The effectiveness of an intervention in increasing community health clinician provision of preventive care: a study protocol of a non-randomised, multiple-baseline trial.

Kathleen M Mcelwaine,Carolyn Slattery,Elizabeth M Campbell,Luke Wolfenden,Karen E Gillham,Emma L Doherty,Megan Freund,John H Wiggers,Paula M Wye,Patrick Mcelduff,Jennifer A Bowman,Jenny Knight

doi:10.1186/1472-6963-11-354

Abstract

BackgroundThe primary behavioural risks for the most common causes of mortality and morbidity in developed countries are tobacco smoking, poor nutrition, risky alcohol use, and physical inactivity. Evidence, guidelines and policies support routine clinician delivery of care to prevent these risks within primary care settings. Despite the potential afforded by community health services for the delivery of such preventive care, the limited evidence available suggests it is provided at suboptimal levels. This study aims to assess the effectiveness of a multi-strategic practice change intervention in increasing clinician's routine provision of preventive care across a network of community health services.Methods/DesignA multiple baseline study will be conducted involving all 56 community health facilities in a single health district in New South Wales, Australia. The facilities will be allocated to one of three administratively-defined groups. A 12 month practice change intervention will be implemented in all facilities in each group to facilitate clinician risk assessment of eligible clients, and clinician provision of brief advice and referral to those identified as being 'at risk'. The intervention will be implemented in a non-random sequence across the three facility groups. Repeated, cross-sectional measurement of clinician provision of preventive care for four individual risks (smoking, poor nutrition, risky alcohol use, and physical inactivity) will occur continuously for all three facility groups for 54 months via telephone interviews. The interviews will be conducted with randomly selected clients who have visited a community health facility in the last two weeks. Data collection will commence 12 months prior to the implementation of the intervention in the first group, and continue for six months following the completion of the intervention in the last group. As a secondary source of data, telephone interviews will be undertaken prior to and following the intervention with randomly selected samples of clinicians from each facility group to assess the reported provision of preventive care, and the acceptability of the practice change intervention and implementation.DiscussionThe study will provide novel evidence regarding the ability to increase clinician's routine provision of preventive care across a network of community health facilities.Trial registrationAustralian Clinical Trials Registry ACTRN12611001284954Universal Trial Number (UTN)U1111-1126-3465

Highlights

The primary behavioural risks for the most common causes of mortality and morbidity in developed countries are tobacco smoking, poor nutrition, risky alcohol use, and physical inactivity
Cochrane review evidence [8,9,10,11,12] supports the efficacy of clinician delivery of care to increase: smoking cessation [11,12], the consumption of fruit and vegetables [8], to reduce at-risk alcohol consumption [9], and to increase physical activity [10]
In a range of countries including Australia, community health services represent a key primary health care setting for the provision of preventive health care [19,20,24,25,26,27,28,29,30]

Summary

Introduction

The primary behavioural risks for the most common causes of mortality and morbidity in developed countries are tobacco smoking, poor nutrition, risky alcohol use, and physical inactivity. Cochrane review evidence [8,9,10,11,12] supports the efficacy of clinician delivery of care to increase: smoking cessation [11,12], the consumption of fruit and vegetables [8], to reduce at-risk alcohol consumption [9], and to increase physical activity [10] Consistent with such evidence, the routine delivery by health care providers of preventive care incorporating risk assessment, brief advice and referral for such behavioural risks has been recommended in a number of countries [13,14,15,16,17,18,19,20,21,22,23]. In Australia, community health services provide a diverse range of care types, including: community nursing, allied health, community child and family health, diabetes services, aged care, post acute care, mental health, drug and alcohol, and sexual assault care; and are delivered by a variety of providers, most commonly nurses and allied health professionals [29]

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