Eva Grunfeld|Donna Manca|Rahim Moineddin|Kevin E. Thorpe|Jeffrey S. Hoch|Denise Campbell?Scherer|Christopher Meaney|Joel Rogers|Jaclyn Beca|Paul Krueger|Muhammad Mamdani
Improving chronic disease prevention and screening in primary care: results of the BETTER pragmatic cluster randomized controlled trial
University of Toronto|University of Alberta|University of Toronto|St. Michael's Hospital|St. Michael's Hospital|University of Alberta|University of Toronto|St. Michael's Hospital|University of Toronto|St. Michael's Hospital
primary care provides evidencebased chronic disease prevention screening services offered healthcare system however remains gap recommended preventive services actual practice trial better trial aimed improve preventive care heart disease diabetes colorectal breast cervical cancers relevant lifestyle factors practice facilitation intervention set primary carepragmatic twoway factorial cluster rct primary care physicians practices unit allocation individual patients unit analysis setting urban primary care team practices two canadian provinces eight primary care team practices randomly assigned receive practicelevel intervention waitlist control 4 physicians team 32 physicians randomly assigned receive patientlevel intervention waitlist control patients randomly selected physicians rosters stratified two groups 1 general 2 moderate mental illness interventions involved multifaceted evidencebased tailored practicelevel intervention practice facilitator patientlevel intervention involving onehour visit prevention practitioner patients received tailored prevention prescription primary outcome composite summary quality index 28 evidencebased chronic disease prevention screening actions predefined targets expressed ratio eligible actions baseline met followup costeffectiveness analysis conducted789 1260 63 eligible patients participated average patients eligible 896 sd 32 actions baseline adjusted analysis control patients met 231 95 ci 192 271 target actions compared 285 95 ci 209 360 receiving practicelevel intervention 556 95 ci 490 621 receiving patientlevel intervention 589 95 ci 547 631 receiving practice patientlevel interventions patientlevel intervention versus control p 0001 benefit patientlevel intervention seen strata extra cost intervention 2643can 95 ci 16 44 per additional action meta prevention practitioner improve implementation clinically important prevention screening chronic diseases costeffective manner