Setting

The study is performed in the Zwolle region in the Netherlands. This region includes 56 general practices (solo, duo and group practices) with in total 157 general practitioners (GPs), which are all affiliated to a care group 'Medrie’. Integrated care for CVRM is implemented in this region and coordinated by this care group by providing a practical guideline for the implementation of integrated care for CVRM, offering training to the PNs and organizing yearly benchmark meetings. Furthermore, all general practices collaborate with the same regional hospital (Isala Hospital) with dedicated medical specialists involved in organizing integrated care for CVRM. The care group reached an agreement on integrated care for CVRM with the regionally largest health care insurance company for 3 yrs. Implementation of other disease management programmes e.g. for diabetes mellitus and COPD is also organized by the same care group.

From January 2016, all practices were given the opportunity to participate in the integrated care for CVRM. Every 3 months there was a possibility to start with the programme. Participation was not mandatory. Consequently, the intervention was not randomly allocated to the practices. Prior to our study, approximately two third of the general practices (n = 37) chose to implement integrated care for CVRM, while the remaining general practices (n = 19) will continue usual care due to a variety of reasons. The practices in the usual care group will not have the opportunity to start with the integrated care for CVRM during the study.

This allowed the opportunity to compare integrated care for CVRM (intervention group) with usual care.