The Virtual BETTER Study

Building on Existing Tools To Improve Chronic Disease Prevention and Screening in Primary Care Virtually: the Virtual BETTER Study

The focus of this project is to examine how delivering virtual care impacts health behaviour change for patients with chronic illnesses compared to in-person visits using a chronic disease prevention and screening (CDPS) program called BETTER (Building on Existing Tools To ImprovE Chronic Disease PRevention and Screening in Primary Care).

While the current pandemic has launched a likely irreversible transition towards increased utilization of virtual methods for delivery of healthcare, we have only a very superficial understanding of how this shift will affect health outcomes and equity of access to health services. Several randomized trials comparing virtual to in-person delivery of health services have been completed, but none have examined the effect of interventions to address health behaviours, arguably one of the most challenging issues in healthcare and one that is most sensitive to the therapeutic relationship and modifiers to that relationship such as the mode of communication. The focus of this project is to examine how delivering virtual care impacts health behaviour change for patients with chronic illnesses compared to in-person visits using a chronic disease prevention and screening (CDPS) program called BETTER (Building on Existing Tools To ImprovE Chronic Disease PRevention and Screening in Primary Care).

We will study two experimental groups (telephone and video) compared to the control group of in-person BETTER intervention delivery. Mode of delivery will be randomized between patients. If it is not feasible yo offer all three (e.g. PP only has capacity to offer virtual appointments, study population lives greater than 30 minutes travel from PP location), a subset of the three will be offered.

To compare readiness to implement lifestyle change after telephone, video, and in-person BETTER Prevention visits. Min Score: 4 Max Score: 20 Higher scores indicate a higher readiness to change (better outcome)

To assess satisfaction with the three different delivery modalities. Min Score: 4 Max Score: 16 Higher scores indicate higher satisfaction (better outcome)

To assess acceptability of the three different delivery modalities. Assessed through enrollment questionnaire which will ask which delivery method they agree to. (Not scored on scale)

To assess accessibility of the three different delivery modalities. Assessed through enrollment questionnaire which will ask why they chose which delivery method they did. (Not scored on scale)

Inclusion Criteria: Persons aged 40-65 Persons who are already booking a BETTER prevention visit. Exclusion Criteria: Persons with the presence of a terminal illness Persons in active treatment (i.e., systemic and/or radiation therapy) for cancer. Persons who are unable to provide informed consent.

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from the BETTER RCT (0.381) to calculate a sample inflation factor which produced an estimated total sample size requirement of 160 patients from 10 practices.<sup data-refid="34" data-citation="~[(34)Donner A, Birkett N, Buck C, Randomization by cluster. Sample size requirements and analysis., Am J Epidemiol. 1981 Dec;114(6):906-14