USING PLAN DO CHECK ACT (PDCA) QUALITY IMPROVEMENT CYCLES TO IMPLEMENT PREVENTION RECOMMENDATIONS AMONG PRIMARY CARE PHYSICIANS IN SWITZERLAND

Purpose: The EviPrev collaboration, a group of primary care physicians (PCPs), has developed a table that grades and summarizes the prevention topics such as smoking cessation counseling and cancer screening based on their evidence in the literature. However, little is known about the adequate formal to facilitate dissemination of the table among PCPs. We aimed to collect PCPs’ current practices and needs for communication tools and to test solutions to facilitate implementation of the EviPrev table.

Methods: We conducted sequential, semi-qualitative interviews among a convenience sample of PCPs. We performed two Plan, Do Check, Act (PDCA) quality improvement cycles to collect process outcomes (type of tools used: brochures, websites), PCPs’ needs, and to test proposed solutions from PCPs. We used a backwards mapping approach, aiming at identifying and testing contextual solutions to facilitate future dissemination of the findings.

Results: Fifteen PCPs and 2 medical assistant in three regions of the State of Vaud, Switzerland were involved, including senior and junior PCPs, individual and group practices, academic and non-academic settings and  in rural and urban areas. An academic researcher met each study participant between 2 to 3 times, for 30 to 80 minutes, over a 6 month period. In the first round, over 90% of PCPs found the table useful. Most regretted the lack of useful communication tools available and coordination from public health agencies; they were interested in automated solutions for some topics such as colon screening. They reported that they needed simple to read tools for their patients and high quality information for their own continuous medical education. In the second cycle, a smaller pocket version of the table and an online interactive table with links to recommended brochures and websites was successfully tested. However, we were limited by the quality of available communication tools to be linked with the EviPrev table.

Conclusion: PCPs need Coordination from prevention agencies, solutions to Automate prevention, Simple and High quality communication tools (CASH). Most available tools do not meet these criteria. Our proposed method using a cyclic approach to elicit needs and test contextual solutions allowed us to tailor an interactive table meeting PCPs needs. An additional PDCA cycle if foreseen before implementation and dissemination of the tested prevention tools among other PCPs in Switzerland.