Screening While You Wait: An Intervention to Facilitate Exercise in Primary Care
Condition: Physical Activity
Study type: Interventional

Summary: 
      Despite knowing that exercise improves health, primary care providers (PCPs) do not regularly
      assess physical activity (PA) levels or use proven techniques to help patients to increase
      their PA levels. Studies have shown that PCPs don't talk to patients about their PA levels
      because they don't feel they have adequate knowledge or resources to help their patients.
      Additionally they don't feel they have time to provide personalized advice regarding PA.

      This study will use tablet computers and email to engage patients in contemplating their own
      PA levels and starting conversations with their PCPs. Electronic surveys delivered via
      tablets and email prior to periodic health reviews will be used to support customized,
      patient-centred health care. The patient's survey responses will be used to develop a
      printable 'toolkit' with individualized PA recommendations, a personalized exercise
      prescription (Rx), as well as patient-specific educational and community resources. The
      exercise Rx and resources can be edited by the PCP based on the resulting discussion between
      patient and PCP.

      The overarching aim of this study is to determine how the use of technology in family
      doctors' offices can help patients to engage with their PCPs regarding PA and ultimately
      increase their PA levels.
    

Detailed description: 
      The study will take place at the academic Women's College Hospital (WCH) Family Practice (FP)
      in Toronto, Canada. The clinic provides over 50,000 patient visits per year and is split into
      four sub-teams for operational purposes. These teams have unique members with no crossover of
      PCPs. Patients typically see their own PCP for planned care visit (e.g., preventative care
      and chronic disease management) but access any PCP available when more acute issues arise.

      The PA surveys are administered via Ocean by CognisantMD. Ocean connects patients, PCPs, and
      researchers using secure surveys on tablets in the FP waiting room and online patient surveys
      that integrate with WCH FP Electronic Medical Records.

      This is a pilot step wedge trial, with graduated, random intervention roll-out across the
      clinical setting in four steps over five time intervals. Eligible patients presenting to the
      clinic during the study period will be allocated to intervention or control depending on
      whether the PCP they have booked to see has had the intervention 'turned-on'. The order
      determining when each PCP and his or her team change from control to intervention is randomly
      assigned. This design was chosen to avoid the risk of intervention contamination and to
      enable logistics of implementation. The teams will receive the control and intervention
      according to the following schedule:

      Time Interval 1: Team A-D Control Time Interval 2: Team A Intervention, Team B-D Control Time
      Interval 3: Team A+B Intervention, Team C+D Control Time Interval 4: Team A-C Intervention,
      Team D Control Time Interval 5: Team A-D Intervention
    

Intervention name(s): Personalized exercise Rx and resources
Intervention type(s): Behavioral
Intervention description(s): Patients will receive the IPAQ to collect baseline PA levels as well as questions evaluating precursors to behaviour change and identifying medical conditions that may affect PA capability. In the Electronic Medical Record chart, a 'stamp' will be automatically created, accompanied by a link which will open a printable 'toolkit' with individualized PA recommendations, a personalized exercise Rx, as well as educational and community resources, all based on the patient's survey responses. The exercise Rx and resources can be edited by the PCP based on the resulting discussion between patient and PCP, and printed during the PHR for the patient to take home. The exercise Rx and resources will also be emailed to the patient following their appointment.
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: Single-centre, pilot step wedge trial, with graduated, random intervention roll-out across the clinical setting in four steps
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Family Medicine; Primary Care; Exercise prescriptions; Technology