title: Guideline harmonization and implementation plan for the BETTER trial: Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice.
abstract: BACKGROUND
  The aim of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice (BETTER) randomized controlled trial is to improve the primary prevention of and screening for multiple conditions (diabetes, cardiovascular disease, cancer) and some of the associated lifestyle factors (tobacco use, alcohol overuse, poor nutrition, physical inactivity). In this article, we describe how we harmonized the evidence-based clinical practice guideline recommendations and patient tools to determine the content for the BETTER trial.
  
  
  METHODS
  We identified clinical practice guidelines and tools through a structured literature search; we included both indexed and grey literature. From these guidelines, recommendations were extracted and integrated into knowledge products and outcome measures for use in the BETTER trial. End-users (family physicians, nurse practitioners, nurses and dieticians) were engaged in reviewing the recommendations and tools, as well as tailoring the content to the needs of the BETTER trial and family practice.
  
  
  RESULTS
  In total, 3-5 high-quality guidelines were identified for each condition; from these, we identified high-grade recommendations for the prevention of and screening for chronic disease. The guideline recommendations were limited by conflicting recommendations, vague wording and different taxonomies for strength of recommendation. There was a lack of quality evidence for manoeuvres to improve the uptake of guidelines among patients with depression. We developed the BETTER clinical algorithms for the implementation plan. Although it was difficult to identify high-quality tools, 180 tools of interest were identified.
  
  
  CONCLUSIONS
  The intervention for the BETTER trial was built by integrating existing guidelines and tools, and working with end-users throughout the process to increase the intervention's utility for practice.
  
  
  BACKGROUND
  ISRCTN07170460.
authors: Department of Family Medicine, University of Alberta, Edmonton, Alta.
authors: Denise
authors: D
authors: Campbell-Scherer
authors: Centre for Effective Practice, Toronto, Ont. ; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.
authors: Jess
authors: J
authors: Rogers
authors: Department of Family Medicine, University of Alberta, Edmonton, Alta.
authors: Donna
authors: D
authors: Manca
authors: Centre for Effective Practice, Toronto, Ont.
authors: Kelly
authors: K
authors: Lang-Robertson
authors: Centre for Effective Practice, Toronto, Ont.
authors: Stephanie
authors: S
authors: Bell
authors: Department of Family Medicine, University of Alberta, Edmonton, Alta.
authors: Ginetta
authors: G
authors: Salvalaggio
authors: Department of Family and Community Medicine, North York General Hospital, North York, Ont.
authors: Michelle
authors: M
authors: Greiver
authors: Department of Family Medicine, University of Alberta, Edmonton, Alta.
authors: Christina
authors: C
authors: Korownyk
authors: Department of Family Medicine, University of Alberta, Edmonton, Alta.
authors: Doug
authors: D
authors: Klein
authors: Department of Family and Community Medicine, University of Toronto, Toronto, Ont. ; Department of Family Medicine Mount Sinai Hospital, Toronto, Ont.
authors: June C
authors: JC
authors: Carroll
authors: Department of Family and Community Medicine, University of Toronto, Toronto, Ont. ; Department of Family Medicine, St. Joseph's Health Centre, Toronto, Ont.
authors: Mel
authors: M
authors: Kahan
authors: Department of Family and Community Medicine, University of Toronto, Toronto, Ont. ; College of Family Physicians of Canada, Mississauga, Ont.
authors: Jamie
authors: J
authors: Meuser
authors: Department of Family and Community Medicine, University of Toronto, Toronto, Ont.
authors: Sandy
authors: S
authors: Buchman
authors: Taddle Creek Family Health Team, Toronto, Ont.
authors: Rebekah M
authors: RM
authors: Barrett
authors: Department of Family and Community Medicine, University of Toronto, Toronto, Ont. ; Ontario Institute for Cancer Research, Toronto, Ont.
authors: Eva
authors: E
authors: Grunfeld