Navigating Change: How Outreach Facilitators Can Help Clinicians Improve Patient Outcomes

Laferriere, Dianne; Liddy, Clare; Nash, Kate; Hogg, William

doi:10.3122/jabfm.2012.02.110192

Cited by 17 publications

(15 citation statements)

References 6 publications

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“…Nevertheless, to the best of our knowledge, it is one of the first studies to solely focus on qualitative exploration of practice facilitators’ perspectives who worked with such a large number of primary care practices. We found a number of studies that looked at the role of PFs, the methods [13-16] used during facilitation, and the skills and attributes [17-19] facilitators need to have in order to substantially improve practice performance. Most of these studies did not use interviews with PFs as their data source.…”

Section: Discussionmentioning

confidence: 99%

Primary care quality improvement from a practice facilitator’s perspective

et al. 2014

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BackgroundPractice facilitation has proven to be effective at improving care delivery. Practice facilitators are healthcare professionals who work with and support other healthcare providers. To the best of our knowledge, very few studies have explored the perspective of facilitators. The objective of this study was to gain insight into the barriers that facilitators face during the facilitation process and to identify approaches used to overcome these barriers to help practices move towards positive change.MethodsWe conducted semi-structured interviews with four practice facilitators who worked with 84 primary care practices in Eastern Ontario, Canada over a period of five years (2007–2012). The transcripts were analyzed independently by three members of the research team using an open coding technique. A qualitative data analysis using immersion/crystallization technique was applied to interpret the interview transcripts.ResultsCommon barriers identified by the facilitators included accessibility to the practice (e.g., difficulty scheduling meetings, short meetings), organizational behaviour (team organization, team conflicts, etc.), challenges with practice engagement (e.g., lack of interest, lack of trust), resistance to change, and competing priorities. To help practices move towards positive change the facilitators had to tailor their approach, integrate themselves, be persistent with practices, and exhibit flexibility.ConclusionsThe consensus on redesigning and transforming primary care in North America and around the world is rapidly growing. Practice facilitation has been pivotal in materializing the transformation in the way primary care practices deliver care. This study provides an exclusive insight into facilitator approaches which will assist the design and implementation of small- and large-scale facilitation interventions.

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Section: Discussionmentioning

confidence: 99%

Primary care quality improvement from a practice facilitator’s perspective

et al. 2014

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“…Family practice is an ideal setting for most chronic disease prevention and screening (CDPS) actions and there are several evidence-based tools and strategies available to improve CDPS, but they are inconsistently applied [3-17]. Examples include the use of electronic medical records (EMR), reminder systems [11], evidence-based guidelines and tools for CDPS actions, patient targeted interventions such as self-management tools [8-10,12,13], and practice-based quality improvement strategies such as practice facilitators [4,6,7,14-16,18]. …”

Section: Introductionmentioning

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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“…(1,2) One approach to increasing adoption of clinical guidelines is practice facilitation (PF). (3)(4)(5)(6)(7)(8)(9)(10)(11) PF is an implementation strategy that emphasizes building organizational capacity to implement innovations in health care delivery into routine primary care practice.…”

Section: Page 3/11mentioning

confidence: 99%

A practice facilitation-guided intervention in primary care settings to reduce cardiovascular disease risk: A cost analysis

Gold

Siman

Cuthel

et al. 2020

Preprint

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Background. A stepped-wedge, cluster randomized controlled trial assessed the effectiveness of practice facilitation (PF) for adoption of guidelines for prevention and treatment of cardiovascular disease risk factors. This study estimated the associated cost of PF for guideline adoption in small, private primary care practices. Methods. The cost analysis included categories for start-up costs, intervention costs, and practice staff costs for the implemented PF-guided intervention. We estimated the total one-year costs to operate the program, and calculated the mean and range of the cost-per-practice by quarter of the intervention. We estimated the lower and upper bounds for all salary expenses, rounding to the nearest $100. Results. Total one-year intervention costs for all 261 practices ranged from $7,900,000-$10,200,000, with program and practice salaries comprising $6,600,000-$8,400,000 of the total. Start-up costs were a small proportion (3%) of total one-year costs. Excluding start-up costs, quarter 1 cost-per-practice was the most expensive at $20,400-$26,700, and quarter 4 was least expensive at about $10,000. Practice staff time (compared with program staff time) was the majority of the staffing costs at 75-84%. Conclusions. The PF strategy cost approximately $10,000 per practice per quarter for program and practice costs, once implemented and running at highest efficiency. Whether this program is “worth it” to the decision-maker depends on the relative costs and effectiveness of their other options for improving cardiovascular risk reduction.Trial Registration. This study is retrospectively registered on January 5, 2016 at www.clinicaltrials.gov as NCT02646488. https://clinicaltrials.gov/ct2/show/NCT02646488

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Navigating Change: How Outreach Facilitators Can Help Clinicians Improve Patient Outcomes

Cited by 17 publications

References 6 publications

Primary care quality improvement from a practice facilitator’s perspective

Primary care quality improvement from a practice facilitator’s perspective

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

A practice facilitation-guided intervention in primary care settings to reduce cardiovascular disease risk: A cost analysis

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