Preventive evidence into practice: what factors matter in a facilitation intervention to prevent vascular disease in family practice?

Russell, Grant, Lane, Riki, Parker, Sharon, Litt, John, Mazza, Danielle, Lloyd, Jane, Zwar, Nicholas, Van Driel, Mieke, Del Mar, Chris, Smith, Jane, Harris, Mark F., Denney-Wilson, Elizabeth, Davies, Gawaine Powell, Taylor, Richard, Laws, Rachel, Snowdon, Teri, Bolger-Harris, Helen, Groombridge, Stephan, Goldstein, Stan, Howarth, Teresa, Huang, Nancy and Wilson, Jinty 2019, Preventive evidence into practice: what factors matter in a facilitation intervention to prevent vascular disease in family practice?, BMC family practice, vol. 20, pp. 1-10, doi: 10.1186/s12875-019-0995-7.

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Title Preventive evidence into practice: what factors matter in a facilitation intervention to prevent vascular disease in family practice?
Author(s) Russell, Grant
Lane, Riki
Parker, Sharon
Litt, John
Mazza, Danielle
Lloyd, Jane
Zwar, Nicholas
Van Driel, Mieke
Del Mar, Chris
Smith, Jane
Harris, Mark F.
Denney-Wilson, Elizabeth
Davies, Gawaine Powell
Taylor, Richard
Laws, RachelORCID iD for Laws, Rachel
Snowdon, Teri
Bolger-Harris, Helen
Groombridge, Stephan
Goldstein, Stan
Howarth, Teresa
Huang, Nancy
Wilson, Jinty
Journal name BMC family practice
Volume number 20
Article ID 113
Start page 1
End page 10
Total pages 10
Publisher BMC
Place of publication London, Eng.
Publication date 2019
ISSN 1471-2296
Keyword(s) Primary care
Family medicine
Outreach facilitation
Preventive care
Qualitative research
Summary Background: A perennial challenge of primary care quality improvement is to establish why interventions work in some circumstances, but not others. This study aimed to identify factors explaining variations in the impact on clinical practice of a facilitation led vascular health intervention in Australian family practice. Methods: Our mixed methods study was embedded within a cluster randomised controlled trial of a facilitation intervention designed to increase the uptake of evidence-based prevention of vascular disease in family practices. The study was set in four Australian states using eight of the study's 16 intervention practices. Facilitators worked with intervention practices to develop and implement improvements in preventive care informed by a vascular risk factor audit. We constructed case studies of each practice's "intervention narrative" from semi-structured interviews with clinicians, facilitators and other staff, practice observation, and document analysis of facilitator diaries. The intervention narratives were combined with pre- and post-intervention audit data to generate typologies of practice responses to the intervention. Results: We found substantial variability between practices in the changes made to vascular risk recording. Context (i.e. practice size), adaptive reserve (i.e. interpersonal relationships, manager and nurse involvement), and occasional data idiosyncrasies interacted to influence this variability. Conclusion: The findings emphasise the importance of tailoring facilitation interventions to practice size, clinician engagement and, critically, the organisation of, and relationships between, the members of the practice team. Trial registration: The trial was registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTR N12612000578808 (29/5/2012). This trial registration is retrospective as our first patient returned their consent on the 21/5/2012. Patient recruitment was ongoing until 31/10/2012.
Language eng
DOI 10.1186/s12875-019-0995-7
Indigenous content off
Field of Research 1117 Public Health and Health Services
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2019, The Author(s)
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