Table 2 Intervention trials reporting change in routine provision of preventive care: January 1992–May 2014

-Bakker et al. (2003) [66]

-Netherlands

-Cluster RCT

-Smoking cessation for pregnant women.

-42 pre-natal care clinics (22 IV, 20 C)

118 midwives:

-IV n = 57 (37 did questionnaire-65 %)

-C n = 61 (32 did questionnaire-52 %)

556 clients:

-IV n = 253 (sample for presented analysis = 44)

-C n = 303 (sample for presented analysis = 51)

IV:

-Distribution of educational

-Offered educational meetings

-Patient resources

C:

-Patient resources

Clinician target:

-Midwives

-Clinician questionnaire at follow-up. Client questionnaires.

[M (SD), C vs IV]

-Scale 1–5 for clinician self-report data (1 = never, 5 = always).

-Scale 0–1 for client self-report (0 = no, 1 = yes).

Continuous variables.

Ask:

-Clinician: 5.00 vs 4.91 (0.37)^a

-Client: 0.72 (0.29) vs 0.91 (0.18)**

Advise: (to quit)

-Clinician:

(during pregnancy): 4.19 (1.03) vs 4.60 (0.77)*

(to partner): 3.58 (1.42) vs 4.03 (1.33)^a

-Client

(during pregnancy): 0.64 (0.36) vs 0.85 (0.25)**

(post-partum): 0.04 (0.08) vs 0.21 (0.25)**

Assist:

-clinician: 1.63 (1.10) vs 3.63 (1.19)***

-client: 0.03 (0.16) vs 0.33 (0.34)***

Arrange:

-clinician: 2.84 (0.99) vs 3.97 (0.89)***

Results similar when analysed at practice level (except clinician reported advice to quit during pregnancy no longer statistically significant).

-Chan et al. (2013) [67]

-Australia

-Quasi-experimental design

-Relevant risks: Smoking, nutrition, alcohol consumption, and physical inactivity

Other risks: weight

-4 generalist community nursing services randomised to:

-IV: n = NR

-C: n = NR

Clinicians:

-Baseline: n = 129/178 (72.5 %)

-6 months F/U: n = 81/129 (62.8 %)

-12 months F/U: n = 65/129 (50.4 %)

Overall response rate across all time points n = 54/129 (41.9 %)

IV (early IV):

-Educational meetings

-Reminders

-Patient resources

-Distribution of educational materials

C (late IV):

-Usual care

-Followed by intervention after collection of outcome data

Clinician target:

-Generalist community health nurses

-Clinician questionnaire:

-Baseline

-6 months F/U

-12 months F/U

[Group mean effect size (95 % CI) at 6 and 12 months F/U, respectively. Based on Likert scale 1 (never)-7 (always) provided care as part of routine practice].^e

[For ask and advise/assist scores: tested for significant differential change between IV vs C groups over time (baseline, 6 and 12 mths F/U). (Time by group interaction p value). For Arrange scores: significance testing conducted for IV vs C groups at baseline vs 6 mths, and baseline vs 12 mths]

Ask:

-S: 0.15 (−0.40–0.69), 0.30 (−0.26–0.84)^a

-N: 0.26 (−0.29–0.80), 1.12 (0.52–1.69)***

-A: 0.60 (0.01–1.16), 0.56 (−0.02–1.13)^a

-P: 0.34 (−0.21–0.89), 0.72 (0.15–1.27)***

Advise/assist

-S: 0.48 (−0.12–1.06), 0.42 (−0.17–1.00)***

-N: 0.09 (−0.46–0.64), 0.30 (−0.26–0.85)^a

-A: 0.23 (−0.33–0.79), 0.31 (−0.26–0.86)^a

-P: 0.36 (−0.21–0.92), 0.05 (−0.51–0.60)**

Arrange:

-S (Quitline): 0.17 (−0.38–0.71),^a 0.39 (−0.16-0.93)^a

-N: 0.09 (−0.45–0.63),^a 0.10 (−0.45–0.64)^a

-A: −0.39 (−0.93–0.16),^a −0.13 (−0.67–0.42)^a

-P: −0.33 (−0.87–0.22),^a −0.29 (−0.83–0.26)^a

-Kaner et al., (2003) [68]

-UK

-Cluster RCT

-Alcohol

-212 general practices randomised to:

-C: n = 76

-IV 1: n = 68

-IV 2: n = 68

(data for 156 practices)

IV 1—Outreach Training

-Educational outreach visit

-Patient mediated intervention

-Educational meeting

IV 2—Training plus telephone-based support

-Educational outreach visit

-Patient mediated intervention

-Educational meeting

-Ongoing support

C:

-Patient mediated intervention

-Distribution of educational materials

Clinician target:

-Nurses

Clinician questionnaire:

-Baseline

-3 months F/U (collection of screening forms)

(Median [interquartile range], C vs IV 1 vs IV 2)

Ask:

0 [0–17] vs 11 [0–28] vs 13 [0–37]**

Advise: 0 [0–3] vs 1 [0–4] vs 1 [0–7]*

(% of clients) 60 vs 61 vs 64 %*

-Katz et al. (2004) [69]

-USA

-RCT

-Smoking cessation

-9 primary care clinics (routine non-emergency care: 7 family practice, 2 internal medicine)

-Patients: n = 1221 (includes patients seen by medical assistants)

n = 663 patients seen by below clinicians:

IV sites:

-Registered nurses: n = 100

-Licenced practical nurses: n = 154

C sites:

-Registered nurses: n = 153

-Licenced practical nurses: n = 256

IV (clinician targeted):

-Educational meeting

-Audit and feedback

-Reminders

-Patient resources

C:

-Unspecified

Clinician target:

-Registered nurses,

-Licenced practical nurses

-(Medical assistants)^e

Client interviews (during IV period)

(% C vs IV site patients receiving care)

Ask:

-Registered nurses: 67 % vs 92 %^b

-Licenced practical nurses: 35 % vs 86 %^b

Assess:

-Registered nurses: 15 % vs 85 %^b

-Licenced practical nurses: 8 % vs 75 %^b

Advise:

-Registered nurses: 16 % vs 41 %^b

-Licenced practical nurses: 7 % vs 46 %^b

Assist:

-Registered nurses: 17 % vs 73 %^b

-Licensed practical nurses: 8 % vs 69 %^b

-Lennox et al., (1998) [72]

-UK

-RCT

-Smoking

-Primary care:

16 general practices:

(IV, n = 8; C, n = 8).

Clinicians receiving IV:

Practice nurses: 15/16 (93.7 %)

Health visitors: 16/16 (100 %)

Clients:

14 months F/U response rate: 1693/2588 (65.4 %).

IV:

-Educational meeting

C:

-Usual care (no educational meeting)

Clinician target:

-Practice nurses

-Health visitors

-(General practitioners)^c

Client questionnaire:

-14 months F/U

(% (n) of C vs IV patients)

Ask:

Practice nurses: 76.2 % (n = 77/101) vs 83.2 % (n = 104/125)^a

Health visitors: 68.6 % (n = 24/35) vs 73.7 % (n = 28/38)^a

-Moher et al., (2001) [70]

-UK

-Cluster

RCT

-Coronary heart disease

Relevant risks: smoking

Other risks: blood pressure, cholesterol

-Primary care:

21 general practices:

(IV 1, n = 7; IV 2, n = 7; C, n = 7).

Clients: n = 4048

Baseline (IV 1, n = 772; IV 2, n = 747; C, n = 623).

F/U: (IV 1, n = 682; IV 2, n = 665; C, n = 559).

Nurse targeted IV:

-Audit and feedback

-Local consensus processes

-Educational outreach visits and academic detailing

-Ongoing support

-Patient mediated intervention

C:

-Audit and feedback

-Usual care

Clinician target:

-Nurses

-(General practitioners)^c

Medical records audit:

-Baseline

-18 months F/U

[Mean % of clients (range), C vs general practitioners targeted IV vs nurse targeted IV]

Ask: ***

-Baseline: 73 % (50–91) vs 71 % (47–96) vs 71 % (46–85)

-F/U: 78 % (56–92) vs 92 % (77–100) vs 95 % (88–98)

-Secker-Walker et al., (2000) [71]

-USA

-Non-RCT

-Smoking in women (18–64 years)

-Primary care: n = 4

2 IV counties

2 C counties

Clinicians: n = 289 (eligible)

-Dentists

(IV: n = 51, C: n = 46),

-Dental hygienists

(IV: n = 38, C: n = 44),

-Family planning counsellors and WIC^f nurse counsellors

(IV: n =14 C: n =16),

-Community mental health counsellors

(IV: n = 57, C: n = 23)

-Physicians

(IV: n = 73, C: n = 73),

-IV (4-year multi-strategic, clinician targeted):

Family Planning and WIC nurse counsellors:

-Educational meeting

-Patient resources

Dentists, and dental hygienists:

-Educational meeting

-Ongoing support

Mental health counsellors:

(no formal approaches, but educational meeting attended by 3 staff members)

C:

-Usual care

Clinician target:

-dentists

-dental hygienists

-family planning counsellors and WIC nurse counsellors

Clinician questionnaire:

-Baseline

-Yr 5 F/U

-Yr 7 F/U

(Means for baseline vs F/U

% of smokers receiving cessation activity on 4 point scale: 0 = none, 1 = some, 2 = most, 3 = all). (Time by group interaction p value).

Paired comparisons at Yr 5 (Paired)

(Means for C vs IV counties % of smokers receiving cessation activity on a 4 point scale: 0 = none, 1 = some, 2 = most, 3 = all)

Unpaired comparisons at Yr 5; Unpaired comparisons at Yr 7 (Unpaired)

Paired Comparisons (Yr 5)

Advise (to quit):

-Dentists: IV: 1.7 vs 1.7;^d C:1.3 vs 1.6^a

Assist (provision of self-help materials):

-Dentists: IV: 0.2 vs 0.6; C: 0.3 vs 0.3*

-Dental hygienists: IV: 0.3 vs 0.7; C: 0.4 vs 0.4^a

Arrange (Referral to support group):

-Dental hygienists: IV: 0.2 vs 0.6; C: 0.1 vs 0.1;**

Arrange (Referral to quit group):

-Dentists: IV: 0.1 vs 0.4; C:0.2 vs 0.2;*

-Dental hygienists: IV: 0.3 vs 0.9; C: 0.3 vs 0.4;**

Unpaired Comparisons (Yr 5 and Yr 7)

Assist (provision of self-help materials):

-Family Planning and WIC counsellors: Yr 5: 1.1 vs 1.7;** Yr 7: 1.5 vs 1.6^a

Assist (setting quit dates):

-Family planning and WIC counsellors: Yr 5: 0.4 vs 0.8;* Yr 7: 0.7 vs 0.6^a

Arrange (referral to support group):

-Dentists: Yr 5: 0.0 vs 0.2;* Yr 7: 0.2 vs 0.2^a

-Dental hygienists: Yr 5: 0.1 vs 0.6;*** Yr 7: 0.2 vs 0.4^a

-Family planning and WIC counsellors: Yr 5: 0.4 vs 1.3;*** Yr 7: 0.3 vs 0.3^a

-Community mental health counsellors: Yr 5: 0.1 vs 0.4;* Yr 7: 0.3 vs 0.3^a

Arrange (referral to quit group):

-Dentists: Yr 5: 0.2 vs 0.4;* Yr 7: 0.3 vs 0.4^a

-Dental hygienists: Yr 5: 0.4 vs 0.9;** Yr 7: 0.3 vs 0.5^a

-Family planning and WIC counsellors: Yr 5: 0.7 vs 1.7;*** Yr 7: 1.0 vs 0.6^a

Arrange (referral one-to-one telephone support):

-Family planning and WIC counsellors: Yr 5: 0.3 vs 1.4;*** Yr 7: 0.5 vs 0.6^a