- Title
- Increasing the provision of preventive care by community healthcare services: a stepped wedge implementation trial
- Creator
- Wiggers, John; McElwaine, Kathleen; Gillham, Karen; Bartlem, Kate; Freund, Megan; Campbell, Libby; Bowman, Jenny; Wye, Paula; Wolfenden, Luke; Tremain, Danika; Barker, Daniel; Slattery, Carolyn
- Relation
- Funding BodyNHMRCGrant Number1016650 http://purl.org/au-research/grants/nhmrc/1016650
- Relation
- Implementation Science Vol. 12, no. 105
- Publisher Link
- http://dx.doi.org/10.1186/s13012-017-0636-2
- Publisher
- Biomed Central (BMC)
- Resource Type
- journal article
- Date
- 2017
- Description
- Background: Although clinical guidelines recommend the provision of care to reduce client chronic disease risk behaviours, such care is provided sub-optimally by primary healthcare providers. A study was undertaken to determine the effectiveness of an intervention in increasing community-based clinician implementation of multiple elements of recommended preventive care for four risk behaviours. Methods: A three-group stepped-wedge trial was undertaken with all 56 community-based primary healthcare facilities in one health district in New South Wales, Australia. A 12-month implementation intervention was delivered sequentially in each of three geographically and administratively defined groups of facilities. The intervention consisted of six key strategies: leadership and consensus processes, enabling systems, educational meetings and training, audit and feedback, practice change support, and practice change information and resources. Client-reported receipt of three elements of preventive care: assessment; brief advice; referral for four behavioural risks: smoking, inadequate fruit and/or vegetable consumption, alcohol overconsumption, and physical inactivity, individually, and for all such risks combined were collected for 56 months (October 2009–May 2014). Segmented logistic regression models were developed to assess intervention effectiveness. Results: A total of 5369 clients participated in data collection. Significant increases were found for receipt of four of five assessment outcomes (smoking OR 1.53; fruit and/or vegetable intake OR 2.18; alcohol consumption OR 1.69; all risks combined OR 1.78) and two of five brief advice outcomes (fruit and/or vegetable intake OR 2.05 and alcohol consumption OR 2.64). No significant increases in care delivery were observed for referral for any risk behaviour, or for physical inactivity. Conclusions: The implementation intervention was effective in enhancing assessment of client risk status but less so for elements of care that could reduce client risk: provision of brief advice and referral. The intervention was ineffective in increasing care addressing physical inactivity. Further research is required to identify barriers to the provision of preventive care and the effectiveness of practice change interventions in increasing its provision.
- Subject
- preventive care; practice change; community health care; assessment; advice; referral; smoking; alcohol; physical inactivity; nutrition
- Identifier
- http://hdl.handle.net/1959.13/1396476
- Identifier
- uon:34048
- Identifier
- ISSN:1748-5908
- Rights
- This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Language
- eng
- Full Text
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