Effects of Outreach Visits by Trained Nurses on Cardiovascular Risk-Factor Recording in General Practice

Objectives: To study the effects of outreach visits by trained nurses on cardiovascular risk-factor recording. This strategy was compared with a strategy composed of more commonly used methods to improve the quality of care in general practice such as written feedback. Methods: A controlled trial was conducted, in which 33 practices were visited by a trained nurse, 31 practices received written feedback and 31 other practices served as controls. To assess the level of risk-factor recording a chart audit was carried out before and after 18 months of intervention. A sample of medical records of patients aged 30 to 60 was evaluated looking for risk-factor entries: their presence, their combined presence, and their signal function to indicate a risk patient. Risk factors considered were: blood pressure, individual (medical) history as well as family history of cardiovascular diseases, smoking status, serum cholesterol, body weight and alcohol intake. Results: In practices visited by a trained nurse, a significant increase in the recording of most risk factors was found for the presence, the combined presence as well as the signal function. The increase in the presence of entries was consistent in all risk factors and independent of the baseline level. Changes in the group receiving written feedback were inconsistent and statistically not significant. Conclusions: Outreach visits by trained nurses is an effective tool to increase cardiovascular risk-factor recording in general practice.