1
|
Russell G, Lane R, Parker S, Litt J, Mazza D, Lloyd J, Zwar N, van Driel M, Del Mar C, Smith J, Harris MF. Preventive Evidence into Practice: what factors matter in a facilitation intervention to prevent vascular disease in family practice? BMC Fam Pract 2019; 20:113. [PMID: 31395020 PMCID: PMC6688202 DOI: 10.1186/s12875-019-0995-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/15/2019] [Indexed: 11/24/2022]
Abstract
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): ACTRN12612000578808 (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. Electronic supplementary material The online version of this article (10.1186/s12875-019-0995-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Grant Russell
- Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic, 3168, Australia.
| | - Riki Lane
- Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic, 3168, Australia
| | - Sharon Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia
| | - John Litt
- Discipline of General Practice, Health Sciences Building, Flinders University, Adelaide, SA, 5042, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic, 3168, Australia
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, 2052, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4229, Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, 4029, Australia
| | - Chris Del Mar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4229, Australia
| | - Jane Smith
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4229, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia
| | | |
Collapse
|