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The BETTER Approach focuses on prevention and screening of cancer, diabetes, heart disease and associated lifestyle factors (nutrition, exercise, smoking, cannabis, and alcohol). Specifically, the approach identifies a new role in the primary care setting (the BETTER Prevention Practitioner™), which can be taken on by a clinician/allied health professional.
Our Mandate: To improve cancer and chronic disease prevention and screening for cardiovascular disease, diabetes, and breast, colorectal, cervical, lung, and prostate cancers and their associated lifestyle factors in patients 40-69 years of age.
Areas of Focus
- Training of BETTER Prevention Practitioners™: hands-on training of healthcare professionals on the Prevention Practitioner role and BETTER approach.
- Continuing education: providing learning opportunities to interprofessional healthcare providers and learners to help inform patient care.
This project has the potential to improve the health of Canadians through the introduction of a new model of care that integrates cancer and chronic disease prevention and screening into diverse primary care settings throughout Canada.
It was developed in Canada. The BETTER Trial began in two Canadian cities, Edmonton and Toronto.
- Cancer (breast, cervical, colorectal, lung, prostate), diabetes, heart disease, and osteoporosis.
- We also take into consideration mental health
Smoking, alcohol, nutrition, cannabis, and physical activity
Informed by the BETTER toolkit, the purpose of this skilled role is to work directly with patients to determine which cancer and chronic disease prevention and screening (CCDPS) actions they are eligible to receive, and through a process involving shared decision-making and S.M.A.R.T. (specific, measurable, attainable, realistic, time-based) goal setting, develop a unique, personalized BETTER Prevention Prescription™ with each patient.
In the research studies the BETTER Prevention Practitioner™ were allied health professionals.
The role is versatile – we now have a wide range of BETTER Prevention Practitioner™ which include, RNs, RPNs, LPNs, NPs, RDs, Kinesiologists, Pharmacists, Physicians, and more.
The BETTER Institute provides virtual training workshops over 2 or 3 days for a total of 13 hours of instruction.
The visit is usually between 45 minutes to 1 hour.
We recommend beginning with 1-hour visits.
There are a number of variations of the BETTER Program. Some clinics have decided to have 45 minutes with the BETTER Prevention Practitioner™, with a 15-minute visit with their primary care provider before or after the BETTER Prevention Practitioner™ appointment. The length of the visit depends on the capacity of the individual clinic.
A BETTER Prevention Practitioner™ should ideally have at least one-half day a week devoted to BETTER Prevention Practitioner™ visits.
Note, this does not include the patient’s time to complete the survey.
Through the BETTER Institute, there may be potential to offer implementation support in order to help you integrate the program into your current workflow. If you are interested, please contact email@example.com.
Yes! Clinics and practitioners have been adapting the BETTER Program to fit their needs. We understand each practice is different and encourage participants to adapt Classic BETTER into their setting.
Interprofessional healthcare providers who complete Prevention Practitioner™ training or any of our other courses will receive electronic copies of the BETTER tools included in the course.
To request a copy of the BETTER tools, please contact us at firstname.lastname@example.org
The BETTER tools are currently available in English. Some of the BETTER tools are also available in French.
If your practice/organization has the IT capacity and resources to do this then, yes. The BETTER team is unable to provide IT support for EMR-related matters.
Yes, you can add additional screening and prevention measures. However, the measures included in the BETTER Care Map are the ones that are supported by our evidence review. The BETTER team cannot provide recommendations or guideline support for any additional measures. For example, you could add immunization screening, but your practice would need to determine the guidelines and scope associated with this additional screening.
The BETTER Institute has developed the suite of BETTER Health Surveys as a secure electronic resource (i.e. the BETTER web-application or BETTER web-app) to help assess individuals’ risk for chronic diseases such as cancer, cardiovascular disease, and diabetes.
The BETTER web-app enables primary care settings and organizations implementing the BETTER Program to virtually distribute, collect and manage the BETTER Health Surveys. The surveys include questions derived from evidence-based, validated tools and expert recommendations, and are a central component of the Prevention Practitioner role as they collect information that is not often well documented in EMRs (e.g. family history, personal history, and lifestyle behaviours).
Individuals complete the BETTER Health Survey(s) electronically on a web browser. The BETTER web-app automatically develops a Survey Summary, which is a printer-friendly copy of each of the patient’s survey answers that can be downloaded or printed to file in the patient’s medical chart for future reference. The Web App also uses integrated logic to pre-populate portions of the BETTER Prevention Prescription.
If you are interested in learning more about the BETTER web-app, please contact us at email@example.com
Yes, there have been numerous BETTER publications. The first publication was in 2011. For a list of all publications, go to here.
Allied health professionals. The role is versatile – we now have a wide range of BETTER Prevention Practitioner™ which include, RNs, RPNs, LPNs, NPs, RDs, Pharmacists, Physicians, and more.
BETTER research studies have taken place in three Provinces in Canada: Alberta, Ontario, and Newfoundland and Labrador.
To learn more about the BETTER program of research, visit our evidence page .
Pragmatic two-way factorial cluster Randomized Control Trial (RCT).
A cluster randomized trial is a type of trial in which groups of subjects are randomized, rather than individual subjects – physicians’ practices were the unit of allocation and individual patients were the unit of analysis. Pragmatic trials take place in a setting where patients receive their usual care.
A large clinic practice guideline review was completed to create a screening algorithm to guide the work of a Prevention Practitioner. The guideline review process included provincial, Canadian and international guidelines.
Clinical practice guidelines and tools were identified using a structured literature search, which included both indexed and grey literature. Two questions from the Agree II tool were used to screen the rigor of the guidelines. The full Agree II tool was used on the guideline after it passed the screen. A clinical working group was convened to review the guidelines and tools, with representatives from family medicine, nursing, nutrition and researchers. Subgroups reviewed the guidelines and tools for each topic and the larger group discussed and voted on which recommendations should be included. The guidelines that were selected were designed to be measurable, actionable and explicit.
40 to 69 years
The evidence review was conducted for patients between the ages of 40 and 69.
The BETTER Institute does not provide screening recommendations for patients under the age of 40 or over the age of 69. Your clinic would be responsible for any recommendations outside this age range.
A copy of the screening algorithm is provided in BETTER Prevention Practitioner Training. To request a copy of the BETTER Care map contact us at firstname.lastname@example.org
The BETTER 2 study included a qualitative evaluation which analyzed the feedback we received from patients.
Patient feedback showed that patients who received a visit with a Prevention Practitioner valued personalized care and dedicated time to talk about screening and prevention.
After the study was completed, patients expressed a desire for the program to continue and for preventative care to be a focus of the Canadian healthcare system.
Training is provided virtually over the course of 2 or 3 days for a total of 13 hours of continuing education. In a small group setting, you will learn about the BETTER Prevention Practitioner™ role, review the BETTER research, use the BETTER Tool Kit, and practice behavior change techniques. We use a hands-on approach to learning, which includes case studies, discussions and videos. Though this training, you will gain specialized skills in chronic disease prevention and screening.
The BETTER Institute is a not-for profit organization. Registration fees for BETTER Prevention Practitioner™ training will apply.
Registration fees include training time (13 hours of continuing education), mailing of hard copies of training materials, and access to the Community of Practice upon successful completion of training. Access to the BETTER tools, electronic or otherwise, is not included in the registration fee.
If you would like to learn more about our registration fees please contact us at email@example.com
All training sessions are capped at 8 participants. Depending on the size of your team, multiple training sessions may be needed.
To explore potential options please contact us at firstname.lastname@example.org
Yes! Email email@example.com to express interest.
The BETTER Prevention Practitioner™ role is designed to be a compliment to primary care providers and they work they are doing. It is designed promote interdisciplinary teamwork.
The Prevention Practitioner works in partnership with primary care providers. The Prevention Practitioner helps to collect detailed patient information, develop a personal rapport with a patient and makes referrals, which benefits the work of the primary care team and often saves the primary care provides valuable time.