Preventive evidence into practice (PEP) study: implementation of guidelines to prevent primary vascular disease in general practice protocol for a cluster randomised controlled trial

Implementation Science

Justine Waters⁴  Helen Bolger-Harris⁹  Jinty Wilson⁵  Nick Zwar¹  Richard Taylor¹  Upali W Jayasinghe^1,10  Yordanka Krastev³  Sharon Parker^1,10  Elizabeth Denney-Wilson^1,11  Chris Del Mar²  Jane Smith²  Grant Russell⁷  Danielle Mazza⁷  Mieke van Driel⁶  John Litt⁸  Jane Lloyd^1,10  Mark F Harris^1,10 

[1] School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, 2052, Australia;Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia;Ethics Secretariate, University of Technology Sydney, Ultimo, NSW, 2007, Australia;BUPA Foundation, Sydney, Australia;National Heart Foundation of Australia, Melbourne, Australia;Discipline of General Practice, University of Queensland, St Lucia, QLD, Australia;School of Primary Health Care, Monash University, Melbourne, Australia;Discipline of General Practice, Flinders University, Adelaide, Australia;Royal Australian College of General Practitioners, Melbourne, Australia;Centre for Primary Health Care and Equity, University of New South Wales, Kensington, NSW, 2052, Australia;Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia

关键词: Cardiovascular disease;    Preventive care;    Guidelines;    Family medicine;    Primary care;   

Others  :  813824
DOI  :  10.1186/1748-5908-8-8

 received in 2012-11-23, accepted in 2013-01-11,  发布年份 2013

【 摘 要 】

Background

There are significant gaps in the implementation and uptake of evidence-based guideline recommendations for cardiovascular disease (CVD) and diabetes in Australian general practice. This study protocol describes the methodology for a cluster randomised trial to evaluate the effectiveness of a model that aims to improve the implementation of these guidelines in Australian general practice developed by a collaboration between researchers, non-government organisations, and the profession.

Methods

We hypothesise that the intervention will alter the behaviour of clinicians and patients resulting in improvements of recording of lifestyle and physiological risk factors (by 20%) and increased adherence to guideline recommendations for: the management of CVD and diabetes risk factors (by 20%); and lifestyle and physiological risk factors of patients at risk (by 5%). Thirty-two general practices will be randomised in a 1:1 allocation to receive either the intervention or continue with usual care, after stratification by state. The intervention will be delivered through: small group education; audit of patient records to determine preventive care; and practice facilitation visits adapted to the needs of the practices. Outcome data will be extracted from electronic medical records and patient questionnaires, and qualitative evaluation from provider and patient interviews.

Discussion

We plan to disseminate study findings widely and directly inform implementation strategies by governments, professional bodies, and non-government organisations including the partner organisations.

【 授权许可】

   
2013 Harris et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Britt H, Miller GC, Charles J, Henderson J, Bayram C, Pan Y, Valenti L, Harrison C, O’Halloran J, Fahridin S: General practice activity in Australia 2009–10. Canberra: AIHW; 2010. [General practice series no 27]
• [2]Australian Institute of Health and Welfare: Heart, stroke and vascular diseases, Australian facts. Canberra: Australian Institute of Health and Welfare; 2004.
• [3]Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD: The burden of disease and injury in Australia. Canberra: Australian Institute of Health and Welfare; 2007.
• [4]Litt JC: Exploration of the delivery of prevention in the general practice setting. PhD. Adelaide: Flinders; 2007.
• [5]Young J, Ward J: Implementing guidelines of smoking cessation advice in Australian general practice: opinions, current practice, readiness to change and perceived barriers. Fam Pract 2001, 18:14-20.
• [6]Laws R, Kemp L, Harris M, Powell Davies G, Williams A, Eames-Brown R: An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study. Implement Sci 2009, 4:66. BioMed Central Full Text
• [7]Harris MF, Fanaian M, Jayasinghe U, Passey MM, Lyle D, McKenzie S, Powell DG: What predicts patient reported GP management of SNAPW behaviours? Australian J Prim Health 2011, 18:23-28.
• [8]Whitlock E, Orleans T, Pender N, Allan J: Evaluating primary care behavioural counseling interventions: an evidence-based approach. Am J Prev Med 2002, 22(4):267-284.
• [9]Oxman AD, Thomson MA, Davis DA, et al.: No magic bullets: a systematic review of 102 trials of interventions to help health care professionals deliver services more effectively or efficiently. J Canadian Med Assoc 1995, 153:1423-1431.
• [10]Hulscher ME, Wensing M, van der Weijden T, Grol R: Interventions to implement prevention in primary care. Cochrane Database Syst Rev: Rev 2005., (Issue 1) Art. No.: CD000362.
• [11]Britt H, Miller GC, Charles J, et al.: General practice activity in Australia 1990–00 to 2008–09: 10 year data tables. Canberra: AIHW; 2009.
• [12]Amoroso C, Harris MF, Ampt M, et al.: Health check for 45–49 year old patients in general practice: feasibility and impact on practices and patient behaviour. Australian Family Physician 2009, 38:358-362.
• [13]Mazza D, Harris MF: improving implementation of evidence-based prevention in primary care. Med Australia 2010, 193(2):101-102.
• [14]Harris MF, Hobbs C, Powell Davies G, et al.: Implementation of a SNAP intervention in two divisions of general practice: a feasibility study. Med J Australia 2005, 183:s54-s58.
• [15]Passey ME, Laws RA, Jayasinghe UW, Fanaian M, McKenzie S, Powell-Davies G, Lyle D, Harris MF: Predictors of primary care referrals to a vascular disease prevention lifestyle program among participants in a cluster randomised trial. BMC Health Serv Res 2012, 12:234. BioMed Central Full Text
• [16]Beach M, Roter D, Wang N, Duggan P, Cooper L: Are physicians’ attitudes of respect accurately perceived by patients and associated with more positive communication behaviours? Patient Ed Counsell 2006, 62:347-354.
• [17]Mazza D, Harris MF: Improving implementation of evidence-based prevention in primary care. Med J Aust 2010, 193(2):101-102.
• [18]Hung DY, Rundall TG, Tallia AF, Cohen DJ, Halpin HA, Crabtree BF: Rethinking prevention in primary care: applying the chronic care model to address health risk behaviors. Milbank Quarter 2007, 85(1):69-91.
• [19]Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P: Framework for design and evaluation of complex interventions to improve health. BMJ 2000, 321(7262):694-696.
• [20]Christl B, Lloyd J, Krastev Y, Litt J, Harris M: Preventing vascular disease: effective strategies for implementing guidlines in general practice. Australian Family Physician 2011, 40(10):825-828.
• [21]Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O’Brien Mary A, Wolf F, Davis D, Odgaard-Jensen J, Oxman Andrew D: Continuing education meetings and workshops: effects on professional practice and health care outcomes. Chichester, UK: John Wiley & Sons, Ltd; 2009. [Cochrane database of systematic reviews]
• [22]Satterlee WG, Eggers RG, Grimes DA: Effective medical education: insights from the cochrane library. Obstet Gynecol Surv 2008, 63(5):329-333.
• [23]Davis D, Davis N: Selecting educational interventions for knowledge translation. CMAJ 2010, 182(2):E89-E93.
• [24]Bywood PT, Lunnay B, Roche AM: Strategies for facilitating change in alcohol and other drugs (AOD) professional practice: a systematic review of the effectiveness of reminders and feedback. Drug Alcohol Rev 2008, 27(5):548-558.
• [25]Hogg W, Lemelin J, Graham ID, Grimshaw J, Martin C, Moore L, Soto E, O’Rourke K: Improving prevention in primary care: evaluating the effectiveness of outreach facilitation. Fam Pract 2008, 25(1):40-48.
• [26]PEN Clinical Audit Tool. Pen Computer Systems Pty Ltd and the The Royal Australian College of General Practitioners (RACGP) Melbourne Australiahttp://www.clinicalaudit.com.au/ webcite (accessed 17 Jan 2013)
• [27]Yeazel M, Lindstrom Bremer K, Center B: A validated tool for gaining insight into clinicians’ preventive medicine behaviors and beliefs: The preventive medicine attitudes and activities questionnaire (PMAAQ). Prev Med 2006, 43:86-91.
• [28]Fanaian M, Laws RA, Passey M, McKenzie S, Wan Q, Powell Davies G, Lyle D, Harris MF: Health improvement and prevention study (HIPS) - evaluation of an intervention to prevent vascular disease in general practice. BMC Family Pracice 2010, 11:57. BioMed Central Full Text
• [29]Irvine K, Baker DF, Eyeson-Annan M: Population health monitoring and surveillance: question development field testing - field test 3 report. Sydney: NSW: Department of Health; 2004.
• [30]Amoroso C, Harris MF, Arno A, Laws RA, McKenzie S, Williams AM, Jayasinghe UW, Zwar NA, Davies GP: The 45 year old health check–feasibility and impact on practices and patient behaviour. Australian Family Physician 2010, 38(5):358.
• [31]Steptoe A, Perkins-Porras L, McKay C, Rink E, Hilton S, Cappuccio FP: Behavioural counselling to increase consumption of fruit & vegetables in low income adults. British M J 2003, 326:855-857.
• [32]Smith B, Marshall A, Huang N: Screening for physical activity in family practice: evaluation of two brief assessment tools. Am J Prev Med 2005, 29:256-264.
• [33]Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, Maynard C, Burman ML, Kivlahan DR: Two brief alcohol-screening tests from the alcohol Use disorders identification test (AUDIT): validation in a female veterans affairs patient population. Chicago, IL, ETATS-UNIS: American Medical Association; 2003.
• [34]Zwar N, Richmond RL, Harris M: General practice patients: their readiness to quit smoking. Australian Family Physician 2008, 37(1–2):81-83.
• [35]Marshall AL, Smith BJ, Bauman AE, Kaur S, Bull F: Reliability and validity of a brief physical activity assessment for use by family doctors. British J Sports Med 2005, 39(5):294-297.
• [36]Becker MC, Lazaric N, Nelson RR, Winter SG: Applying organizational routines in understanding organizational change. Ind Corp Chang 2005, 14(5):775-791.
• [37]Becker MC: Organizational routines: a review of the literature. Ind Corp Chang 2004, 13(4):643-678.
• [38]Miller WL, Crabtree BF, Nutting PA, Stange KC, Jaen CR: Primary care practice development: a relationship-centered approach. Annals Family Med 2010, 8(Suppl 1):S68-S79.
• [39]Stroebel CK, McDaniel RR, Crabtree BF, Miller WL, Nutting PA, Stange KC: How complexity science Can inform a reflective process for improvement in primary care practices. Jt Com J Qual Patient Saf 2005, 31(8):438-446.
• [40]Plsek PE, Greenhalgh T: Complexity science: the challenge of complexity in health care. BMJ 2001, 323(7313):625-628.
• [41]Gunn JM, Palmer VJ, Dowrick CF, Herrman HE, Griffiths FE, Kokanovic R, Blashki GA, Hegarty KL, Johnson CL, Potiriadis M, et al.: Embedding effective depression care: using theory for primary care organisational and systems change. Implement Sci 2010, 5:62. BioMed Central Full Text
• [42]Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness. JAMA 2002, 288(14):1775-1779.
• [43]Cohen DJ, Crabtree BF, Etz RS, Balasubramanian BA, Donahue KE, Leviton LC, Clark EC, Isaacson NF, Stange KC, Green LW: Fidelity versus flexibility: translating evidence-based research into practice. Am J Prev Med 2008, 35(5 Suppl):S381-S389.
• [44]Georgiou A, Burns J, McKenzie S, Penn D, Flack J, Harris M: Monitoring change in diabetes care using diabetes registers: experience from divisions of general practice. Australian Family Physician 2006, 35(1–2):77-80.
• [45]The Counterweight Project Team: Evaluation of the counterweight programme for obesity management in primary care: a starting point for continuous improvement. Br J Gen Pract 2008, 58:548-554.
• [46]Counterweight Project Team and Trueman P: Long-term cost-effectiveness of weight management in primary care. Int J Clin Pract 2010, 64:775-783.
• [47]Harris MF, Lloyd J, Krastev Y, Fanaian M, Davies GP, Zwar N, Liaw S-T: Routine use of clinical management guidelines in Australian general practice. Australian J Prim Health 2012. http://dx.doi.org/10.1071/PY12078 webcite
• [48]Christl B, Harris M, Jayasinghe U, Proudfoot J, Taggart J, Tan J: Readiness for organisational change among general practice staff. Quality Safety Health Care 2010, 19(5):1-4.
• [49]Harrison MB, Legare F, Graham ID, Fervers B: Adapting clinical practice guidelines to local context and assessing barriers to their use. Cmaj 2010, 182(2):E78-E84.
• [50]Medves J, Godfrey C, Turner C, Paterson M, Harrison M, MacKenzie L, Durando P: Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice. Int J Evid Based Healthc 2010, 8(2):79-89.
• [51]Hogg W, Lemelin J, Moroz I, Soto E, Russell G: Improving prevention in primary care: evaluating the sustainability of outreach facilitation. Canadian Family Physician 2008, 54:712-720.
• [52]Knox L, Taylor EF, Geonnotti K, Machta R, Kim J, Nysenbaum J, Parchman M: Developing and running a primary care practice facilitation program: a How-to guide: december 2011. Rockville, MD: US Agency for Healthcare Research and Quality; 2011.