The effectiveness of a proven chronic disease prevention and screening intervention in diverse and remote primary care settings: an implementation study on the BETTER 2 Program
Kris Aubrey-Bassler,
Carolina Fernandes,
Carla Penney,
Richard Cullen,
Christopher Meaney,
Nicolette Sopcak,
Denise Campbell-Scherer,
Rahim Moineddin,
Julia Baxter,
Paul Krueger,
Margo Wilson,
Andrea Pike,
Eva Grunfeld,
Donna Manca
Affiliations
Kris Aubrey-Bassler
Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John’s, Canada
Carolina Fernandes
Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
Carla Penney
Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John's, Canada
Richard Cullen
Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John's, Canada
Christopher Meaney
Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
Nicolette Sopcak
Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
Denise Campbell-Scherer
Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
Rahim Moineddin
Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
Julia Baxter
Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
Paul Krueger
Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
Margo Wilson
Discipline of Emergency Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada
Andrea Pike
Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John's, Canada
Eva Grunfeld
Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
Donna Manca
Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
Background: The Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER) randomised control trial (RCT) showed that the BETTER Program improved chronic disease prevention and screening (CDPS) by 32.5% in urban team-based primary care clinics. Aim: To evaluate outcomes from implementation of BETTER in diverse clinical settings. Design & setting: An implementation study was undertaken to apply the CDPS intervention from the BETTER trial to diverse settings in BETTER 2. Patients aged 40–65 years were invited to enrol in the study from three clinics in Newfoundland and Labrador, Canada. Method: At baseline, eligibility for 27 CDPS actions (for example, cancer, diabetes and hypertension screening, lifestyle) was determined. Patients then met with a trained provider and prioritised goals to address their eligible CDPS actions. Providers received training in behaviour change theory and practice. Descriptive analysis of clinical outcomes and success factors were reported. Results: A total of 154 patients (119 female and 35 male) had a baseline visit; 106 had complete outcome assessments, and the remainder had partial outcome assessments. At baseline, patients were eligible for a mean of 12.3 CDPS actions and achieved a mean of 6.0 (49%, 95% confidence intervals [CI] = 24% to 74%) at 6-month follow-up, including reduced hypertension (86% of eligible patients, 95% CI = 67% to 96%), weight control (51% of eligible patients, 95% CI = 42% to 60%), and smoking cessation (36% of eligible patients, 95% CI = 17% to 59%). Male, highly educated, and lower income individuals achieved a higher proportion of CDPS manoeuvers than their counterparts. Conclusion: Clinical outcomes from this implementation study were comparable with those of the prior BETTER RCT, providing support for the BETTER Program as an effective approach to CDPS in more diverse general practice settings.
