Denise Campbell-Scherer1, Jess Rogers2, Donna Manca1, Kelly Lang-Robertson3, Stephanie Bell3, Ginetta Salvalaggio1, Michelle Greiver4, Christina Korownyk1, Doug Klein1, June C Carroll5, Mel Kahan6, Jamie Meuser7, Sandy Buchman8, Rebekah M Barrett9, Eva Grunfeld10. 1. Department of Family Medicine, University of Alberta, Edmonton, Alta. 2. Centre for Effective Practice, Toronto, Ont. ; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. 3. Centre for Effective Practice, Toronto, Ont. 4. Department of Family and Community Medicine, North York General Hospital, North York, Ont. 5. Department of Family and Community Medicine, University of Toronto, Toronto, Ont. ; Department of Family Medicine Mount Sinai Hospital, Toronto, Ont. 6. Department of Family and Community Medicine, University of Toronto, Toronto, Ont. ; Department of Family Medicine, St. Joseph's Health Centre, Toronto, Ont. 7. Department of Family and Community Medicine, University of Toronto, Toronto, Ont. ; College of Family Physicians of Canada, Mississauga, Ont. 8. Department of Family and Community Medicine, University of Toronto, Toronto, Ont. 9. Taddle Creek Family Health Team, Toronto, Ont. 10. Department of Family and Community Medicine, University of Toronto, Toronto, Ont. ; Ontario Institute for Cancer Research, Toronto, Ont.
Abstract
BACKGROUND: The aim of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice (BETTER) randomized controlled trial is to improve the primary prevention of and screening for multiple conditions (diabetes, cardiovascular disease, cancer) and some of the associated lifestyle factors (tobacco use, alcohol overuse, poor nutrition, physical inactivity). In this article, we describe how we harmonized the evidence-based clinical practice guideline recommendations and patient tools to determine the content for the BETTER trial. METHODS: We identified clinical practice guidelines and tools through a structured literature search; we included both indexed and grey literature. From these guidelines, recommendations were extracted and integrated into knowledge products and outcome measures for use in the BETTER trial. End-users (family physicians, nurse practitioners, nurses and dieticians) were engaged in reviewing the recommendations and tools, as well as tailoring the content to the needs of the BETTER trial and family practice. RESULTS: In total, 3-5 high-quality guidelines were identified for each condition; from these, we identified high-grade recommendations for the prevention of and screening for chronic disease. The guideline recommendations were limited by conflicting recommendations, vague wording and different taxonomies for strength of recommendation. There was a lack of quality evidence for manoeuvres to improve the uptake of guidelines among patients with depression. We developed the BETTER clinical algorithms for the implementation plan. Although it was difficult to identify high-quality tools, 180 tools of interest were identified. INTERPRETATION: The intervention for the BETTER trial was built by integrating existing guidelines and tools, and working with end-users throughout the process to increase the intervention's utility for practice. TRIAL REGISTRATION: ISRCTN07170460.
BACKGROUND: The aim of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Family Practice (BETTER) randomized controlled trial is to improve the primary prevention of and screening for multiple conditions (diabetes, cardiovascular disease, cancer) and some of the associated lifestyle factors (tobacco use, alcohol overuse, poor nutrition, physical inactivity). In this article, we describe how we harmonized the evidence-based clinical practice guideline recommendations and patient tools to determine the content for the BETTER trial. METHODS: We identified clinical practice guidelines and tools through a structured literature search; we included both indexed and grey literature. From these guidelines, recommendations were extracted and integrated into knowledge products and outcome measures for use in the BETTER trial. End-users (family physicians, nurse practitioners, nurses and dieticians) were engaged in reviewing the recommendations and tools, as well as tailoring the content to the needs of the BETTER trial and family practice. RESULTS: In total, 3-5 high-quality guidelines were identified for each condition; from these, we identified high-grade recommendations for the prevention of and screening for chronic disease. The guideline recommendations were limited by conflicting recommendations, vague wording and different taxonomies for strength of recommendation. There was a lack of quality evidence for manoeuvres to improve the uptake of guidelines among patients with depression. We developed the BETTER clinical algorithms for the implementation plan. Although it was difficult to identify high-quality tools, 180 tools of interest were identified. INTERPRETATION: The intervention for the BETTER trial was built by integrating existing guidelines and tools, and working with end-users throughout the process to increase the intervention's utility for practice. TRIAL REGISTRATION: ISRCTN07170460.
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