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

From: Systematic review of interventions to increase the delivery of preventive care by primary care nurses and allied health clinicians

Author/year/country/trial design Trial focus/care setting/sample size Intervention strategies Clinician group/data collection tool Preventive care practices examined/outcome
-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 WICf 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 1.6a
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 0.4a
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 1.6a
Assist (setting quit dates):
-Family planning and WIC counsellors: Yr 5: 0.4 vs 0.8;* Yr 7: 0.7 vs 0.6a
Arrange (referral to support group):
-Dentists: Yr 5: 0.0 vs 0.2;* Yr 7: 0.2 vs 0.2a
-Dental hygienists: Yr 5: 0.1 vs 0.6;*** Yr 7: 0.2 vs 0.4a
-Family planning and WIC counsellors: Yr 5: 0.4 vs 1.3;*** Yr 7: 0.3 vs 0.3a
-Community mental health counsellors: Yr 5: 0.1 vs 0.4;* Yr 7: 0.3 vs 0.3a
Arrange (referral to quit group):
-Dentists: Yr 5: 0.2 vs 0.4;* Yr 7: 0.3 vs 0.4a
-Dental hygienists: Yr 5: 0.4 vs 0.9;** Yr 7: 0.3 vs 0.5a
-Family planning and WIC counsellors: Yr 5: 0.7 vs 1.7;*** Yr 7: 1.0 vs 0.6a
Arrange (referral one-to-one telephone support):
-Family planning and WIC counsellors: Yr 5: 0.3 vs 1.4;*** Yr 7: 0.5 vs 0.6a
  1. *p ≤ 0.05, **p ≤ 0.01, ***p ≤ 0.001
  2. RCT randomised control trial, IV intervention, C control, NR not reported, F/U follow-up, S smoking, N nutrition, A alcohol, P physical activity, NR not reported
  3. aNot statistically significant at p < 0.05
  4. bSignificance testing not conducted
  5. cPaper reported results separately for this clinician target
  6. dCorrectly reported from paper. Confidence intervals (1.3–2.0 vs 1.4–2.0)
  7. eNote: only effect size results summarised. Group M and 95 % CI for IV and C groups at baseline, 6- and 12-month follow-up reported but not summarised in table due to space constraints
  8. fWIC refers to Special Supplemental Food Program for Women, Infants and Children