TAPESTRY with BETTER for Chronic Disease Prevention & Screening (TAP-BPS)
This project involved collaboration between the BETTER Program and the TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) Project. The goal of TAPESTRY is to promote optimal aging. Optimal aging within the TAPESTRY program means supporting people to move through life with good health in the best possible way: Being Alive Well.
The aim of this collaboration was to refine and integrate electronic versions of the BETTER Program tools (i.e. the BETTER App) into the TAPESTRY Application (or TAP-App) platform developed for use in the McMaster personal health record. Three primary care clinics, one in Alberta and two in Newfoundland & Labrador, will be asked pilot the e-tool enhanced BETTER approach and designate one or more personnel to undertake the role of Prevention Practitioner.
The Prevention Practitioner is a member of the team who receives training on the BETTER approach to chronic disease prevention and screening (CDPS), including shared decision-making and motivational interviewing. Using the BETTER App, and existing TAP-App tools as appropriate, the Prevention Practitioner worked directly with patients by inviting them to a special prevention visit at which an individualized “prevention prescription” was developed and patients were able to set their own CDPS goals. The Prevention Practitioner followed patients over time to assess their progress on their goals and their achievement/completion of the CDPS manoeuvers they were eligible to receive.
This project provided an opportunity to:
- Determine how CDPS information should be best collected from patients through the BETTER App, and TAP-App tools as appropriate,
- Understand the feasibility and usability of the BETTER App and TAP App tools from the perspectives of patients and primary care providers, and
- Explore how the BETTER and TAP Apps and processes can help inform the care delivered to patients.
The desired long-term goals of the TAPESTRY-BETTER collaboration are to enhance patients’ care by:
- Informing patients about their CDPS status through the use of the BETTER App and TAP App tools,
- Enhancing primary care providers/teams’ processes of care through the personalization of the CDPS care delivered to patients, and
- Increasing and streamlining the collaboration between patients and primary care.
For more information about the TAPESTRY project, please visit their website.
The BETTER 2 Program
Through the BETTER Trial, we developed and tested a unique, comprehensive and integrated approach to chronic disease prevention and screening at the patient level.
To assess the adaptability, sustainability and effectiveness of the Prevention Practitioner intervention in other settings, including rural and remote settings, the BETTER approach was expanded into the Northwest Territories and Newfoundland & Labrador, and disseminated in Alberta, Ontario and Nova Scotia.
The BETTER 2 Program engaged patients, clinicians, researchers and policy-makers to develop an integrated, comprehensive, longitudinal and sustainable approach to chronic disease prevention and screening within the various settings. The BETTER 2 team also adapted and refined the BETTER tools, maneuvers, and training resources in order to increase feasibility and sustainability of the approach.
The specific aims of the BETTER 2 Program were:
- To expand the BETTER approach into three new jurisdictions and deepen the impact in the existing provinces by providing a framework, tools and resources to do chronic disease prevention and screening.
- To further adapt, revise and tailor the BETTER individual patient-level chronic disease prevention and screening intervention including the survey, tools, maneuvers and resources to each setting including remote, rural and disadvantaged populations (such as aboriginal populations and populations with mental illness and substance abuse).
- Evaluate the adapted BETTER individual patient intervention including a qualitative program evaluation of perceived effectiveness, facilitators and barriers, benefits and disadvantages in varied settings including remote, rural and disadvantaged populations.
- Synthesize BETTER knowledge products for translation, dissemination and exchange.
- To develop a sustainable coalition and linkages between primary care clinicians, researchers and policy-makers and evaluate the efforts of the Coalition for sustained work on chronic disease prevention and screening in primary care.
Each primary care setting wishing to implement the BETTER approach to chronic disease prevention and screening adapted the BETTER tools and approach to their setting and/or identified one or more personnel available to the practice to take on the role Prevention Practitioner. This individual:
- Developed skills in chronic disease prevention and screening
- Adapted the BETTER maneuvers and tools to their setting so that they are culturally relevant and sensitive
- Identified resources to integrate into the practice
- Developed a process within their setting for chronic disease prevention and screening
- Identified which patients are ideal to target in their setting
- Met with patients to develop individualized chronic disease prevention and screening prescriptions
More information about this implementation phase of the BETTER Program, can be found in our publications section.
For a downloadable version of the BETTER 2 Program Executive Summary, please click here.
The BETTER 2 Program Team (2012 – 2015)
Principal Investigators: Dr. Donna Manca and Dr. Eva Grunfeld
Co-Investigators: Dr. Kris Aubrey-Bassler and Dr. Kami Kandola
Dissemination Leads: Dr. Catherine Cervin, Dr. Emily Marshall, Dr. Nandini Natarajan, Dr. Sarah Newbery.
Collaborators: P. Corcoran-Mooney, D. Gallant.
Methodology Working Group: E. Grunfeld (Co-Chair), D. Manca (Co-Chair), K. Aubrey-Bassler, V. Faria, K. Kandola, P. Krueger, C. Meaney, R. Moineddin, C. Nykiforuk, N. Sopcak.
Qualitative Methodology Working Group: N. Sopcak (Lead), C. Aguilar, L. Green, E. Grunfeld, P. Krueger, D. Manca, E. Marshall, C. Nykiforuk, M.A. O’Brien, G. Salvalaggio.
Clinical Working Group: D. Campbell-Scherer (Chair), K. Aubrey-Bassler, J. Carroll, V. Faria, E. Grunfeld, J. Inman, K. Kandola, D. Klein, C. Korownyk, L. Lyall, D. Manca, J. Mercer, J. Neudorf, G. Salvalaggio, G. Stagg-Sturge, M. Wilson.
Statistical Analysis: R. Moineddin, C. Meaney.
Program Coordination: C. Fernandes, J. Baxter, R. Cullen, V. Faria.
Research Assistant: M. Heatherington.
Students/Trainees: Y. Khakhuda, M. Lukasewich.