Results from the BETTER WISE trial: a pragmatic cluster two arm parallel randomized controlled trial for primary prevention and screening in primary care during the COVID-19 pandemic

BMC Primary Care

Research

Melissa Shea-Budgell¹  Carolina Fernandes²  Nicolette Sopcak²  Donna Patricia Manca³  Denise Campbell-Scherer⁴  Christopher Meaney⁵  Aisha Lofters⁵  Paul Krueger⁵  Rahim Moineddin⁵  Eva Grunfeld⁶  Kerry McBrien⁷  Kris Aubrey-Bassler⁸  Tracy Wong⁹ 

[1] Charbonneau Cancer Institute and Department of Oncology, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6, Calgary, AB, Canada;Department of Family Medicine, University of Alberta, 6-10 University Terrace, T6G 2T4, Edmonton, AB, Canada;Department of Family Medicine, University of Alberta, 6-10 University Terrace, T6G 2T4, Edmonton, AB, Canada;Covenant Health, Grey Nuns Community Hospital, 1100 Youville Drive Northwest, T6L 5X8, Edmonton, AB, Canada;Department of Family Medicine, University of Alberta, 6-10 University Terrace, T6G 2T4, Edmonton, AB, Canada;Office of Lifelong Learning & Physician Learning Program, University of Alberta, 2-590 Edmonton Clinic Health Academy, T6G 1C9, Edmonton, AB, Canada;Department of Family and Community Medicine, University of Toronto, 500 University Ave, M5G 1V7, Toronto, ON, Canada;Department of Family and Community Medicine, University of Toronto, 500 University Ave, M5G 1V7, Toronto, ON, Canada;Ontario Institute for Cancer Research, 661 University Avenue, Suite 510, M5G 0A3, Toronto, ON, Canada;Departments of Family Medicine and Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, T2N 4Z6, Calgary, AB, Canada;Discipline of Family Medicine, Memorial University of Newfoundland, 300 Prince Phillip Drive, A1B 3V6, St. John’s, Newfoundland, Canada;Patient Advisor, Alberta Health Services, Strategic Clinical Networks, Calgary, AB, Canada;

关键词: Cancer survivors;    Chronic disease;    Clinical practice guidelines;    Prevention;    Primary care;    Screening;    COVID-19;    Clinical trial;    Canada;   

DOI  :  10.1186/s12875-023-02159-6

 received in 2022-11-25, accepted in 2023-09-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundCancer and chronic diseases are a major cost to the healthcare system and multidisciplinary models with access to prevention and screening resources have demonstrated improvements in chronic disease management and prevention. Research demonstrated that a trained Prevention Practitioner (PP) in multidisciplinary team settings can improve achievement of patient level prevention and screening actions seven months after the intervention.MethodsWe tested the effectiveness of the PP intervention in a pragmatic two-arm cluster randomized controlled trial. Patients aged 40–65 were randomized at the physician level to an intervention group or to a wait-list control group. The intervention consisted of a patient visit with a PP. The PP received training in prevention and screening and use of the BETTER WISE tool kit. The effectiveness of the intervention was assessed using a composite outcome of the proportion of the eligible prevention and screening actions achieved between intervention and control groups at 12-months. ResultsFifty-nine physicians were recruited in Alberta, Ontario, and Newfoundland and Labrador. Of the 1,005 patients enrolled, 733 (72.9%) completed the 12-month analysis. The COVID-19 pandemic occurred during the study time frame at which time nonessential prevention and screening services were not available and in-person visits with the PP were not allowed. Many patients and sites did not receive the intervention as planned.The mean composite score was not significantly higher in patients receiving the PP intervention as compared to the control group. To understand the impact of COVID on the project, we also considered a subset of patients who had received the intervention and who attended the 12-month follow-up visit before COVID-19. This assessment demonstrated the effectiveness of the BETTER visits, similar to the findings in previous BETTER studies. ConclusionsWe did not observe an improvement in cancer and chronic disease prevention and screening (CCDPS) outcomes at 12 months after a BETTER WISE prevention visit: due to the COVID-19 pandemic, the study was not implemented as planned. Though benefits were described in those who received the intervention before COVID-19, the sample size was too small to make conclusions. This study may be a harbinger of a substantial decrease and delay in CCDPS activities under COVID restrictions. Trial registrationISRCTN21333761. Registered on 19/12/2016. http://www.isrctn.com/ISRCTN21333761.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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