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W Hogg

Publications and source records attributed to W Hogg.

8 recordsLinked to original sources
PubMed2001

Evidence to action: a tailored multifaceted approach to changing family physician practice patterns and improving preventive care.

BACKGROUND: Although there is much room for improvement in the performance of recommended preventive manoeuvres, many inappropriate preventive interventions are being done. We evaluated a multifaceted intervention, delivered by nurses trained in prevention facilitation, to improve prevention in primary care. METHODS: Forty-six health service organizations (HSOs) were recruited from 100 sites in Ontario. After baseline data were collected, we randomly assigned the practices to either an 18-month (July 1997 to December 1998) multifaceted intervention delivered by 1 of 3 nurse facilitators (23 practices) or no intervention (23 practices). The unit of intervention and analysis was the medical practice. The outcome measure was an overall index of preventive performance, which was calculated as the proportion of eligible patients who received 8 recommended preventive manoeuvres less the proportion of eligible patients who received 5 inappropriate preventive manoeuvres. RESULTS: One HSO, in the intervention group, was lost to follow-up. Before the intervention, the index of preventive performance was similar for the intervention and control groups (31.9% [95% confidence interval (CI) 27.3%-36.5%] and 32.1% [95% CI 27.2%-37.0%] respectively). At follow-up the corresponding values were 43.2% (95% CI 38.4%-48.0%) and 31.9% (95% CI 26.8%-37.0%), for an absolute improvement in the intervention group of 11.5% (p < 0.001). The mean proportion of eligible patients who received the recommended manoeuvres was 62.3% (95% CI 58.2%-66.4%) in the intervention group, as compared with 57.4% (95% CI 54.1%-60.7%) in the control group, for an absolute improvement of 7.2% (p = 0.008). The corresponding values for the inappropriate manoeuvres were 19.1% (95% CI 15.6%-22.6%) and 25.5% (95% CI 20.0%-31.0%), for an absolute improvement of 4.4% (p = 0.019). INTERPRETATION: The tailored multifaceted intervention delivered by nurse facilitators was effective in modifying physician practice patterns and significantly improved preventive care performance.

Family Practice↗
PubMed2001

Process evaluation of a tailored multifaceted approach to changing family physician practice patterns improving preventive care.

BACKGROUND: We conducted a process evaluation of a multifaceted outreach facilitation intervention to document the extent to which the intervention was implemented with fidelity. We also hoped to gain insight into how facilitation worked to improve preventive performance. METHODS: We used 5 data collection tools to evaluate the implementation of the intervention, and a combination of descriptive, quantitative, and qualitative analyses. Triangulation was used to attain a complete understanding of the quality of implementation. Twenty-two intervention practices with a total of 54 physicians participated in a randomized controlled trial that took place in Southwestern Ontario, Canada. The key measures of process were the frequency and time involved to deliver intervention components, the scope of the delivery and the utility of the components, and physician satisfaction with the intervention. RESULTS: Of the 7 components in the intervention model, prevention facilitators (PFs) visited the practice most often to deliver the audit and feedback, consensus building, and reminder system components. All the study practices received preventive performance audit and feedback, achieved consensus on a plan for improvement, and implemented a reminder system. Ninety percent of the practices implemented a customized flow sheet, and 10% used a computerized reminder system. Ninety-five percent of the intervention practices wanted critically appraised evidence for prevention, 82% participated in a workshop with opinion leaders in preventive care, and 100% received patient education materials in a binder. Content analysis of the physician interviews and bivariate analysis of physician self-reported changes between intervention and control group physicians revealed that the audit and feedback, consensus building, and development of reminder systems were the key intervention components. Ninety-five percent of the physicians were either satisfied or very satisfied with the intervention, and 90% would have been willing to have the PF continue working with their practice. CONCLUSIONS: Primary care practices in Ontario can implement significant changes in their practice environments that will improve preventive care activity with the assistance of a facilitator. The main components for creating change are audit and feedback of preventive performance, achieving consensus on a plan for improvement, and implementing a reminder system.

Family Practice↗
PubMed2001

The effect of cluster randomization on sample size in prevention research.

BACKGROUND: This paper concerns the issue of cluster randomization in primary care practice intervention trials. We present information on the cluster effect of measuring the performance of various preventive maneuvers between groups of physicians based on a successful trial. We discuss the intracluster correlation coefficient of determining the required sample size and the implications for designing randomized controlled trials where groups of subjects (e.g., physicians in a group practice) are allocated at random. METHODS: We performed a cross-sectional study involving data from 46 participating practices with 106 physicians collected using self-administered questionnaires and a chart audit of 100 randomly selected charts per practice. The population was health service organizations (HSOs) located in Southern Ontario. We analyzed performance data for 13 preventive maneuvers determined by chart review and used analysis of variance to determine the intraclass correlation coefficient. An index of "up-to-datedness" was computed for each physician and practice as the number of a recommended preventive measure done divided by the number of eligible patients. An index called "inappropriateness" was computed in the same manner for the not-recommended measures. The intraclass correlation coefficients for 2 key study outcomes (up-to-datedness and inappropriateness) were also calculated and compared. RESULTS: The mean up-to-datedness score for the practices was 53.5% (95% confidence interval [CI], 51.0%-56.0%), and the mean inappropriateness score was 21.5% (95% CI, 18.1%-24.9%). The intraclass correlation for up-to-datedness was 0.0365 compared with inappropriateness at 0.1790. The intraclass correlation for preventive maneuvers ranged from 0.005 for blood pressure measurement to 0.66 for chest radiographs of smokers, and as a consequence required the sample size ranged from 20 to 42 physicians per group. CONCLUSIONS: Randomizing by practice clusters and analyzing at the level of the physician has important implications for sample size requirements. Larger intraclass correlations indicate interdependence among the physicians within a cluster; as a consequence, variability within clusters is reduced, and the required sample size increased. The key finding that many potential outcome measures perform differently in terms of the intracluster correlation reinforces the need for researchers to carefully consider the selection of outcome measures and adjust sample sizes accordingly when the unit of analysis and randomization are not the same.

Humans↗
PubMed1999

Peer consultation reflection exercise.

OBJECTIVE: To explore participants' overall perception of the value of the Peer Consultation Reflection Exercise (PCRE); of barriers and facilitators to participation and learning during a PCRE; and of the transferability of the experience to participants' own settings. DESIGN: This study used the qualitative techniques of key informant interviews and a focus group. SETTING: Focus group and key informant interviews at the 1996 Annual Meeting of the College of Family Physicians of Canada's Section of Teachers. PARTICIPANTS: Family medicine teachers attending a PCRE. METHOD: Five key informant interviews and one focus group composed of five participants were conducted to explore participants' experience of participating and learning during a PCRE. MAIN FINDINGS: Participants viewed the PCRE as a valuable opportunity to interact and learn from colleagues a were especially impressed with the opportunity to listen. Confidentiality and the important role of the facilitator were identified as key components. The greatest perceived barrier was the formal structure of the PCRE. CONCLUSIONS: The PCRE is an innovative strategy for personal and professional development. It could be used in other settings.

Adult↗
PubMed1993

Effect of location on family medicine residents' training.

A survey of family medicine residents trained at community-based or hospital-based centres suggested differences in experience and in career plans. Community-based residents saw more patients in the same family, believed they knew the community better, made more housecalls, expected to use allied health professionals more frequently, and were more likely to choose a small community practice.

Adult↗
PubMed1990

The role of computers in preventive medicine in a rural family practice.

Five family physicians in a group practice in rural Quebec have introduced a computer system to improve the delivery of preventive medicine. In addition to billing, the computer is used mainly to recall specific groups of patients for preventive measures, to prompt the physicians to carry out certain procedures at the patient's next visit, to indicate which procedures are required for the family members and to generate reminder letters. The physicians are conducting a randomized controlled trial to evaluate the impact of computer-generated reminder letters on patient compliance and disease prevention among families in their practice.

Adult↗