The applicants consider this application to be a third generation intervention for increasing the delivery of prevention in primary care. They document the lack of adherence to prevention guidelines. Physicians tend to overestimate their delivery of prevention services. Single interventions such as reminders, audit and feedback, and patient-held mini-records can make changes in practice behavior. Second generation interventions provide flexibility by allowing individual physicians and practices to choose specific interventions. A third generation intervention offers choices from a menu of effective single interventions, and tailors them to the individual needs and characteristics of the practice.
The Specific Aims are to: 1) evaluate the effect of this intervention on the level of cancer preventive service delivery to eligible patients; 2) evaluate the ancillary effects of the interventions on delivery of other services, the practice environment, patients, physicians and office; 3) evaluate the effect of co-variates on the effect of the intervention; and 4) describe and evaluate the process of change in physician and practice behavior. There are 16 major hypotheses associated with these Specific Aims. The application provides a rationale for each of these hypotheses. In the analysis section, an analysis strategy is outlined for each the hypotheses. The sample will be 138 physicians who participated in the previous study. The intervention will be four scheduled visits to each practice by a nurse-facilitator with follow-up telephone calls. The nurse-facilitator will first conduct an orientation visit. Two weeks later the visit will focus on preparing the practice to implement the changes necessary to increase the utilization of prevention modalities. These will be chosen from a menu. Each practice will assign a practice team leader, who will serve as the main contact to the study. On the third visit, the nurse-facilitator will deliver the personalized intervention materials that have been prepared for the practice. This will occur within one week prior to the implementation date. Several monthly phone calls will be made to the practice leader to discuss problems with the implementation process. The last visit will occur seven months after the initiation of the intervention. This will be one month after the six-month outcome assessment by the research assistant. Data will be available from the outcome assessment to provide feedback to the practice and allow an opportunity to fine tune the intervention.
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