title: Increasing preventive care by primary care nursing and allied health clinicians: a non-randomized controlled trial.
abstract: BACKGROUND
  Although primary care nurse and allied health clinician consultations represent key opportunities for the provision of preventive care, it is provided suboptimally.
  
  
  OBJECTIVE
  To assess the effectiveness of a practice change intervention in increasing primary care nursing and allied health clinician provision of preventive care for four health risks.
  
  
  METHODS
  Two-group (intervention versus control), non-randomized controlled study assessing the effectiveness of the intervention in increasing clinician provision of preventive care.
  
  
  METHODS
  Randomly selected clients from 17 primary healthcare facilities participated in telephone surveys that assessed their receipt of preventive care prior to (September 2009-2010, n=876) and following intervention (October 2011-2012, n=1,113).
  
  
  METHODS
  The intervention involved local leadership and consensus processes, electronic medical record system modification, educational meetings and outreach, provision of practice change resources and support, and performance monitoring and feedback.
  
  
  METHODS
  The primary outcome was differential change in client-reported receipt of three elements of preventive care (assessment, brief advice, referral/follow-up) for each of four behavioral risks individually (smoking, inadequate fruit and vegetable consumption, alcohol overconsumption, physical inactivity) and combined. Logistic regression assessed intervention effectiveness.
  
  
  RESULTS
  Analyses conducted in 2013 indicated significant improvements in preventive care delivery in the intervention compared to the control group from baseline to follow-up for assessment of fruit and vegetable consumption (+23.8% vs -1.5%); physical activity (+11.1% vs -0.3%); all four risks combined (+16.9% vs -1.0%) and for brief advice for inadequate fruit and vegetable consumption (+19.3% vs -2.0%); alcohol overconsumption (+14.5% vs -8.9%); and all four risks combined (+14.3% vs +2.2%). The intervention was ineffective in increasing the provision of the remaining forms of preventive care.
  
  
  CONCLUSIONS
  The intervention's impact on the provision of preventive care varied by both care element and risk type. Further intervention is required to increase the consistent provision of preventive care, particularly referral/follow-up.
authors.affiliation: Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: McElwaine
authors.affiliation: Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia. Electronic address: megan.freund@hnehealth.nsw.gov.au.
authors.forename: Megan
authors.initials: M
authors.lastname: Freund
authors.affiliation: Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Campbell
authors.affiliation: Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Knight
authors.affiliation: School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Bowman
authors.affiliation: Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia.
authors.forename: Luke
authors.initials: L
authors.lastname: Wolfenden
authors.affiliation: Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia.
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.affiliation: Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Bartlem
authors.affiliation: Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Gillham
authors.affiliation: Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia.
authors.forename: John H
authors.initials: JH
authors.lastname: Wiggers
mesh_terms: D000328:Adult; D000488:Allied Health Personnel / Q000458:organization & administration*; D003625:Data Collection; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services / Q000458:organization & administration*; D059017:Primary Care Nursing / Q000379:methods*; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data