Tailored outreach visits as a method for implementing guidelines and improving preventive care.
OBJECTIVE
Authors of successful outreach visit studies stress the importance of tailoring the intervention to the unique attributes and needs of each practice. For a better understanding of the outreach visit method, the tailoring mechanism is explored in this article. The variation among practices in preventive outreach visits to implement guidelines and characteristics that determine the variation (baseline adherence to organizational guidelines, practice and visitor characteristics) are described. We explored whether and how many visits were paid to practices that showed no increase in adherence to guidelines.


METHODS
For 18 months, six trained nurse visitors assisted 33 family practices in implementing a set of guidelines to organize a program for cardiovascular disease prevention.


METHODS
Visit and consultative action parameters (number and duration of visits, duration of training and of conferring) and increase in adherence to organizational guidelines after 18 months of assistance compared to baseline adherence.


RESULTS
Practices differed considerably concerning the visit and consultative action parameters. Exploratory multiple regression analysis showed that baseline adherence to guidelines, and practice and visitor characteristics were related to the number of visits. Visitor characteristics were strongly related to the total time spent on visits, training, and conferring.


CONCLUSIONS
Our findings confirm that, concerning the number of visits, assistance is primarily adapted to the unique attributes of each clinic. It may be useful, from the viewpoint of cost-effectiveness, to standardize the performance of visitors somewhat more with regard to the visit length. The tailoring mechanism resulted in time well spent in assisting practices. We hope that our results contribute to the further development of the outreach method.
Hulscher
M E
ME
Centre for Quality of Care Research, University of Nijmegen, The Netherlands. m.hulscher@hsv.kun.nl
van Drenth
B B
BB
Mokkink
H G
HG
van De Lisdonk
E H
EH
van Der Wouden
J C
JC
van Weel
C
C
Grol
R P
RP
D000328:Adult; D000553:Ambulatory Care; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003152:Community Health Nursing; D004493:Education; D005194:Family Practice; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012017:Referral and Consultation