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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Family Practice 1/2014

Finding a BETTER way: A qualitative study exploring the prevention practitioner intervention to improve chronic disease prevention and screening in family practice

Zeitschrift:
BMC Family Practice > Ausgabe 1/2014
Autoren:
Donna Patricia Manca, Michelle Greiver, June C Carroll, Ginetta Salvalaggio, Andrew Cave, Jess Rogers, James Pencharz, Carolina Aguilar, Rebekah Barrett, Shelley Bible, Eva Grunfeld
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2296-15-66) contains supplementary material, which is available to authorized users.
Donna Patricia Manca, Michelle Greiver, June C Carroll, Ginetta Salvalaggio, Andrew Cave, Jess Rogers, James Pencharz, Carolina Aguilar, Rebekah Barrett, Shelley Bible and Eva Grunfeld contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

We certify that all individuals listed as authors of this manuscript: 1) have made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; 2) have been involved in drafting the manuscript or revising it critically for important intellectual content; 3) have given final approval of the version to be published; and 4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DPM conceived and designed the study, conducted interviews in Alberta, analyzed and interpreted the data, and wrote the manuscript. MG contributed to the conception and design of the study, conducted interviews in Ontario, assisted with analysis and interpretation of the data, and assisted with drafting and writing the manuscript. JC contributed to the conception and design of the study, conducted interviews in Ontario, assisted with analysis and interpretation of the data, and assisted with drafting and writing the manuscript. GS contributed to the conception and design of the study, assisted with analysis and interpretation of the data, and assisted with drafting and writing the manuscript. AC contributed to the conception and design of the study, conducted interviews in Alberta, assisted with analysis and interpretation of the data, and assisted with drafting and writing the manuscript. JR contributed to the conception and design of the study, assisted with analysis and interpretation of the data, and assisted with drafting and writing the manuscript. JP contributed to the conception and design of the study, assisted with analysis and interpretation of the data, and assisted with drafting and writing the manuscript. CA contributed to the conception and design of the study, conducted interviews in Alberta, assisted with analysis and interpretation of the data, and assisted with drafting and writing the manuscript. RB contributed to the conception and design of the study, assisted with analysis and interpretation of the data, and assisted with drafting and writing the manuscript. SB contributed to the conception and design of the study, assisted with analysis and interpretation of the data, and assisted with drafting and writing the manuscript. EG contributed to the conception and design of the study, assisted with analysis and interpretation of the data, and assisted with drafting and writing the manuscript.

Abstract

Background

Our randomized controlled trial (The BETTER Trial) found that training a clinician to become a Prevention Practitioner (PP) in family practices improved chronic disease prevention and screening (CDPS). PPs were trained on CDPS and provided prevention prescriptions tailored to participating patients. For this embedded qualitative study, we explored perceptions of this new role to understand the PP intervention.

Methods

We used grounded theory methodology and purposefully sampled participants involved in any capacity with the BETTER Trial. Two physicians and one coordinator in each of two cities (Toronto, Ontario and Edmonton, Alberta) conducted eight individual semi-structured interviews and seven focus groups. We used an interview guide and documented research activities through an audit trail, journals, field notes and memos. We analyzed the data using the constant comparative method throughout open coding followed by theoretical coding.

Results

A framework and process involving external and internal practice facilitation using the new role of PP was thought to impact CDPS. The PP facilitated CDPS through on-going relationships with patients and practice team members. Key components included: 1) approaching CDPS in a comprehensive manner, 2) an individualized and personalized approach at multiple levels, 3) integrated continuity that included linking the patients and practices to CPDS resources, and 4) adaptability to different practices and settings.

Conclusions

The BETTER framework and key components are described as impacting CDPS through a process that involved a new role, the PP. The introduction of a novel role of a clinician within the primary care practice with skills in CDPS could appropriately address gaps in prevention and screening.
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