None listed
Conditions
Brief summary
A multiple baseline study will be conducted involving all 56 community health facilities in a single health district in New South Wales, Australia. The facilities will be allocated to one of three administratively-defined groups. A 12 month practice change intervention will be implemented in all facilities in each group to facilitate clinician risk assessment of eligible clients, and clinician provision of brief advice and referral to those identified as being ‘at risk’. The intervention will be implemented in a non-random sequence across the three facility groups. Repeated, cross-sectional measurement of clinician provision of preventive care for four individual risks (smoking, poor nutrition, risky alcohol use, and physical inactivity), and all such risks combined, will occur continuously for all three facility groups for 54 months via telephone interviews. The interviews will be conducted with randomly selected clients who have visited a community health facility in the last two weeks. Data collection will commence 12 months prior to the implementation of the intervention in the first group, and continue for six months following the completion of the intervention in the last group. As a secondary source of data, telephone interviews will be undertaken prior to and following the intervention with randomly selected samples of clinicians from each facility group to assess the reported provision of preventive care, and the acceptability of the practice change intervention and implementation.
Interventions
A 12 month multi-strategic clinical practice change intervention will be implemented including:
-Local opinion leaders and consensus processes:
Oversight and corporate support of the intervention will be via a purpose specific Taskforce involving health service executives. To increase intervention adherence, consensus for the model of preventive care will be sought and formalised through the development of a Preventive care policy, applicable to all clinicians. An Aboriginal Advisory group wil
A 12 month multi-strategic clinical practice change intervention will be implemented including: -Local opinion leaders and consensus processes: Oversight and corporate support of the intervention will be via a purpose specific Taskforce involving health service executives. To increase intervention adherence, consensus for the model of preventive care will be sought and formalised through the development of a Preventive care policy, applicable to all clinicians. An Aboriginal Advisory group will be established to provide oversight regarding the cultural appropriateness of the intervention. At the facility level, consultation with managers and clinicians will be undertaken. -Enabling clinical and management organisational systems; patient mediated intervention: The electronic medical record system, utilised across all sites within the area health service to record care provided by clinicians will be modified to standardise: client eligibility for risk assessment, brief advice and referral; prompt clinician delivery of preventive care; provide assessments and suggestions for provision of brief advice based on age; record the provision of each form of care; enable the production of an automated tailored letter for clients’ general practitioner and such a letter for the client; and enable the generation of preventive care delivery performance reports for health service managers. A hard copy preventive care checklist will be provided to facilitate care provision and recording for use in home visits. -Clinician and manager educational meetings; educational outreach visits and academic detailing; and client and clinician practice change resources: -Clinician and manager educational meetings: The Health District Population Health service will provide current clinicians with competency based online training. The modular training will take approximately two hours in total, involve didactic and quiz based components, and will address the model of preventive care, the standards of delivery for each aspect of preventive care, and how to record care delivery in the electronic medical record. New clinicians will attend such training as a component of new staff orientation procedures. All managers will be required to complete two hours of face to face training regarding leadership of the initiative and the conduct of performance audit and feedback. -Educational outreach visits and academic detailing Practice change support officers will be allocated to each community health facility to facilitate implementation of practice change strategies and clinician provision of preventive care. The support officers will provide a minimum of one face to face visit per month during the intervention period and fortnightly telephone support for managers to support the implementation and maintenance of the intervention. -Clinician practice change resources: An email helpline, an internet site that includes all clinician support resources (e.g. referral forms, hardcopy assessment tool for home visits, electronic medical records data entry guide), a clinician resource pack (also containing these support resources), and referral resources will be provided. Managers and clinicians will be provided with newsletters, tips and updates sheets, and a workstation reminder to prompt and provide additional information and solutions to problems. -Audit and feedback: Monthly performance reports describing the prevalence of clinician preventive care provision will be provided to managers via email. The reports will provide information regarding care delivery at the individual service, facility, and larger administrative unit levels. Feedback and advice regarding care delivery performance will be provided by the support officers. -Community promotion: General practice (GP) organisations will be regularly briefed regarding the initiative, and articles describing the intervention will be published in GP newsletters. To increase awareness of the initiative among clients and community members general community and Aboriginal-focused media releases will be issued at the commencement of the initiative in each facility. A series of posters and an Aboriginal community brochure will be disseminated by health facilities to further promote awareness of the initiative.
Sponsors
University of Newcastle
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
All adult clients who have at least one visit to a community health facility within the prior two weeks, and who meet the following inclusion criteria will be eligible to participate in the data collection: over 18 years of age; speak English; mentally and physically capable of completing an interview; not determined by clinician discretion as inappropriate to contact; not involved in another community health care focused survey; and not living in aged care facilities or gaol.
Exclusion criteria
Clients seeing the following specific forms of services within their visit to the community health facility will be excluded: inpatient services, sexual assault, palliative care, genetics services, and child protection services (parents).
Outcome results
None listed