Guideline harmonization and implementation plan for the BETTER trial: Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice

Campbell‐Scherer, Denise; Rogers, Joel; Manca, Donna; Lang-Robertson, Kelly; Bell, Stephanie; Salvalaggio, Ginetta; Greiver, Michelle; Korownyk, Christina; Klein, Doug; Carroll, June C.; Kahan, Mel; Meuser, Jamie; Buchman, Sandy; Barrett, R M S; Grunfeld, Eva

doi:10.9778/cmajo.20130040

Cited by 18 publications

(42 citation statements)

References 28 publications

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“…A clinical working group selected and harmonized the high-quality recommendations for the chronic conditions in the BETTER Trial [21]. The BETTER pragmatic cluster randomized controlled trial demonstrated that a unique intervention through a PP could improve the implementation of clinically important CDPS in a cost-effective manner [19].…”

Section: Discussionmentioning

confidence: 99%

Finding a BETTER way: A qualitative study exploring the prevention practitioner intervention to improve chronic disease prevention and screening in family practice

et al. 2014

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BackgroundOur randomized controlled trial (The BETTER Trial) found that training a clinician to become a Prevention Practitioner (PP) in family practices improved chronic disease prevention and screening (CDPS). PPs were trained on CDPS and provided prevention prescriptions tailored to participating patients. For this embedded qualitative study, we explored perceptions of this new role to understand the PP intervention.MethodsWe used grounded theory methodology and purposefully sampled participants involved in any capacity with the BETTER Trial. Two physicians and one coordinator in each of two cities (Toronto, Ontario and Edmonton, Alberta) conducted eight individual semi-structured interviews and seven focus groups. We used an interview guide and documented research activities through an audit trail, journals, field notes and memos. We analyzed the data using the constant comparative method throughout open coding followed by theoretical coding.ResultsA framework and process involving external and internal practice facilitation using the new role of PP was thought to impact CDPS. The PP facilitated CDPS through on-going relationships with patients and practice team members. Key components included: 1) approaching CDPS in a comprehensive manner, 2) an individualized and personalized approach at multiple levels, 3) integrated continuity that included linking the patients and practices to CPDS resources, and 4) adaptability to different practices and settings.ConclusionsThe BETTER framework and key components are described as impacting CDPS through a process that involved a new role, the PP. The introduction of a novel role of a clinician within the primary care practice with skills in CDPS could appropriately address gaps in prevention and screening.

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Section: Discussionmentioning

confidence: 99%

Finding a BETTER way: A qualitative study exploring the prevention practitioner intervention to improve chronic disease prevention and screening in family practice

et al. 2014

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“…Although the role is new, the person who takes on the PP role is typically a health care provider who is already an integral part of a primary care team, such as a nurse, licensed practical nurse, or a dietician who gains specialized skills in CDPS. PPs use tools specifically developed for BETTER that are based on an extensive review and synthesis of high-level evidence for CDPS activities, which has been previously described [3, 4]. Before their prevention visit with the PP, patient participants completed the BETTER health survey, an instrument that captured a detailed prevention and screening history including risk factors such as smoking, physical activity, diet, alcohol, and family history.…”

Section: Introductionmentioning

confidence: 99%

Implementation of the BETTER 2 program: a qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care

et al. 2016

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BackgroundBETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) is a patient-based intervention to improve chronic disease prevention and screening (CDPS) for cardiovascular disease, diabetes, cancer, and associated lifestyle factors in patients aged 40 to 65. The key component of BETTER is a prevention practitioner (PP), a health care professional with specialized skills in CDPS who meets with patients to develop a personalized prevention prescription, using the BETTER toolkit and Brief Action Planning. The purpose of this qualitative study was to understand facilitators and barriers of the implementation of the BETTER 2 program among clinicians, patients, and stakeholders in three (urban, rural, and remote) primary care settings in Newfoundland and Labrador, Canada.MethodsWe collected and analyzed responses from 20 key informant interviews and 5 focus groups, as well as memos and field notes. Data were organized using Nvivo 10 software and coded using constant comparison methods. We then employed the Consolidated Framework for Implementation Research (CFIR) to focus our analysis on the domains most relevant for program implementation.ResultsThe following key elements, within the five CFIR domains, were identified as impacting the implementation of BETTER 2: (1) intervention characteristics—complexity and cost of the intervention; (2) outer setting—perception of fit including lack of remuneration, lack of resources, and duplication of services, as well as patients’ needs as perceived by physicians and patients; (3) characteristics of prevention practitioners—interest in prevention and ability to support and motivate patients; (4) inner setting—the availability of a local champion and working in a team versus working as a team; and (5) process—planning and engaging, collaboration, and teamwork.ConclusionsThe implementation of a novel CDPS program into new primary care settings is a complex, multi-level process. This study identified key elements that hindered or facilitated the implementation of the BETTER approach in three primary care settings in Newfoundland and Labrador. Employing the CFIR as an overarching typology allows for comparisons with other contexts and settings, and may be useful for practices, researchers, and policy-makers interested in the implementation of CDPS programs.

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“…The Canadian and US Task Forces on Preventive Health Care, as well as other guideline developers, have provided evidence‐based recommendations for chronic disease prevention, screening, and management (CDPSM) . These were recently reviewed and summarized as part of the BETTER trial, through evidence‐based reviews of multiple guidelines . Recommendations applicable to almost all patients age 45 or older and responsible for the largest effect on health included recording tobacco use, alcohol use, diet, exercise, fasting blood glucose or haemoglobin A1c (A1c), lipid profile including low‐density lipoprotein (LDL), body mass index (BMI), waist circumference (WC), and blood pressure (BP) .…”

Section: Introductionmentioning

confidence: 99%

“…6,7 These were recently reviewed and summarized as part of the BETTER trial, 8 through evidence-based reviews of multiple guidelines. 9 Recommendations applicable to almost all patients age 45 or older and responsible for the largest effect on health included recording tobacco use, alcohol use, diet, exercise, fasting blood glucose or haemoglobin A1c (A1c), lipid profile including low-density lipoprotein (LDL), body mass index (BMI), waist circumference (WC), and blood pressure (BP). 8 While there is some controversy about the frequency with which these data elements should be recorded, frequently proposed intervals and standards for most patients are at least every 2 years for vital signs (BP, WC, and BMI) and at least every 3 years for laboratory tests (fasting blood glucose/A1c and LDL), recorded information about lifestyle risk factors in a summary health profile.…”

Section: Introductionmentioning

confidence: 99%

Would you like to add a weight after this blood pressure, doctor? Discovery of potentially actionable associations between the provision of multiple screens in primary care

Kalia

Greiver

Zhao

et al. 2018

Evaluation Clinical Practice

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Rationale, aims, and objectiveGuidelines recommend screening for risk factors associated with chronic diseases but current electronic prompts have limited effects. Our objective was to discover and rank associations between the presence of screens to plan more efficient prompts in primary care.MethodsRisk factors with the greatest impact on chronic diseases are associated with blood pressure, body mass index, waist circumference, glycaemic and lipid levels, smoking, alcohol use, diet, and exercise. We looked for associations between the presence of screens for these in electronic medical records. We used association rule mining to describe relationships among items, factor analysis to find latent categories, and Cronbach α to quantify consistency within latent categories.ResultsData from 92 140 patients in or around Toronto, Ontario, were included. We found positive correlations (lift >1) between the presence of all screens. The presence of any screen was associated with confidence greater than 80% that other data on items with high prevalence (blood pressure, glycaemic and lipid levels, or smoking) would also be present. A cluster of rules predicting the presence of blood pressure were ranked highest using measures of interestingness such as standardized lift. We found 3 latent categories using factor analysis; these were laboratory tests, vital signs, and lifestyle factors; Cronbach α ranged between .58 for lifestyle factors and .88 for laboratory tests.ConclusionsAssociations between the provision of important screens can be discovered and ranked. Rules with promising combinations of associated screens could be used to implement data driven alerts.

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Guideline harmonization and implementation plan for the BETTER trial: Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice

Cited by 18 publications

References 28 publications

Finding a BETTER way: A qualitative study exploring the prevention practitioner intervention to improve chronic disease prevention and screening in family practice

Finding a BETTER way: A qualitative study exploring the prevention practitioner intervention to improve chronic disease prevention and screening in family practice

Implementation of the BETTER 2 program: a qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care

Would you like to add a weight after this blood pressure, doctor? Discovery of potentially actionable associations between the provision of multiple screens in primary care

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