Effective practice facilitators improve CVD management in primary care

Key takeaways

• Facilitators are often used in primary care settings to help practices incorporate evidence-based recommendations and improve health outcomes.
• Practices with more effective facilitators saw greater improvements in health outcomes regarding aspirin use, BP control and smoking cessation counseling compared with practices that had less effective facilitators.

Effective facilitators in primary care settings helped practices to think more critically and motivated them to support change, resulting in significant improvements in preventive CVD care, a recent study found.

“Facilitators have been particularly used in primary care settings to help practices improve process and outcome measures and adopt evidence-based guidelines,” Shannon Sweeney, PhD, MPH, a senior research associate at Oregon Health & Science University, and colleagues wrote in Annals of Family Medicine. “Research suggests that facilitation can be effective and that use of facilitators is growing, as policies and guidelines affecting primary care rapidly change.”

Sweeney and colleagues conducted a mixed methods study to identify strategies that contribute to facilitator effectiveness, organizational change and clinical outcome improvement, an area where prior research has been limited.

The study assessed 162 facilitators who were employed at 1,630 small- or medium-sized primary care practices. To qualify for analysis, facilitators had to have worked with at least four practices.

The researchers classified a facilitator as more effective if at least 75% of their practices improved at least one outcome deemed by CMS to be a measure of quality clinical care: aspirin usage in high-risk individuals; BP control; and smoking cessation counseling (ABS). Facilitators were less effective if fewer than than 50% of their practices improved on the measures.

Of the 116 facilitators eligible, the researchers reported that 28% (n = 33) were more effective and 26% (n = 30) were less effective.

Sweeney and colleagues noted that practices with effective facilitators had higher composite ABS outcomes, regardless of whether their baseline change capacity or baseline performance were high or low.

“In our regression model, when adjusting for baseline ABS measure and [Change Process Capability Questionnaire] score, practices working with a more effective facilitator had a 3.6% greater change in mean composite ABS performance,” they wrote.

Sweeny and colleagues also found that effective facilitators demonstrated a wide variety of strategies that were successful in cultivating change, which include:

• addressing resistance directly while working with the practice to overcome barriers;

• providing project management support;

• sharing ideas from other practices, such as workflows and patient education; and

• being able to clearly articulate the work done with practices, how they were tailored to specific practices and which strategies likely led to improvement.

Less effective facilitators — described as having “rigidity” in their approaches — were less likely to tailor and describe strategies and motivate practices. They were also more likely to do the work for the practice without having structured meetings or pushing them to identify next steps in the change process.

Sweeney and colleagues concluded that while backgrounds did not distinguish the effectiveness of a facilitator, “a range of strategies, including cultivating motivation, addressing resistance, helping practices to think critically and providing accountability, did.”

“Practices considering working with a facilitator and organizations that employ facilitators should seek out these qualities,” they wrote.

References:

• More effective facilitators can support primary care organizational change. https://www.eurekalert.org/news-releases/966008. Published Sept. 27, 2022. Accessed Sept. 28, 2022.
• Sweeney S, et al. Ann Fam Med. 2022;doi:10.1370/afm.2847