PT  - JOURNAL ARTICLE
AU  - Kris Aubrey-Bassler
AU  - Carolina Fernandes
AU  - Carla Penney
AU  - Richard Cullen
AU  - Christopher Meaney
AU  - Nicolette Sopcak
AU  - Denise Campbell-Scherer
AU  - Rahim Moineddin
AU  - Julia Baxter
AU  - Paul Krueger
AU  - Margo Wilson
AU  - Andrea Pike
AU  - Eva Grunfeld
AU  - Donna Manca
TI  - 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
AID  - 10.3399/bjgpopen19X101656
DP  - 2019 Oct 01
TA  - BJGP Open
PG  - bjgpopen19X101656
VI  - 3
IP  - 3
4099  - http://bjgpopen.org/content/3/3/bjgpopen19X101656.short
4100  - http://bjgpopen.org/content/3/3/bjgpopen19X101656.full
SO  - BJGP Open2019 Oct 01; 3
AB  - 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 40–65 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.