Preventive Evidence into Practice: What factors matter in a facilitation intervention to prevent vascular disease in family practice?

Grant Russell, Riki Lane, Sharon Parker, John Litt, Danielle Mazza, Jane Lloyd, Nicholas Zwar, Mieke Van Driel, Chris Del Mar, Jane Smith, Mark F. Harris, Richard Taylor, Elizabeth Denney-Wilson, Gawaine Powell Davies, Rachel Laws, Teri Snowdon, Helen Bolger-Harris, Stephan Groombridge, Stan Goldstein, Teresa Howarth & 2 others Nancy Huang, Jinty Wilson

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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): 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.

Original languageEnglish
Article number113
Pages (from-to)113
JournalBMC Family Practice
Volume20
Issue number1
DOIs
Publication statusPublished - 8 Aug 2019

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Family Practice
Vascular Diseases
Blood Vessels
Preventive Medicine
Quality Improvement
New Zealand
Patient Selection
Registries
Primary Health Care
Randomized Controlled Trials
Nurses
Observation
Clinical Trials
Interviews
Health
vascular factor

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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. ; Taylor, Richard ; Denney-Wilson, Elizabeth ; Davies, Gawaine Powell ; Laws, Rachel ; Snowdon, Teri ; Bolger-Harris, Helen ; Groombridge, Stephan ; Goldstein, Stan ; Howarth, Teresa ; Huang, Nancy ; Wilson, Jinty. / Preventive Evidence into Practice : What factors matter in a facilitation intervention to prevent vascular disease in family practice?. In: BMC Family Practice. 2019 ; Vol. 20, No. 1. pp. 113.
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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): 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.",
author = "Grant Russell and Riki Lane and Sharon Parker and John Litt and Danielle Mazza and Jane Lloyd and Nicholas Zwar and {Van Driel}, Mieke and {Del Mar}, Chris and Jane Smith and Harris, {Mark F.} and Richard Taylor and Elizabeth Denney-Wilson and Davies, {Gawaine Powell} and Rachel Laws and Teri Snowdon and Helen Bolger-Harris and Stephan Groombridge and Stan Goldstein and Teresa Howarth and Nancy Huang and Jinty Wilson",
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Russell, G, Lane, R, Parker, S, Litt, J, Mazza, D, Lloyd, J, Zwar, N, Van Driel, M, Del Mar, C, Smith, J, Harris, MF, Taylor, R, Denney-Wilson, E, Davies, GP, Laws, R, Snowdon, T, Bolger-Harris, H, Groombridge, S, Goldstein, S, Howarth, T, Huang, N & Wilson, J 2019, 'Preventive Evidence into Practice: What factors matter in a facilitation intervention to prevent vascular disease in family practice?' BMC Family Practice, vol. 20, no. 1, 113, pp. 113. https://doi.org/10.1186/s12875-019-0995-7, https://doi.org/10.1186/s12875-019-0995-7

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.; Taylor, Richard; Denney-Wilson, Elizabeth; Davies, Gawaine Powell; Laws, Rachel; Snowdon, Teri; Bolger-Harris, Helen; Groombridge, Stephan; Goldstein, Stan; Howarth, Teresa; Huang, Nancy; Wilson, Jinty.

In: BMC Family Practice, Vol. 20, No. 1, 113, 08.08.2019, p. 113.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Russell, Grant

AU - Lane, Riki

AU - Parker, Sharon

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AU - Mazza, Danielle

AU - Lloyd, Jane

AU - Zwar, Nicholas

AU - Van Driel, Mieke

AU - Del Mar, Chris

AU - Smith, Jane

AU - Harris, Mark F.

AU - Taylor, Richard

AU - Denney-Wilson, Elizabeth

AU - Davies, Gawaine Powell

AU - Laws, Rachel

AU - Snowdon, Teri

AU - Bolger-Harris, Helen

AU - Groombridge, Stephan

AU - Goldstein, Stan

AU - Howarth, Teresa

AU - Huang, Nancy

AU - Wilson, Jinty

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N2 - 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.

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