Improving chronic disease prevention and screening in primary care: results of the BETTER pragmatic cluster randomized controlled trial.
Improving chronic disease prevention and screening in primary care: results of the BETTER pragmatic cluster randomized controlled trial.
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DOI：
10.1186/1471-2296-14-175
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发表时间：
2013-11-20
影响因子：
2.9
通讯作者：
BETTER Trial Investigators
中科院分区：
文献类型：
--
作者：
Grunfeld E;Manca D;Moineddin R;Thorpe KE;Hoch JS;Campbell-Scherer D;Meaney C;Rogers J;Beca J;Krueger P;Mamdani M;BETTER Trial Investigators
初级保健提供医疗保健系统提供的大部分循证慢性病预防和筛查服务。然而，建议的预防服务与实际做法之间仍然存在差距。该试验（BETTER 试验）旨在通过初级保健中的实践促进干预措施，改善心脏病、糖尿病、结直肠癌、乳腺癌和宫颈癌以及相关生活方式因素的预防护理。实用双向因子聚类随机对照试验，以初级保健医生的实践为分配单位，以个体患者为分析单位。背景是加拿大两个省的城市初级保健团队的实践。八个初级保健团队诊所被随机分配接受诊所级别干预或候补名单控制；每组 4 名医生（32 名医生）被随机分配接受患者层面的干预或等待名单控制。从医生名册中随机选择的患者被分为两组：1）普通组和 2）中度精神疾病组。这些干预措施包括由实践协调员进行多方面的、基于证据的、量身定制的实践水平干预，以及患者水平的干预，包括与预防从业者进行一小时的访问，患者接受量身定制的“预防处方”。主要结果是 28 项基于证据的慢性病预防和筛查行动以及预先确定的目标的综合总结质量指数，表示为基线时合格行动与随访时满足的比率。进行了成本效益分析。 1,260 名符合条件的患者中有 789 名 (63%) 参加了。平均而言，患者在基线时有资格采取 8.96 (SD 3.2) 项行动。在调整分析中，对照患者达到目标行动的率为 23.1%（95% CI：19.2% 至 27.1%），而接受实践水平干预的患者为 28.5%（95% CI：20.9% 至 36.0%），接受患者水平干预的患者为 55.6%（95% CI：49.0% 至 62.1%），接受患者水平干预的患者为 58.9%（95% CI）。 CI：54.7% 至 63.1%）同时接受实践层面和患者层面的干预（患者层面的干预与对照，P < 0.001）。患者层面干预的好处在两个层面都得到了体现。每次采取额外行动，干预的额外成本为 26.43 美元 CAN（95% CI：16 至 44 美元）。预防从业者可以以具有成本效益的方式改善临床上重要的慢性病预防和筛查的实施。
Primary care provides most of the evidence-based chronic disease prevention and screening services offered by the healthcare system. However, there remains a gap between recommended preventive services and actual practice. This trial (the BETTER Trial) aimed to improve preventive care of heart disease, diabetes, colorectal, breast and cervical cancers, and relevant lifestyle factors through a practice facilitation intervention set in primary care. Pragmatic two-way factorial cluster RCT with Primary Care Physicians’ practices as the unit of allocation and individual patients as the unit of analysis. The setting was urban Primary Care Team practices in two Canadian provinces. Eight Primary Care Team practices were randomly assigned to receive the practice-level intervention or wait-list control; 4 physicians in each team (32 physicians) were randomly assigned to receive the patient-level intervention or wait-list control. Patients randomly selected from physicians’ rosters were stratified into two groups: 1) general and 2) moderate mental illness. The interventions involved a multifaceted, evidence-based, tailored practice-level intervention with a Practice Facilitator, and a patient-level intervention involving a one-hour visit with a Prevention Practitioner where patients received a tailored ‘prevention prescription’. The primary outcome was a composite Summary Quality Index of 28 evidence-based chronic disease prevention and screening actions with pre-defined targets, expressed as the ratio of eligible actions at baseline that were met at follow-up. A cost-effectiveness analysis was conducted. 789 of 1,260 (63%) eligible patients participated. On average, patients were eligible for 8.96 (SD 3.2) actions at baseline. In the adjusted analysis, control patients met 23.1% (95% CI: 19.2% to 27.1%) of target actions, compared to 28.5% (95% CI: 20.9% to 36.0%) receiving the practice-level intervention, 55.6% (95% CI: 49.0% to 62.1%) receiving the patient-level intervention, and 58.9% (95% CI: 54.7% to 63.1%) receiving both practice- and patient-level interventions (patient-level intervention versus control, P < 0.001). The benefit of the patient-level intervention was seen in both strata. The extra cost of the intervention was $26.43CAN (95% CI: $16 to $44) per additional action met. A Prevention Practitioner can improve the implementation of clinically important prevention and screening for chronic diseases in a cost-effective manner.
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影响因子：
105.7
作者：
Kaczorowski, Janusz;Chambers, Larry W.;Sabaldt, Rolf J.
通讯作者：
Sabaldt, Rolf J.
影响因子：
3.6
作者：
Schneider, Kathleen M.;O'Donnell, Brian E.;Dean, Debbie
通讯作者：
Dean, Debbie
DOI：
10.1503/cmaj.081316
发表时间：
2009-05-26
期刊：
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
影响因子：
--
作者：
Glazier, Richard H;Klein-Geltink, Julie;Sibley, Lyn M
通讯作者：
Sibley, Lyn M
影响因子：
2.7
作者：
Chalkidou, Kalipso;Tunis, Sean;Zwarenstein, Merrick
通讯作者：
Zwarenstein, Merrick
影响因子：
2.9
作者：
Feifer, C;Ornstein, SM;Liszka, H
通讯作者：
Liszka, H