Implementing and evaluating a program to facilitate chronic disease prevention and screening in primary care: a mixed methods program evaluation

Implementation Science

Eva Grunfeld⁵  Andrew Cave¹  Lee Green¹  Ginetta Salvalaggio¹  Rahim Moineddin⁴  Julia Baxter⁴  Vee Faria²  Christopher Meaney⁴  Mary Ann O¿Brien⁴  Nicolette Sopcak¹  Denise Campbell-Scherer⁶  Carolina Aguilar¹  Kami Kandola²  Kris Aubrey-Bassler³  Donna Patricia Manca⁶ 

[1] Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton T6G 2T4, Alberta, Canada;Department of Health and Social Services, Government of Northwest Territories, Yellowknife X1A 2L9, Northwest Territories, Canada;Discipline of Family Medicine, Memorial University of Newfoundland, 300 Prince Phillip Drive, St. John¿s A1B 3V6, Newfoundland, Canada;Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto M5G 1V7, ON, Canada;Ontario Institute for Cancer Research, 661 University Avenue, Suite 510, Toronto M5G 0A3, ON, Canada;Covenant Health, Grey Nuns Community Hospital, 1100 Youville Drive W Northwest, Edmonton T6L 5X8, Alberta, Canada

关键词: Clinical practice guidelines;    Screening;    Prevention;    Chronic disease;    Program evaluation;   

Others  :  1139538
DOI  :  10.1186/s13012-014-0135-7

 received in 2014-08-13, accepted in 2014-09-19,  发布年份 2014

【 摘 要 】

Background

The objectives of this paper are to describe the planned implementation and evaluation of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER 2) program which originated from the BETTER trial. The pragmatic trial, informed by the Chronic Care Model, demonstrated the effectiveness of an approach to Chronic Disease Prevention and Screening (CDPS) involving the use of a new role, the prevention practitioner. The desired goals of the program are improved clinical outcomes, reduction in the burden of chronic disease, and improved sustainability of the health-care system through improved CDPS in primary care.

Methods/design

The BETTER 2 program aims to expand the implementation of the intervention used in the original BETTER trial into communities across Canada (Alberta, Ontario, Newfoundland and Labrador, the Northwest Territories and Nova Scotia). This proactive approach provides at-risk patients with an intervention from the prevention practitioner, a health-care professional. Using the BETTER toolkit, the prevention practitioner determines which CDPS actions the patient is eligible to receive, and through shared decision-making and motivational interviewing, develops a unique and individualized `prevention prescription¿ with the patient. This intervention is 1) personalized; 2) addressing multiple conditions; 3) integrated through linkages to local, regional, or national resources; and 4) longitudinal by assessing patients over time. The BETTER 2 program brings together primary care providers, policy/decision makers and researchers to work towards improving CDPS in primary care. The target patient population is adults aged 40¿65. The reach, effectiveness, adoption, implementation, maintain (RE-AIM) framework will inform the evaluation of the program through qualitative and quantitative methods. A composite index will be used to quantitatively assess the effectiveness of the prevention practitioner intervention. The CDPS actions comprising the composite index include the following: process measures, referral/treatment measures, and target/change outcome measures related to cardiovascular disease, diabetes, cancer and associated lifestyle factors.

Discussion

The BETTER 2 program is a collaborative approach grounded in practice and built from existing work (i.e., integration not creation). The program evaluation is designed to provide an understanding of issues impacting the implementation of an effective approach for CDPS within primary care that may be adapted to become sustainable in the non-research setting.

【 授权许可】

   
2014 Manca et al.; licensee BioMed Central Ltd.

【 图 表 】

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