title: Improving prevention in primary care: evaluating the effectiveness of outreach facilitation.
abstract: BACKGROUND
  Out reach facilitation is designed to promote uptake of evidence-based guidelines. There is evidence indicating that outreach facilitation can be effective in improving implementation of preventive care in GPs' offices. In this trial, we test a modified version of an outreach facilitation intervention.
  
  
  OBJECTIVE
  To evaluate whether a comprehensive preventive intervention program using outreach facilitators improves preventive care delivery.
  
  
  METHODS
  Match-paired, cluster-randomized controlled trial.
  
  
  METHODS
  Fee-for-service primary care practices in Eastern Ontario, Canada, at a time of physician shortage.
  
  
  METHODS
  Volunteer sample of 54 primary care practices.
  
  
  METHODS
  Mean difference between trial arms in practices' delivery of preventive manoeuvres, measured by preventive performance indices estimated from chart reviews and patient survey data.
  
  
  RESULTS
  No difference was detected between the trial's arms for the primary outcome's overall prevention index [2.0%; 95% confidence interval (CI) -3.2 to 7.3; P = 0.44]. A small significant difference between the arms was detected for the secondary outcome's overall prevention index (2.8%; 95% CI 0.7-4.8; P = 0.01).
  
  
  CONCLUSIONS
  In contrast to similar facilitation trials, this outreach facilitation program did not produce improvements in the delivery of preventive care. This lack of effect may be due to differences in the intervention and context, or the practice's limited capacity to change. Our intervention simultaneously facilitated a high number of manoeuvres, blinded facilitators and physicians to the targeted tests and had a relatively short intervention period and large number of practices assigned per facilitator. Changes in the primary care service model in Ontario at the time of the trial could have also washed out the intervention effect.
authors.affiliation: Department of Family Medicine, University of Ottawa, Canada. whogg@uottawa.ca
authors.forename: W
authors.initials: W
authors.lastname: Hogg
authors.forename: J
authors.initials: J
authors.lastname: Lemelin
authors.forename: I D
authors.initials: ID
authors.lastname: Graham
authors.forename: J
authors.initials: J
authors.lastname: Grimshaw
authors.forename: C
authors.initials: C
authors.lastname: Martin
authors.forename: L
authors.initials: L
authors.lastname: Moore
authors.forename: E
authors.initials: E
authors.lastname: Soto
authors.forename: K
authors.initials: K
authors.lastname: O'Rourke
mesh_terms: D003159:Community-Institutional Relations; D004311:Double-Blind Method; D018588:Fee-for-Service Plans; D005260:Female; D006801:Humans; D008297:Male; D009864:Ontario; D010821:Physicians, Family; D011314:Preventive Health Services; D011320:Primary Health Care; D015397:Program Evaluation