Please select the eligibility criteria that correspond to the clinical trial below.
Title: Improved Delivery of Cardiovascular Preventive Care (IDOCC) Through Outreach Facilitation
Brief Summary: The aim of the proposed study is to implement and evaluate Outreach Facilitation as a means to increase the uptake of evidence-based practice for secondary prevention and management of patients with established CVD and cardiovascular risk factors, in primary care practices throughout the Champlain LHIN. This initiative centers on the use of an Outreach Facilitation Model, in which skilled health professionals known as facilitators (Practice Change Consultants) serve as an expert resource to primary care practices in three areas: a) practice performance assessment, feedback, and consensus building towards goal setting and implementation; b) clinical, technical, organizational resources and practical advice; and c) encouragement to face and move through the challenges associated with implementing system change.


Options:
A: Participant Types

* Primary care workers (primary beneficiary)
* Patients (indirect beneficiary)

Inclusion Criteria:

* All primary care workers participating in either the prescriber or non-prescriber PRIME trainings will be invited to participate
* Primary care trainees will need to be 21-65 years of age
* Recruitment will attempt to balance gender distribution in the recruitment health clusters
* All participants will need to have Nepali language competency, be actively engaged in care provision in their health cluster, and have a valid certificate of practice from the Ministry of Health
* Primary care trainees need to have permission from their health supervisor to attend the entire duration of the training.
* Any patient receiving PRIME services will be invited to participate. This includes persons with diagnoses of depression, psychosis, harmful drinking, or epilepsy. Providers make the diagnosis based on mhGAP criteria.
* For patients, inclusion criteria will be 21-65 years of age and fluency in Nepali.

Exclusion Criteria:

* Primary care trainees will be excluded if they have any prior citations on their clinical practice licensure.
* Patients who cannot provide consent will be excluded.
B: Inclusion Criteria:

* Men and women over 40 years of age, who meet at least one of the following criteria:

  1. have established cardiovascular disease: Coronary Artery Disease, Cerebrovascular disease (documented stroke and/or TIA), and Peripheral Vascular Disease;
  2. have Diabetes Mellitus;
  3. have Chronic Kidney Disease ;
  4. are at high risk for CVD based on a presence of at least three of the following established cardiovascular risk factors: age (males ≥ 45, females ≥ 55), smoker status, hypertension, and dyslipidemia.
* No restrictions will be imposed on the recruitment process; all practices in the region will be eligible to participate.

Exclusion Criteria:

* see above
C: Inclusion Criteria:

* Age ≥ 18 years
* Acute HF as a primary cause of hospitalization

  * Hospitalizations for acute HF will be determined by local clinician-investigators but should include the following:
  * Symptoms (eg, dyspnea, fatigue), signs (eg, elevated jugular venous pressure, peripheral edema), or laboratory/imaging evidence of HF (eg, pulmonary congestion on chest x-ray, elevated natriuretic peptide levels) during the hospitalization and
  * Treatments aimed at acute HF (eg, intravenous diuretics, vasodilators, or inotropes)
* LVEF ≤ 40% based on last local measurement using echocardiography, multigated acquisition scan, computed tomography (CT) scanning, magnetic resonance imaging, or ventricular angiography
* Planned discharge to home or other supported care facility where patients are individually responsible for medication management

Exclusion Criteria:

* Prior heart transplant or current/planned left ventricular assistance device
* Chronic kidney disease requiring dialysis
* Terminal illness other than HF, such as malignancy, or with a life expectancy of less than 1 year as determined by the enrolling clinician-investigator
* Unable to participate in longitudinal follow-up, such as plans to move outside the US in the following year
D: Inclusion Criteria for participating patients:

* diagnosed with neoplasms (ICD 10: C00-D49, excluding D10-D36)
* admitted for inpatient or outpatient treatment at the participating clinics
* age \> 18 years
* German-speaking

Exclusion Criteria for participating patients:

* severe cognitive impairment

Inclusion Criteria for participating health care professionals:

* physician or nurse working at the participating clinics

Exclusion Criteria for participating health care professionals:

* none

Answer: B