title: Improving prevention in primary care: Evaluating the sustainability of outreach facilitation.
abstract: OBJECTIVE
  To assess the extent to which advances in preventive care delivery, achieved in primary care practices through outreach facilitation, could be sustained over time after purposefully redirecting the focus of practice physicians and staff away from prevention and toward a new content area in need of improvement-chronic illness management.
  
  
  METHODS
  Before-and-after study.
  
  
  METHODS
  Primary care networks and family health networks in Ontario.
  
  
  METHODS
  A volunteer sample of 30 primary care practices recruited from 99 eligible sites.
  
  
  METHODS
  Outreach visits directed at modifying physician behaviour were delivered by trained nurse facilitators using practice-tailored systems strategies. For the first 12 months, the intervention focused on improving delivery of preventive care, after which facilitation of chronic illness management was introduced for another 3 to 9 months.
  
  
  METHODS
  Changes in practices' performance rates for selected preventive maneuvers (according to recommendations of the Canadian Task Force on Preventive Health Care) between baseline and follow-up, conducted 3 to 9 months after the end of the prevention intervention, measured from chart reviews for those maneuvers likely to be recorded and from telephoneinterviews with patients for lifestyle counseling.
  
  
  RESULTS
  Four of the 30 practices dropped out of the study. In the remaining practices, at the postintervention follow-up, there was an increase in the delivery of the appropriate grade A (19.3%, 95% confidence interval [CI] 10.4% to 28.3%) and B (9.3%, 95% CI 5.4% to 13.2%) maneuvers, accompanied by a reduction in inappropriate grade D maneuvers (-15.9%, 95% CI -22.1% to -9.6%), for an absolute improvement of 12% (P < .0001) in the overall preventive care performance, as determined by a chart audit. We found no changes in the provision of lifestyle counseling maneuvers measured from telephone interviews with patients (1.3%, 95% CI 1.0% to 3.7%).
  
  
  CONCLUSIONS
  The tailored, multifaceted intervention delivered by nurse facilitators was effective in producing significant improvements in preventive care performance that extended beyond the prevention intervention period.
authors.affiliation: Department of Family Medicine, University of Ottawa, ON. whogg@uottawa.ca
authors.forename: William
authors.initials: W
authors.lastname: Hogg
authors.forename: Jacques
authors.initials: J
authors.lastname: Lemelin
authors.forename: Isabella
authors.initials: I
authors.lastname: Moroz
authors.forename: Enrique
authors.initials: E
authors.lastname: Soto
authors.forename: Grant
authors.initials: G
authors.lastname: Russell
mesh_terms: D005194:Family Practice / Q000592:standards; D006293:Health Promotion; D006801:Humans; D009864:Ontario; D017063:Outcome Assessment, Health Care; D011314:Preventive Health Services / Q000592:standards* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care