Browsing by Author "Campbell-Scherer, Denise"

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    Harmonization of clinical practice guidelines for primary prevention and screening: actionable recommendations and resources for primary care
    (2024-05-06) Fernandes, Carolina; Campbell-Scherer, Denise; Lofters, Aisha; Grunfeld, Eva; Aubrey-Bassler, Kris; Cheung, Heidi; Latko, Katherine; Tink, Wendy; Lewanczuk, Richard; Shea-Budgell, Melissa; Heisey, Ruth; Wong, Tracy; Yang, Huiming; Walji, Sakina; Wilson, Margo; Holmes, Elizabeth; Lang-Robertson, Kelly; DeLonghi, Christina; Manca, Donna P.
    Abstract Background Clinical practice guidelines (CPGs) synthesize high-quality information to support evidence-based clinical practice. In primary care, numerous CPGs must be integrated to address the needs of patients with multiple risks and conditions. The BETTER program aims to improve prevention and screening for cancer and chronic disease in primary care by synthesizing CPGs into integrated, actionable recommendations. We describe the process used to harmonize high-quality cancer and chronic disease prevention and screening (CCDPS) CPGs to update the BETTER program. Methods A review of CPG databases, repositories, and grey literature was conducted to identify international and Canadian (national and provincial) CPGs for CCDPS in adults 40–69 years of age across 19 topic areas: cancers, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, hepatitis C, obesity, osteoporosis, depression, and associated risk factors (i.e., diet, physical activity, alcohol, cannabis, drug, tobacco, and vaping/e-cigarette use). CPGs published in English between 2016 and 2021, applicable to adults, and containing CCDPS recommendations were included. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and a three-step process involving patients, health policy, content experts, primary care providers, and researchers was used to identify and synthesize recommendations. Results We identified 51 international and Canadian CPGs and 22 guidelines developed by provincial organizations that provided relevant CCDPS recommendations. Clinical recommendations were extracted and reviewed for inclusion using the following criteria: 1) pertinence to primary prevention and screening, 2) relevance to adults ages 40–69, and 3) applicability to diverse primary care settings. Recommendations were synthesized and integrated into the BETTER toolkit alongside resources to support shared decision-making and care paths for the BETTER program. Conclusions Comprehensive care requires the ability to address a person’s overall health. An approach to identify high-quality clinical guidance to comprehensively address CCDPS is described. The process used to synthesize and harmonize implementable clinical recommendations may be useful to others wanting to integrate evidence across broad content areas to provide comprehensive care. The BETTER toolkit provides resources that clearly and succinctly present a breadth of clinical evidence that providers can use to assist with implementing CCDPS guidance in primary care.
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    Results from the BETTER WISE trial: a pragmatic cluster two arm parallel randomized controlled trial for primary prevention and screening in primary care during the COVID-19 pandemic
    (2023-09-28) Manca, Donna P.; Fernandes, Carolina; Lofters, Aisha; Aubrey-Bassler, Kris; Shea-Budgell, Melissa; Campbell-Scherer, Denise; Sopcak, Nicolette; Meaney, Christopher; Moineddin, Rahim; McBrien, Kerry; Krueger, Paul; Wong, Tracy; Grunfeld, Eva
    Abstract Background Cancer and chronic diseases are a major cost to the healthcare system and multidisciplinary models with access to prevention and screening resources have demonstrated improvements in chronic disease management and prevention. Research demonstrated that a trained Prevention Practitioner (PP) in multidisciplinary team settings can improve achievement of patient level prevention and screening actions seven months after the intervention. Methods We tested the effectiveness of the PP intervention in a pragmatic two-arm cluster randomized controlled trial. Patients aged 40–65 were randomized at the physician level to an intervention group or to a wait-list control group. The intervention consisted of a patient visit with a PP. The PP received training in prevention and screening and use of the BETTER WISE tool kit. The effectiveness of the intervention was assessed using a composite outcome of the proportion of the eligible prevention and screening actions achieved between intervention and control groups at 12-months. Results Fifty-nine physicians were recruited in Alberta, Ontario, and Newfoundland and Labrador. Of the 1,005 patients enrolled, 733 (72.9%) completed the 12-month analysis. The COVID-19 pandemic occurred during the study time frame at which time nonessential prevention and screening services were not available and in-person visits with the PP were not allowed. Many patients and sites did not receive the intervention as planned. The mean composite score was not significantly higher in patients receiving the PP intervention as compared to the control group. To understand the impact of COVID on the project, we also considered a subset of patients who had received the intervention and who attended the 12-month follow-up visit before COVID-19. This assessment demonstrated the effectiveness of the BETTER visits, similar to the findings in previous BETTER studies. Conclusions We did not observe an improvement in cancer and chronic disease prevention and screening (CCDPS) outcomes at 12 months after a BETTER WISE prevention visit: due to the COVID-19 pandemic, the study was not implemented as planned. Though benefits were described in those who received the intervention before COVID-19, the sample size was too small to make conclusions. This study may be a harbinger of a substantial decrease and delay in CCDPS activities under COVID restrictions. Trial registration ISRCTN21333761. Registered on 19/12/2016. http://www.isrctn.com/ISRCTN21333761 .
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    The BETTER WISE protocol: building on existing tools to improve cancer and chronic disease prevention and screening in primary care for wellness of cancer survivors and patients – a cluster randomized controlled trial embedded in a mixed methods design
    (2018-09-26) Manca, Donna P; Fernandes, Carolina; Grunfeld, Eva; Aubrey-Bassler, Kris; Shea-Budgell, Melissa; Lofters, Aisha; Campbell-Scherer, Denise; Sopcak, Nicolette; O’Brien, Mary A; Meaney, Christopher; Moineddin, Rahim; McBrien, Kerry; Salvalaggio, Ginetta; Krueger, Paul
    Abstract Background There is a pressing need to reduce the burden of chronic disease and improve healthcare system sustainability through improved cancer and chronic disease prevention and screening (CCDPS) in primary care. We aim to create an integrated approach that addresses the needs of the general population and the special concerns of cancer survivors. Building on previous research, we will develop, implement, and test the effectiveness of an approach that proactively targets patients to attend an individualized CCDPS intervention delivered by a Prevention Practitioner (PP). The objective is to determine if patients randomized to receive an individualized PP visit (vs standard care) have improved cancer surveillance and CCDPS outcomes. Implementation frameworks will help identify and address facilitators and barriers to the approach and inform future dissemination and uptake. Methods/design The BETTER WISE project is a pragmatic two-arm cluster randomized controlled trial embedded in a mixed methods design, including a qualitative evaluation and an economic assessment. The intervention, informed by the expanded chronic care model and previous research, will be refined by engaging researchers, practitioners, policy makers, and patients. The BETTER WISE tool kit includes blended care pathways for cancer survivors (breast, colorectal, prostate) and CCDPS including lifestyle risk factors and screening for poverty. Patients aged 40–65, including both cancer survivors and general population patients, will be randomized at the physician level to an intervention group or to a wait-list control group. Once the intervention is completed, patients randomized to wait-list control will be invited to receive a prevention visit. The main outcome, calculated at 12-months follow-up, will be an individual patient-level summary composite index, defined as the proportion of CCDPS actions achieved relative to those for which the patient was eligible at baseline. A qualitative evaluation will capture information related to program outcome, implementation (facilitators and barriers), and sustainability. An economic assessment will examine the projected cost-benefit impact of investing in the BETTER WISE approach. Discussion This project builds on existing work and engages end users throughout the process to develop, implement, and determine the effectiveness of a multi-faceted intervention that addresses CCDPS and cancer survivorship in primary care settings. Trial registration ISRCTN21333761 . Registered on December 19, 2016
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    The cirrhosis care Alberta (CCAB) protocol: implementing an evidence-based best practice order set for the management of liver cirrhosis - a hybrid type I effectiveness-implementation trial
    (2020-06-18) Carbonneau, Michelle; Eboreime, Ejemai A; Hyde, Ashley; Campbell-Scherer, Denise; Faris, Peter; Gramlich, Leah; Tsuyuki, Ross T; Congly, Stephen E; Shaheen, Abdel A; Sadler, Matthew; Zeman, Marilyn; Spiers, Jude; Abraldes, Juan G; Sugars, Benjamin; Sia, Winnie; Green, Lee; Abdellatif, Dalia; Schaefer, Jeffrey P; Selvarajah, Vijeyakumar; Marr, Kaleb; Ryan, David; Westra, Yolande; Bakshi, Neeja; Varghese, Jayant C; Tandon, Puneeta
    Abstract Background Liver cirrhosis is a leading cause of morbidity, premature mortality and acute care utilization in patients with digestive disease. In the province of Alberta, hospital readmission rates for patients with cirrhosis are estimated at 44% at 90 days. For hospitalized patients, multiple care gaps exist, the most notable stemming from i) the lack of a structured approach to best practice care for cirrhosis complications, ii) the lack of a structured approach to broader health needs and iii) suboptimal preparation for transition of care into the community. Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial which aims to address these gaps. The proposed intervention is initiated at the time of hospitalization through implementation of a clinical information system embedded electronic order set for delivering evidence-based best practices under real-world conditions. The overarching objective of the CCAB trial is to demonstrate effectiveness and implementation feasibility for use of the order set in routine patient care within eight hospital sites in Alberta. Methods A mixed methods hybrid type I effectiveness-implementation design will be used to evaluate the effectiveness of the order set intervention. The primary outcome is a reduction in 90-day cumulative length of stay. Implementation outcomes such as reach, adoption, fidelity and maintenance will also be evaluated alongside other patient and service outcomes such as readmission rates, quality of care and cost-effectiveness. This theory-based trial will be guided by Normalization Process Theory, Consolidated Framework on Implementation Research (CFIR) and the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) Framework. Discussion The CCAB project is unique in its breadth, both in the comprehensiveness of the multi-component order set and also for the breadth of its roll-out. Lessons learned will ultimately inform the feasibility and effectiveness of this approach in “real-world” conditions as well as adoption and adaptation of these best practices within the rest of Alberta, other provinces in Canada, and beyond. Trial registration ClinicalTrials.gov: NCT04149223, November 4, 2019.
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    Understanding the Development of a Physician Practice Reflection Tool – A Case Study
    (2024-04-30) Burnett, Hongyu; Alonso-Yañez, Gabriela; Armson, Heather; Simmons, Marlon; Bharwani, Aleem; Campbell-Scherer, Denise
    This study investigated the development of a physician practice reflection tool by Continuing Professional Development (CPD) educators at the University of Calgary, focusing on the operationalization of the Physician Practice Improvement (PPI) system. The problem addressed was the evolving expectations of physician CPD in Canada, emphasizing the need for tools that support reflective practice and meet specific learning needs. Using an instrumental case study methodology within an interpretive paradigm, this study explored the design process of the My Practice Improvement (MyPI) tool from November 2020 to November 2021. Data were collected through field observations, document reviews, and interviews, providing insights into tool conceptualization, educators' collaborative efforts in tool design, and the challenges faced in the project process. These findings revealed considerable advancements in the translation of the PPI system into CPD programming. The MyPI tool was designed to facilitate physicians' self-assessment and reflection, thus aligning their learning with individual practice improvements. The key strategies developed included structured guidance for reflective practice and linking learning with quality improvement metrics. This study illustrates how CPD tools can be designed to empower physicians to direct their learning and improve their patient care. This research contributes to the field by detailing a practical approach to developing CPD tools that support PPI systems. It offers insights into collaborative educational practices and the potential for broader application across CPD programs aimed at addressing physician practice improvement.