Trial reportQuality & safety in health care2007
Multifaceted implementation of stroke prevention guidelines in primary care: cluster-randomised evaluation of clinical and cost effectiveness.
Trial report in Quality & safety in health care, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 4 syntheses or guidelines pooled it, 57 citations in OpenAlex.
- Local opinion leaders: effects on professional practice and healthcare outcomes.The Cochrane database of systematic reviews · 2019Pooled it
- Systematic screening for the detection of atrial fibrillation.The Cochrane database of systematic reviews · 2016Pooled it
- Guideline
- Local opinion leaders: effects on professional practice and health care outcomes.The Cochrane database of systematic reviews · 2011Pooled it
- Supporting anticoagulant treatment decision making to optimise stroke prevention in complex patients with atrial fibrillation: a cluster randomised trial.BMC family practice · 2020Trial
- Improving stroke prevention therapy for patients with atrial fibrillation in primary care: protocol for a pragmatic, cluster-randomized trial.Implementation science : IS · 2016Trial
- Study protocol: the DESPATCH study: delivering stroke prevention for patients with atrial fibrillation - a cluster randomised controlled trial in primary healthcare.Implementation science : IS · 2011Trial
- Application of Nudges to Design Clinical Decision Support Tools: Systematic Approach Guided by Implementation Science.Journal of medical Internet research · 2025Article
- What methods are currently available for incorporating implementation considerations within the economic evaluation of health technologies? A scoping review.Health research policy and systems · 2024Article
- Audit as a Tool for Improving the Quality of Stroke Care: A Review.International journal of environmental research and public health · 2023Review
- Estimating Costs of Implementing Stroke Systems of Care and Data-Driven Improvements in the Paul Coverdell National Acute Stroke Program.Preventing chronic disease · 2019Article
- SUPPORT-AF: Piloting a Multi-Faceted, Electronic Medical Record-Based Intervention to Improve Prescription of Anticoagulation.Journal of the American Heart Association · 2018Article
- Long-term morbidity and mortality in patients without early complications after stroke or transient ischemic attack.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2017Article
- Clinical practice guidelines in the AANS/CNS Section on Tumors: past, present and future directions.Journal of neuro-oncology · 2014Article
- Supporting Treatment decision making to Optimise the Prevention of STROKE in Atrial Fibrillation: the STOP STROKE in AF study. Protocol for a cluster randomised controlled trial.Implementation science : IS · 2012Article
- Guideline implementation in clinical practice: use of statistical process control charts as visual feedback devices.Journal of family & community medicine · 2009Article
- The Sandwell Project: a controlled evaluation of a programme of targeted screening for prevention of cardiovascular disease in primary care.BMC public health · 2008Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo evaluate clinical and cost effectiveness of implementing evidence-based guidelines for the prevention of stroke.
designCluster-randomised trial
settingThree primary care organisations in the North of England covering a population of 400,000.
participantsSeventy six primary care teams in four clusters: North, South & West, City I and City II.
interventionGuidelines for the management of patients with atrial fibrillation and transient ischaemic attack (TIA) were developed and implemented using a multifaceted approach including evidence-based recommendations, audit and feedback, interactive educational sessions, patient prompts and outreach visits. OUTCOMES: Identification and appropriate treatment of patients with atrial fibrillation or TIA, and cost effectiveness.
resultsImplementation led to 36% increase (95% CI 4% to 78%) in diagnosis of atrial fibrillation, and improved treatment of TIA (odds ratio of complying with guidelines 1.8; 95% CI 1.1 to 2.8). Combined analysis of atrial fibrillation and TIA estimates that compliance was significantly greater (OR 1.46 95% CI 1.10 to 1.94) in the condition for which practices had received the implementation programme. The development and implementation of guidelines cost less than 1500 pounds per practice. The estimated costs per quality-adjusted life year gained by patients with atrial fibrillation or TIA were both less than 2000 pounds, very much less than the usual criterion for cost effectiveness.
conclusionsImplementation of evidence-based guidelines improved the quality of primary care for atrial fibrillation and TIA. The intervention was feasible and very cost effective. Key components of the model include contextual analysis, strong professional support, clear recommendations based on robust evidence, simplicity of adoption, good communication and use of established networks and opinion leaders.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.