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Transcript of 1 Finding a BETTER Way Donna Manca, Carolina Aguilar, Kami Kandola, Kris Aubrey-Bassler, Denise...
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Finding a BETTER Way
Donna Manca, Carolina Aguilar, Kami Kandola, Kris Aubrey-Bassler, Denise Campbell-Scherer, Nicolette Sopcak, Christopher Meaney,
Julia Baxter, Melanie Heatherington, and Eva Grunfeld
CPHA Conference Toronto - May 27, 2014
A Program to Facilitate Chronic Disease Prevention and Screening in Primary Care
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Acknowledgements & Disclaimer
Production of this presentation has been made possible through a financial contribution from Health Canada, through the Canadian Partnership Against
Cancer.
The views expressed herein represent the views of the BETTER 2 Coalition and do not necessarily represent the views of the project funders.
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Background• Primary care is an ideal setting for most chronic disease
prevention and screening (CDPS) activities
• Evidence-based tools and strategies are inconsistently applied• It would take an additional 7.4 hours/day to address prevention1
• Plethora of guidelines - many lack rigor,2 conflicting guidelines confuse primary care providers
• Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER) - informed by the Chronic Disease Framework – developed and tested effective approach to CDPS
1. Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? American journal of public health 2003;93:635-41.
2. Graham ID, Beardall S, Carter AO, et al. What is the quality of drug therapy clinical practice guidelines in Canada? CMAJ 2001;165:157-63.
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The BETTER Trial• Setting - 8 Primary Care Teams (PCTs)• Two interventions• Patient Level Intervention: Prevention Practitioner
(PP), 1 per PCT• Prevention visits with individual patients, prepare
prevention prescription tailored to each patient• Practice Level Intervention: Practice Facilitator (PF), 1
per 4 PCTs• Enable EMR (invitation letters, audit and feedback,
decision support), “prevention prescriptions” tailored to the circumstances of each PCT
• Patient level (PP) intervention - most effective BETTER 2 Program (expansion & deepen impact)
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The BETTER Trial Results
Grunfeld E, Manca D, Moineddin R, Thorpe KE, Hoch JS, Campbell-Scherer D, Meaney C, Rogers J, Beca J, Krueger P et al: Improving chronic disease prevention and screening in primary care: results of the BETTER pragmatic cluster randomized controlled trial. BMC family practice 2013, 14(1):175.
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Objectives of the BETTER Program
• Overall Objective of the BETTER:• Improve CDPS in the primary care team setting for: heart
disease, diabetes, & cancers including their associated lifestyle risk factors
• Integrated knowledge translation - research, practice & policy
• Desired long-term goals of the BETTER:• Improved clinical outcomes
• Reduced burden of chronic disease
• Improved sustainability of the health care system through improved CDPS in primary care
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BETTER 2 ProgramTarget Audiences
• Patients at risk for chronic disease: adults aged 40 – 65, a population eligible for most CDPS maneuvers• Increased knowledge, self-management & access to CDPS
resources
• Primary care providers, researchers and policy makers: To improve CDPS in adults aged 40-65 • Develop comprehensive source of tools and transform
practice through a patient-level intervention using practice facilitation via a patient level intervention by a health care professional within the practice (PP)
• Primary Care Groups and Organizations:• Facilitate change by dedicating resources (e.g. PPs) to CDPS
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The Prevention Practitioner – A New RoleTargets both at risk populations & individual patients
Manca DP, Greiver M, Carroll JC, et al: Finding a BETTER way: A qualitative study exploring the prevention practitioner intervention to improve chronic disease prevention and screening in family practice. BMC family practice 2014, 15(1):66.
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Guideline Harmonization through Integrated Knowledge Translation
Clinicians, Researchers & Policy Working Together
Campbell-Scherer D, Rogers J, Manca D, Lang-Robertson K, Bell S, Salvalaggio G, Greiver M, Korownyk C, Klein D, Carroll JC et al: Guideline harmonization and implementation plan for the BETTER trial: Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice. CMAJ Open 2014, 2(1):E1-E10.
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Spaghetti DiagramBETTER Developed Tools to Address the Modifiable Risk Factors
Haydon E, Roerecke M, Giesbrecht N, Rehm J, Kobus-Matthews M. (2006, March). Chronic disease iOntario and Canada: Determinants, risk factors and prevention priorities: Summary of full report. Prepared
for the Ontario Chronic Disease Prevention Alliance & the Ontario Public Health Association. Availablefrom: http://www.ocdpa.on.ca/docs/CDP-SummaryReport-Mar06.pdf
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Preparing for a Prevention VisitThe Health Survey is filled in by patients before the visit and includes tools to capture a detailed prevention and screening history including risks such as• Smoking• Exercise • Diet• Alcohol• Family History
An assessment of• Readiness to change
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Prevention Visit FormExtracts information from the patients’ surveys, health record and physical measures to determine eligible CDPS maneuvers & develop an approach informed by the individuals’ risks (lifestyle, family history, etc.)
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Algorithm
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Prevention Prescription
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Program EvaluationRE-AIM
Evaluation of Effectiveness & Sustainability:• REACH • Representativeness & proportion participating
• EFFECTIVENESS • Impact on outcomes including a composite index of met/eligible
outcomes
• ADOPTION in different settings
• IMPLEMENTATION • Adaptations and how the intervention was delivered
• MAINTAIN the approach• How BETTER is adapted and maintained in different settings• Time and cost of the intervention will be captured
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Questions?
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BETTER 2 Logic model
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BETTER Tools