Supporting Cardiovascular Risk Factor Management in Primary Care Clinics: The Relationship Between External Linkages...

Primary care organizations increasingly face pressures to implement evidence-based practices that can support patient-centered goals. Foundational to these implementation efforts is how prepared the organization is to change. The purpose of this study was to examine whether different types of external linkages among 47 primary care practices participating in a statewide, community-academic partnership/cooperative focused on improving cardiovascular health outcomes were associated with greater change preparedness. Relatively little research has examined these linkages among smaller primary care practices in the U.S. and the extent to which they may support or hinder efforts to adopt innovative, evidence-based practices.

The study adopted a non-randomized, pre-post design with primary care clinics as the unit of observation. Cross-sectional regression analysis of data collected via surveys administered in 2022 to 2023. Our dependent variables included 2 summated scales related to change readiness (change commitment and change efficacy) and 1 summated scale related to change process capacity, while controlling for differences in clinic characteristics and community characteristics.

Clinics that were part of a network (structural linkage) were associated with lower levels of change commitment (b = -1.36, P = .006) and change efficacy (b = -1.16, P = .021). The other 2 types of external linkages (informational and consumer/patient) were not significantly associated with either change commitment or change efficacy.

Study clinics exhibited relatively high levels of change preparedness, providing a solid foundation for efforts to reduce cardiovascular risks in critical primary care settings. However, primary care clinics that were linked structurally were associated with lower levels of change preparedness. Primary care leaders and policy makers may want to consider the relationships between primary care clinics and other entities in their environment when developing and implementing programs to reduce cardiovascular disease risks in these settings.