Family Practice Advance Access originally published online on January 21, 2008
Family Practice 2008 25(1):40-48; doi:10.1093/fampra/cmm070
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Improving prevention in primary care: evaluating the effectiveness of outreach facilitation
a Department of Family Medicine, University of Ottawa
b CT Lamont Primary Health Care Research Center
c Clinical Epidemiology Program, Ottawa Health Research Institute
d Department of Medicine, University of Ottawa
e Department of Nursing, University of Ottawa
f Northern Ontario School of Medicine
g Department of Epidemiology and Community Medicine, University of Ottawa
Correspondence to William Hogg, Department of Family Medicine, University of Ottawa, Ottawa, Canada; Email: whogg{at}uottawa.ca
Received 3 April 2007; Revised 12 September 2007; Accepted 25 October 2007.
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Abstract |
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Background. Out reach facilitation is designed to promote uptake of evidence-based guidelines. There is evidence indicating that outreach facilitation can be effective in improving implementation of preventive care in GPs’ offices. In this trial, we test a modified version of an outreach facilitation intervention.
Objective. To evaluate whether a comprehensive preventive intervention program using outreach facilitators improves preventive care delivery.
Design. Match-paired, cluster-randomized controlled trial.
Setting. Fee-for-service primary care practices in Eastern Ontario, Canada, at a time of physician shortage.
Participants. Volunteer sample of 54 primary care practices.
Main outcome measures. Mean difference between trial arms in practices’ delivery of preventive manoeuvres, measured by preventive performance indices estimated from chart reviews and patient survey data.
Results. No difference was detected between the trial’s arms for the primary outcome’s overall prevention index [2.0%; 95% confidence interval (CI) –3.2 to 7.3; P = 0.44]. A small significant difference between the arms was detected for the secondary outcome’s overall prevention index (2.8%; 95% CI 0.7–4.8; P = 0.01).
Conclusion. In contrast to similar facilitation trials, this outreach facilitation program did not produce improvements in the delivery of preventive care. This lack of effect may be due to differences in the intervention and context, or the practice’s limited capacity to change. Our intervention simultaneously facilitated a high number of manoeuvres, blinded facilitators and physicians to the targeted tests and had a relatively short intervention period and large number of practices assigned per facilitator. Changes in the primary care service model in Ontario at the time of the trial could have also washed out the intervention effect.
Keywords. Cluster-randomized controlled trials, family physicians, outreach facilitation, preventive care.
Hogg W, Lemelin J, Graham ID, Grimshaw J, Martin C, Moore L, Soto E and O’Rourke K. Improving prevention in primary care: evaluating the effectiveness of outreach facilitation. Family Practice 2008; 25: 40–48.