The systematizing of primary care prevention services has the potential of improving physicians' implementation of national guidelines for coronary heart disease (CHD) prevention. this five-year study, to be conducted in community practices in three Midwestern states, will provide extensive descriptive information regarding current prevention practices of primary care physicians and will evaluate two interventions designed to improve recognition and management of patients who have high blood cholesterol, hypertension, history of smoking, or family history of premature CHD. The study's interventions are: (1) PRACTICE CONSULTATION, and (2) introduction of a project-trained PREVENTION COORDINATOR into a practice. The first intervention uses a series of meetings between study consultants and practice personnel to identify and evaluate a practice's current systems of preventive care delivery, provide feedback from baseline audits, develop plans for detection and management of patients at risk of CHD, and reinforce positive changes instituted by the practice during the study. The second intervention involves adding a grant-funded Prevention Coordinator to a practice's staff to organize systematic delivery of preventive and patient education services. The two interventions are developed from educational and organizational theory, a successful feasibility project, and experience from pilot practice research. Our prior research found that: (1) detection, assessment, and management of CHD risk factors in primary care are not optimal; (2) practice organization for delivery of preventive and patient education services is irregular and idiosyncratic; and (3) barriers to adequate preventive care such as limited clinical time, inadequate physician and staff training, patients' reluctance to accept preventive services, practice inefficiency, and lack of practice support can be assessed objectively and addressed realistically. The pilot project which we conducted demonstrated that the proposed interventions can be implemented successfully in typical primary care practices. The study's factorial design tests these two interventions separately and in combination to establish the level of support required to ensure adequate delivery of preventive services in primary care practices. The study will utilize medical record audits, practice organization audits, physician and staff surveys, Prevention Coordinator activity logs, patient reports of practice and personal behaviors, and financial analyses of Prevention Coordinators' productivity to quantify the effectiveness and feasibility of these interventions for improving heart disease prevention services in primary care.
