@article {Aubrey-Basslerbjgpopen19X101656, author = {Kris Aubrey-Bassler and Carolina Fernandes and Carla Penney and Richard Cullen and Christopher Meaney and Nicolette Sopcak and Denise Campbell-Scherer and Rahim Moineddin and Julia Baxter and Paul Krueger and Margo Wilson and Andrea Pike and Eva Grunfeld and Donna Manca}, title = {The effectiveness of a proven chronic disease prevention and screening intervention in diverse and remote primary care settings: an implementation study on the BETTER 2 Program}, elocation-id = {bjgpopen19X101656}, year = {2019}, doi = {10.3399/bjgpopen19X101656}, publisher = {Royal College of General Practitioners}, abstract = {Background The Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER) randomised control trial (RCT) showed that the BETTER Program improved chronic disease prevention and screening (CDPS) by 32.5\% in urban team-based primary care clinics.Aim To evaluate outcomes from implementation of BETTER in diverse clinical settings.Design \& setting An implementation study was undertaken to apply the CDPS intervention from the BETTER trial to diverse settings in BETTER 2. Patients aged 40{\textendash}65 years were invited to enrol in the study from three clinics in Newfoundland and Labrador, Canada.Method At baseline, eligibility for 27 CDPS actions (for example, cancer, diabetes and hypertension screening, lifestyle) was determined. Patients then met with a trained provider and prioritised goals to address their eligible CDPS actions. Providers received training in behaviour change theory and practice. Descriptive analysis of clinical outcomes and success factors were reported.Results A total of 154 patients (119 female and 35 male) had a baseline visit; 106 had complete outcome assessments, and the remainder had partial outcome assessments. At baseline, patients were eligible for a mean of 12.3 CDPS actions and achieved a mean of 6.0 (49\%, 95\% confidence intervals [CI] = 24\% to 74\%) at 6-month follow-up, including reduced hypertension (86\% of eligible patients, 95\% CI = 67\% to 96\%), weight control (51\% of eligible patients, 95\% CI = 42\% to 60\%), and smoking cessation (36\% of eligible patients, 95\% CI = 17\% to 59\%). Male, highly educated, and lower income individuals achieved a higher proportion of CDPS manoeuvers than their counterparts.Conclusion Clinical outcomes from this implementation study were comparable with those of the prior BETTER RCT, providing support for the BETTER Program as an effective approach to CDPS in more diverse general practice settings.}, URL = {https://bjgpopen.org/content/early/2019/09/16/bjgpopen19X101656}, eprint = {https://bjgpopen.org/content/early/2019/09/16/bjgpopen19X101656.full.pdf}, journal = {BJGP Open} }