Improving chronic disease prevention and screening in primary care: results of the BETTER pragmatic cluster randomized controlled trial

Grunfeld, Eva; Manca, Donna; Moineddin, Rahim; Thorpe, Kevin E.; Hoch, Jeffrey S.; Campbell‐Scherer, Denise; Meaney, Christopher; Rogers, Joel; Beca, Jaclyn; Krueger, Paul; Mamdani, Muhammad

doi:10.1186/1471-2296-14-175

Cited by 74 publications

(153 citation statements)

References 32 publications

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“…35 Our results also contrast with those of our chart audit, which failed to show a significant difference in screening rates in a small subsample of patients. 28 This highlights one of the advantages of using population-level data to achieve the power required to detect changes in situations in which event frequency or effect sizes mean that resource-intensive audits of patient records are not feasible.…”

Section: Discussioncontrasting

confidence: 99%

Impact of a provincial quality-improvement program on primary health care in Ontario: a population-based controlled before-and-after study

et al. 2017

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CMAJ OPEN, 5(2) E281 P rimary health care plays a key role in health care systems in Canada and around the world. 1,2 Studies consistently show that the vast majority of care is delivered in primary care settings [3][4][5][6][7] and that strong primary care systems are associated with improved outcomes and decreased health care costs. 5,8,9 In Ontario, primary care is the backbone of the publicly funded health care system, accounting for about 80% of all visits annually. 7,10 Over the past decade, improving and strengthening primary health care have been key priorities of successive governments in Ontario, which have implemented a series of reforms and initiatives in this key sector. 10 These include changes to payment models for physicians, formal enrolment of patients with primary care providers, support for multidisciplinary teams, support for the adoption of electronic health records and province-wide quality-improvement initiatives. 8,11,12 Family Health Teams represent the most highly reformed model of primary health care in Ontario and include all of the elements described above. 13 There is also consistent evidence that there is room for improvement in the quality of Impact of a provincial quality-improvement program on primary health care in Ontario: a population-based controlled before-and-after study

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Section: Discussioncontrasting

confidence: 99%

Impact of a provincial quality-improvement program on primary health care in Ontario: a population-based controlled before-and-after study

et al. 2017

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“…Participants commented on the program’s quality and the strength of evidence as indicated by the results of the BETTER trial [6]. For instance, one of the collaborators observed that:

The biggest facilitator , I think , was that it was multi - factorial , just the materials that were prepared , the strength of the evidence from [ the BETTER trial ], the recognition that it was a quality program .

…”

Section: Resultsmentioning

confidence: 99%

“…The follow-up visit was shorter and in total about 60 min for patients (30 min follow up health survey + 30 min follow-up visit) and 45 min for PPs (15 minutes preparation + 30 min follow-up visit). The BETTER trial, a pragmatic cluster randomized controlled trial, demonstrated that the prevention visits with PPs were effective in improving patients’ CDPS outcomes in the participating urban primary care settings [6]. Furthermore, a qualitative study that complemented the BETTER trial found that PPs played a key role in facilitating CDPS that benefitted both patients and primary care team members [7].…”

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 results of this process were used to inform the interventions in the Building on Existing Tools to Improve Primary Prevention and Screening in Family Practice (BETTER) randomized controlled trial. 24 …”

Section: Cmaj Openmentioning

confidence: 99%

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

et al. 2014

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Improving chronic disease prevention and screening in primary care: results of the BETTER pragmatic cluster randomized controlled trial

Cited by 74 publications

References 32 publications

Impact of a provincial quality-improvement program on primary health care in Ontario: a population-based controlled before-and-after study

Impact of a provincial quality-improvement program on primary health care in Ontario: a population-based controlled before-and-after study

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

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

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