What is the BETTER approach?

The BETTER Program is a training process developed for individuals within health practice settings to become experts in chronic disease prevention and screening.

The BETTER approach focuses on prevention and screening of cancer, diabetes, heart disease and associated lifestyle factors (diet, exercise, smoking, and alcohol).

Specifically, the approach identifies a new role in the primary care setting (the BETTER Prevention Practitioner™), which can be taken on by any clinician/allied health professional.

Informed by the BETTER toolkit, the purpose of this skilled role is to work directly with patients to determine which cancer and chronic disease prevention and screening actions they are eligible to receive, and through a process involving shared decision-making and S.M.A.R.T. (specific, measurable, attainable, realistic, time-based) goal setting, develop a unique, personalized “Prevention Prescription” with each patient

The personalized BETTER Prevention Prescription™ is based on blended evidence-based guidelines on prevention/ screening actions specific to the patient’s personal medical history, behavioural risk factors, and family history. Patients 40 to 65 years of age are targeted, since most chronic disease prevention and screening activities in primary care are applicable to people in this age group.

The overarching aims of the BETTER approach are to improve clinical outcomes, reduce the burden of chronic disease, and improve the sustainability of the healthcare system through improved chronic disease prevention and screening in primary care.

This approach is adaptable and can be integrated into diverse clinical settings. Implementation Support is available to practices and organizations interested in adopting or adapting the approach through The BETTER Prevention Practitioner Training Institute.

Our Principles

Personalized

The BETTER approach is tailored to the unique needs and risks of each patient. Patients are empowered to become active participants in their health and make meaningful health goals that are important to them.

Comprehensive

A comprehensive approach that proactively addresses multiple cancers and chronic diseases , not just one single disease, including their root causes – diet, physical activity, smoking, and alcohol.

Collaborative

BETTER provides a framework for healthcare professionals to come together in the shared goal of improving prevention efforts. The approach fully supports the Patient-centred Medical Home Model and the aim is to complement and reinforce the key messages that primary care providers already deliver to their patients.

Adaptable

The BETTER Approach provides a framework to shift from chronic disease management to prevention and screening, which can be adapted into any primary care practice setting without disrupting current workflows.

Integrated Continuity

Improves and supports the continuity of communication between primary care providers, while developing personal relationships between patients and healthcare professionals. Patients are further integrated into their community through linkages to community resources.

The BETTER Program in Practice

BETTER employs a collaborative approach grounded in practice and built from the best available clinical evidence.

Developed by primary care providers for primary care settings, the BETTER approach provides a framework and the tools for a paradigm shift from a siloed, management approach to a personalized, comprehensive, proactive approach to chronic disease prevention and screening that is intended to enhance and facilitate current efforts in primary care.

BETTER Program implementation support, including determining if BETTER would be a good fit for your setting, is available through the BETTER Prevention Practitioner Training Institute.

The Program in Practice

How it Works

Step One

Identify your Prevention Practitioner

Once you have decided to implement the BETTER Program within your practice setting, you will need to identify your Prevention Practitioner. This person can be any health care professional available to your practice whom you would like to develop expertise in prevention and screening. Ideally, this person should have the capacity and time to take on this role.

Identify Your Prevention Practictioner

Step Two

Develop skills to discuss prevention

To become a BETTER Prevention Practitioner™, your chosen health care professional will need to attend a 2-day, in-person training session. These sessions are led by our Trainers and provide an overview of the evidence behind the approach, a thorough review of the clinical recommendations used to guide the prevention visit, opportunities for hands-on use of the BETTER tools, and practice of the Prevention Practitioner role through patient cases and role-play. Sessions are provided across Canada and can be made available in your local area. A minimum of 4 trainees are required for each session (to a maximum of 8).

Develop skills to discuss prevention

Step Three

Adapt BETTER to your setting

Following training, you and your Prevention Practitioner will decide how you will carry out the program within your practice. Other members of your team may be involved in the decision making and you may choose to work in collaboration with a member of the BETTER Team (i.e. one of our Implementation Leads) should you need Implementation Support. Important items that you may consider include: who will be invited to see your Prevention Practitioner, how much of your team member’s time will be allocated to the Prevention Practitioner role, where visits will take place, etc. If you are working with a BETTER Implementation Lead to implement the program in your setting, they will walk you through all of the decision points that should be considered before launching the program.

Adapt BETTER to your setting

Step Four

Identify at risk patients

The Prevention Practitioner’s first job is to work with you to identify at-risk patients within your practice whom you think would benefit from the program. For example, you could choose to invite all of your patients 40-65 age, perhaps only those 40-65 year olds who are pre-diabetic, or those patients who have not been in to see you for 2-3 years, etc. These patients will then be invited to come in for a personalized prevention visit with your Prevention Practitioner. Typically, an initial visit can take up to 1 hour, though these can be adapted to fit your setting.

Identify at risk patients

Step Five

Assess patients and help identify goals

During the prevention visit, each patient will have a chance to learn how their medical history, family history, and lifestyle behaviours affect their chronic disease risk and how these also determine what their appropriate screening actions should be (e.g. out of date mammogram). Through shared decision-making and action planning, your Prevention Practitioner will help patients make S.M.A.R.T. goals for their health. They will create a “Prevention Prescription” with each patient, outlining their current health status, agreed upon next steps, and any linkages made to practice or community resources to help patients meet their health goals. This also provides an opportunity loop patients back to you if they are determined to be at higher risk or if they require your follow-up.

Assess patients’ prevention status and help patients identify prevention goals

Step Six

Determine and capture important outcomes

Participating in BETTER can provide a resource for quality improvement to ensure prevention targets are achieved. The Prevention Prescription that is prepared for each patient is a summary of the patient’s current health status and can be used to track screening rates and patient change over time. You may also consider capturing process outcomes (e.g. number of patients invited for a prevention visit vs. number of patients who received a visit) or patients’ satisfaction with the program.

Determine and capture important outcomes
“I think The BETTER Program is invaluable as it empowers individuals to take control of their health on their terms. Patients have the opportunity to reflect on their lifestyle in a non-judgemental setting and set goals to improve their health that are a priority for that person…I believe The BETTER Program benefits people of all “ walks of life” and education levels..”
Dawn Gallant RN, Prevention Practitioner
“The BETTER program is instrumental in changing the patient experience and engages the patient in changes that are meaningful to them. When a patient is actively engaged… there is a greater likelihood of the change occurring and being maintained. The benefit to patients is making small sustainable changes that are meaningful and significant to THEM…..not us (the providers).”
Jordis Gheseger NP, Prevention Practitioner

Want to learn more about differing perspectives on The BETTER Program? Read our publications

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