Finding a BETTER way: a qualitative study exploring the prevention practitioner intervention to improve chronic disease prevention and screening in family practice.
BACKGROUND
Our randomized controlled trial (The BETTER Trial) found that training a clinician to become a Prevention Practitioner (PP) in family practices improved chronic disease prevention and screening (CDPS). PPs were trained on CDPS and provided prevention prescriptions tailored to participating patients. For this embedded qualitative study, we explored perceptions of this new role to understand the PP intervention.


METHODS
We used grounded theory methodology and purposefully sampled participants involved in any capacity with the BETTER Trial. Two physicians and one coordinator in each of two cities (Toronto, Ontario and Edmonton, Alberta) conducted eight individual semi-structured interviews and seven focus groups. We used an interview guide and documented research activities through an audit trail, journals, field notes and memos. We analyzed the data using the constant comparative method throughout open coding followed by theoretical coding.


RESULTS
A framework and process involving external and internal practice facilitation using the new role of PP was thought to impact CDPS. The PP facilitated CDPS through on-going relationships with patients and practice team members. Key components included: 1) approaching CDPS in a comprehensive manner, 2) an individualized and personalized approach at multiple levels, 3) integrated continuity that included linking the patients and practices to CPDS resources, and 4) adaptability to different practices and settings.


CONCLUSIONS
The BETTER framework and key components are described as impacting CDPS through a process that involved a new role, the PP. The introduction of a novel role of a clinician within the primary care practice with skills in CDPS could appropriately address gaps in prevention and screening.
Department of Family Medicine, University of Alberta, University of Alberta, 901 College Plaza, Edmonton, Alberta, T6G 2C8, Canada. dmanca@med.ualberta.ca.
Donna Patricia
DP
Manca
Michelle
M
Greiver
June C
JC
Carroll
Ginetta
G
Salvalaggio
Andrew
A
Cave
Jess
J
Rogers
James
J
Pencharz
Carolina
C
Aguilar
Rebekah
R
Barrett
Shelley
S
Bible
Eva
E
Grunfeld
D000288:Administrative Personnel / Q000592:standards; D000328:Adult; D000368:Aged; D000416:Alberta; D002908:Chronic Disease / Q000517:prevention & control*; D002983:Clinical Competence; D016000:Cluster Analysis; D005260:Female; D017144:Focus Groups; D058005:General Practitioners / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000592:standards; D008503:Medical Staff / Q000592:standards; D008875:Middle Aged; D009864:Ontario; D011320:Primary Health Care / Q000592:standards*; D024382:Professional Role; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D012107:Research Design; D000078329:Workforce