Improving Stroke Prevention Therapy for Patients With Atrial Fibrillation in Primary Care
2017年10月3日 更新者：Sunnybrook Health Sciences Centre
Improving Stroke Prevention Therapy for Patients With Atrial Fibrillation in Primary Care: Protocol for a Pragmatic, Cluster-randomized Trial
The objective of this project is to increase the proportion of patients with AF that receive adequate stroke prevention therapy.
Over half of patients with AF who suffer strokes are permanently disabled.
Yet there remains a large portion of patients who do not receive appropriate stroke prevention therapy.
The investigators hypothesize that a toolkit of quality improvement strategies in primary care could increase the proportion of patients with atrial fibrillation appropriately treated with stroke prevention therapy.
The investigators' goal is to ensure the toolkit of interventions can be easily incorporated into day-to-day practice in primary care and can be readily and broadly disseminated if successful.
研究概览
详细说明
The prevalence of atrial fibrillation (AF) is growing as the population ages and 15% of all strokes are already attributed to AF.
Unfortunately, half of patients with AF do not receive prescriptions for anticoagulation to prevent stroke due to a variety of system, provider, and patient-level barriers.
The investigators will conduct a pragmatic, cluster-randomized controlled trial to test a 'toolkit' of quality improvement interventions in primary care.
In keeping with the recommendations of the chronic care model to simultaneously facilitate proactive care by providers and activate patients, the toolkit includes provider- focused strategies (education, audit and feedback, electronic medical record-based tools including decision support and reminders) plus patient-directed strategies (educational letters and reminders).
Thirty three primary care clinics will be randomized to the intervention or usual care.
The trial will last 12 months and will be powered to show a difference of 10% in the primary outcome of proportion of patients receiving guideline-concordant care for stroke prevention.
Analysis will be blind to allocation.
研究类型
介入性
注册 (实际的)
5000
阶段
- 不适用
联系人和位置
本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。
学习地点
-
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Ontario
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Toronto、Ontario、加拿大、M4N 3M5
- Institute for Clinical Evaluative Sciences
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参与标准
研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
18年 及以上 (成人、年长者)
接受健康志愿者
不
有资格学习的性别
全部
描述
Inclusion Criteria:
- Physicians are participants in the Electronic Medical Record Administrative-data Linked Database (EMRALD).
- Patients are rostered to participating physicians, with a diagnosis in the chart of atrial fibrillation
Exclusion Criteria:
- Physicians who do not consent to data sharing
- Patients who change physicians during the course of the study
学习计划
本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。
研究是如何设计的？
设计细节
- 主要用途：卫生服务研究
- 分配：随机化
- 介入模型：并行分配
- 屏蔽：单身的
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
|
无干预：Usual care
No standardized intervention for management of patients with atrial fibrillation.
Instead participants receive interventions for management of chronic kidney disease.
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实验性的：quality improvement toolkit
The toolkit includes provider-focused strategies (education, audit and feedback, electronic decision support and reminders) plus patient-directed strategies (educational letters and reminders).
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educational and informatics-based interventions, including brief guideline summary, decision support and audit and feedback
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研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Proportion of patients with AF receiving guideline-concordant stroke prevention therapy
大体时间：one year
|
Patients with risk factors for stroke (ie.
CHADS2 >1 or age >65) who are prescribed anticoagulants and patients with no risk factors for stroke (ie.
CHADS2 = 0 and age <65) who are not prescribed anticoagulants will be considered to be receiving guideline concordant therapy.
(For patients with CHADS2 = 1 but aged < 65 the guideline recommendations are unclear, so these patients will not be considered in the primary analysis.
For example, in patients with AF and hypertension at a younger age, anticoagulation or aspirin or no treatment would each be reasonable.)
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one year
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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proportion of patients taking warfarin in therapeutic range
大体时间：one year
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patients must have INR measured 8 times during the year and therapeutic range assessed using Rosendaal method
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one year
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proportion of patients taking a novel anticoagulant with appropriate dosing
大体时间：one year
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Dabigatran, rivaroxaban and apixaban should be dose-adjusted in renal failure and avoided if estimated creatinine clearance is <30.
Lower dose dabigatran is recommended for patients over 80.
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one year
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proportion receiving aspirin
大体时间：one year
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one year
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proportion receiving clopidogrel
大体时间：one year
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one year
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proportion achieving target blood pressure
大体时间：one year
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target defined as <130/80 for patients with diabetes, <150/80 for patients over 80, and <140/90 for all others
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one year
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合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
调查人员
- 首席研究员：Karen Tu, MD、ICES
出版物和有用的链接
负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。
研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始
2014年8月1日
初级完成 (实际的)
2017年4月1日
研究完成 (实际的)
2017年6月1日
研究注册日期
首次提交
2013年8月14日
首先提交符合 QC 标准的
2013年8月19日
首次发布 (估计)
2013年8月22日
研究记录更新
最后更新发布 (实际的)
2017年10月5日
上次提交的符合 QC 标准的更新
2017年10月3日
最后验证
2017年10月1日
更多信息
此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.