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Article:
Jens Søndergaard, Dorte Gilså Hansen, Peter Aarslev, and Anders P. Munck
A multifaceted intervention according to the Audit Project Odense method improved secondary prevention of ischemic heart disease: a randomised controlled trial
Fam. Pract. 2005; 0: cmi090v1 [Abstract] [PDF]
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[Read eLetter] An over-optimistic interpretation?
Mary C Byrne, Margaret C Cupples, Susan M Smith, Molly Byrne, Andrew W Murphy   (28 March 2006)

An over-optimistic interpretation? 28 March 2006
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Mary C Byrne,
Researcher
Department of General Practice, 1 Distillery Road, National University of Ireland, Galway, Ireland,
Margaret C Cupples, Susan M Smith, Molly Byrne, Andrew W Murphy

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Re: An over-optimistic interpretation?

Dear Professor Delaney,

We read with interest the paper by Sondergaard et al. (1) on the achievement of improved secondary prevention of heart disease in Denmark using a multi-faceted intervention. We are currently carrying out a randomised controlled trial in Irish general practice of another complex intervention, also designed to improve secondary prevention of heart disease (the SPHERE study) (2).

The Danish intervention significantly increased prescribing of lipid- lowering drugs and aspirin. While this outcome is to be welcomed, we feel the authors are being over-optimistic in concluding that the Audit Project Odense is ‘a promising way of improving the quality of preventive treatment’. The key area for research in this field is not improving prescribing but achieving long-term lifestyle behaviour change (3). This approach is supported by a recently-published paper on the World Health Organization’s MONICA project which acknowledges that medication alone could not have been responsible for patterns of declining blood pressure across Europe and highlights that ‘other factors, potentially of great public health interest, were more pervasive and powerful’ such as ‘lifestyle or hygienic methods of controlling risk factors’ (4).

The multi-faceted approach of the SPHERE intervention targets both medication prescribing and behaviour change (5), in a bid to tackle the determinants of heart disease as comprehensively as possible. Final results of this trial will be published in 2008 when we hope to be able to shed further light on effective solutions to this important public health issue.

Finally, a detailed protocol describing the various components of a complex intervention, together with parallel qualitative work, can be helpful in delineating the relative effectiveness of different elements.

Yours sincerely,

Dr. Mary C Byrne, Department of General Practice, NUI, Galway

Dr. Margaret C Cupples, Department of General Practice, Queen’s University Belfast

Dr. Susan M Smith, Department of Public Health and Primary Care, Trinity College Dublin

Dr. Molly Byrne, Department of Psychology, NUI, Galway

Prof. Andrew W Murphy, Department of General Practice, NUI, Galway

References

1. Sondergaard J, Hansen DG, Aarslev P, Munck AP. A multifaceted intervention according to the Audit Project Odense method improved secondary prevention of ischemic heart disease: a randomised controlled trial. Fam. Pract. 2006;23(2):198-202.

2. Murphy AW, Cupples ME, Smith S, Byrne M, Leathem C, Byrne MC. The SPHERE Study. Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411]. Current Controlled Trials in Cardiovascular Medicine 2005. Jul 29;6(1):11

3. Hulscher MEJL, Wensing M, van der Weijden T, Grol R. Interventions to implement prevention in primary care. The Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD000362. DOI: 10.1002/14651858.CD000362.pub2.

4. Tunstall-Pedoe H, Connaghan J, Woodward M, Tolonen H, Kuulasmaa K. Pattern of declining blood pressure across replicate population surveys of the WHO MONICA project, mid-1980s to mid-1990s, and the role of medication. BMJ, doi:10.1136/ bmj.38753.779005.BE (published 10 March 2006).

5. Byrne M, Corrigan M, Cupples ME, Smith SM, Leathem C, Murphy AW. The SPHERE study: Using psychological theory to inform the development of behaviour change training for primary care staff to increase secondary prevention of coronary heart disease. Irish Journal of Psychology 2005; 26(1-2):53-64.

Conflict of Interest:

None declared