Practice visitations in primary care to improve performance of cardiovascular risk management: an observational study

BACKGROUND: Despite programmatic protocolized care and structured support, considerable variation is observed in completeness of registration and achieving targets of cardiovascular risk management between individual general practitioners in the Netherlands.

AIM: To determine whether completeness of registration and achieved targets of cardiovascular risk factors improves with practice visitation.

DESIGN & SETTING: Observational study utilizing the care groups' database (2016-2019) comparing changes in registration and achieved targets in non-visited practices and visited practices.

METHOD: We compared completeness scores of registration and scores of targets achieved before visitation and 1 year after visitation. Data were analyzed on patient level and on general practitioners level. Separate analyses were performed among general practitioners who were ranked in the lower 25% of score distributions.

RESULTS: We observed no clinically relevant improvements in completeness of registration and targets achieved in 2017, 2018 and 2019 that could be attributed to visitations in the previous year, both on individual patient level as on aggregated level per general practice.In practices ranked in the lower 25% of the distribution, improvements over time were clinically relevant and larger than the overall changes. Yet, these findings were irrespective of the number of practice visitations.

CONCLUSION: Practice visitations in our setting did not seem to lead to improvements in practice performance, nor in completeness of registration of risk factors or in reaching predefined target goals for cardiovascular risk factors.