clinical practice guidelines. [ABSTRACT FROM AUTHOR]

Background . To explore unfavorable effects, health perception was assessed in patients enrolled in a cardiovascular program in general practice. Methods. A prospective questionnaire survey was conducted shortly after risk detection and after 1 year of intervention. Patients (n=413) with an elevated risk were selected from 27 practices in The Netherlands. The outcome measure was patients' perceptions of their general health status. Results. The response rate was 62%. Two thirds of the patients did not show any change in general health status at either point in time. Substantially more patients showed improvement after 1 year of intervention. Compared to reference data, no major differences were found. Conclusion. Enrollment in a cardiovascular risk detection and intervention program did not lead to unfavorable perceptions of general health status, either shortly after risk detection or after 1 year of intervention. [ABSTRACT FROM AUTHOR]