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Vol. 54, No. 5, May 2008, pp.712 - 720
Copyright © 2008 by The College of Family Physicians of Canada
Research |
Improving prevention in primary care
Evaluating the sustainability of outreach facilitation
William Hogg, MSc MCISc MD FCFP, Jacques Lemelin, MD CCFP FCFP, Isabella Moroz, PhD, Enrique Soto, PhD and Grant Russell, MDDr Hogg is a Professor and the Director of Research in the Department of Family Medicine at the University of Ottawa and Director of the C.T. Lamont Primary Health Care Research Centre at the Élisabeth Bruyère Research Institute in Ottawa, Ont. Dr Lemelin is a Professor and the Acting Chair of the Department of Family Medicine at the University of Ottawa and a Principal Scientist at the C.T. Lamont Primary Health Care Research Centre. Dr Moroz was a Research Associate and Dr Soto was a Research Manager at the C.T. Lamont Primary Health Care Research Centre at the time of the study. Dr Russell is an Associate Professor in the Department of Family Medicine at the University of Ottawa and a Clinical Investigator at the C.T. Lamont Primary Health Care Research Centre. Drs Hogg and Lemelin are affiliated with the Institute of Population Health at the University of Ottawa
Correspondence to: Dr William Hogg, Professor and Director of Research, Department of Family Medicine, University of Ottawa, 43 Bruyère St, Ottawa, ON K1N 5C8; telephone 613 562-4262, extension 1354; e-mail whogg{at}uottawa.ca
OBJECTIVE To assess the extent to which advances in preventive care delivery, achieved in primary care practices through outreach facilitation, could be sustained over time after purposefully redirecting the focus of practice physicians and staff away from prevention and toward a new content area in need of improvement—chronic illness management.
DESIGN Before-and-after study.
SETTING Primary care networks and family health networks in Ontario.
PARTICIPANTS A volunteer sample of 30 primary care practices recruited from 99 eligible sites.
INTERVENTION Outreach visits directed at modifying physician behaviour were delivered by trained nurse facilitators using practice-tailored systems strategies. For the first 12 months, the intervention focused on improving delivery of preventive care, after which facilitation of chronic illness management was introduced for another 3 to 9 months.
MAIN OUTCOME MEASURES Changes in practices’ performance rates for selected preventive maneuvers (according to recommendations of the Canadian Task Force on Preventive Health Care) between baseline and follow-up, conducted 3 to 9 months after the end of the prevention intervention, measured from chart reviews for those maneuvers likely to be recorded and from telephoneinterviews with patients for lifestyle counseling.
RESULTS Four of the 30 practices dropped out of the study. In the remaining practices, at the postintervention follow-up, there was an increase in the delivery of the appropriate grade A (19.3%, 95% confidence interval [CI] 10.4% to 28.3%) and B (9.3%, 95% CI 5.4% to 13.2%) maneuvers, accompanied by a reduction in inappropriate grade D maneuvers (–15.9%, 95% CI –22.1% to –9.6%), for an absolute improvement of 12% (P < .0001) in the overall preventive care performance, as determined by a chart audit. We found no changes in the provision of lifestyle counseling maneuvers measured from telephone interviews with patients (1.3%, 95% CI 1.0% to 3.7%).
CONCLUSION The tailored, multifaceted intervention delivered by nurse facilitators was effective in producing significant improvements in preventive care performance that extended beyond the prevention intervention period.
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