The effectiveness of a clinical practice change intervention in increasing clinician provision of preventive care across a network of community based mental health services

The total duration of the two group multiple baseline trial is 36 months. Each intervention group will receive a 12 month clinical practice change intervention, implemented sequentially. Data collection will commence in both groups six months prior to the intervention implementation in the first group, and continue until six months post the intervention implementation in the second. Hence, the first intervention group will have a baseline period of 6 months, and a follow-up period of 18 months. The second intervention group will have a baseline period of 18 months, and a follow-up period of 6 months. The 12 month clinical practice change intervention will consist of: Leadership and consensus: Area wide policy guidelines and policy compliance procedures will be implemented to formalise the intervention and increase adherence. Existing clinical networks, clinical sites and teams will be engaged and consulted prior to and during the implementation of the intervention. Consultation will be undertaken with high level management regarding their advocacy, leadership and support of the intervention, and to gain agreement on Key Performance Indicators. At each clinical site, managers and clinicians will be consulted regularly throughout the intervention. Enabling systems and procedures: Modifications will be made to the existing medical record software routinely used by all community mental health clinicians. A standardised electronic assessment tool will be incorporated into the medical record to enable the standardised provision and recording of: risk assessment for each health risk behaviour, brief advice on how to improve behaviours in order to meet the Australian National Guidelines (where a client is at risk), referral to the recommended referral services and/or additional local referral avenues (where a client is at risk), automated production of a tailored client information handout regarding health risk behaviour, advice, and referral, and automated production of a referral letter to clients’ General Practitioner or Aboriginal Medical Service regarding care provided during the appointment(s). The standardised tool will prompt assessment for each health risk behaviour and based on the risk assessment information entered, will prompt advice and referral where a client has a risk. Clinician and manager training: Clinicians will be required to complete three online educational competency based training modules covering the importance of providing preventive care, information on the policy guidelines and Key Performance Indicators, the model of preventive care, and the recording of preventive care in the standardised electronic assessment tool. The online training modules will take approximately two hours to complete, and will be followed by a brief competency based multiple choice quiz. Training modules will be made available at the commencement of the intervention period, and remain available for existing and new clinicians to complete throughout the intervention period. Existing clinicians will be expected to complete all training modules and the quiz within the first two months of the intervention. Clinicians will be considered trained upon the completion of the quiz, with a score of 100% attained. Managers of each service will be required to attend a two hour face to face training session within the first three months of the intervention covering the importance of providing leadership in preventive care, and education around the performance monitoring and feedback strategy including interpretation and use of preventive care performance reports. Monitoring and feedback: Modifications will be made to the existing electronic medical record software to allow automated production of preventive care performance reports. The reports will include: the proportion of clients assessed, and of those identified at risk, the proportions provided brief advice and offered referral. Reports will be provided to, and discussed with managers on a monthly basis. Report discussions will be linked to the area wide Key Performance Indicator and will focus on developing strategies to improve performance where required. Existing area wide quality assurance systems will also be modified to incorporate preventive care indicators. Provision of practice change resources: All clinicians and managers will receive a Preventive Care resource pack to assist with delivery of care. Resources within these packs include: a preventive care process flowchart, a guide for providing and recording care within the electronic medical record software, information on fruit and vegetable serving sizes and standard alcoholic drinks, fax-based referral forms to the Quitline and Get Healthy lines, a preventive care flipchart to use as a visual aid during care provision, and paper based preventive care assessment tools for the delivery and recording of preventive care when away from a computer. All clinicians will be provided with monthly newsletters and tip-sheets, and access to an e-mail helpline and internet resource site. Each service will be provided a clinical practice change support officer to support intervention delivery, and provide a minimum of fortnightly phone calls and/or e-mails to support managers in implementing and maintaining preventive care delivery, and monthly face to face visits to support managers and clinicians.