Study to Improve Quality of Care and Patient Health in the Field of Cardiovascular Risk Factors in General Practice

NCT ID: NCT00348855

Last Updated: 2011-11-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

1836 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-11-30

Study Completion Date

2010-03-31

Brief Summary

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Observational studies performed in France and abroad in hypertensive patients at high cardiovascular risk have shown a wide gap between the therapeutic targets reached in ambulatory patients and those set by guidelines. In primary prevention, in hypertensive patients at high cardiovascular risk (+ at least 2 risk factors), the gap is secondary to 1) the ignorance of the validated therapeutic targets and strategies, 2) the absence of global cardiovascular risk management, 3) the usual ambulatory medical practice, which is not adapted to a global cardiovascular prevention approach.

Objectives Principal. To demonstrate that a series of 5 specific prevention consultations over 2 years allows a greater number of hypertensive patients at high cardiovascular risk to reach the goals set by guidelines with no deterioration of their quality of life compared with no particular intervention.

Method Pragmatic, cluster-randomised controlled trial. At least 1904 high cardiovascular risk hypertensive patients will be included and followed up during two years by 268 teaching general practitioners from 23 regional teaching colleges. The regional teaching colleges will be randomised to avoid a contamination bias. The study will be coordinated by local coordinators at the college level.

Intervention In the intervention group, the investigators will have training, information, and feed back regarding the management of high risk hypertensive patients. The training will concern the targets to be reached, therapeutic strategies recommended by the AFSSAPS/HAS, and scientific data. The investigators will have an easy guide that can be used during consultations, and will be informed about tobacco withdrawal programs and education for improving diet, exercise and compliance.

In the control group, investigators will care for their patients as usual. End points Main: number of patients who reach all the therapeutic targets defined by the guidelines in the total study population, in the sub-group of patients with hypertension, but free of type-2 diabetes (T2D), and in the sub-group with hypertension and DT2.

Secondary: number of targets reached by the patients, changes in level of blood pressure, LDL-cholesterol, HbA1c, tobacco consumption, and use of aspirin if needed in the total population and its two subgroups, estimated cardiovascular risk, quality of life.

Detailed Description

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Cluster randomised pragmatic controlled trial in general practice

Conditions

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High Risk Hypertensive Patients

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Investigators

Study Groups

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1

Intervention with one day training, electronic device to measure bood pressure, leaflet with goals and drug strategies according to guidelines, six specific cardiovascular consultations during two years, feed back on results of the intervention group at inclusion, year 1 and year 2.

Specific consultations will be focused on goals to be reach, compliance, exercise and diet.

Group Type EXPERIMENTAL

Cardiovascular drugs strategies

Intervention Type OTHER

Implementation of drug strategies according to guidelines to try to reach goals proposed in these guidelines.

Compliance

Intervention Type BEHAVIORAL

Discussion about compliance and questionnaire to assess compliance at inclusion, Year 1 and Year 2.

Exercise

Intervention Type BEHAVIORAL

Discussion with the patient on necessity to have regular exercise. Assessment of exercise by questionnaire at inclusion, year 1 and year 2.

Stop Smoking

Intervention Type BEHAVIORAL

Minimal intervention

Diet

Intervention Type BEHAVIORAL

Discussion with the patient on his (her) alimentation during each of the six consultations and assessment of daily diet at inclusion, year 1 and year 2.

Feed Back

Intervention Type OTHER

Feed back on results in the intervention group at baseline, Year 1 ans Year 2.

2

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Cardiovascular drugs strategies

Implementation of drug strategies according to guidelines to try to reach goals proposed in these guidelines.

Intervention Type OTHER

Compliance

Discussion about compliance and questionnaire to assess compliance at inclusion, Year 1 and Year 2.

Intervention Type BEHAVIORAL

Exercise

Discussion with the patient on necessity to have regular exercise. Assessment of exercise by questionnaire at inclusion, year 1 and year 2.

Intervention Type BEHAVIORAL

Stop Smoking

Minimal intervention

Intervention Type BEHAVIORAL

Diet

Discussion with the patient on his (her) alimentation during each of the six consultations and assessment of daily diet at inclusion, year 1 and year 2.

Intervention Type BEHAVIORAL

Feed Back

Feed back on results in the intervention group at baseline, Year 1 ans Year 2.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Treated High blood Pressure patients with at least two other cardiovascular risks

Exclusion Criteria

* Secondary prevention
Minimum Eligible Age

40 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Institut National de la Santé Et de la Recherche Médicale, France

OTHER_GOV

Sponsor Role collaborator

Assistance Publique - Hôpitaux de Paris

OTHER

Sponsor Role collaborator

Laboratoires Takeda

INDUSTRY

Sponsor Role collaborator

Merck Serono International SA

INDUSTRY

Sponsor Role collaborator

Collège National des Généralistes Enseignants

OTHER

Sponsor Role lead

Responsible Party

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Denis Pouchain

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Denis POUCHAIN, MD

Role: PRINCIPAL_INVESTIGATOR

French National College of GP Teatchers

Michel LIEVRE, MD

Role: STUDY_DIRECTOR

EZUS LYON

Dominique HUAS, MD

Role: STUDY_DIRECTOR

French National College of GP Teatchers

Locations

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Service de Pharmacologie Clinique

Lyon, , France

Site Status

French National College of GP Teatchers

Vincennes, , France

Site Status

Countries

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France

References

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Lebeau JP, Cadwallader JS, Vaillant-Roussel H, Pouchain D, Yaouanc V, Aubin-Auger I, Mercier A, Rusch E, Remmen R, Vermeire E, Hendrickx K. General practitioners' justifications for therapeutic inertia in cardiovascular prevention: an empirically grounded typology. BMJ Open. 2016 May 13;6(5):e010639. doi: 10.1136/bmjopen-2015-010639.

Reference Type DERIVED
PMID: 27178974 (View on PubMed)

Pouchain D, Lievre M, Huas D, Lebeau JP, Renard V, Bruckert E, Girerd X, Boutitie F; French National College of Teachers in General Practice. Effects of a multifaceted intervention on cardiovascular risk factors in high-risk hypertensive patients: the ESCAPE trial, a pragmatic cluster randomized trial in general practice. Trials. 2013 Oct 1;14:318. doi: 10.1186/1745-6215-14-318.

Reference Type DERIVED
PMID: 24083783 (View on PubMed)

Related Links

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Other Identifiers

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CNGE20060702

Identifier Type: -

Identifier Source: org_study_id