Finding a BETTER Way

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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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www.better.utoronto.ca

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

Finding a BETTER Way

Documents

Transcript of Finding a BETTER Way