Increasing preventive care delivery by primary care nurses and allied health clinicians

Background and aims: Primary care nurses and allied health clinicians are potential providers of care that aims to reduce chronic disease health risk behaviours through risk assessment, brief advice and referral/follow-up. Evidence suggests the delivery of such preventive care by primary care nurses and allied health clinicians is often sub-optimal, however few studies have assessed care for risks other than smoking or for referral/follow-up. Limited evidence exists regarding the effectiveness of interventions to increase the delivery of preventive care by this clinician group. To address these evidence gaps this thesis aimed to: examine the prevalence of preventive care delivery for four chronic disease health risk behaviours by primary care nurses and allied health clinicians; identify the service, clinician, and client characteristics and practice support strategies associated with such care delivery; examine the effectiveness of interventions to increase the routine provision of preventive care; and provide recommendations for future research. Results: Two cross-sectional surveys were conducted across public community health services within one health district in NSW, Australia. The surveys, one of clinicians and one of clients, both found that the delivery of preventive care was suboptimal, least frequently provided for referral, and least likely to be provided by allied health practitioners. A systematic review of controlled trials concluded that while there was some evidence that multi-strategic practice change interventions may be effective in increasing the provision of smoking cessation care, no conclusions could be drawn regarding strategies to increase preventive care for alcohol overconsumption, inadequate nutrition, and physical inactivity. To address this evidence gap, a two group non-randomized controlled trial was conducted in public community health facilities to assess the effectiveness of a multi-strategy practice change intervention on client-reported receipt of three elements of preventive care for each of four behavioural risks. The intervention significantly increased 6 of 10 measures of risk assessment or brief advice for risks other than smoking, but did not increase referrals. Conclusions: Improvements in routine preventive care delivery by primary care nurses and allied health clinicians are required, particularly for services that traditionally do not deliver such care. While an intervention had some effect in increasing the provision of such care, further research is required to identify how to increase the provision of preventive care by primary care nurses and allied health clinicians.