Evaluating an implementation strategy in cardiovascular prevention to improve prescribing of statins in Germany: an intention to treat analysis.

Background: The prescription of statins is an evidence-based treatment to reduce the risk of cardiovascular events in patients with elevated cardiovascular risk or with a cardiovascular disorder (CVD). In spite of this, many of these patients do not receive statins.

Methods: We evaluated the impact of a brief educational intervention in cardiovascular prevention in primary care physicians' prescribing behaviour regarding statins beyond their participation in a randomised controlled trial (RCT).

arriba-lib: Analyses of user interactions with an electronic library of decision aids on the basis of log data.

Computerised log files are important for analysing user behaviour in health informatics to gain insight into processes that lead to suboptimal user patterns. This is important for software training programmes or for changes to improve usability. Technical user behaviour regarding decision aids has not so far been thoroughly investigated with log files.

Arriba-lib: evaluation of an electronic library of decision aids in primary care physicians.

Background: The successful implementation of decision aids in clinical practice initially depends on how clinicians perceive them. Relatively little is known about the acceptance of decision aids by physicians and factors influencing the implementation of decision aids from their point of view. Our electronic library of decision aids (arriba-lib) is to be used within the encounter and has a modular structure containing evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression.

Arriba-lib: association of an evidence-based electronic library of decision aids with communication and decision-making in patients and primary care physicians.

Aim: In shared decision-making, patients are empowered to actively ask questions and participate in decisions about their healthcare based on their preferences and values. Decision aids should help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes; however, they have rarely been field tested, especially in the primary care context. We therefore evaluated associations between the use of an interactive, transactional and evidence-based library of decision aids (arriba-lib) and communication and decision-making in patients and physicians in the primary care context.

Acceptance of shared decision making with reference to an electronic library of decision aids (arriba-lib) and its association to decision making in patients: an evaluation study.

Background: Decision aids based on the philosophy of shared decision making are designed to help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes. A patient decision aid can be regarded as a complex intervention because it consists of several presumably relevant components. Decision aids have rarely been field tested to assess patients' and physicians' attitudes towards them.

Pitfalls in the statistical examination and interpretation of the correspondence between physician and patient satisfaction ratings and their relevance for shared decision making research.

Background: The correspondence of satisfaction ratings between physicians and patients can be assessed on different dimensions. One may examine whether they differ between the two groups or focus on measures of association or agreement. The aim of our study was to evaluate methodological difficulties in calculating the correspondence between patient and physician satisfaction ratings and to show the relevance for shared decision making research.

Reliability and validity of the German version of the OPTION scale.

Objective: To examine the psychometric properties of the German version of the 'observing patient involvement' scale (OPTION) by analysing video recordings of primary care consultations dealing with counselling in cardiovascular prevention.

Design: Cross-sectional assessment of physician-patient interaction by two rater pairs and two experts in shared decision making (SDM).

Setting: Primary care.

Arriba: effects of an educational intervention on prescribing behaviour in prevention of CVD in general practice.

Background: Evidence on the effectiveness of educational interventions on prescribing behaviour modification in prevention of cardiovascular disease is still insufficient. We evaluated the effects of a brief educational intervention on prescription of hydroxymethylglutaryl-CoA reductase inhibitors (statins), inhibitors of platelet aggregation (IPA), and antihypertensive agents (AH).

Design: Cluster randomised controlled trial with continuous medical education (CME) groups of general practitioners (GPs).

Satisfaction of patients and primary care physicians with shared decision making.

Satisfaction with treatment is regarded as an important outcome measure, but its suitability has not been thoroughly investigated in the context of shared decision making (SDM). The authors evaluated whether both patients' and physicians' satisfaction ratings differ between an intervention group and a control group within a structured tool for cardiovascular prevention (ARRIBA-Herz). In a pragmatic, cluster-randomized, controlled trial, 44 family physicians in the intervention group consecutively recruited 550 patients whereas 47 physicians in the control group included 582 patients.

The course of nonspecific chest pain in primary care: symptom persistence and health care usage.

Background: Nonspecific chest pain is common in primary care, yet knowledge is sparse about its course and outcome and how they relate to optimum health care usage. We investigated the following observations: (1) many patients who present with nonspecific chest pain in primary care show symptom persistence for 6 months, (2) many patients with nonspecific chest pain showed signs of overinvestigation, and (3) many patients with chronic chest pain were referred to mental health specialists.

Methods: We conducted a prospective, general physician-based cohort study with 6-week and 6-month follow-ups in 74 primary care offices in Hessen, Germany.

The theory of planned behaviour in a randomized trial of a decision aid on cardiovascular risk prevention.

Objective: To assess the feasibility and outcome of measuring the theory of planned behaviour (TPB) in patients receiving routine counselling versus counselling with a decision aid (DA) during primary care consultation on cardiovascular risk prevention.

Methods: A DA was developed, based on models of shared decision-making (SDM) and the TPB. We evaluated the impact of the intervention in a randomized controlled trial.

Absolute cardiovascular disease risk and shared decision making in primary care: a randomized controlled trial.

Purpose: We wanted to determine the effect of promoting the effective communication of absolute cardiovascular disease (CVD) risk and shared decision making through disseminating a simple decision aid for use in family practice consultations.

Methods: The study was based on a pragmatic, cluster randomized controlled trial (phase III) with continuing medical education (CME) groups of family physicians as the unit of randomization. In the intervention arm, 44 physicians (7 CME groups) consecutively recruited 550 patients in whom cholesterol levels were measured.

Different from what the textbooks say: how GPs diagnose coronary heart disease.

Background: In patients with chest pain, GPs have to identify those with coronary heart disease (CHD) to arrange for further investigation and treatment. Previous studies have shown that only between 8% and 18% of patients have CHD. In primary care, the history is the most important diagnostic tool.

Aerobic and lung performance in premature children with and without chronic lung disease of prematurity.

Objective: This study intended to identify pulmonary and exercise-related effects of chronic lung disease of infancy (CLD) versus prematurity (PRE) without CLD in children 5 to 7 years old who were born prematurely (24-30 weeks of gestation) with very low and extremely low birthweight of 500 to 1500 g (VLBW, ELBW).

Subjects: Seventeen CLD and 14 PRE were compared with 24 term controls (CON). The premature children had no overt manifestations of a neuromuscular disease.