title: Implementing and evaluating a program to facilitate chronic disease prevention and screening in primary care: a mixed methods program evaluation.
abstract: BACKGROUND
  The objectives of this paper are to describe the planned implementation and evaluation of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER 2) program which originated from the BETTER trial. The pragmatic trial, informed by the Chronic Care Model, demonstrated the effectiveness of an approach to Chronic Disease Prevention and Screening (CDPS) involving the use of a new role, the prevention practitioner. The desired goals of the program are improved clinical outcomes, reduction in the burden of chronic disease, and improved sustainability of the health-care system through improved CDPS in primary care.
  
  
  METHODS
  The BETTER 2 program aims to expand the implementation of the intervention used in the original BETTER trial into communities across Canada (Alberta, Ontario, Newfoundland and Labrador, the Northwest Territories and Nova Scotia). This proactive approach provides at-risk patients with an intervention from the prevention practitioner, a health-care professional. Using the BETTER toolkit, the prevention practitioner determines which CDPS actions the patient is eligible to receive, and through shared decision-making and motivational interviewing, develops a unique and individualized 'prevention prescription' with the patient. This intervention is 1) personalized; 2) addressing multiple conditions; 3) integrated through linkages to local, regional, or national resources; and 4) longitudinal by assessing patients over time. The BETTER 2 program brings together primary care providers, policy/decision makers and researchers to work towards improving CDPS in primary care. The target patient population is adults aged 40-65. The reach, effectiveness, adoption, implementation, maintain (RE-AIM) framework will inform the evaluation of the program through qualitative and quantitative methods. A composite index will be used to quantitatively assess the effectiveness of the prevention practitioner intervention. The CDPS actions comprising the composite index include the following: process measures, referral/treatment measures, and target/change outcome measures related to cardiovascular disease, diabetes, cancer and associated lifestyle factors.
  
  
  CONCLUSIONS
  The BETTER 2 program is a collaborative approach grounded in practice and built from existing work (i.e., integration not creation). The program evaluation is designed to provide an understanding of issues impacting the implementation of an effective approach for CDPS within primary care that may be adapted to become sustainable in the non-research setting.
authors.affiliation: Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton T6G 2T4, Alberta, Canada. dpmanca@ualberta.ca.
authors.forename: Donna Patricia
authors.initials: DP
authors.lastname: Manca
authors.forename: Kris
authors.initials: K
authors.lastname: Aubrey-Bassler
authors.forename: Kami
authors.initials: K
authors.lastname: Kandola
authors.forename: Carolina
authors.initials: C
authors.lastname: Aguilar
authors.forename: Denise
authors.initials: D
authors.lastname: Campbell-Scherer
authors.forename: Nicolette
authors.initials: N
authors.lastname: Sopcak
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: O'Brien
authors.forename: Christopher
authors.initials: C
authors.lastname: Meaney
authors.forename: Vee
authors.initials: V
authors.lastname: Faria
authors.forename: Julia
authors.initials: J
authors.lastname: Baxter
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.forename: Ginetta
authors.initials: G
authors.lastname: Salvalaggio
authors.forename: Lee
authors.initials: L
authors.lastname: Green
authors.forename: Andrew
authors.initials: A
authors.lastname: Cave
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000592:standards; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D016730:Program Development; D015397:Program Evaluation