The effectiveness of a clinical practice change intervention in increasing clinician provision of preventive care across a network of community based drug and alcohol services.

The total duration of the trial is 24 months. All participating drug and alcohol community health services will receive a 12 month clinical practice change intervention, implemented simultaneously. Data collection will commence six months prior to the intervention implementation, and continue until six months post the intervention implementation. The 12 month clinical practice change intervention will consist of: Leadership and consensus: the intervention will be formalised through district-wide policy guidelines and compliance procedures, made available to all clinicians. Clinical services, teams and management will be consulted prior to and during the implementation of the intervention. Senior management will be consulted regarding their support for the intervention and to reach agreement on key performance indicators. The service managers and clinicians for each individual facility will be regularly consulted throughout the intervention. Enabling systems & procedures: the existing medical record system used district-wide by all community health services will be modified to include a standardised electronic tool. The tool will be incorporated into medical records to allow the standardized provision and recording of assessment of each health risk behaviour and for clients at risk: provision of brief advice in line with the current Australian national guidelines, referral to best practice referral options, automatic generation of a tailored client information handout detailing advice and referral for health risk behaviour(s), and automatic generation of a letter to the clients’ general practitioner or Aboriginal Medical Service detailing the care provided during the appointment(s). Clinician training & support: clinicians and managers will be trained using both online and face-to-face training. Training will be made available at the start of the intervention and all existing clinicians will be expected to complete training within the first 2 months. The online training will take approximately 2 hours to complete and will cover the importance of providing preventive care, the policy guidelines and Key Performance Indicators (KPIs), the model of preventive care, and how to use the standardized assessment tool to record preventive care in the existing medical record system. Clinicians will be required to complete a brief competency based multiple choice quiz following the training. Clinicians will be considered trained once they have completed the quiz and scored 100%. Each site will have a designated support officer who will provide the initial face to face training to managers and follow up with a minimum of one face to face visit per month and fortnightly phone or email contact with managers. Further support and resources will be provided through an email helpline and internet information site. Monitoring and feedback: Each month, feedback reports detailing the provision of preventive care at a service and facility level will be emailed to managers. The reports will include the proportion of eligible clients assessed, the proportion of at risk clients given brief advice and the proportion of at risk clients offered a referral. Effective feedback will include measuring performance and comparing to professional standards through district wide key performance indicators, delivering both verbal and written feedback through printed reports and discussions with support officers, and providing frequent feedback through monthly performance reports. Furthermore, the feedback will be sent to managers to disseminate to clinicians. Support officers will discuss reports with managers each month to highlight the team’s performance against district-wide key performance indicators, review strategies that are working for the team and develop strategies to increase the provision of preventive care where applicable. Provision of clinical practice change resources: clinicians and managers will be provided with resources to aid the provision of preventive care including, a detailed guide to providing and recording care within the electronic medical records system, copies of a paper tool for assessment away from a computer (e.g. home visits), flip charts to use as visual aids with clients, client handouts to provide further information about risk factors and care, helpline fax referral forms, a detailed flow chart outlining preventive care steps and processes, and posters to be used in waiting and assessment rooms. Additionally clinicians will be provided with monthly newsletters containing helpful tips and tricks and managers will have email and phone access to the support officer a minimum of once a fortnight.