A Process Evaluation of an Intervention to Improve Respiratory Infection Control Practices in Family Physician Offices
Huston, Patricia, Hogg, William, Martin, Carmel, Soto, Enrique, Newbury, Adriana, Canadian Journal of Public Health
Objective: To conduct a process evaluation of a short-term intervention by public nurses for physicians to facilitate the incorporation of new respiratory infection control practices in physicians' offices.
Design: Process evaluation.
Setting: Family physician offices in Ottawa, Ontario, Canada.
Participants: Five public health nurse-facilitators and 53 primary care practices including 143 family physicians.
Method: Effectiveness of facilitator training assessed by self-administered questionnaires. Data assessing process of facilitation collected through activity logs and narrative reports. Physicians' satisfaction assessed by post-intervention questionnaire.
Main Findings: Facilitators reported that training strongly contributed to their knowledge and skills and all were either satisfied or highly satisfied with their facilitation training. All practices received at least two visits by the facilitator and more than half (51%) were visited three or more times. Facilitators identified the provision of the evidence-based Tool Kit and consensus-building with office staff as key factors contributing to the intervention's success. Of the 45% of physicians who completed the questionnaire (65/143), only 5% reported being somewhat dissatisfied with the intervention, 11% reported the visits were not frequent enough, and 9% thought the visits were too close together. The majority (97%) felt the facilitation program should be available to all family physicians and 98% would continue to use the service if available.
Conclusions: It is feasible for public health nurses to be trained in outreach facilitation to improve respiratory infection control practices in physicians' offices and this has been widely appreciated by physicians. This model of public health/primary care collaboration deserves further exploration.
MeSH terms: Infection control; family physicians; physicians' offices; public health nursing
The first health care professional to die in the SARS epidemic in Canada was a family physician. Reports regarding the public health response to SARS raised concerns about infection control in health care settings1-3 and there is now evidence on transmission of SARS in physician offices.4 Both the Naylor and Campbell Reports raised concerns about information flow to family physicians and the lack of necessary supplies.1,2 The Walker Report identified the need for improved training of all health care workers.3 SARS has been perceived as a "dry run" for a larger respiratory infectious outbreak, such as pandemic influenza. The Canadian Pandemic Influenza Plan identifies the federal, provincial and local responsibilities before and during a pandemic, including the need for local implementation of infection control measures.5
To address the need for improved respiratory infection control in family physician offices, Ottawa Public Health and the University of Ottawa Family Medicine Department applied an outreach facilitation model to encourage knowledge transfer on best practices in respiratory infection control to family physicians. The facilitation model addresses educational, attitudinal and organizational barriers to change, and tailors interventions to the needs and unique characteristics of the practice.6-10
The use of trained facilitators to change practice patterns has been successful in both the United Kingdom and the United States.11-13 It has also been found that the use of multifaceted intervention strategies rather than single interventions can result in substantial changes in physician behaviour and health outcomes.14,15
The overall objective of our study was to determine whether family physician practice teams would improve their respiratory infection control practices following our facilitator-based intervention. We conducted both an outcome evaluation16 and a process evaluation. This paper describes the process evaluation. …