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Pragmatic randomised controlled trial
Advanced practice nurses achieve results equal to or better than those of GPs in cardiovascular risk management in primary care
  1. Christianne L Roumie1,2,3,4,
  2. Russell L Rothman4
  1. 1VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, USA
  2. 2HSR&D Targeted Research Enhancement Program for Patient Healthcare Behavior, Nashville, Tennessee, USA
  3. 3Clinical Research Center of Excellence (CRCoE), Nashville, Tennessee, USA
  4. 4Departments of Medicine and Pediatrics, Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  1. Correspondence to Russell L Rothman
    Center for Health Services Research, Vanderbilt University Medical Center, Suite 6000 Medical Center East, Nashville, Tennessee 37232-8300, USA; russell.rothman{at}vanderbilt.edu

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Context of the problem

Guidelines have been available for the diagnosis and management of chronic diseases, particularly cardiovascular risk factors, for the past 25 years. Despite widespread promotion, guidelines have had limited effects on provider behaviour, and a gap in the quality of healthcare remains.1 Strategies to increase the provision of cardiovascular disease (CVD) prevention in primary care may involve information technology, decision support, provider and patient education and the use of physician extenders. For example, a recent study by Becker and colleagues2 demonstrated that a nurse-led intervention could significantly improve cholesterol levels compared with usual primary care.

Current study

Voogdt-Pruis and colleagues investigated the effectiveness of CVD risk management by advanced practice nurses in six primary care practices in the Netherlands. They used a modified Zelen's design …

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