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Abstract：
BACKGROUND: There is inconsistent utilisation of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by healthcare professionals to identify CVD risk factors early and to intervene using current recommendations. To address this issue, the Cardiovascular Assessment Screening Program (CASP) was developed, implemented, and evaluated. This manuscript reports on the second phase of an exploratory sequential mixed methods study that tested the effectiveness of the CASP with nurse practitioners (NPs) and patients in Canada.
METHODS: A two-armed, non-blinded, cluster randomised controlled trial (cRCT) compared the NP-led implementation of CASP with usual care by NPs in community practice clinics across one Canadian province. The NPs were the cluster variable as their screening practices could be affected by their educational training, resources, or other factors. NPs were eligible for inclusion in the study if they were located in different urban and rural community settings and could conduct follow-up visits with patients. NPs recruited and enrolled the patients from their own practices as participants if they were healthy individuals, aged 40-74 years, with no established CVD or vascular disease. Researchers randomly allocated the NPs (n = 10) to the intervention group (IG) or the control group (CG).
RESULTS: Eight (8) NPs and 167 patients participated in the cRCT study. Patient participant-level data were analysed by the originally assigned groups IG (n = 68) and CG (n = 99). Utilising GLM (generalized linear modeling) more IG patients (90%; n = 61) received comprehensive CVD screening compared to the CG patients (2%; n = 2), RR = 30.2, 95% CI [8.76, 103.9], p < .0001, controlling for the effect of NP and BP category.
CONCLUSIONS: NP implementation of CASP was effective for comprehensive screening compared to usual care and led to identifying previously unknown CVD risk factors, calculated FRS, heart health priorities and personalised goal-setting.
BACKGROUND: ClinicalTrial.gov ID#: NCT03170752, date of registration 2017/05/31.
METHODS: A two-armed, non-blinded, cluster randomised controlled trial (cRCT) compared the NP-led implementation of CASP with usual care by NPs in community practice clinics across one Canadian province. The NPs were the cluster variable as their screening practices could be affected by their educational training, resources, or other factors. NPs were eligible for inclusion in the study if they were located in different urban and rural community settings and could conduct follow-up visits with patients. NPs recruited and enrolled the patients from their own practices as participants if they were healthy individuals, aged 40-74 years, with no established CVD or vascular disease. Researchers randomly allocated the NPs (n = 10) to the intervention group (IG) or the control group (CG).
RESULTS: Eight (8) NPs and 167 patients participated in the cRCT study. Patient participant-level data were analysed by the originally assigned groups IG (n = 68) and CG (n = 99). Utilising GLM (generalized linear modeling) more IG patients (90%; n = 61) received comprehensive CVD screening compared to the CG patients (2%; n = 2), RR = 30.2, 95% CI [8.76, 103.9], p < .0001, controlling for the effect of NP and BP category.
CONCLUSIONS: NP implementation of CASP was effective for comprehensive screening compared to usual care and led to identifying previously unknown CVD risk factors, calculated FRS, heart health priorities and personalised goal-setting.
BACKGROUND: ClinicalTrial.gov ID#: NCT03170752, date of registration 2017/05/31.
摘要：
背景：医疗保健专业人员对心血管疾病（CVD）筛查和管理的临床实践指南（CPG）的使用不一致，无法及早识别CVD危险因素并使用当前建议进行干预。为了解决这个问题，制定了心血管评估筛查计划（CASP），已实施，并进行了评估。本手稿报告了探索性序贯混合方法研究的第二阶段，该研究测试了CASP与加拿大的护士从业人员（NPs）和患者的有效性。
方法：双臂，非致盲,整群随机对照试验(cRCT)在加拿大一个省的社区诊所中比较了NP主导的CASP实施和NPs的常规治疗.NP是聚类变量，因为他们的筛查实践可能会受到他们的教育培训的影响，资源,或其他因素。如果NPs位于不同的城市和农村社区环境，并且可以对患者进行随访，则他们有资格纳入研究。NPs从他们自己的实践中招募并招募患者作为参与者，如果他们是健康的个体，40-74岁,没有确定的CVD或血管疾病。研究人员将NP（n=10）随机分配到干预组（IG）或对照组（CG）。
结果：八（8）名NP和167名患者参与了cRCT研究。患者参与者水平的数据由最初分配的组IG（n=68）和CG（n=99）进行分析。使用GLM（广义线性模型），与CG患者（2％；n=2）相比，更多的IG患者（90％；n=61）接受了全面的CVD筛查，RR=30.2，95%CI[8.76，103.9]，p<.0001，控制NP和BP类别的影响。
结论：NP实施CASP与常规治疗相比，可有效进行全面筛查，并可识别先前未知的CVD危险因素。计算FRS，心脏健康优先事项和个性化目标设定。
背景：ClinicalTrial.govID#：NCT03170752，注册日期2017/05/31。
方法：双臂，非致盲,整群随机对照试验(cRCT)在加拿大一个省的社区诊所中比较了NP主导的CASP实施和NPs的常规治疗.NP是聚类变量，因为他们的筛查实践可能会受到他们的教育培训的影响，资源,或其他因素。如果NPs位于不同的城市和农村社区环境，并且可以对患者进行随访，则他们有资格纳入研究。NPs从他们自己的实践中招募并招募患者作为参与者，如果他们是健康的个体，40-74岁,没有确定的CVD或血管疾病。研究人员将NP（n=10）随机分配到干预组（IG）或对照组（CG）。
结果：八（8）名NP和167名患者参与了cRCT研究。患者参与者水平的数据由最初分配的组IG（n=68）和CG（n=99）进行分析。使用GLM（广义线性模型），与CG患者（2％；n=2）相比，更多的IG患者（90％；n=61）接受了全面的CVD筛查，RR=30.2，95%CI[8.76，103.9]，p<.0001，控制NP和BP类别的影响。
结论：NP实施CASP与常规治疗相比，可有效进行全面筛查，并可识别先前未知的CVD危险因素。计算FRS，心脏健康优先事项和个性化目标设定。
背景：ClinicalTrial.govID#：NCT03170752，注册日期2017/05/31。
