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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.
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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