Improved preventive care in family practices with outreach facilitation: understanding success and failure

William Hogg,
Neil Baskerville,
Candace Nykiforuk,
Dan Mallen

Department of Family Medicine, University of Ottawa, Ottawa, Canada;
Department of Family Medicine, University of Ottawa, Ottawa;
Department of Health Studies & Gerontology, University of Waterloo, Waterloo;
Grand Valley Medical Clinic, Grand Valley, Ontario, Canada

Objectives: To understand why some family practices with a facilitator improved preventive performance more than others. Sustainability of practice improvements one year after the intervention was also explored.

Methods: Interviews with physicians and nurses from seven practicesand data gathered during the intervention were used to formcase studies of three high performing and four low performingfamily practices. Case studies were developed using cross-caseanalysis with a combination of the constant-comparative methodand memoing-diagramming. Two researchers independently conductedin-depth coding of transcripts and documents, individual caseconstruction for each study site, and then cross-case analysisof the identified themes between study sites.

Results: Staff involvement and a positive attitude toward implementationof changes were central to high improvement in performance.A lack of computers, low staff involvement or high staff turnoverwere associated with low improvement in performance. Personalcharacteristics of the facilitator are important. Six of theseven practices still had the prevention tools in place oneyear after the intervention and all noted that participationhad improved their understanding of preventive medicine.

Conclusions: When using facilitators, one should avoid practicesin turmoil, strive for continuity over time, and recognise theimportance of the relationship between the facilitator and thepractice.

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