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Sample records for care interventional study

  1. Exploring Environment-Intervention Fit: A Study of a Work Environment Intervention Program for the Care Sector

    PubMed Central

    Smith, Louise Hardman; Aust, Birgit; Flyvholm, Mari-Ann

    2015-01-01

    Targeting occupational health and safety interventions to different groups of employees and sectors is important. The aim of this study was to explore the environment-intervention fit of a Danish psychosocial work environment intervention program for the residential and home care sector. Focus group interviews with employees and interviews with mangers were conducted at 12 selected workplaces and a questionnaire survey was conducted with managers at all 115 workplaces. The interventions enhanced the probability of employees experiencing more “good” work days, where they could make a difference to the lives of clients. The interventions may therefore be characterized as culturally compelling and having a good fit with the immediate work environment of employees. The interventions furthermore seemed to fit well with the wider organizational environment and with recent changes in the societal and economic context of workplaces. However, some workplaces had difficulties with involving all employees and adapting the interventions to the organization of work. The findings suggest that flexibility and a variety of strategies to involve all employees are important aspects, if interventions are to fit well with the care sector. The focus on employees' conceptualization of a “good” work day may be useful for intervention research in other sectors. PMID:26380356

  2. Evaluation of occupational therapy interventions for elderly patients in Swedish acute care: a pilot study.

    PubMed

    Wressle, Ewa; Filipsson, Viveka; Andersson, Lena; Jacobsson, Beatrice; Martinsson, Karin; Engel, Kristina

    2006-12-01

    The aim was to evaluate whether occupational therapy interventions in acute care could improve the elderly patient's perception of ability to manage at home after discharge. A pilot study was performed, including 22 patients in the experimental group and 19 in the control group. Occupational therapy interventions were conducted in the experimental group concerning personal care, information, prescription of assistive devices, planning of discharge, and reporting to primary care or community care. The control group was given no occupational therapy interventions. Structured interviews were performed on discharge and at a follow-up in about 14 weeks after discharge. The two groups were comparable concerning gender, age, days of care, and diagnoses. Patients in the experimental group scored lower on mental health and were more anxious on discharge. However, there was no difference between the groups in managing at home after discharge. Patients in the control group had greater need of further contacts with healthcare after discharge. Due to the small sample interpretations must be made with caution. The findings indicate that occupational therapy interventions in acute care might have a positive effect from the perspective of the elderly patient. These results need to be confirmed in a larger study.

  3. Evaluation of occupational therapy interventions for elderly patients in Swedish acute care: a pilot study.

    PubMed

    Wressle, Ewa; Filipsson, Viveka; Andersson, Lena; Jacobsson, Beatrice; Martinsson, Karin; Engel, Kristina

    2006-12-01

    The aim was to evaluate whether occupational therapy interventions in acute care could improve the elderly patient's perception of ability to manage at home after discharge. A pilot study was performed, including 22 patients in the experimental group and 19 in the control group. Occupational therapy interventions were conducted in the experimental group concerning personal care, information, prescription of assistive devices, planning of discharge, and reporting to primary care or community care. The control group was given no occupational therapy interventions. Structured interviews were performed on discharge and at a follow-up in about 14 weeks after discharge. The two groups were comparable concerning gender, age, days of care, and diagnoses. Patients in the experimental group scored lower on mental health and were more anxious on discharge. However, there was no difference between the groups in managing at home after discharge. Patients in the control group had greater need of further contacts with healthcare after discharge. Due to the small sample interpretations must be made with caution. The findings indicate that occupational therapy interventions in acute care might have a positive effect from the perspective of the elderly patient. These results need to be confirmed in a larger study. PMID:17203670

  4. The perceived quality of interprofessional teamwork in an intensive care unit: A single centre intervention study.

    PubMed

    Van den Bulcke, Bo; Vyt, Andre; Vanheule, Stijn; Hoste, Eric; Decruyenaere, Johan; Benoit, Dominique

    2016-05-01

    This article describes a study that evaluated the quality of teamwork in a surgical intensive care unit and assessed whether teamwork could be improved significantly through a tailor-made intervention. The quality of teamwork prior to and after the intervention was assessed using the Interprofessional Practice and Education Quality Scales (IPEQS) using the PROSE online diagnostics and documenting system, which assesses three domains of teamwork: organisational factors, care processes, and team members' attitudes and beliefs. Furthermore, team members evaluated strengths and weaknesses of the teamwork through open-ended questions. Information gathered by means of the open questions was used to design a tailor-made 12-week intervention consisting of (1) optimising the existing weekly interdisciplinary meetings with collaborative decision-making and clear communication of goal-oriented actions, including the psychosocial aspects of care; and (2) organising and supporting the effective exchange of information over time between all professions involved. It was found that the intervention had a significant impact on organisational factors and care processes related to interprofessional teamwork for the total group and within all subgroups, despite baseline differences between the subgroups in interprofessional teamwork. In conclusion, teamwork, and more particularly the organisational aspects of interprofessional collaboration and processes of care, can be improved by a tailor-made intervention that takes into account the professional needs of healthcare workers. PMID:27152533

  5. The perceived quality of interprofessional teamwork in an intensive care unit: A single centre intervention study.

    PubMed

    Van den Bulcke, Bo; Vyt, Andre; Vanheule, Stijn; Hoste, Eric; Decruyenaere, Johan; Benoit, Dominique

    2016-05-01

    This article describes a study that evaluated the quality of teamwork in a surgical intensive care unit and assessed whether teamwork could be improved significantly through a tailor-made intervention. The quality of teamwork prior to and after the intervention was assessed using the Interprofessional Practice and Education Quality Scales (IPEQS) using the PROSE online diagnostics and documenting system, which assesses three domains of teamwork: organisational factors, care processes, and team members' attitudes and beliefs. Furthermore, team members evaluated strengths and weaknesses of the teamwork through open-ended questions. Information gathered by means of the open questions was used to design a tailor-made 12-week intervention consisting of (1) optimising the existing weekly interdisciplinary meetings with collaborative decision-making and clear communication of goal-oriented actions, including the psychosocial aspects of care; and (2) organising and supporting the effective exchange of information over time between all professions involved. It was found that the intervention had a significant impact on organisational factors and care processes related to interprofessional teamwork for the total group and within all subgroups, despite baseline differences between the subgroups in interprofessional teamwork. In conclusion, teamwork, and more particularly the organisational aspects of interprofessional collaboration and processes of care, can be improved by a tailor-made intervention that takes into account the professional needs of healthcare workers.

  6. A Narrative Review of Diabetes Intervention Studies to Explore Diabetes Care Opportunities for Pharmacists.

    PubMed

    Ayadurai, Shamala; Hattingh, H Laetitia; Tee, Lisa B G; Md Said, Siti Norlina

    2016-01-01

    Background. We conducted a review of current diabetes intervention studies in type 2 diabetes and identified opportunities for pharmacists to deliver quality diabetes care. Methods. A search on randomised controlled trials (RCT) on diabetes management by healthcare professionals including pharmacists published between 2010 and 2015 was conducted. Results and Discussion. Diabetes management includes multifactorial intervention which includes seven factors as outlined in diabetes guidelines, namely, glycaemic, cholesterol and blood pressure control, medication, lifestyle, education, and cardiovascular risk factors. Most studies do not provide evidence that the intervention methods used included all seven factors with exception of three RCT which indicated HbA1c (glycated hemoglobin) reduction range of 0.5% to 1.8%. The varied HbA1C reduction suggests a lack of standardised and consistent approach to diabetes care. Furthermore, the duration of most studies was from one month to two years; therefore long term outcomes could not be established. Conclusion. Although pharmacists' contribution towards improving clinical outcomes of diabetes patients was well documented, the methods used to deliver structured, consistent evidence-based care were not clearly stipulated. Therefore, approaches to achieving long term continuity of care are uncertain. An intervention strategy that encompass all seven evidence-based factors will be useful. PMID:27247949

  7. A Narrative Review of Diabetes Intervention Studies to Explore Diabetes Care Opportunities for Pharmacists

    PubMed Central

    Ayadurai, Shamala; Hattingh, H. Laetitia; Tee, Lisa B. G.; Md Said, Siti Norlina

    2016-01-01

    Background. We conducted a review of current diabetes intervention studies in type 2 diabetes and identified opportunities for pharmacists to deliver quality diabetes care. Methods. A search on randomised controlled trials (RCT) on diabetes management by healthcare professionals including pharmacists published between 2010 and 2015 was conducted. Results and Discussion. Diabetes management includes multifactorial intervention which includes seven factors as outlined in diabetes guidelines, namely, glycaemic, cholesterol and blood pressure control, medication, lifestyle, education, and cardiovascular risk factors. Most studies do not provide evidence that the intervention methods used included all seven factors with exception of three RCT which indicated HbA1c (glycated hemoglobin) reduction range of 0.5% to 1.8%. The varied HbA1C reduction suggests a lack of standardised and consistent approach to diabetes care. Furthermore, the duration of most studies was from one month to two years; therefore long term outcomes could not be established. Conclusion. Although pharmacists' contribution towards improving clinical outcomes of diabetes patients was well documented, the methods used to deliver structured, consistent evidence-based care were not clearly stipulated. Therefore, approaches to achieving long term continuity of care are uncertain. An intervention strategy that encompass all seven evidence-based factors will be useful. PMID:27247949

  8. Alcohol brief interventions in Scottish antenatal care: a qualitative study of midwives’ attitudes and practices

    PubMed Central

    2014-01-01

    Background Infants exposed to alcohol in the womb are at increased risk of experiencing health problems. However, mixed messages about the consequences of prenatal alcohol consumption have resulted in inconsistent attitudes and practices amongst some healthcare practitioners. Screening and alcohol brief interventions (ABIs) can reduce risky drinking in various clinical settings. Recently, a program of screening and ABIs have been implemented in antenatal care settings in Scotland. However, current evidence suggests that midwives’ involvement in alcohol brief interventions activities is patchy. This study explored midwives’ attitudes and practices regarding alcohol screening and ABIs in order to understand why they are relatively underutilized in antenatal care settings compared to other clinical settings. Methods This was a qualitative study, involving semi-structured interviews with 15 midwives and a focus group with a further six midwifery team leaders (21 participants in total) in Scotland. Interview transcripts were analysed using thematic analysis. Results Midwives were positive about their involvement in the screening and ABI program. However, they were not completely convinced about the purpose and value of the screening and ABIs in antenatal care. In the midst of competing priorities, the program was seen as having a low priority in their workload. Midwives felt that the rapport between them and pregnant women was not sufficiently established at the first antenatal appointment to allow them to discuss alcohol issues appropriately. They reported that many women had already given up drinking or were drinking minimal amounts prior to the first antenatal appointment. Conclusions Midwives recognised the important role they could play in alcohol intervention activities in antenatal care. As the majority of women stop consuming alcohol in pregnancy, many will not need an ABI. Those who have not stopped are likely to need an ABI, but midwives were concerned

  9. Study protocol: a multi-professional team intervention of physical activity referrals in primary care patients with cardiovascular risk factors—the Dalby lifestyle intervention cohort (DALICO) study

    PubMed Central

    2012-01-01

    Background The present study protocol describes the trial design of a primary care intervention cohort study, which examines whether an extended, multi-professional physical activity referral (PAR) intervention is more effective in enhancing and maintaining self-reported physical activity than physical activity prescription in usual care. The study targets patients with newly diagnosed hypertension and/or type 2 diabetes. Secondary outcomes include: need of pharmacological therapy; blood pressure/plasma glucose; physical fitness and anthropometric variables; mental health; health related quality of life; and cost-effectiveness. Methods/Design The study is designed as a long-term intervention. Three primary care centres are involved in the study, each constituting one of three treatment groups: 1) Intervention group (IG): multi-professional team intervention with PAR, 2) Control group A (CA): physical activity prescription in usual care and 3) Control group B: treatment as usual (retrospective data collection). The intervention is based on self-determination theory and follows the principles of motivational interviewing. The primary outcome, physical activity, is measured with the International Physical Activity Questionnaire (IPAQ) and expressed as metabolic equivalent of task (MET)-minutes per week. Physical fitness is estimated with the 6-minute walk test in IG only. Variables such as health behaviours; health-related quality of life; motivation to change; mental health; demographics and socioeconomic characteristics are assessed with an electronic study questionnaire that submits all data to a patient database, which automatically provides feed-back to the health-care providers on the patients’ health status. Cost-effectiveness of the intervention is evaluated continuously and the intermediate outcomes of the intervention are extrapolated by economic modelling. Discussions By helping patients to overcome practical, social and cultural obstacles and increase

  10. Measuring Group Care Worker Interventions in Residential Youth Care

    ERIC Educational Resources Information Center

    Bastiaanssen, Inge L. W.; Kroes, Gert; Nijhof, Karin S.; Delsing, Marc J. M. H.; Engels, Rutger C. M. E.; Veerman, Jan Willem

    2012-01-01

    Background: By interacting with children, group care workers shape daily living environments to influence treatment. Current literature provides little knowledge about the content of youth residential care. Objective: In this study, a questionnaire called the Group care worker Intervention Checklist was developed. Method: Group care workers…

  11. An Evaluation of Collaborative Interventions to Improve Chronic Illness Care: Framework and Study Design

    ERIC Educational Resources Information Center

    Cretin, Shan; Shortell, Stephen M.; Keeler, Emmett B.

    2004-01-01

    The authors' dual-purpose evaluation assesses the effectiveness of formal collaboratives in stimulating organizational changes to improve chronic illness care (the chronic care model or CCM). Intervention and comparison sites are compared before and after introduction of the CCM. Multiple data sources are used to measure the degree of…

  12. TechCare: mobile assessment and therapy for psychosis – an intervention for clients in the Early Intervention Service: A feasibility study protocol

    PubMed Central

    Husain, Nusrat; Gire, Nadeem; Kelly, James; Duxbury, Joy; McKeown, Mick; Riley, Miv; Taylor, Christopher DJ; Taylor, Peter J; Emsley, Richard; Farooq, Saeed; Caton, Neil; Naeem, Farooq; Kingdon, David; Chaudhry, Imran

    2016-01-01

    Objectives: Technological advances in healthcare have shown promise when delivering interventions for mental health problems such as psychosis. The aim of this project is to develop a mobile phone intervention for people with psychosis and to conduct a feasibility study of the TechCare App. Methods: The TechCare App will assess participant’s symptoms and respond with a personalised guided self-help-based psychological intervention with the aim of exploring feasibility and acceptability. The project will recruit 16 service users and 8–10 health professionals from the Lancashire Care NHS Foundation Trust Early Intervention Service. Results: In strand 1 of the study, we will invite people to discuss their experience of psychosis and give their opinions on the existing evidence-based treatment (cognitive behavioural therapy) and how the mobile app can be developed. In strand 2, we will complete a test run with a small number of participants (n = 4) to refine the mobile intervention (TechCare). Finally, in strand 3 of the study, the TechCare App will be examined in a feasibility study with 12 participants. Conclusion: It has been suggested that there is a need for a rapid increase in the efforts to develop the evidence base for the clinical effectiveness of digital technologies, considering mHealth research can potentially be helpful in addressing the demand on mental health services globally. PMID:27790373

  13. The Keys to Healthy Family Child Care Homes intervention: Study design and rationale

    PubMed Central

    Østbye, Truls; Mann, Courtney M.; Vaughn, Amber E.; Namenek Brouwer, Rebecca J.; Benjamin Neelon, Sara E.; Hales, Derek; Bangdiwala, Shrikant I.; Ward, Dianne S.

    2014-01-01

    Background Obesity is a major public health problem for which early preventive interventions are needed. Large numbers of young children are enrolled in some form of child care program, making these facilities influential environments in children’s development. Family child care homes (FCCH) are a specific type of child care in which children are cared for within the provider’s own residence. FCCHs serve approximately 1.5 million children in the U.S.; however, research to date has overlooked FCCH providers and their potential to positively influence children’s health-related behaviors. Methods Keys to Healthy Family Child Care Homes (Keys) is a cluster-randomized controlled trial testing the efficacy of an intervention designed to help providers become healthy role models, provide quality food- and physical activity-supportive FCCH environments, and implement effective business practices. The intervention is delivered through workshops, home visits, tailored coaching calls, and educational toolkits. Primary outcomes are child physical activity measured via accelerometry data and dietary intake data collected using direct observation at the FCCH. Secondary outcomes include child body mass index, provider weight-related behaviors, and observed obesogenic environmental characteristics. Conclusion Keys is an innovative approach to promoting healthy eating and physical activity in young children. The intervention operates in a novel setting, targets children during a key developmental period, and addresses both provider and child behaviors to synergistically promote health. PMID:25460337

  14. A contact-based intervention for people recently discharged from inpatient psychiatric care: a pilot study.

    PubMed

    Bennewith, Olive; Evans, Jonathan; Donovan, Jenny; Paramasivan, Sangeetha; Owen-Smith, Amanda; Hollingworth, William; Davies, Rosemary; O'Connor, Susan; Hawton, Keith; Kapur, Navneet; Gunnell, David

    2014-01-01

    People recently discharged from inpatient psychiatric care are at high risk of suicide and self-harm, with 6% of all suicides in England occurring in the 3 months after discharge. There is some evidence from a randomized trial carried out in the United States in the 1960s-70s that supportive letters sent by psychiatrists to high-risk patients in the period following hospital discharge resulted in a reduction in suicide. The aim of the current pilot study was to assess the feasibility of conducting a similar trial, but in a broader group of psychiatric discharges, in the context of present day UK clinical practice. The intervention was piloted on 3 psychiatric inpatient wards in southwest England. On 2 wards a series of 8 letters were sent to patients over the 12 months after discharge and 6 letters were sent from the third ward over a 6 month period. A total of 102 patients discharged from the wards received at least 1 letter, but only 45 (44.1%) received the full series of letters. The main reasons for drop-out were patient opt-out (n = 24) or readmission (n = 26). In the context of a policy of intensive follow-up post-discharge, qualitative interviews with service users showed that most already felt adequately supported and the intervention added little to this. Those interviewed felt that it was possible that the intervention might benefit people new to or with little follow-up from mental health services but that fewer letters should be mailed. PMID:24673299

  15. Reducing occupational risk for blood and body fluid exposure among home care aides: an intervention effectiveness study.

    PubMed

    Amuwo, Shakirudeen; Lipscomb, Jane; McPhaul, Kathleen; Sokas, Rosemary K

    2013-01-01

    The purpose of this quasi-experimental pretest/posttest research study was to examine the effectiveness of an intervention designed through a participatory process to reduce blood and body fluid exposure among home care aides. Employer A, the intervention site, was a large agency with approximately 1,200 unionized home care aides. Employer B, the comparison group, was a medium-sized agency with approximately 200 home care aides. The intervention was developed in partnership with labor and management and included a 1-day educational session utilizing peer educators and active learning methods to increase awareness about the risks for occupational exposure to blood and body fluids among home care aides and a follow-up session introducing materials to facilitate communication with clients about safe sharps disposal. Self-administered preintervention and postintervention questionnaires identifying knowledge about and self-reported practices to reduce bloodborne pathogen exposure were completed in person during mandatory training sessions 18 months apart. Home care aides in the intervention group for whom the preintervention and postintervention questionnaires could be directly matched reported an increase in their clients' use of proper sharps containers (31.9% pre to 52.2% post; p = .033). At follow-up, the intervention group as a whole also reported increased use of sharps containers among their clients when compared to controls (p = .041).

  16. Multistrategy childcare-based intervention to improve compliance with nutrition guidelines versus usual care in long day care services: a study protocol for a randomised controlled trial

    PubMed Central

    Seward, Kirsty; Finch, Meghan; Wiggers, John; Wyse, Rebecca; Jones, Jannah; Gillham, Karen; Yoong, Sze Lin

    2016-01-01

    Introduction Interventions to improve child diet are recommended as dietary patterns developed in childhood track into adulthood and influence the risk of chronic disease. For child health, childcare services are required to provide foods to children consistent with nutrition guidelines. Research suggests that foods and beverages provided by services to children are often inconsistent with nutrition guidelines. The primary aim of this study is to assess, relative to a usual care control group, the effectiveness of a multistrategy childcare-based intervention in improving compliance with nutrition guidelines in long day care services. Methods and analysis The study will employ a parallel group randomised controlled trial design. A sample of 58 long day care services that provide all meals (typically includes 1 main and 2 mid-meals) to children while they are in care, in the Hunter New England region of New South Wales, Australia, will be randomly allocated to a 6-month intervention to support implementation of nutrition guidelines or a usual care control group in a 1:1 ratio. The intervention was designed to overcome barriers to the implementation of nutrition guidelines assessed using the theoretical domains framework. Intervention strategies will include the provision of staff training and resources, audit and feedback, ongoing support and securing executive support. The primary outcome of the trial will be the change in the proportion of long day care services that have a 2-week menu compliant with childcare nutrition guidelines, measured by comprehensive menu assessments. As a secondary outcome, child dietary intake while in care will also be assessed. To assess the effectiveness of the intervention, the measures will be undertaken at baseline and ∼6 months postbaseline. Ethics and dissemination The study was approved by the Hunter New England Human Research Ethics Committee. Study findings will be disseminated widely through peer-reviewed publications. PMID

  17. A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: study protocol

    PubMed Central

    2013-01-01

    Background Racial disparities in blood pressure control have been well documented in the United States. Research suggests that many factors contribute to this disparity, including barriers to care at patient, clinician, healthcare system, and community levels. To date, few interventions aimed at reducing hypertension disparities have addressed factors at all of these levels. This paper describes the design of Project ReD CHiP (Reducing Disparities and Controlling Hypertension in Primary Care), a multi-level system quality improvement project. By intervening on multiple levels, this project aims to reduce disparities in blood pressure control and improve guideline concordant hypertension care. Methods Using a pragmatic trial design, we are implementing three complementary multi-level interventions designed to improve blood pressure measurement, provide patient care management services and offer expanded provider education resources in six primary care clinics in Baltimore, Maryland. We are staggering the introduction of the interventions and will use Statistical Process Control (SPC) charting to determine if there are changes in outcomes at each clinic after implementation of each intervention. The main hypothesis is that each intervention will have an additive effect on improvements in guideline concordant care and reductions in hypertension disparities, but the combination of all three interventions will result in the greatest impact, followed by blood pressure measurement with care management support, blood pressure measurement with provider education, and blood pressure measurement only. This study also examines how organizational functioning and cultural competence affect the success of the interventions. Discussion As a quality improvement project, Project ReD CHiP employs a novel study design that specifically targets multi-level factors known to contribute to hypertension disparities. To facilitate its implementation and improve its sustainability, we have

  18. Exposing the key functions of a complex intervention for shared care in mental health: case study of a process evaluation

    PubMed Central

    Byng, Richard; Norman, Ian; Redfern, Sally; Jones, Roger

    2008-01-01

    Background Complex interventions have components which can vary in different contexts. Using the Realistic Evaluation framework, this study investigates how a complex health services intervention led to developments in shared care for people with long-term mental illness. Methods A retrospective qualitative interview study was carried out alongside a randomised controlled trial. The multi-faceted intervention supported by facilitators aimed to develop systems for shared care. The study was set in London. Participants included 46 practitioners and managers from 12 participating primary health care teams and their associated community mental health teams. Interviews focussed on how and why out comes were achieved, and were analysed using a framework incorporating context and intervening mechanisms. Results Thirty-one interviews were completed to create 12 case studies. The enquiry highlighted the importance of the catalysing, doing and reviewing functions of the facilitation process. Other facets of the intervention were less dominant. The intervention catalysed the allocation of link workers and liaison arrangements in nearly all practices. Case discussions between link workers and GPs improved individual care as well as helping link workers become part of the primary care team; but sustained integration into the team depended both on flexibility and experience of the link worker, and upon selection of relevant patients for the case discussions. The doing function of facilitators included advice and, at times, manpower, to help introduce successful systems for reviewing care, however time spent developing IT systems was rarely productive. The reviewing function of the intervention was weak and sometimes failed to solve problems in the development of liaison or recall. Conclusion Case discussions and improved liaison at times of crisis, rather than for proactive recall, were the key functions of shared care contributing to the success of Mental Health Link. This

  19. Effectiveness of a stepped primary care smoking cessation intervention (ISTAPS study): design of a cluster randomised trial

    PubMed Central

    Cabezas, Carmen; Martin, Carlos; Granollers, Silvia; Morera, Concepció; Ballve, Josep Lluis; Zarza, Elvira; Blade, Jordi; Borras, Margarida; Serra, Antoni; Puente, Diana

    2009-01-01

    Background There is a considerable body of evidence on the effectiveness of specific interventions in individuals who wish to quit smoking. However, there are no large-scale studies testing the whole range of interventions currently recommended for helping people to give up smoking; specifically those interventions that include motivational interviews for individuals who are not interested in quitting smoking in the immediate to short term. Furthermore, many of the published studies were undertaken in specialized units or by a small group of motivated primary care centres. The objective of the study is to evaluate the effectiveness of a stepped smoking cessation intervention based on a trans-theoretical model of change, applied to an extensive group of Primary Care Centres (PCC). Methods/Design Cluster randomised clinical trial. Unit of randomization: basic unit of care consisting of a family physician and a nurse, both of whom care for the same population (aprox. 2000 people). Intention to treat analysis. Study population: Smokers (n = 3024) aged 14 to 75 years consulting for any reason to PCC and who provided written informed consent to participate in the trial. Intervention: 6-month implementation of recommendations of a Clinical Practice Guideline which includes brief motivational interviews for smokers at the precontemplation – contemplation stage, brief intervention for smokers in preparation-action who do not want help, intensive intervention with pharmacotherapy for smokers in preparation-action who want help, and reinforcing intervention in the maintenance stage. Control group: usual care. Outcome measures: Self-reported abstinence confirmed by exhaled air carbon monoxide concentration of ≤ 10 parts per million. Points of assessment: end of intervention period and 1 and 2 years post-intervention; continuous abstinence rate for 1 year; change in smoking cessation stage; health status measured by SF-36. Discussion The application of a stepped

  20. A brief intervention for weight management in primary care: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Obesity affects 25% of the UK adult population but modest weight loss can reduce the incidence of obesity-related chronic disease. Some effective weight loss treatments exist but there is no nationally available National Health Service (NHS) treatment service, and general practitioners (GPs) rarely discuss weight management with patients or support behavior change. Evidence shows that commercial weight management services, that most primary care trusts have 'on prescription', are more effective than primary care treatment. Methods/design We propose a controlled trial where patients will be randomized to receive either the offer of help by referral to a weight management service and follow-up to assess progress, or advice to lose weight on medical grounds. The primary outcome will be weight change at 12-months. Other questions are: what actions do people take to manage their weight in response to the two GP intervention types? How do obese patients feel about GPs opportunistically discussing weight management and how does this vary by intervention type? How do GPs feel about raising the issue opportunistically and giving the two types of brief intervention? What is the cost per kg/m2 lost for each intervention? Research assistants visiting GP practices in England (n = 60) would objectively measure weight and height prior to GP consultations and randomize willing patients (body mass index 30+, excess body fat, 18+ years) using sealed envelopes. Full recruitment (n = 1824) is feasible in 46 weeks, requiring six sessions of advice-giving per GP. Participants will be contacted at 3 months (postintervention) via telephone to identify actions they have taken to manage their weight. We will book appointments for participants to be seen at their GP practice for a 12-month follow-up. Discussion Trial results could make the case for brief interventions for obese people consulting their GP and introduce widespread simple treatments akin to the NHS Stop

  1. Complex social intervention for multidisciplinary teams to improve patient referrals in obstetrical care: protocol for a stepped wedge study design

    PubMed Central

    Romijn, Anita; de Bruijne, Martine C; Teunissen, Pim W; de Groot, Christianne J M; Wagner, Cordula

    2016-01-01

    Introduction In obstetrics, patients often experience referral situations between different care professionals. In these multidisciplinary teams, a focus on communication and interprofessional collaboration is needed to ensure care of high quality. Crew resource management team training is increasingly being applied in healthcare settings to improve team performance and coordination. Efforts to improve communication also include tools for standardisation such as SBAR (situation, background, assessment, recommendation). Despite the growing adoption of these interventions, evidence on their effectiveness is limited, especially on patient outcomes. This article describes a study protocol to examine the effectiveness of a crew resource management team training intervention aimed at implementing the SBAR tool for structured communication during patient referrals in obstetrical care. Methods and analysis The intervention is rolled out sequentially in five hospitals and surrounding primary care midwifery practices in the Netherlands, using a stepped wedge design. The intervention involves three phases over a period of 24 months: (1) preparation, (2) training and (3) follow-up with repeated measurements. The primary outcomes are perinatal and maternal outcomes calculated using the Adverse Outcome Index. The secondary outcomes are the reaction of participating professionals to the training programme, attitudes towards safety and teamwork (Safety Attitudes Questionnaire), cohesion (Interprofessional Collaboration Measurement Scale), use of the tool for structured communication (self-reported questionnaire) and patient experiences. These secondary outcomes from professional and patient level allow triangulation and an increased understanding of the effect of the intervention on patient outcomes. Ethics and dissemination The study was approved by the Medical Ethical Committee of the VU University Medical Centre in the Netherlands and the protocol is in accordance with Dutch

  2. An intervention to improve care and reduce costs for high-risk patients with frequent hospital admissions: a pilot study

    PubMed Central

    2011-01-01

    Background A small percentage of high-risk patients accounts for a large proportion of Medicaid spending in the United States, which has become an urgent policy issue. Our objective was to pilot a novel patient-centered intervention for high-risk patients with frequent hospital admissions to determine its potential to improve care and reduce costs. Methods Community and hospital-based care management and coordination intervention with pre-post analysis of health care utilization. We enrolled Medicaid fee-for-service patients aged 18-64 who were admitted to an urban public hospital and identified as being at high risk for hospital readmission by a validated predictive algorithm. Enrolled patients were evaluated using qualitative and quantitative interview techniques to identify needs such as transportation to/advocacy during medical appointments, mental health/substance use treatment, and home visits. A community housing partner initiated housing applications in-hospital for homeless patients. Care managers facilitated appropriate discharge plans then worked closely with patients in the community using a harm reduction approach. Results Nineteen patients were enrolled; all were male, 18/19 were substance users, and 17/19 were homeless. Patients had a total of 64 inpatient admissions in the 12 months before the intervention, versus 40 in the following 12 months, a 37.5% reduction. Most patients (73.3%) had fewer inpatient admissions in the year after the intervention compared to the prior year. Overall ED visits also decreased after study enrollment, while outpatient clinic visits increased. Yearly study hospital Medicaid reimbursements fell an average of $16,383 per patient. Conclusions A pilot intervention for high-cost patients shows promising results for health services usage. We are currently expanding our model to serve more patients at additional hospitals to see if the pilot's success can be replicated. Trial registration Clinicaltrials.gov Identifier: NCT

  3. A quasi-experimental study of the effects of an integrated care intervention for the frail elderly on informal caregivers’ satisfaction with care and support

    PubMed Central

    2014-01-01

    Background This study explored the effects of an integrated care model for the frail elderly on informal caregivers’ satisfaction with care and support services. Methods A 62-item instrument was developed and deployed in an evaluative before/after study using a quasi-experimental design and enrolling a control group. The definitive study population (n = 63) consisted mainly of female informal caregivers who did not live with the care recipient. Analysis of separate items involved group comparisons, using paired and unpaired tests, and regression analyses, with baseline measurements, control variables (sex, age and living together with care recipient) and the intervention as independent variables. Subsequently, the underlying factor structure of the theoretical dimensions was investigated using primary component analysis. Group comparisons and regression analyses were performed on the resulting scales. Results Satisfaction with the degree to which care was provided according to the need for care of the recipients increased, while satisfaction with the degree to which professionals provided help with administrative tasks, the understandability of the information provided and the degree to which informal caregivers knew which professionals to call, decreased. Primary component analysis yielded 6 scales for satisfaction with care and 5 scales for satisfaction with caregiver support, with sufficient reliability. Conclusions The results suggest that expectations regarding the effects of integrated care on informal caregiver satisfaction may not be realistic. However, the results must be seen in light of the small sample size and should therefore be considered as preliminary. Nonetheless, this study provides guidance for further research and integrated care interventions involving informal caregivers. Trial registration Current Controlled Trials ISRCTN05748494. Date of registration: 14/03/2013. PMID:24678804

  4. Assessment of a primary care-based telemonitoring intervention for home care patients with heart failure and chronic lung disease. The TELBIL study

    PubMed Central

    2011-01-01

    Background Telemonitoring technology offers one of the most promising alternatives for the provision of health care services at the patient's home. The primary aim of this study is to evaluate the impact of a primary care-based telemonitoring intervention on the frequency of hospital admissions. Methods/design A primary care-based randomised controlled trial will be carried out to assess the impact of a telemonitoring intervention aimed at home care patients with heart failure (HF) and/or chronic lung disease (CLD). The results will be compared with those obtained with standard health care practice. The duration of the study will be of one year. Sixty patients will be recruited for the study. In-home patients, diagnosed with HF and/or CLD, aged 14 or above and with two or more hospital admissions in the previous year will be eligible. For the intervention group, telemonitoring will consist of daily patient self-measurements of respiratory-rate, heart-rate, blood pressure, oxygen saturation, weight and body temperature. Additionally, the patients will complete a qualitative symptom questionnaire daily using the telemonitoring system. Routine telephone contacts will be conducted every fortnight and additional telephone contacts will be carried out if the data received at the primary care centre are out of the established limits. The control group will receive usual care. The primary outcome measure is the number of hospital admissions due to any cause that occurred in a period of 12 months post-randomisation. The secondary outcome measures are: duration of hospital stay, hospital admissions due to HF or CLD, mortality rate, use of health care resources, quality of life, cost-effectiveness, compliance and patient and health care professional satisfaction with the new technology. Discussion The results of this study will shed some light on the effects of telemonitoring for the follow-up and management of chronic patients from a primary care setting. The study may

  5. Using behavioural theories to optimise shared haemodialysis care: a qualitative intervention development study of patient and professional experience

    PubMed Central

    2013-01-01

    Background Patients in control of their own haemodialysis report better outcomes than those receiving professional controlled care in a hospital setting, even though home and hospital haemodialysis are largely equivalent from mechanical and physiological perspectives. Shared Haemodialysis Care (SHC) describes an initiative in which hospital haemodialysis patients are supported by dialysis staff to become as involved as they wish in their own care; and can improve patient safety, satisfaction and may reduce costs. We do not understand why interventions to support self-management in other conditions have variable effects or how to optimise the delivery of SHC. The purpose of this study was to identify perceived patient and professional (nurses and healthcare assistants) barriers to the uptake of SHC, and to use these data to identify intervention components to optimise care. Methods Individual semi-structured interviews with patients and professionals were conducted to identify barriers and facilitators. Data were coded to behavioural theory to identify solutions. A national UK learning event with multiple stakeholders (patients, carers, commissioners and professionals) explored the salience of these barriers and the acceptability of solutions. Results A complex intervention strategy was designed to optimise SHC for patients and professionals. Interviews were conducted with patients (n = 15) and professionals (n = 7) in two hospitals and three satellite units piloting SHC. Data from patient and professional interviews could be coded to behavioural theory. Analyses identified key barriers (knowledge, beliefs about capabilities, skills and environmental context and resources). An intervention strategy that focuses on providing, first, patients with information about the shared nature of care, how to read prescriptions and use machines, and second, providing professionals with skills and protected time to teach both professionals/patients, as well as providing

  6. The Effects of Foster Care Intervention on Socially Deprived Institutionalized Children's Attention and Positive Affect: Results from the BEIP Study

    ERIC Educational Resources Information Center

    Ghera, Melissa M.; Marshall, Peter J.; Fox, Nathan A.; Zeanah, Charles H.; Nelson, Charles A.; Smyke, Anna T.; Guthrie, Donald

    2009-01-01

    Background: We examined the effects of a foster care intervention on attention and emotion expression in socially deprived children in Romanian institutions. Methods: Institutionalized children were randomized to enter foster care or to remain under institutional care. Subsequently, the institutionalized and foster care groups, along with a…

  7. Palliative Care Nursing Interventions in Thailand

    PubMed Central

    Doorenbos, Ardith Z.; Juntasopeepun, Phanida; Eaton, Linda H.; Rue, Tessa; Hong, Elizabeth; Coenen, Amy

    2013-01-01

    Purpose This study aimed to describe the nursing interventions that nurses in Thailand identify as most important in promoting dignified dying. Design This study used a cross-sectional descriptive design. Method A total of 247 Thai nurses completed a paper-and-pencil survey written in Thai. The survey included both demographic questions and palliative care interventions, listed with summative rating scales, from the International Classification for Nursing Practice (ICNP) catalogue Palliative Care for Dignified Dying. Descriptive statistics were used to analyze the data. Findings The five most important nursing interventions to promote dignified dying, ranked by average importance rating, were (a) maintain dignity and privacy, (b) establish trust, (c) manage pain, (d) establish rapport, and (e) manage dyspnea. Conclusions This research identified the palliative care nursing interventions considered most important by nurses in Thailand to promote dignified dying. Implications for Practice The ICNP catalogue Palliative Care for Dignified Dying can be used for planning and managing palliative nursing care in Thailand. PMID:24014487

  8. Self-care telephone talks as a health-promotion intervention in urban home-living persons 75+ years of age: a randomized controlled study

    PubMed Central

    Sundsli, Kari; Söderhamn, Ulrika; Espnes, Geir Arild; Söderhamn, Olle

    2014-01-01

    Aim The aim of this study was to evaluate the effects of a telephone-based self-care intervention among urban living individuals 75+ years of age by comparing self-reported perceived health, mental health, sense of coherence, self-care ability, and self-care agency before and after the intervention. Materials and methods In a randomized controlled study, 15 persons answered a questionnaire about perceived health, mental health, sense of coherence, self-care ability, and self-care agency. In a sex- and age-matched control group (n=15), the same questions were answered. Data were collected before and after intervention. An open-ended question about experiences of the intervention was included in the last questionnaire. The intervention consisted of a first meeting with health professionals and additional five self-care telephone calls. The control group did not receive any intervention or attention except for the questionnaires. Descriptive statistics were used to describe the study group. To compare the intervention group and control group on nominal and ordinal levels, the McNemar test and the Wilcoxon signed-rank test, respectively, were chosen. Results Thirty individuals (14 females and 16 males) participated in the study, ranging in age between 75 and 93 years. A significant difference was obtained in the intervention group regarding mental health. Mental health improved significantly in the intervention group (P=0.037). In the control group, mental health, sense of coherence, self-care ability, and self-care agency showed worse outcome results after the intervention (19 weeks). Conclusion Self-care telephone talks improved mental health significantly in our sample, and mental health focus could be understood as a possible condition for health promotion to take place. Structured self-care telephone talks have proved to be successful and a relevant method to use in practice. PMID:24421638

  9. Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit.

    PubMed

    Engwall, Marie; Fridh, Isabell; Johansson, Lotta; Bergbom, Ingegerd; Lindahl, Berit

    2015-12-01

    Patients in an intensive care unit (ICU) may risk disruption of their circadian rhythm. In an intervention research project a cycled lighting system was set up in an ICU room to support patients' circadian rhythm. Part I aimed to compare experiences of the lighting environment in two rooms with different lighting environments by lighting experiences questionnaire. The results indicated differences in advantage for the patients in the intervention room (n=48), in perception of daytime brightness (p=0.004). In nighttime, greater lighting variation (p=0.005) was found in the ordinary room (n=52). Part II aimed to describe experiences of lighting in the room equipped with the cycled lighting environment. Patients (n=19) were interviewed and the results were presented in categories: "A dynamic lighting environment", "Impact of lighting on patients' sleep", "The impact of lighting/lights on circadian rhythm" and "The lighting calms". Most had experiences from sleep disorders and half had nightmares/sights and circadian rhythm disruption. Nearly all were pleased with the cycled lighting environment, which together with daylight supported their circadian rhythm. In night's actual lighting levels helped patients and staff to connect which engendered feelings of calm.

  10. A preliminary study of an internet-based intervention for OEF/OIF veterans presenting for VA specialty PTSD care.

    PubMed

    Belsher, Bradley E; Kuhn, Eric; Maron, David; Prins, Annabel; Cueva, David; Fast, Elsbeth; France, Deborah

    2015-04-01

    This preliminary study sought to evaluate the feasibility and potential effectiveness of a cognitive-behavioral, web-based intervention for posttraumatic stress in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans who are not able to participate, or not eligible to participate, in evidence-based posttraumatic stress disorder (PTSD) treatments. The study used an uncontrolled pre-posttest design with a sample of 24 OEF/OIF veterans presenting to a VA PTSD specialty clinic. Participants used the afterdeployment.org, Post-Traumatic Stress (PTS) Workshop, which was supplemented with brief weekly telephone calls. Half of the participants (n = 12) completed at least 5 of the 8 workshop sessions. At posttreatment, 40.0% of completers demonstrated reliable reductions on PTSD symptoms and overall d = 1.04. Treatment satisfaction and acceptability was generally positive based on Likert ratings. This web-based intervention for PTS appears to be a feasible and potentially helpful intervention for veterans who may not otherwise receive psychosocial interventions. Given the minimal resources required and the potential reach, this web-based intervention could be a viable addition to services provided to OEF/OIF veterans seeking PTSD specialty care. Efforts to further develop and more rigorously evaluate this approach are warranted.

  11. Utility of a thematic network in primary health care: a controlled interventional study in a rural area

    PubMed Central

    Coma del Corral, Maria Jesús; Abaigar Luquín, Pedro; Cordero Guevara, José; Olea Movilla, Angel; Torres Torres, Gerardo; Lozano Garcia, Javier

    2005-01-01

    Background UniNet is an Internet-based thematic network for a virtual community of users (VCU). It supports a virtual multidisciplinary community for physicians, focused on the improvement of clinical practice. This is a study of the effects of a thematic network such as UniNet on primary care medicine in a rural area, specifically as a platform of communication between specialists at the hospital and doctors in the rural area. Methods In order to study the effects of a thematic network such as UniNet on primary care medicine in a rural area, we designed an interventional study that included a control group. The measurements included the number of patient displacements due to disease, number of patient hospital stays and the number of prescriptions of drugs of low therapeutic utility and generic drug prescriptions by doctors. These data were analysed and compared with those of the control center. Results Our study showed positive changes in medical practice, reflected in the improvement of the evaluated parameters in the rural health area where the interventional study was carried out, compared with the control area. We discuss the strengths and weaknesses of UniNet as a potential medium to improve the quality of medical care in rural areas. Conclusion The rural doctors had an effective, useful, user-friendly and cheap source of medical information that may have contributed to the improvement observed in the medical quality indices. PMID:16042778

  12. A self-care educational intervention to improve knowledge of dietary phosphorus control in patients requiring hemodialysis: a pilot study.

    PubMed

    Brogdon, Rhonda M

    2013-01-01

    The purpose of this pilot study was to improve knowledge of dietary phosphorus control in patients requiring hemodialysis. The evidence-based literature suggests that nonadherence to phosphorous control in diets is a major health concern for patients who require hemodialysis because they have limited kidney function. Phosphorus tends to accumulate rather than be excreted. A self-care educational intervention was used in a pilot study (N = 10) to increase patients' knowledge about low phosphorous diets to promote dietary adherence. The outcome of this study was evaluated by a pre-test/post-test of patients' knowledge about phosphorus in the diet. A positive gain in knowledge was realized related to the intervention.

  13. Transforming rural health care through information technology: an interventional study in China.

    PubMed

    Liu, Gordon Guoen; Chen, Yiqun; Qin, Xuezheng

    2014-12-01

    This article estimates the impacts of health information technology (HIT) on health-care delivery in the Wenchuan County of China, where the devastation of the 2008 Great Wenchuan Earthquake and the subsequent large-scale HIT implementation (the Healthy Wenchuan Program) offers a 'natural experiment' opportunity, enabling us to conduct a difference-in-difference evaluation of the potential benefits of HIT on accessibility, affordability and appropriateness of health-care services in the underdeveloped rural area. Based on data collected from two field surveys in township hospitals, we find that for both the inpatient and outpatient samples, the HIT system promotes access to medical care by increasing doctor referrals and encouraging within-county medical utilization, reduces patient financial burden in certain expenditure categories, and contributes to higher patient satisfaction on medical care quality. On the other hand, we also find that HIT leads to increased patient waiting time for hospital registration, reflecting the unique challenges in implementing HIT in the underdeveloped areas. Our study contributes to the growing body of literature on evaluating the impacts of HIT application in the developing regions, and provides implications on the potential role of HIT in China's national health system reforms.

  14. Inequalities in the uptake of weight management interventions in a pragmatic trial: an observational study in primary care

    PubMed Central

    Ahern, Amy L; Aveyard, Paul; Boyland, Emma J; Halford, Jason CG; Jebb, Susan A

    2016-01-01

    Background Primary care referral to a commercial open-group behavioural weight-loss programme is a cost-effective intervention, but only 10% of patients receiving this intervention are male. Aim To explore whether observed biases in participation in these interventions reflect biases in the uptake of the invitation to participate. Design and setting Comparison of invited population and recruited participants in a multicentre randomised controlled trial of primary care referral to a commercial open-group behavioural weight-loss programme in England (WRAP [Weight loss Referrals for Adults in Primary care]). Method Between October 2012 and February 2014, participants were recruited through 23 primary care practices in England; 17 practices provided data on the characteristics of invited participants. Results Females were twice as likely as males to enrol in the trial (odds ratio [OR] 2.01, 95% confidence interval [CI] = 1.75 to 2.32). However, the proportion of males was threefold higher than seen in routine primary care referrals or similar trials that invited patients opportunistically. People from less deprived areas were more likely to enrol than those in more deprived areas (OR 1.77, 95% CI = 1.55 to 2.03). Older patients (≥40 years) were more likely to enrol than younger patients (OR 1.60, 95% CI = 1.34 to 1.91). Conclusion Males, younger people, and those from more deprived areas were less likely to take up the invitation to participate in this trial. The gender bias was smaller than observed in routine practice, suggesting that a substantial proportion of the inequity observed previously is a consequence of bias with regard to the offer of intervention. This study suggests that a simple way to overcome much of the gender bias is to write to patients who are overweight and offer referral. Uptake of the invitation to participate was lower in groups of lower socioeconomic status suggesting the need to preferentially offer referrals to this group to reduce

  15. Reducing Phthalate, Paraben, and Phenol Exposure from Personal Care Products in Adolescent Girls: Findings from the HERMOSA Intervention Study

    PubMed Central

    Harley, Kim G.; Kogut, Katherine; Madrigal, Daniel S.; Cardenas, Maritza; Vera, Irene A.; Meza-Alfaro, Gonzalo; She, Jianwen; Gavin, Qi; Zahedi, Rana; Bradman, Asa; Eskenazi, Brenda; Parra, Kimberly L.

    2016-01-01

    Background: Personal care products are a source of exposure to potentially endocrine-disrupting chemicals such as phthalates, parabens, triclosan, and benzophenone-3 (BP-3) for adolescent girls. Methods: We enrolled 100 Latina girls in a youth-led, community-based participatory research intervention study to determine whether using personal care products whose labels stated they did not contain these chemicals for 3 days could lower urinary concentrations. Pre- and postintervention urine samples were analyzed for phthalate metabolites, parabens, triclosan, and BP-3 using high-performance liquid chromatography/tandem mass spectrometry. Results: Urinary concentrations of mono-ethyl phthalate (MEP) decreased by 27.4% (95% CI: –39.3, –13.2) on average over the 3-day intervention; no significant changes were seen in urinary concentrations of mono-n-butyl phthalate (MnBP) and mono-isobutyl phthalate (MiBP). Methyl and propyl paraben concentrations decreased by 43.9% (95% CI: –61.3, –18.8) and 45.4% (95% CI: –63.7, –17.9), respectively. Unexpectedly, concentrations of ethyl and butyl paraben concentrations increased, although concentrations were low overall and not detected in almost half the samples. Triclosan concentrations decreased by 35.7% (95% CI: –53.3, –11.6), and BP-3 concentrations decreased by 36.0% (95% CI: –51.0, –16.4). Discussion: This study demonstrates that techniques available to consumers, such as choosing personal care products that are labeled to be free of phthalates, parabens, triclosan, and BP-3, can reduce personal exposure to possible endocrine-disrupting chemicals. Involving youth in the design and implementation of the study was key to recruitment, retention, compliance, and acceptability of the intervention. Citation: Harley KG, Kogut K, Madrigal DS, Cardenas M, Vera IA, Meza-Alfaro G, She J, Gavin Q, Zahedi R, Bradman A, Eskenazi B, Parra KL. 2016. Reducing phthalate, paraben, and phenol exposure from personal care

  16. The prevention of preterm delivery through prenatal care: an intervention study in Martinique.

    PubMed

    Goujon, H; Papiernik, E; Maine, D

    1984-10-01

    During 1976-1978, improvements were made in the free prenatal care provided by the maternal and child health authority (PMI) of Martinique. Central to these changes was implementation of a program of preventive prenatal care developed in France by one of the authors (EP). Data on all births during 1980-1982 show no significant difference in pregnancy outcomes between women receiving free prenatal care from the government and women receiving private care from obstetricians.

  17. Study protocol: translating and implementing psychosocial interventions in aged home care the lifestyle engagement activity program (LEAP) for life

    PubMed Central

    2013-01-01

    Background Tailored psychosocial activity-based interventions have been shown to improve mood, behaviour and quality of life for nursing home residents. Occupational therapist delivered activity programs have shown benefits when delivered in home care settings for people with dementia. The primary aim of this study is to evaluate the effect of LEAP (Lifestyle Engagement Activity Program) for Life, a training and practice change program on the engagement of home care clients by care workers. Secondary aims are to evaluate the impact of the program on changes in client mood and behaviour. Methods/design The 12 month LEAP program has three components: 1) engaging site management and care staff in the program; 2) employing a LEAP champion one day a week to support program activities; 3) delivering an evidence-based training program to care staff. Specifically, case managers will be trained and supported to set meaningful social or recreational goals with clients and incorporate these into care plans. Care workers will be trained in and encouraged to practise good communication, promote client independence and choice, and tailor meaningful activities using Montessori principles, reminiscence, music, physical activity and play. LEAP Champions will be given information about theories of organisational change and trained in interpersonal skills required for their role. LEAP will be evaluated in five home care sites including two that service ethnic minority groups. A quasi experimental design will be used with evaluation data collected four times: 6-months prior to program commencement; at the start of the program; and then after 6 and 12 months. Mixed effect models will enable comparison of change in outcomes for the periods before and during the program. The primary outcome measure is client engagement. Secondary outcomes for clients are satisfaction with care, dysphoria/depression, loneliness, apathy and agitation; and work satisfaction for care workers. A process

  18. A feasibility study of a telephone-supported self-care intervention for depression among adults with a comorbid chronic physical illness in primary care

    PubMed Central

    2012-01-01

    Objective We assessed the feasibility and acceptability to patients of a telephone-supported self-care intervention for depression among adults aged 40 years or over with one of six targeted chronic physical illnesses and comorbid depressive symptoms in family practice settings. Methods An open, uncontrolled trial (feasibility study) was conducted among patients treated in Montreal family practices. Eligible patients were aged 40 years or over, had one or more of the targeted chronic physical illnesses for at least 6 months (arthritis, hypertension, diabetes, heart disease, asthma and chronic obstructive pulmonary disease) and were evaluated as having at least mild depressive symptoms (a score of ≥ 5 on the 9-item Patient Health Questionnaire, PHQ-9). Participants received a package of six self-care tools (information booklet, video, Internet programme, action plan, workbook and mood-monitoring tool) with telephone support by a lay coach for up to 6 months. Results In total, 63 eligible patients provided written consent and completed the baseline interview; 57 (90%) and 55 (87%) patients completed 2-month and 6-month follow-up interviews, respectively. The mean number of telephone calls made by coaches to participants was 10.5 (SD 4.0), and the average length of these calls was 10.6 minutes. At the 6-month follow-up, 83.6% of the participants reported that one or more of the tools were helpful. Clinically significant improvements were seen in depressive symptoms (as assessed by the PHQ-9) at 6 months, with an effect size of 0.88 (95% CI, 0.55, 1.14). Conclusion A telephone-supported self-care intervention for depression was feasible, was acceptable to patients, and was associated with a significant 6-month improvement in depressive symptoms. A randomised trial of this intervention is justified. PMID:24294301

  19. The impact of a managed care obesity intervention on clinical outcomes and costs: A prospective observational study

    PubMed Central

    Rothberg, Amy E.; McEwen, Laura N.; Fraser, Tom; Burant, Charles F.; Herman, William H.

    2013-01-01

    Objective To evaluate the impact of a managed care obesity intervention that requires enrollment in an intensive medical weight management program, a commercial weight loss program, or a commercial pedometer-based walking program to maintain enhanced benefits. Design and Methods Prospective observational study involving 1,138 adults with BMI ≥32 kg/m2 with one or more comorbidities or BMI ≥35 kg/m2 enrolled in a commercial, independent practice association-model health maintenance organization. Body mass index, blood pressure, lipids, HbA1c or fasting glucose, and per-member per-month costs were assessed one year before and one year after program implementation. Results Program uptake (90%) and one year adherence (79%) were excellent. Enrollees in all three programs exhibited improved clinical outcomes and reduced rates of increase in direct medical costs compared to members who did not enroll in any program. Conclusions A managed care obesity intervention that offered financial incentives for participation and a variety of programs was associated with excellent program uptake and adherence, improvements in cardiovascular risk factors, and a lower rate of increase in direct medical costs over one year. PMID:24136667

  20. Expectations Among Patients and Health Professionals Regarding Web-Based Interventions for Depression in Primary Care: A Qualitative Study

    PubMed Central

    Montero-Marín, Jesús; Prado-Abril, Javier; Botella, Cristina; Mayoral-Cleries, Fermin; Baños, Rosa; Herrera-Mercadal, Paola; Romero-Sanchiz, Pablo; Gili, Margalida; Castro, Adoración; Nogueira, Raquel

    2015-01-01

    Background One-quarter of the world’s population will suffer from depression symptoms at some point in their lives. Mental health services in developed countries are overburdened. Therefore, cost-effective interventions that provide mental health care solutions such as Web-based psychotherapy programs have been proposed. Objective The intent of the study was to identify expectations regarding Web-based psychotherapy for the treatment of depression in primary care among patients and health professionals that might facilitate or hinder its effects. Methods The expectations of untreated patients and health professionals were examined by means of interviews and focus groups. There were 43 participants (20 patients with mild and moderate levels of depression, 11 primary care physicians, and 12 managers; 22 of them for interviews and 21 for groups). A thematic content analysis from the grounded theory for interviews, and an analysis of the discursive positions of participants based on the sociological model for groups were performed. Interpretations were achieved by agreement between three independent analysts. Results All participants showed a good general acceptance of Web-based psychotherapy, appreciating possible advantages and improvements. Patients, physicians, and managers shared the same conceptualization of their expectations, although highlighting different aspects. Patients focused on the need for individualized and personalized interaction, while professionals highlighted the need for the standardization of the program. Physicians were concerned with extra workload, while managers were worried about optimizing cost-effectiveness. Conclusions Expectations of the different participants can conflict with each other. Finding a balanced position among them is needed if we are to harmoniously implement effective Web-based interventions for depression in routine clinical practice. PMID:25757358

  1. A cluster randomised controlled trial of the efficacy of a brief walking intervention delivered in primary care: Study protocol

    PubMed Central

    2011-01-01

    Background The aim of the present research is to conduct a fully powered explanatory trial to evaluate the efficacy of a brief self-regulation intervention to increase walking. The intervention will be delivered in primary care by practice nurses (PNs) and Healthcare Assistants (HCAs) to patients for whom increasing physical activity is a particular priority. The intervention has previously demonstrated efficacy with a volunteer population, and subsequently went through an iterative process of refinement in primary care, to maximise acceptability to both providers and recipients. Methods/ Design This two arm cluster randomised controlled trial set in UK general practices will compare two strategies for increasing walking, assessed by pedometer, over six months. Patients attending practices randomised to the self-regulation intervention arm will receive an intervention consisting of behaviour change techniques designed to increase walking self-efficacy (confidence in ability to perform the behaviour), and to help people translate their "good" intentions into behaviour change by making plans. Patients attending practices randomised to the information provision arm will receive written materials promoting walking, and a short unstructured discussion about increasing their walking. The trial will recruit 20 PN/HCAs (10 per arm), who will be trained by the research team to deliver the self-regulation intervention or information provision control intervention, to 400 patients registered at their practices (20 patients per PN/HCA). This will provide 85% power to detect a mean difference of five minutes/day walking between the self-regulation intervention group and the information provision control group. Secondary outcomes include health services costs, and intervention effects in sub-groups defined by age, ethnicity, gender, socio-economic status, and clinical condition. A mediation analysis will investigate the extent to which changes in constructs specified by the

  2. Process Evaluation of a Lifestyle Intervention in Primary Care: Implementation Issues and the Participants' Satisfaction of the GOAL Study

    ERIC Educational Resources Information Center

    Barte, Jeroen C. M.; ter Bogt, Nancy C. W.; Beltman, Frank W.; van der Meer, Klaas; Bemelmans, Wanda J. E.

    2012-01-01

    The Groningen Overweight and Lifestyle (GOAL) intervention effectively prevents weight gain. The present study describes a process evaluation in which 214 participants in the intervention group received a structured questionnaire within 7 months (a median of 5 months) after the end of the intervention. The authors investigated the content of the…

  3. Factors influencing health care access perceptions and care-seeking behaviors of immigrant Latino sexual minority men and transgender individuals: Baseline findings from the HOLA intervention study

    PubMed Central

    Tanner, AE; Reboussin, BA; Mann, L; Ma, A; Song, E; Alonzo, J; Rhodes, SD

    2014-01-01

    Little is known about immigrant Latino sexual minorities' health seeking behaviors. This study examined factors associated with perceptions of access and actual care behaviors among this population in North Carolina. Methods A community-based participatory research partnership recruited 180 Latino sexual minority men and transgender individuals within preexisting social networks to participate in a sexual health intervention. Mixed-effects logistic regression models examined factors influencing health care access perceptions and use of services (HIV testing and routine check-ups). Results Results indicate that perceptions of access and actual care behaviors are low and affected by individual and structural factors, including: years living in NC, reported poor general health, perceptions of discrimination, micro-, meso-, and macro-level barriers, and residence in a Medically Underserved Area. Discussion To improve Latino sexual minority health, focus must be placed on multiple levels, individual characteristics (e.g., demographics), clinic factors (e.g., provider competence and clinic environment), and structural factors (e.g., discrimination). PMID:25418235

  4. Evaluation of the effectiveness of testicular cancer and testicular self-examination training for patient care personnel: intervention study.

    PubMed

    Akar, Serife Zehra; Bebiş, Hatice

    2014-12-01

    Testicular cancer (TC) is the most common malignancy among men aged 15-35 years. Testicular self-examination (TSE) is an important tool for preventing late-stage TC diagnoses. This study aimed to assess health beliefs and knowledge related to TC and TSE and the effectiveness of TC and TSE training for patient care staff in a hospital. This was a prospective, randomized, controlled intervention study. The study included 96 patient care staff divided into two groups of 48 participants each: Group I, the interactive education group, and Group II, the pamphlet education group. The results demonstrated that TSE practice and TC knowledge significantly increased in both Group I and Group II. Significant differences were observed between the groups pre and post education. TSE and TC knowledge levels were higher for participants in Group I than those in Group II. There was a significant difference in the performance of TSEs between groups: the rates were 83.3% in Group I and 54.2% in Group II. Perceived confidence and perceived barriers increased significantly for both groups. Interactive education sessions should be used to train men at risk for TC to perform TSEs. PMID:25248831

  5. A cardiovascular educational intervention for primary care professionals in Spain: positive impact in a quasi-experimental study

    PubMed Central

    Gil-Guillén, Vicente; Hermida, Enrique; Pita-Fernandez, Salvador; Palazon-Bru, Antonio; Durazo-Arvizu, Ramon; Pallares-Carratala, Vicente; Orozco-Beltran, Domingo; Carratala-Munuera, Concepcion; Lopez-Pineda, Adriana; Navarro, Jorge

    2015-01-01

    Background Routine general practice data collection can help identify patients at risk of cardiovascular disease. Aim To determine whether a training programme for primary care professionals improves the recording of cardiovascular disease risk factors in electronic health records. Design and setting A quasi-experimental study without random assignment of professionals. This was an educational intervention study, consisting of an online-classroom 1-year training programme, and carried out in the Valencian community in Spain. Method The prevalence rates of recording of cardiovascular factors (recorded every 6 months over a 4-year period) were compared between intervention and control group. Clinical relevance was calculated by absolute risk reduction (ARR), relative risk reduction (RRR), and number of patients needed-to-attend (NNA), to avoid under-recording, with their 95% confidence intervals (CIs). Linear regression models were used for each of the variables. Results Of the 941 professionals initially registered, 78.1% completed the programme. The ARR ranged from 1.87% (95% CI = 1.79 to 1.94) in the diagnosis of diabetes to 15.27% (95% CI = 15.14 to 15.40) in the recording of basal blood glucose. The NNA ranged from 7 in blood pressure, cholesterol, and blood glucose recording to 54 in the diagnosis of diabetes. The RRR ranged from 26.7% in the diagnosis of diabetes to 177.1% in the recording of the Systematic Coronary Risk Evaluation (SCORE). The rates of change were greater in the intervention group and the differences were significant for recording of cholesterol (P<0.001), basal blood glucose (P<0.001), smoking (P<0.001), alcohol (P<0.001), microalbuminuria (P = 0.001), abdominal circumference (P<0.001), and SCORE (P<0.001). Conclusion The education programme had a beneficial effect at the end of the follow-up that was significant and clinically relevant. PMID:25548314

  6. A Pilot Study of a Creative Bonding Intervention to Promote Nursing Students' Attitudes towards Taking Care of Older People

    PubMed Central

    Lamet, Ann R.; Sonshine, Rosanne; Walsh, Sandra M.; Molnar, David; Rafalko, Sharon

    2011-01-01

    Although numbers of older people are increasing, nursing students have negative attitudes towards older people and do not plan to care for them following graduation. Multiple strategies have been implemented to reverse students' attitudes with mixed results. The purpose of this pilot quasi-experimental study was to test a Creative-Bonding Intervention (CBI) with students implementing art activities with older people to promote students' willingness to take care of them. Using a self-transcendence conceptual framework, control (n = 56) and experimental (n = 14) student groups were pre- and post-tested on attitudes toward older people, self-transcendence, and willingness to serve. The CBI improved attitudes towards older people with negative attitudes significantly changed (P = .008) but with no significant differences on self-transcendence and willingness to serve. However, willingness to serve results approached significance (P = .08). The willingness measure (one question) should be expanded. Curricula changes that incorporate creative activities such as the CBI with larger and equal numbers in student groups and longitudinal follow up to determine long-term results after graduation are suggested. PMID:21994833

  7. Observations of Group Care Worker-Child Interaction in Residential Youth Care: Pedagogical Interventions and Child Behavior

    ERIC Educational Resources Information Center

    Bastiaanssen, Inge L. W.; Delsing, Marc J. M. H.; Geijsen, Luuk; Kroes, Gert; Veerman, Jan W.; Engels, Rutger C. M. E.

    2014-01-01

    Background: The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children. Objective: The aim of the current study was to observe the pedagogical interventions of group care workers within residential…

  8. Health Care Provider Physical Activity Prescription Intervention

    ERIC Educational Resources Information Center

    Josyula, Lakshmi; Lyle, Roseann

    2013-01-01

    Purpose: To examine the feasibility and impact of a health care provider’s (HCP) physical activity (PA) prescription on the PA of patients on preventive care visits. Methods: Consenting adult patients completed health and PA questionnaires and were sequentially assigned to intervention groups. HCPs prescribed PA using a written prescription only…

  9. Impact of Health Awareness Campaign in Improving the Perception of the Community about Palliative Care: A Pre- and Post-intervention Study in Rural Tamil Nadu

    PubMed Central

    Chandra, Ankit; Sarkar, Sonali; Adinarayanan, S; Balajee, Karthik Laksham

    2016-01-01

    Background and Objective: The only way to provide palliative care to a huge number of people in need in India is through community participation, which can be achieved by improving the awareness of the people about palliative care. We conducted a study to assess the impact of health awareness campaign in improving the awareness of people about palliative care. Materials and Methods: This was a pre- and post-intervention study conducted in Kadaperikuppam village of Vanur Taluk in Villupuram district, Tamil Nadu. One respondent each from 145 households in the village was interviewed regarding the knowledge and attitude on palliative care before and after the health awareness campaign using a pretested questionnaire. Health awareness campaign consisted of skit, pamphlet distribution, poster presentation, giving door-to-door information, and general interaction with palliative team in the village. Results: The awareness regarding palliative care during the preintervention was nil. After the intervention, it increased to 62.8%. However, there was a decline in the attitude and the interest of the people toward palliative care. Interpretation and Conclusions: Health awareness campaigns can increase the awareness of people in the rural parts of the country about palliative care. However, to improve the attitude of the community about delivery of palliative care services, more sustained efforts are required to make them believe that palliative care can be provided by community volunteers also and not necessarily only by professionals. PMID:27803570

  10. Reporting of Adverse Events in Published and Unpublished Studies of Health Care Interventions: A Systematic Review

    PubMed Central

    Golder, Su; Wright, Kath

    2016-01-01

    Background We performed a systematic review to assess whether we can quantify the underreporting of adverse events (AEs) in the published medical literature documenting the results of clinical trials as compared with other nonpublished sources, and whether we can measure the impact this underreporting has on systematic reviews of adverse events. Methods and Findings Studies were identified from 15 databases (including MEDLINE and Embase) and by handsearching, reference checking, internet searches, and contacting experts. The last database searches were conducted in July 2016. There were 28 methodological evaluations that met the inclusion criteria. Of these, 9 studies compared the proportion of trials reporting adverse events by publication status. The median percentage of published documents with adverse events information was 46% compared to 95% in the corresponding unpublished documents. There was a similar pattern with unmatched studies, for which 43% of published studies contained adverse events information compared to 83% of unpublished studies. A total of 11 studies compared the numbers of adverse events in matched published and unpublished documents. The percentage of adverse events that would have been missed had each analysis relied only on the published versions varied between 43% and 100%, with a median of 64%. Within these 11 studies, 24 comparisons of named adverse events such as death, suicide, or respiratory adverse events were undertaken. In 18 of the 24 comparisons, the number of named adverse events was higher in unpublished than published documents. Additionally, 2 other studies demonstrated that there are substantially more types of adverse events reported in matched unpublished than published documents. There were 20 meta-analyses that reported the odds ratios (ORs) and/or risk ratios (RRs) for adverse events with and without unpublished data. Inclusion of unpublished data increased the precision of the pooled estimates (narrower 95

  11. Preconception care: nutritional risks and interventions

    PubMed Central

    2014-01-01

    Introduction There is increasingly a double burden of under-nutrition and obesity in women of reproductive age. Preconception underweight or overweight, short stature and micronutrient deficiencies all contribute to excess maternal and fetal complications during pregnancy. Methods A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on maternal, newborn and child health (MNCH) outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. Results Maternal pre-pregnancy weight is a significant factor in the preconception period with underweight contributing to a 32% higher risk of preterm birth, and obesity more than doubling the risk for preeclampsia, gestational diabetes. Overweight women are more likely to undergo a Cesarean delivery, and their newborns have higher chances of being born with a neural tube or congenital heart defect. Among nutrition-specific interventions, preconception folic acid supplementation has the strongest evidence of effect, preventing 69% of recurrent neural tube defects. Multiple micronutrient supplementation shows promise to reduce the rates of congenital anomalies and risk of preeclampsia. Although over 40% of women worldwide are anemic in the preconception period, only one study has shown a risk for low birth weight. Conclusion All women, but especially those who become pregnant in adolescence or have closely-spaced pregnancies (inter-pregnancy interval less than six months), require nutritional assessment and appropriate intervention in the preconception period with an emphasis on optimizing maternal body mass index and micronutrient reserves. Increasing coverage of nutrition-specific and nutrition

  12. Tailored interventions to implement recommendations for elderly patients with depression in primary care: a study protocol for a pragmatic cluster randomised controlled trial

    PubMed Central

    2014-01-01

    Background The prevalence of depression is high and the elderly have an increased risk of developing chronic course. International data suggest that depression in the elderly is under-recognised, the latency before clinicians provide a treatment plan is longer and elderly patients with depression are not offered psychotherapy to the same degree as younger patients. Although recommendations for the treatment of elderly patients with depression exist, health-care professionals adhere to these recommendations to a limited degree only. We conducted a systematic review to identify recommendations for managing depression in the elderly and prioritised six recommendations. We identified and prioritised the determinants of practice related to the implementation of these recommendations in primary care, and subsequently discussed and prioritised interventions to address the identified determinants. The objective of this study is to evaluate the effectiveness of these tailored interventions for the six recommendations for the management of elderly patients with depression in primary care. Methods/design We will conduct a pragmatic cluster randomised trial comparing the implementation of the six recommendations using tailored interventions with usual care. We will randomise 80 municipalities into one of two groups: an intervention group, to which we will deliver tailored interventions to implement the six recommendations, and a control group, to which we will not deliver any intervention. We will randomise municipalities rather than patients, individual clinicians or practices, because we will deliver the intervention for the first three recommendations at the municipal level and we want to minimise the risk of contamination across GP practices for the other three recommendations. The primary outcome is the proportion of actions taken by GPs that are consistent with the recommendations. Discussion This trial will investigate whether a tailored implementation approach is an

  13. A Web-Based Patient Activation Intervention to Improve Hypertension Care: Study design and Baseline Characteristics in the Web Hypertension Study

    PubMed Central

    Thiboutot, Jeffrey; Stuckey, Heather; Binette, Aja; Kephart, Donna; Curry, William; Falkner, Bonita; Sciamanna, Christopher

    2010-01-01

    Background Despite the known health risks of hypertension, many hypertensive patients still have uncontrolled blood pressure. Clinical inertia, the tendency of physicians not to intensify treatment, is a common barrier in controlling chronic diseases. This trial is aimed at determining the impact of activating patients to ask providers to make changes to their care through tailored feedback. Methods Diagnosed hypertensive patients were enrolled in this RCT and randomized to one of two study groups: (1) the intervention condition - Web-based hypertension feedback, based on the individual patient’s self-report of health variables and previous BP measurements, to prompt them to ask questions during their next physician’s visit about hypertension care (2) the control condition- Web-based preventive health feedback, based on the individual’s self-report of receiving preventive care (e.g., pap testing), to prompt them to ask questions during their next physician’s visit about preventive care. The primary outcome of the study is change in blood pressure and change in the percentage of patients in each group with controlled blood pressure. Conclusion Five hundred participants were enrolled and baseline characteristics include a mean age of 60.0 years; 57.6% female; and 77.6% white. Overall 37.7% participants had uncontrolled blood pressure; the mean body mass index (BMI) was in the obese range (32.4) and 21.8% had diabetes. By activating patients to become involved in their own care, we believe the addition of the web-based intervention will improve blood pressure control compared to a control group who receive web-based preventive messages unrelated to hypertension. PMID:20837163

  14. Introduction to the Special Issue on the Studies on the Implementation of Integrated Models of Alcohol, Tobacco, and/or Drug Use Interventions and Medical Care.

    PubMed

    Hunter, Sarah B; Schwartz, Robert P; Friedmann, Peter D

    2016-01-01

    National efforts are underway to integrate medical care and behavioral health treatment. This special issue of the Journal of Substance Abuse Treatment presents 13 papers that examine the integration of substance use interventions and medical care. In this introduction, the guest editors first describe the need to examine the integration of substance use treatment into medical care settings. Next, an overview of the emerging field of implementation science and its applicability to substance use intervention integration is presented. Preview summaries of each of the articles included in this special issue are given. Articles include empirical studies of various integration models, study protocol papers that describe currently funded implementation research, and one review/commentary piece that discusses federal research priorities, integration support activities and remaining research gaps. These articles provide important information about how to guide future health system integration efforts to treat the millions of medical patients with substance use problems.

  15. Effectiveness of a primary care based complex intervention to promote self-management in patients presenting psychiatric symptoms: study protocol of a cluster-randomized controlled trial

    PubMed Central

    2014-01-01

    Background Anxiety, Depression and Somatoform (ADSom) disorders are highly prevalent in primary care. Managing these disorders is time-consuming and requires strong commitment on behalf of the General Practitioners (GPs). Furthermore, the management of these patients is restricted by the high patient turnover rates in primary care practices, especially in the German health care system. In order to address this problem, we implement a complex, low-threshold intervention by an Advanced Practice Nurse (APN) using a mixture of case management and counseling techniques to promote self-management in these patients. Here we present the protocol of the “Self-Management Support for Anxiety, Depression and Somatoform Disorders in Primary Care” (SMADS)-Study. Methods/Design The study is designed as a cluster-randomized controlled trial, comparing an intervention and a control group of 10 primary care practices in each case. We will compare the effectiveness of the intervention applied by an APN with usual GP-care. A total of 340 participants will be enrolled in the study, 170 in either arm. We use the Patient Health Questionnaire-German version (PHQ-D) as a screening tool for psychiatric symptoms, including patients with a score above 5 on any of the three symptom scales. The primary outcome is self-efficacy, measured by the General Self-Efficacy Scale (GSE), here used as a proxy for self-management. As secondary outcomes we include the PHQ-D symptom load and questionnaires regarding coping with illness and health related quality of life. Outcome assessments will be applied 8 weeks and 12 months after the baseline assessment. Discussion The SMADS-study evaluates a complex, low threshold intervention for ambulatory patients presenting ADSom-symptoms, empowering them to better manage their condition, as well as improving their motivation to engage in self-help and health-seeking behaviour. The benefit of the intervention will be substantiated, when patients can enhance

  16. Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention

    PubMed Central

    2011-01-01

    Background Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. Methods/Design This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. Discussion

  17. Pilot trial of Stop Delirium! (PiTStop) - a complex intervention to prevent delirium in care homes for older people: study protocol for a cluster randomised controlled trial

    PubMed Central

    2014-01-01

    Background Delirium (or acute confusion) is a serious illness common in older people, in which a person’s thinking and perceptions may be affected. Reducing delirium is important because of the considerable distress it causes, and the poor outcomes associated with it, such as increased admissions to hospital, falls, mortality and costs to the National Health Service (NHS). Preventing delirium is possible using multicomponent interventions; successful interventions in hospitals have reduced it by one-third. However, there is little research to guide practice in care homes, where it is common because of the clustering of known risk factors (older age, frailty, and dementia). In previous work we developed a multicomponent intervention to prevent delirium in care homes, called Stop Delirium! The intervention was based upon evidence from the research literature relating to the prevention of delirium and on strategies to change professional practice. Before starting a large costly trial of Stop Delirium!, this pilot study will test and help improve the design and feasibility of the trial protocol. Methods/Design We plan to conduct a cluster randomised pilot trial in 14 care homes (independent residential and nursing). Following recruitment of residents (over 60 years, consenting or with consultee agreement, able to communicate in English, and not in palliative care) participating homes will be randomised, stratified by size of home and proportion of residents with dementia. Stop Delirium! will be delivered to intervention homes over 16 months, with controls receiving usual care. The primary outcome measure will be the presence of delirium on any day during a one-month post-intervention period. We will collect data to determine 1) recruitment and attrition rates, 2) feasibility of various outcomes measurements, and 3) feasibility of capturing health resource use (resident diaries and by examining health records). We will estimate the between-cluster variation for the

  18. End-of-Life Care Interventions: An Economic Analysis

    PubMed Central

    Pham, B; Krahn, M

    2014-01-01

    Background The annual cost of providing care for patients in their last year of life is estimated to account for approximately 9% of the Ontario health care budget. Access to integrated, comprehensive support and pain/symptom management appears to be inadequate and inequitable. Objective To evaluate the cost-effectiveness of end-of-life (EoL) care interventions included in the EoL care mega-analysis. Data Sources Multiple sources were used, including systematic reviews, linked health administration databases, survey data, planning documents, expert input, and additional literature searches. Review Methods We conducted a literature review of cost-effectiveness studies to inform the primary economic analysis. We conducted the primary economic analysis and budget impact analysis for an Ontario cohort of decedents and their families and included interventions pertaining to team-based models of care, patient care planning discussions, educational interventions for patients and caregivers, and supportive interventions for informal caregivers. The time horizon was the last year of life. Costs were in 2013 Canadian dollars. Effectiveness measures included days at home, percentage dying at home, and quality-adjusted life-days. We developed a Markov model; model inputs were obtained from a cohort of Ontario decedents assembled from Institute for Clinical Evaluative Sciences databases and published literature. Results In-home palliative team care was cost-effective; it increased the chance of dying at home by 10%, increased the average number of days at home (6 days) and quality-adjusted life-days (0.5 days), and it reduced costs by approximately $4,400 per patient. Expanding in-home palliative team care to those currently not receiving such services (approximately 45,000 per year, at an annual cost of $76–108 million) is likely to improve quality of life, reduce the use of acute care resources, and save $191–$385 million in health care costs. Results for the other

  19. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study

    PubMed Central

    Chang, Larry W; Njie-Carr, Veronica; Kalenge, Sheila; Kelly, Jack F; Bollinger, Robert C; Alamo-Talisuna, Stella

    2013-01-01

    mHealth (mobile technologies for health) represents a growing array of tools being applied in diverse health care settings. mHealth interventions for improving HIV/AIDS care is a promising strategy, but its evidence-base is limited. We conducted a formative research evaluation to inform the development of novel, mHealth HIV/AIDS care interventions to be used by community health workers (CHWs) in Kampala, Uganda. A mixed methods formative research approach was utilized. Qualitative methods included 20 in-depth interviews and 6 focus groups with CHWs, clinic staff, and patients. Thematic analysis was performed and selected quotations used to illustrate themes. Quantitative methods consisted of a survey administered to CHWs and clinic staff using categorical and Likert scale questions regarding current mobile phone and internet access and perceptions on the potential use of smartphones by CHWs. Qualitative results included themes on significant current care challenges, multiple perceived mHealth benefits, and general intervention acceptability. Key mHealth features desired included tools to verify CHW task completions, clinical decision support tools, and simple access to voice calling. Inhibiting factors identified included concerns about CHW job security and unrealistic expectations of mHealth capabilities. Quantitative results from 27 staff participants found that 26 (96%) did not have internet access at home; yet, only 2 (7.4%) did not own a mobile phone. Likert scale survey responses (1–5, 1=Strongly Disagree, 5=Strongly Agree) indicated general agreement that smartphones would improve efficiency (Mean=4.35) and patient care (4.31) but might be harmful to patient confidentiality (3.88) and training was needed (4.63). Qualitative and quantitative results were generally consistent, and, overall, there was enthusiasm for mHealth technology. However, a number of potential inhibiting factors were also discovered. Findings from this study may help guide future design

  20. Prevention of Alcohol-Related Crime and Trauma (PACT): brief interventions in routine care pathway – a study protocol

    PubMed Central

    2013-01-01

    Background Globally, alcohol-related injuries cause millions of deaths and huge economic loss each year . The incidence of facial (jawbone) fractures in the Northern Territory of Australia is second only to Greenland, due to a strong involvement of alcohol in its aetiology, and high levels of alcohol consumption. The highest incidences of alcohol-related trauma in the Territory are observed amongst patients in the Maxillofacial Surgery Unit of the Royal Darwin Hospital. Accordingly, this project aims to introduce screening and brief interventions into this unit, with the aims of changing health service provider practice, improving access to care, and improving patient outcomes. Methods Establishment of Project Governance: The project governance team includes a project manager, project leader, an Indigenous Reference Group (IRG) and an Expert Reference Group (ERG). Development of a best practice pathway: PACT project researchers collaborate with clinical staff to develop a best practice pathway suited to the setting of the surgical unit. The pathway provides clear guidelines for screening, assessment, intervention and referral. Implementation: The developed pathway is introduced to the unit through staff training workshops and associate resources and adapted in response to staff feedback. Evaluation: File audits, post workshop questionnaires and semi-structured interviews are administered. Discussion This project allows direct transfer of research findings into clinical practice and can inform future hospital-based injury prevention strategies. PMID:23331868

  1. Attitudes toward care of the terminally ill: an educational intervention.

    PubMed

    Frommelt, Katherine H Murray

    2003-01-01

    This quasiexperimental study examined the effect of an educational program on attitudes toward caring for terminally ill persons and their families. Participants were 115 undergraduate students: intervention group, N = 49; control group, N = 66. Pre- and post-intervention measurements were done with the Frommelt Attitude Toward Care of the Dying Scale (FATCOD, Form B). Students in the intervention group participated in a semester-long (15-week, 45-hour) educational program. Demographic variables, including age, gender, religion, major area of study, influence of religious beliefs, profession, previous education, and past or present experience with loss were evaluated. Statistical analyses (t-test, ANOVA, ANCOVA, and APVs) indicated a significant positive change in the attitude scores of the intervention group and no significant change in the attitude scores of the control group.

  2. The Treatment of cardiovascular Risk in Primary care using Electronic Decision suppOrt (TORPEDO) study: intervention development and protocol for a cluster randomised, controlled trial of an electronic decision support and quality improvement intervention in Australian primary healthcare

    PubMed Central

    Peiris, David; Usherwood, Tim; Panaretto, Katie; Harris, Mark; Hunt, Jenny; Patel, Bindu; Zwar, Nicholas; Redfern, Julie; MacMahon, Stephen; Colagiuri, Stephen; Hayman, Noel; Patel, Anushka

    2012-01-01

    Background Large gaps exist in the implementation of guideline recommendations for cardiovascular disease (CVD) risk management. Electronic decision support (EDS) systems are promising interventions to close these gaps but few have undergone clinical trial evaluation in Australia. We have developed HealthTracker, a multifaceted EDS and quality improvement intervention to improve the management of CVD risk. Methods/design It is hypothesised that the use of HealthTracker over a 12-month period will result in: (1) an increased proportion of patients receiving guideline-indicated measurements of CVD risk factors and (2) an increased proportion of patients at high risk will receive guideline-indicated prescriptions for lowering their CVD risk. Sixty health services (40 general practices and 20 Aboriginal Community Controlled Health Services (ACCHSs) will be randomised in a 1:1 allocation to receive either the intervention package or continue with usual care, stratified by service type, size and participation in existing quality improvement initiatives. The intervention consists of point-of-care decision support; a risk communication interface; a clinical audit tool to assess performance on CVD-related indicators; a quality improvement component comprising peer-ranked data feedback and support to develop strategies to improve performance. The control arm will continue with usual care without access to these intervention components. Quantitative data will be derived from cross-sectional samples at baseline and end of study via automated data extraction. Detailed process and economic evaluations will also be conducted. Ethics and dissemination The general practice component of the study is approved by the University of Sydney Human Research Ethics Committee (HREC) and the ACCHS component is approved by the Aboriginal Health and Medical Research Council HREC. Formal agreements with each of the participating sites have been signed. In addition to the usual scientific forums

  3. Study protocol: Brief intervention for medication overuse headache - A double-blinded cluster randomised parallel controlled trial in primary care

    PubMed Central

    2012-01-01

    Background Chronic headache (headache ≥ 15 days/month for at least 3 months) affects 2–5% of the general population. Medication overuse contributes to the problem. Medication-overuse headache (MOH) can be identified by using the Severity of Dependence Scale (SDS). A “brief intervention” scheme (BI) has previously been used for detoxification from drug and alcohol overuse in other settings. Short, unstructured, individualised simple information may also be enough to detoxify a large portion of those with MOH. We have adapted the structured (BI) scheme to be used for MOH in primary care. Methods/Design A double-blinded cluster randomised parallel controlled trial (RCT) of BI vs. business as usual. Intervention will be performed in primary care by GPs trained in BI. Patients with MOH will be identified through a simple screening questionnaire sent to patients on the GPs lists. The BI method involves an approach for identifying patients with high likelihood of MOH using simple questions about headache frequency and the SDS score. Feedback is given to the individual patient on his/her score and consequences this might have regarding the individual risk of medication overuse contributing to their headache. Finally, advice is given regarding measures to be taken, how the patient should proceed and the possible gains for the patient. The participating patients complete a headache diary and receive a clinical interview and neurological examination by a GP experienced in headache diagnostics three months after the intervention. Primary outcomes are number of headache days and number of medication days per month at 3 months. Secondary outcomes include proportions with 25 and 50% improvement at 3 months and maintenance of improvement and quality of life after 12 months. Discussion There is a need for evidence-based and cost-effective strategies for treatment of MOH but so far no consensus has been reached regarding an optimal medication withdrawal method. To our

  4. Impact of the ‘Artful Moments’ Intervention on Persons with Dementia and Their Care Partners: a Pilot Study

    PubMed Central

    Hazzan, Afeez Abiola; Humphrey, Janis; Kilgour-Walsh, Laurie; Moros, Katherine L.; Murray, Carmen; Stanners, Shannon; Montemuro, Maureen; Giangregorio, Aidan; Papaioannou, Alexandra

    2016-01-01

    Background Engaging with art can be valuable for persons living with dementia. ‘Artful Moments’ was a collaborative project undertaken by the Art Gallery of Hamilton and the Behavioural Health Program at Hamilton Health Sciences that sought to develop and implement a program of arts-based activities for persons in the middle-to-late stages of dementia who exhibit behavioural symptoms and for their accompanying care partners. Methods This pilot study employed a qualitative descriptive design. Eight participants were observed during multiple art sessions to evaluate their level of engagement in the program. Care partners also completed a questionnaire describing their experience. Qualitative content analysis was used to identify themes. Results For program participants, factors that promoted continued interest and engagement in art included: care partner involvement, group activities, opportunities to share opinions, validation of their personhood, and increased engagement over time. Care partners observed improvements in participants’ creativity, communication, relationship forming, and task accomplishment, and some reported reduced stress. Conclusions ‘Artful Moments’ promoted engagement and expression in persons in the middle-to-late stages of dementia, as well as having benefits for their care partners. Limitations of the study included a small convenience sample drawn from one hospital setting. PMID:27403209

  5. Impact of a pharmacist-prepared interim residential care medication administration chart on gaps in continuity of medication management after discharge from hospital to residential care: a prospective pre- and post-intervention study (MedGap Study)

    PubMed Central

    Tran, Tim; Taylor, Simone E; Harvey, Penelope A; Belfrage, Mary K; Jennings, Rhonda J; Marriott, Jennifer L

    2012-01-01

    Objectives To test the impact of a hospital pharmacist-prepared interim residential care medication administration chart (IRCMAC) on medication administration errors and use of locum medical services after discharge from hospital to residential care. Design Prospective pre-intervention and post-intervention study. Setting One major acute care hospital and one subacute aged-care hospital; 128 residential care facilities (RCF) in Victoria, Australia. Participants 428 patients (median age 84 years, IQR 79–88) discharged to a RCF from an inpatient ward over two 12-week periods. Intervention Seven-day IRCMAC auto-populated with patient and medication data from the hospitals' pharmacy dispensing software, completed and signed by a hospital pharmacist and sent with the patient to the RCF. Primary and secondary outcome measures Primary end points were the proportion of patients with one or more missed or significantly delayed (>50% of prescribed dose interval) medication doses, and the proportion of patients whose RCF medication chart was written by a locum doctor, in the 24 h after discharge. Secondary end points included RCF staff and general practitioners' opinions about the IRCMAC. Results The number of patients who experienced one or more missed or delayed doses fell from 37/202 (18.3%) to 6/226 (2.7%) (difference in percentages 15.6%, 95% CI 9.5% to 21.9%, p<0.001). The number of patients whose RCF medication chart was written by a locum doctor fell from 66/202 (32.7%) to 25/226 (11.1%) (difference in percentages 21.6%, 95% CI 13.5% to 29.7%, p<0.001). For 189/226 (83.6%) discharges, RCF staff reported that the IRCMAC improved continuity of care; 31/35 (88.6%) general practitioners said that the IRCMAC reduced the urgency for them to attend the RCF and 35/35 (100%) said that IRCMACs should be provided for all patients discharged to a RCF. Conclusions A hospital pharmacist-prepared IRCMAC significantly reduced medication errors and use of locum medical services

  6. Evaluation of the Effectiveness of Testicular Cancer and Testicular Self-Examination Training for Patient Care Personnel: Intervention Study

    ERIC Educational Resources Information Center

    Akar, Serife Zehra; Bebis, Hatice

    2014-01-01

    Testicular cancer (TC) is the most common malignancy among men aged 15-35 years. Testicular self-examination (TSE) is an important tool for preventing late-stage TC diagnoses. This study aimed to assess health beliefs and knowledge related to TC and TSE and the effectiveness of TC and TSE training for patient care staff in a hospital. This was a…

  7. Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in prehospital emergency care – an intervention study

    PubMed Central

    Aléx, Jonas; Karlsson, Stig; Björnstig, Ulf; Saveman, Britt-Inger

    2015-01-01

    Background The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients’ exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in the prehospital emergency care. Methods A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Results Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001). At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes. Conclusions The use of active heat from underneath increases the patients’ thermal comfort and may prevent the negative consequences of cold stress. PMID:26374468

  8. Study: interventions help prevent readmissions.

    PubMed

    2013-09-01

    In a study by the Bronx Collaborative, patients who received two or more interventions by a dedicated care transition manager had a 17.6% readmission rate compared to a rate of 26.3% for patients who received the current standard of care. Three hospital systems and two health plans collaborated to develop the pilot project. Care transition managers, whose only job was facilitating transitions, visited patients in the hospital and followed up within 48 hours after discharge and again 14 days after discharge. The care transition managers educated the patients on their treatment plan, gave them a personalized booklet with details of their treatment plan, and followed up to answer questions and concerns and make sure they were following the plan. PMID:24032138

  9. Interventions by pharmacists in out-patient pharmaceutical care.

    PubMed

    Al Rahbi, Hussain Abdullah Mubarak; Al-Sabri, Raid Mahmood; Chitme, Havagiray R

    2014-04-01

    Interventions by the pharmacists have always been considered as a valuable input by the health care community in the patient care process by reducing the medication errors, rationalizing the therapy and reducing the cost of therapy. The primary objective of this study was to determine the number and types of medication errors intervened by the dispensing pharmacists at OPD pharmacy in the Khoula Hospital during 2009 retrospectively. The interventions filed by the pharmacists and assistant pharmacists in OPD pharmacy were collected. Then they were categorized and analyzed after a detailed review. The results show that 72.3% of the interventions were minor of which 40.5% were about change medication order. Comparatively more numbers of prescriptions were intervened in female patients than male patients. 98.2% of the interventions were accepted by the prescribers reflecting the awareness of the doctors about the importance of the pharmacy practice. In this study only 688 interventions were due to prescribing errors of which 40.5% interventions were done in changing the medication order of clarifying the medicine. 14.9% of the interventions were related to administrative issues, 8.7% of the interventions were related to selection of medications as well as errors due to ignorance of history of patients. 8.2% of the interventions were to address the overdose of medications. Moderately significant interventions were observed in 19.4% and 7.5% of them were having the impact on major medication errors. Pharmacists have intervened 20.8% of the prescriptions to prevent complications, 25.1% were to rationalize the treatment, 7.9% of them were to improve compliance. Based on the results we conclude that the role of pharmacist in improving the health care system is vital. We recommend more number of such research based studies to bring awareness among health care professionals, provide solution to the prescription and dispensing problems, as it can also improve the documentation

  10. Creating an interest in research and development as a means of reducing the gap between theory and practice in primary care: an interventional study based on strategic communication.

    PubMed

    Morténius, Helena

    2014-08-26

    Today, healthcare professionals are faced with the challenge of implementing research results in an optimal way. It is therefore important to create a climate that is conducive to research and development (R&D). For this reason, new strategies are required to enhance healthcare professionals' interest in innovative thinking and R&D. Strategic communication with roots in sociology, psychology and political science was employed as a means of achieving long-term behavioural change. The aim of this study was to describe, follow up and evaluate a primary care intervention based on strategic communication intended to increase healthcare professionals' interest in R&D over time. An interventional cohort study comprising all staff members (N = 1276) in a Swedish primary care area was initiated in 1997 and continued for 12 years. The intention to engage in R&D was measured on two occasions; at 7 and 12 years. Both descriptive statistics and bivariate analyses were employed. The results demonstrated that the positive attitude to R&D increased over time, representing a first step towards new thinking and willingness to change work practices for the benefit of the patient. Strategic communication has not been previously employed as a scientific tool to create a long-term interest in R&D within primary care.

  11. Creating an Interest in Research and Development as a Means of Reducing the Gap between Theory and Practice in Primary Care: An Interventional Study Based on Strategic Communication

    PubMed Central

    Morténius, Helena

    2014-01-01

    Today, healthcare professionals are faced with the challenge of implementing research results in an optimal way. It is therefore important to create a climate that is conducive to research and development (R&D). For this reason, new strategies are required to enhance healthcare professionals’ interest in innovative thinking and R&D. Strategic communication with roots in sociology, psychology and political science was employed as a means of achieving long-term behavioural change. The aim of this study was to describe, follow up and evaluate a primary care intervention based on strategic communication intended to increase healthcare professionals’ interest in R&D over time. An interventional cohort study comprising all staff members (N = 1276) in a Swedish primary care area was initiated in 1997 and continued for 12 years. The intention to engage in R&D was measured on two occasions; at 7 and 12 years. Both descriptive statistics and bivariate analyses were employed. The results demonstrated that the positive attitude to R&D increased over time, representing a first step towards new thinking and willingness to change work practices for the benefit of the patient. Strategic communication has not been previously employed as a scientific tool to create a long-term interest in R&D within primary care. PMID:25162708

  12. Creating an interest in research and development as a means of reducing the gap between theory and practice in primary care: an interventional study based on strategic communication.

    PubMed

    Morténius, Helena

    2014-09-01

    Today, healthcare professionals are faced with the challenge of implementing research results in an optimal way. It is therefore important to create a climate that is conducive to research and development (R&D). For this reason, new strategies are required to enhance healthcare professionals' interest in innovative thinking and R&D. Strategic communication with roots in sociology, psychology and political science was employed as a means of achieving long-term behavioural change. The aim of this study was to describe, follow up and evaluate a primary care intervention based on strategic communication intended to increase healthcare professionals' interest in R&D over time. An interventional cohort study comprising all staff members (N = 1276) in a Swedish primary care area was initiated in 1997 and continued for 12 years. The intention to engage in R&D was measured on two occasions; at 7 and 12 years. Both descriptive statistics and bivariate analyses were employed. The results demonstrated that the positive attitude to R&D increased over time, representing a first step towards new thinking and willingness to change work practices for the benefit of the patient. Strategic communication has not been previously employed as a scientific tool to create a long-term interest in R&D within primary care. PMID:25162708

  13. Portrait of trauma care in Quebec's rural emergency departments and identification of priority intervention needs to improve the quality of care: a study protocol

    PubMed Central

    Fleet, Richard; Tounkara, Fatoumata Korika; Ouimet, Mathieu; Dupuis, Gilles; Poitras, Julien; Tanguay, Alain; Fortin, Jean Paul; Trottier, Jean-Guy; Ouellet, Jean; Lortie, Gilles; Plant, Jeff; Morris, Judy; Chauny, Jean Marc; Lauzier, François; Légaré, France

    2016-01-01

    Introduction Trauma remains the primary cause of death in individuals under 40 years of age in Canada. In Quebec, the Trauma Care Continuum (TCC) has been demonstrated to be effective in decreasing the mortality rate among trauma victims. Although rural citizens are at greater risk for trauma and trauma death, no empirical data concerning the effectiveness of the TCC for the rural population in Quebec are available. The emergency departments (EDs) are important safety nets for rural citizens. However, our data indicate that access to diagnostic support services, such as intensive care units and CT is limited in rural areas. The objectives are to (1) draw a portrait of trauma services in rural EDs; (2) explore geographical variations in trauma care in Quebec; (3) identify adaptable factors that could reduce variation; and (4) establish consensus solutions for improving the quality of care. Methods and analysis The study will take place from November 2015 to November 2018. A mixed methodology (qualitative and quantitative) will be used. We will include data (2009–2013) from all trauma victims treated in the 26 rural EDs and tertiary/secondary care centres in Quebec. To meet objectives 1 and 2, data will be gathered from the Ministry's Database of the Quebec Trauma Registry Information System. For objectives 3 and 4, the project will use the Delphi method to develop consensus solutions for improving the quality of trauma care in rural areas. Data will be analysed using a Poisson regression to compare mortality rate during hospital stay or death on ED arrival (objectives 1 and 2). Average scores and 95% CI will be calculated for the Delphi questionnaire (objectives 3 and 4). Ethics and dissemination This protocol has been approved by CSSS Alphonse-Desjardins research ethics committee (Project MP-HDL-2016-003). The results will be published in peer-reviewed journals. PMID:27098826

  14. A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study

    PubMed Central

    Bauermeister, Jose A; Fessler, Kathryn; Delva, Jorge; Nelson, Annabelle; Nurenberg, Rachel; Mendoza Lua, Frania; Alers-Rojas, Francheska; Salas-Wright, Christopher P

    2015-01-01

    Background Despite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care. Objectives The purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as “S4E”). Methods A total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5%) and female (n=21, 72.4%) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis. Results A total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician

  15. Costing nursing care: using the clinical care classification system to value nursing intervention in an acute-care setting.

    PubMed

    Moss, Jacqueline; Saba, Virginia

    2011-08-01

    The purpose of this study was to combine an established methodology for coding nursing interventions and action types using the Clinical Care Classification System with a reliable formula (relative value units) to cost nursing services. Using a flat per-diem rate to cost nursing care greatly understates the actual costs and fails to address the high levels of variability within and across units. We observed nurses performing commonly executed nursing interventions and recorded these into an electronic database with corresponding Clinical Care Classification System codes. The duration of these observations was used to calculate intervention costs using relative value unit calculation formulas. The costs of the five most commonly executed interventions were nursing care coordination/manage-refer ($2.43), nursing status report/assess-monitor ($4.22), medication treatment/perform-direct ($6.33), physical examination/assess-monitor ($3.20), and universal precautions/perform-direct ($1.96). Future studies across a variety of nursing specialties and units are needed to validate the relative value unit for Clinical Care Classification System action types developed for use with the Clinical Care Classification System nursing interventions as a method to cost nursing care.

  16. Physical Therapy Intervention in the Neonatal Intensive Care Unit

    ERIC Educational Resources Information Center

    Byrne, Eilish; Garber, June

    2013-01-01

    This article presents the elements of the Intervention section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy interventions presented in this path are evidence-based and the suggested timing of these interventions is primarily based on practice knowledge from expert…

  17. Patient and family satisfaction levels in the intensive care unit after elective cardiac surgery: study protocol for a randomised controlled trial of a preoperative patient education intervention

    PubMed Central

    Leung, Patricia; Chiu, Chun Hung; Ho, Ka Man; Gomersall, Charles David; Underwood, Malcolm John

    2016-01-01

    Introduction Patients and their families are understandably anxious about the risk of complications and unfamiliar experiences following cardiac surgery. Providing information about postoperative care in the intensive care unit (ICU) to patients and families may lead to lower anxiety levels, and increased satisfaction with healthcare. The objectives of this study are to evaluate the effectiveness of preoperative patient education provided for patients undergoing elective cardiac surgery. Methods and analysis 100 patients undergoing elective coronary artery bypass graft, with or without valve replacement surgery, will be recruited into a 2-group, parallel, superiority, double-blinded randomised controlled trial. Participants will be randomised to either preoperative patient education comprising of a video and ICU tour with standard care (intervention) or standard education (control). The primary outcome measures are the satisfaction levels of patients and family members with ICU care and decision-making in the ICU. The secondary outcome measures are patient anxiety and depression levels before and after surgery. Ethics and dissemination Ethical approval has been obtained from the Joint Chinese University of Hong Kong—New Territories East Cluster Clinical Research Ethics Committee (reference number CREC 2015.308). The findings will be presented at conferences and published in peer-reviewed journals. Study participants will receive a 1-page plain language summary of results. Trial registration number ChiCTR-IOR-15006971. PMID:27334883

  18. Comparison of usual podiatric care and early physical therapy intervention for plantar heel pain: study protocol for a parallel-group randomized clinical trial

    PubMed Central

    2013-01-01

    Background A significant number of individuals suffer from plantar heel pain (PHP) and many go on to have chronic symptoms and continued disability. Persistence of symptoms adds to the economic burden of PHP and cost-effective solutions are needed. Currently, there is a wide variation in treatment, cost, and outcomes of care for PHP with limited information on the cost-effectiveness and comparisons of common treatment approaches. Two practice guidelines and recent evidence of effective physical therapy intervention are available to direct treatment but the timing and influence of physical therapy intervention in the multidisciplinary management of PHP is unclear. The purpose of this investigation is to compare the outcomes and costs associated with early physical therapy intervention (ePT) following initial presentation to podiatry versus usual podiatric care (uPOD) in individuals with PHP. Methods A parallel-group, block-randomized clinical trial will compare ePT and uPOD. Both groups will be seen initially by a podiatrist before allocation to a group that will receive physical therapy intervention consisting primarily of manual therapy, exercise, and modalities, or podiatric care consisting primarily of a stretching handout, medication, injections, and orthotics. Treatment in each group will be directed by practice guidelines and a procedural manual, yet the specific intervention for each participant will be selected by the treating provider. Between-group differences in the Foot and Ankle Ability Measure 6 months following the initial visit will be the primary outcome collected by an independent investigator. In addition, differences in the European Quality of Life – Five Dimensions, Numeric Pain Rating Scale, Global Rating of Change (GROC), health-related costs, and cost-effectiveness at 6 weeks, 6 months, and 1 year will be compared between groups. The association between successful outcomes based on GROC score and participant expectations of recovery

  19. The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration

    PubMed Central

    Liberati, Alessandro; Altman, Douglas G.; Tetzlaff, Jennifer; Mulrow, Cynthia; Gøtzsche, Peter C.; Ioannidis, John P. A.; Clarke, Mike; Devereaux, P. J.; Kleijnen, Jos; Moher, David

    2009-01-01

    Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses. PMID:19621070

  20. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

    PubMed

    Liberati, Alessandro; Altman, Douglas G; Tetzlaff, Jennifer; Mulrow, Cynthia; Gøtzsche, Peter C; Ioannidis, John P A; Clarke, Mike; Devereaux, P J; Kleijnen, Jos; Moher, David

    2009-10-01

    Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.

  1. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

    PubMed

    Liberati, Alessandro; Altman, Douglas G; Tetzlaff, Jennifer; Mulrow, Cynthia; Gøtzsche, Peter C; Ioannidis, John P A; Clarke, Mike; Devereaux, P J; Kleijnen, Jos; Moher, David

    2009-07-21

    Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.

  2. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

    PubMed

    Liberati, Alessandro; Altman, Douglas G; Tetzlaff, Jennifer; Mulrow, Cynthia; Gøtzsche, Peter C; Ioannidis, John P A; Clarke, Mike; Devereaux, P J; Kleijnen, Jos; Moher, David

    2009-08-18

    Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement-a reporting guideline published in 1999-there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (www.prisma-statement.org) should be helpful resources to improve reporting of systematic reviews and meta-analyses.

  3. Going Mobile With Diabetes Support: A Randomized Study of a Text Message–Based Personalized Behavioral Intervention for Type 2 Diabetes Self-Care

    PubMed Central

    Woolsey, Sarah; Georgsson, Mattias; Black, Jeff; Bello, Nelly; Lence, Clare; Oostema, Steve; North, Christie

    2015-01-01

    Objective. Patients with type 2 diabetes often fail to achieve self-management goals. This study tested the impact on glycemic control of a two-way text messaging program that provided behavioral coaching, education, and testing reminders to enrolled individuals with type 2 diabetes in the context of a clinic-based quality improvement initiative. The secondary aim examined patient interaction and satisfaction with the program. Methods. Ninety-three adult patients with poorly controlled type 2 diabetes (A1C >8%) were recruited from 18 primary care clinics in three counties for a 6-month study. Patients were randomized by a computer to one of two arms. Patients in both groups continued with their usual care; patients assigned to the intervention arm also received from one to seven diabetes-related text messages per day depending on the choices they made at enrollment. At 90 and 180 days, A1C data were obtained from the electronic health record and analyzed to determine changes from baseline for both groups. An exit survey was used to assess satisfaction. Enrollment behavior and interaction data were pulled from a Web-based administrative portal maintained by the technology vendor. Results. Patients used the program in a variety of ways. Twenty-nine percent of program users demonstrated frequent engagement (texting responses at least three times per week) for a period of ≥90 days. Survey results indicate very high satisfaction with the program. Both groups’ average A1C decreased from baseline, possibly reflecting a broader quality improvement effort underway in participating clinics. At 90 and 180 days, there was no statistically significant difference between the intervention and control groups in terms of change in A1C (P >0.05). Conclusions. This study demonstrated a practical approach to implementing and monitoring a mobile health intervention for self-management support across a wide range of independent clinic practices. PMID:25987806

  4. Going mobile with diabetes support: a randomized study of a text message-based personalized behavioral intervention for type 2 diabetes self-care.

    PubMed

    Capozza, Korey; Woolsey, Sarah; Georgsson, Mattias; Black, Jeff; Bello, Nelly; Lence, Clare; Oostema, Steve; North, Christie

    2015-05-01

    Objective. Patients with type 2 diabetes often fail to achieve self-management goals. This study tested the impact on glycemic control of a two-way text messaging program that provided behavioral coaching, education, and testing reminders to enrolled individuals with type 2 diabetes in the context of a clinic-based quality improvement initiative. The secondary aim examined patient interaction and satisfaction with the program. Methods. Ninety-three adult patients with poorly controlled type 2 diabetes (A1C >8%) were recruited from 18 primary care clinics in three counties for a 6-month study. Patients were randomized by a computer to one of two arms. Patients in both groups continued with their usual care; patients assigned to the intervention arm also received from one to seven diabetes-related text messages per day depending on the choices they made at enrollment. At 90 and 180 days, A1C data were obtained from the electronic health record and analyzed to determine changes from baseline for both groups. An exit survey was used to assess satisfaction. Enrollment behavior and interaction data were pulled from a Web-based administrative portal maintained by the technology vendor. Results. Patients used the program in a variety of ways. Twenty-nine percent of program users demonstrated frequent engagement (texting responses at least three times per week) for a period of ≥90 days. Survey results indicate very high satisfaction with the program. Both groups' average A1C decreased from baseline, possibly reflecting a broader quality improvement effort underway in participating clinics. At 90 and 180 days, there was no statistically significant difference between the intervention and control groups in terms of change in A1C (P >0.05). Conclusions. This study demonstrated a practical approach to implementing and monitoring a mobile health intervention for self-management support across a wide range of independent clinic practices.

  5. Protocol and baseline data from The Inala Chronic Disease Management Service evaluation study: a health services intervention study for diabetes care

    PubMed Central

    2010-01-01

    Background Type 2 Diabetes Mellitus is one of the most disabling chronic conditions worldwide, resulting in significant human, social and economic costs and placing huge demands on health care systems. The Inala Chronic Disease Management Service aims to improve the efficiency and effectiveness of care for patients with type 2 diabetes who have been referred by their general practitioner to a specialist diabetes outpatient clinic. Care is provided by a multidisciplinary, integrated team consisting of an endocrinologist, diabetes nurse educators, General Practitioner Clinical Fellows (general practitioners who have undertaken focussed post-graduate training in complex diabetes care), and allied health personnel (a dietitian, podiatrist and psychologist). Methods/Design Using a geographical control, this evaluation study tests the impact of this model of diabetes care provided by the service on patient outcomes compared to usual care provided at the specialist diabetes outpatient clinic. Data collection at baseline, 6 and 12-months will compare the primary outcome (glycaemic control) and secondary outcomes (serum lipid profile, blood pressure, physical activity, smoking status, quality of life, diabetes self-efficacy and cost-effectiveness). Discussion This model of diabetes care combines the patient focus and holistic care valued by the primary care sector with the specialised knowledge and skills of hospital diabetes care. Our study will provide empirical evidence about the clinical effectiveness of this model of care. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000010392. PMID:20492731

  6. How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children's hospital, Stockholm, Sweden

    PubMed Central

    2012-01-01

    Background There is growing interest in applying lean thinking in healthcare, yet, there is still limited knowledge of how and why lean interventions succeed (or fail). To address this gap, this in-depth case study examines a lean-inspired intervention in a Swedish pediatric Accident and Emergency department. Methods We used a mixed methods explanatory single case study design. Hospital performance data were analyzed using analysis of variance (ANOVA) and statistical process control techniques to assess changes in performance one year before and two years after the intervention. We collected qualitative data through non-participant observations, semi-structured interviews, and internal documents to describe the process and content of the lean intervention. We then analyzed empirical findings using four theoretical lean principles (Spear and Bowen 1999) to understand how and why the intervention worked in its local context as well as to identify its strengths and weaknesses. Results Improvements in waiting and lead times (19-24%) were achieved and sustained in the two years following lean-inspired changes to employee roles, staffing and scheduling, communication and coordination, expertise, workspace layout, and problem solving. These changes resulted in improvement because they: (a) standardized work and reduced ambiguity, (b) connected people who were dependent on one another, (c) enhanced seamless, uninterrupted flow through the process, and (d) empowered staff to investigate problems and to develop countermeasures using a "scientific method". Contextual factors that may explain why not even greater improvement was achieved included: a mismatch between job tasks, licensing constraints, and competence; a perception of being monitored, and discomfort with inter-professional collaboration. Conclusions Drawing on Spear and Bowen's theoretical propositions, this study explains how a package of lean-like changes translated into better care process management. It adds

  7. Study protocol for promoting respectful maternity care initiative to assess, measure and design interventions to reduce disrespect and abuse during childbirth in Kenya

    PubMed Central

    2013-01-01

    Background Increases in the proportion of facility-based deliveries have been marginal in many low-income countries in the African region. Preliminary clinical and anthropological evidence suggests that one major factor inhibiting pregnant women from delivering at facility is disrespectful and abusive treatment by health care providers in maternity units. Despite acknowledgement of this behavior by policy makers, program staff, civil society groups and community members, the problem appears to be widespread but prevalence is not well documented. Formative research will be undertaken to test the reliability and validity of a disrespect and abuse (D&A) construct and to then measure the prevalence of disrespect and abuse suffered by clinic clients and the general population. Methods/design A quasi-experimental design will be followed with surveys at twelve health facilities in four districts and one large maternity hospital in Nairobi and areas before and after the introduction of disrespect and abuse (D&A) interventions. The design is aimed to control for potential time dependent confounding on observed factors. Discussion This study seeks to conduct implementation research aimed at designing, testing, and evaluating an approach to significantly reduce disrespectful and abusive (D&A) care of women during labor and delivery in facilities. Specifically the proposed study aims to: (i) determine the manifestations, types and prevalence of D&A in childbirth (ii) develop and validate tools for assessing D&A (iii) identify and explore the potential drivers of D&A (iv) design, implement, monitor and evaluate the impact of one or more interventions to reduce D&A and (v) document and assess the dynamics of implementing interventions to reduce D&A and generate lessons for replication at scale. PMID:23347548

  8. Enhancing Shared Decision Making Through Carefully Designed Interventions That Target Patient And Provider Behavior.

    PubMed

    Tai-Seale, Ming; Elwyn, Glyn; Wilson, Caroline J; Stults, Cheryl; Dillon, Ellis C; Li, Martina; Chuang, Judith; Meehan, Amy; Frosch, Dominick L

    2016-04-01

    Patient-provider communication and shared decision making are essential for primary care delivery and are vital contributors to patient experience and health outcomes. To alleviate communication shortfalls, we designed a novel, multidimensional intervention aimed at nudging both patients and primary care providers to communicate more openly. The intervention was tested against an existing intervention, which focused mainly on changing patients' behaviors, in four primary care clinics involving 26 primary care providers and 300 patients. Study results suggest that compared to usual care, both the novel and existing interventions were associated with better patient reports of how well primary care providers engaged them in shared decision making. Future research should build on the work in this pilot to rigorously examine the comparative effectiveness and scalability of these interventions to improve shared decision making at the point of care.

  9. The “Retrofitting” Approach to Adapting Evidence-Based Interventions: A Case Study of Pediatric Asthma Care Coordination, United States, 2010–2014

    PubMed Central

    Stoll, Shelley C.; Lara, Marielena; Ramos-Valencia, Gilberto; Stephens, Tyra Bryant; Persky, Victoria; Uyeda, Kimberly; Lesch, Julie Kennedy; Malveaux, Floyd J.

    2016-01-01

    Adaptation of evidence-based interventions upon implementation into new practice settings is universal, yet poorly understood. During a cross-site evaluation of the implementation of a proven intervention for pediatric asthma care coordination into 4 resource-challenged settings, we conducted in-depth interviews with site representatives, who reported how and why they modified intervention components. Interview notes were coded for themes. We focused on a single theme from a respondent who described the adaptation process as “backing” the intervention into ongoing services; we found evidence of a similar process at other sites. We labeled this process “retrofitting” to signify adaptation that consists of altering existing services to align with intervention components, rather than modifying the intervention to fit a new setting. Advantages of retrofitting may include allowing organizations to keep what works, capitalizing on existing support for program activities, elevating the role of local knowledge, and potentially promoting the sustainability of effective innovations. PMID:27560722

  10. The "Retrofitting" Approach to Adapting Evidence-Based Interventions: A Case Study of Pediatric Asthma Care Coordination, United States, 2010-2014.

    PubMed

    Janevic, Mary R; Stoll, Shelley C; Lara, Marielena; Ramos-Valencia, Gilberto; Bryant-Stephens, Tyra; Persky, Victoria; Uyeda, Kimberly; Lesch, Julie Kennedy; Malveaux, Floyd J

    2016-01-01

    Adaptation of evidence-based interventions upon implementation into new practice settings is universal, yet poorly understood. During a cross-site evaluation of the implementation of a proven intervention for pediatric asthma care coordination into 4 resource-challenged settings, we conducted in-depth interviews with site representatives, who reported how and why they modified intervention components. Interview notes were coded for themes. We focused on a single theme from a respondent who described the adaptation process as "backing" the intervention into ongoing services; we found evidence of a similar process at other sites. We labeled this process "retrofitting" to signify adaptation that consists of altering existing services to align with intervention components, rather than modifying the intervention to fit a new setting. Advantages of retrofitting may include allowing organizations to keep what works, capitalizing on existing support for program activities, elevating the role of local knowledge, and potentially promoting the sustainability of effective innovations. PMID:27560722

  11. Young People's Participation in the Development of a Self-Care Intervention--A Multi-Site Formative Research Study

    ERIC Educational Resources Information Center

    Kime, Nicola; McKenna, Jim; Webster, Liz

    2013-01-01

    The poor outcomes of young people with chronic health conditions indicate that current services and self-care programmes are not meeting the needs of young people. How young people self-manage their condition impacts on long-term health outcomes, but there is little published evidence that details the development of self-care programmes and their…

  12. Results of the northern Manhattan diabetes community outreach project: a randomized trial studying a community health worker intervention to improve diabetes care in Hispanic adults.

    PubMed

    Palmas, Walter; Findley, Sally E; Mejia, Miriam; Batista, Milagros; Teresi, Jeanne; Kong, Jian; Silver, Stephanie; Fleck, Elaine M; Luchsinger, Jose A; Carrasquillo, Olveen

    2014-04-01

    OBJECTIVE The Northern Manhattan Diabetes Community Outreach Project evaluated whether a community health worker (CHW) intervention improved clinically relevant markers of diabetes care in adult Hispanics. RESEARCH DESIGN AND METHODS Participants were adult Hispanics, ages 35-70 years, with recent hemoglobin A1c (A1C) ≥8% (≥64 mmol/mol), from a university-affiliated network of primary care practices in northern Manhattan (New York City, NY). They were randomized to a 12-month CHW intervention (n = 181), or enhanced usual care (educational materials mailed at 4-month intervals, preceded by phone calls, n = 179). The primary outcome was A1C at 12 months; the secondary outcomes were systolic blood pressure (SBP), diastolic blood pressure, and LDL-cholesterol levels. RESULTS There was a nonsignificant trend toward improvement in A1C levels in the intervention group (from unadjusted mean A1C of 8.77 to 8.40%), as compared with usual care (from 8.58 to 8.53%) (P = 0.131). There was also a nonsignificant trend toward an increase in SBP and LDL cholesterol in the intervention arm. Intervention fidelity, measured as the number of contacts in the intervention arm (visits, phone contacts, group support, and nutritional education), showed a borderline association with greater A1C reduction (P = 0.054). When assessed separately, phone contacts were associated with greater A1C reduction (P = 0.04). CONCLUSIONS The trend toward A1C reduction with the CHW intervention failed to achieve statistical significance. Greater intervention fidelity may achieve better glycemic control, and more accessible treatment models, such as phone-based interventions, may be more efficacious in socioeconomically disadvantaged populations.

  13. Description of the methodology used in an ongoing pediatric care interventional study of children born with cleft lip and palate in South America [NCT00097149

    PubMed Central

    Wehby, George L; Castilla, Eduardo E; Goco, Norman; Rittler, Monica; Cosentino, Viviana; Javois, Lorette; McCarthy, Ann Marie; Bobashev, Georgiy; Litavecz, Stephen; Mariona, Alejandra; Dutra, Graca; López-Camelo, Jorge S; Orioli, Iêda M; Murray, Jeffrey C

    2006-01-01

    Background The contribution of birth defects, including cleft lip and palate, to neonatal and infant mortality and morbidity is substantial. As other mortality and morbidity causes including infections, hygiene, prematurity, and nutrition are eradicated in less developed countries, the burden of birth defects will increase proportionally. Methods/Design We are using cleft lip and palate as a sentinel birth defect to evaluate its burden on neonatal and infant health and to assess the effectiveness of systematic pediatric care during the first month and first two years of life in decreasing this burden. The neonatal intervention, consisting of weekly pediatric evaluation and referral to appropriate care, is delivered to about 696 infants born with cleft lip and/or palate in 47 hospitals in South America. Neonatal mortality in this group will be compared to that in a retrospective control group of about 464 infants born with cleft lip and/or palate in the same hospitals. The subgroup of infants with isolated clefts of both the lip and palate (about 264) is also randomized into two groups, intervened and non-intervened, and further followed up over 2 years. Intervened cases are evaluated by pediatricians every three months and referred for appropriate care. The intervened and non-intervened cases will be compared over study outcomes to evaluate the intervention effectiveness. Non-intervened cases are matched and compared to healthy controls to assess the burden of cleft lip and palate. Outcomes include child's neurological and physical development and family social and economic conditions. Discussion Large-scale clinical trials to improve infant health in developing countries are commonly suggested, making it important to share the methods used in ongoing studies with other investigators implementing similar research. We describe here the content of our ongoing pediatric care study in South America. We hope that this may help researchers targeting this area to plan

  14. The UPBEAT Nurse-Delivered Personalized Care Intervention for People with Coronary Heart Disease Who Report Current Chest Pain and Depression: A Randomised Controlled Pilot Study

    PubMed Central

    Barley, Elizabeth A.; Walters, Paul; Haddad, Mark; Phillips, Rachel; Achilla, Evanthia; McCrone, Paul; Van Marwijk, Harm; Mann, Anthony; Tylee, Andre

    2014-01-01

    Background Depression is common in people with coronary heart disease (CHD) and associated with worse outcome. This study explored the acceptability and feasibility of procedures for a trial and for an intervention, including its potential costs, to inform a definitive randomized controlled trial (RCT) of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression. Methods Multi-centre, outcome assessor-blinded, randomized parallel group study. CHD patients reporting chest pain and scoring 8 or more on the HADS were randomized to personalized care (PC) or treatment as usual (TAU) for 6 months and followed for 1 year. Primary outcome was acceptability and feasibility of procedures; secondary outcomes included mood, chest pain, functional status, well being and psychological process variables. Result 1001 people from 17 General Practice CHD registers in South London consented to be contacted; out of 126 who were potentially eligible, 81 (35% female, mean age = 65 SD11 years) were randomized. PC participants (n = 41) identified wide ranging problems to work on with nurse-case managers. Good acceptability and feasibility was indicated by low attrition (9%), high engagement and minimal nurse time used (mean/SD = 78/19 mins assessment, 125/91 mins telephone follow up). Both groups improved on all outcomes. The largest between group difference was in the proportion no longer reporting chest pain (PC 37% vs TAU 18%; mixed effects model OR 2.21 95% CI 0.69, 7.03). Some evidence was seen that self efficacy (mean scale increase of 2.5 vs 0.9) and illness perceptions (mean scale increase of 7.8 vs 2.5) had improved in PC vs TAU participants at 1 year. PC appeared to be more cost effective up to a QALY threshold of approximately £3,000. Conclusions Trial and intervention procedures appeared to be feasible and acceptable. PC allowed patients to work on unaddressed problems and appears cheaper than TAU

  15. Interventions for family members caring for an elder with dementia.

    PubMed

    Acton, Gayle J; Winter, Mary A

    2002-01-01

    This chapter reviews 73 published and unpublished research reports of interventions for family members caring for an elder with dementia by nurse researchers and researchers from other disciplines. Reports were identified through searches of MEDLINE, CINAHL, Social Science Index, PsycINFO, ERIC, Social Work Abstracts, American Association of Retired Persons database, CRISP index of the National Institutes of Health, Cochrane Center database, and Dissertation Abstracts using the following search terms: caregiver, caregiving, dementia, Alzheimer's, intervention study, evaluation study, experimental, and quasi-experimental design. Additional keywords were used to narrow or expand the search as necessary. All nursing research was included in the review and nonnursing research was included if published between 1991 and 2001. Studies were included if they used a design that included a treatment and control group or a one-group, pretest-posttest design (ex post facto designs were included if they used a comparison group). Key findings show that approximately 32% of the study outcomes (e.g., burden, depression, knowledge) were changed after intervention in the desired direction. In addition, several problematic issues were identified including small, diverse samples; lack of intervention specificity; diversity in the length, duration, and intensity of the intervention strategies; and problematic outcome measures.

  16. Private health care coverage and increased risk of obstetric intervention

    PubMed Central

    2014-01-01

    Background When clinically indicated, common obstetric interventions can greatly improve maternal and neonatal outcomes. However, variation in intervention rates suggests that obstetric practice may not be solely driven by case criteria. Methods Differences in obstetric intervention rates by private and public status in Ireland were examined using nationally representative hospital discharge data. A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010. Multivariate logistic regression analysis with correction for the relative risk was conducted to determine the risk of obstetric intervention (caesarean delivery, operative vaginal delivery, induction of labour or episiotomy) by private or public status while adjusting for obstetric risk factors. Results 403,642 childbirth hospitalisations were reviewed; approximately one-third of maternities (30.2%) were booked privately. After controlling for relevant obstetric risk factors, women with private coverage were more likely to have an elective caesarean delivery (RR: 1.48; 95% CI: 1.45-1.51), an emergency caesarean delivery (RR: 1.13; 95% CI: 1.12-1.16) and an operative vaginal delivery (RR: 1.25; 95% CI: 1.22-1.27). Compared to women with public coverage who had a vaginal delivery, women with private coverage were 40% more likely to have an episiotomy (RR: 1.40; 95% CI: 1.38-1.43). Conclusions Irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have an obstetric intervention. To better understand both clinical and non-clinical dynamics, future studies of examining health care coverage status and obstetric intervention would ideally apply mixed-method techniques. PMID:24418254

  17. Health reforms as examples of multilevel interventions in cancer care.

    PubMed

    Flood, Ann B; Fennell, Mary L; Devers, Kelly J

    2012-05-01

    To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation's health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.

  18. Cost-effectiveness of a Primary Care Depression Intervention

    PubMed Central

    Pyne, Jeffrey M; Rost, Kathryn M; Zhang, Mingliang; Williams, D Keith; Smith, Jeffrey; Fortney, John

    2003-01-01

    OBJECTIVE To determine the incremental cost-effectiveness of a quality improvement depression intervention (enhanced care) in primary care settings relative to usual care. DESIGN Following stratification, we randomized 12 primary care practices to enhanced or usual care conditions and followed patients for 12 months. SETTING Primary care practices located in 10 states across the United States. PATIENTS/PARTICIPANTS Two hundred eleven patients beginning a new treatment episode for major depression. INTERVENTIONS Training the primary care team to assess, educate, and monitor depressed patients during the acute and continuation stages of their depression treatment episode over 1 year. MEASUREMENTS AND MAIN RESULTS Cost-effectiveness was measured by calculating incremental (enhanced minus usual care) costs and quality-adjusted life years (QALYs) derived from SF-36 data. The mean incremental cost-effectiveness ratio in the main analysis was $15,463 per QALY. The mean incremental cost-effectiveness ratios for the sensitivity analyses ranged from $11,341 (using geographic block variables to control for pre-intervention service utilization) to $19,976 (increasing the cost estimates by 50%) per QALY. CONCLUSIONS This quality improvement depression intervention was cost-effective relative to usual care compared to cost-effectiveness ratios for common primary care interventions and commonly cited cost-effectiveness ratio thresholds for intervention implementation. PMID:12823650

  19. Improving maternal confidence in neonatal care through a checklist intervention.

    PubMed

    Radenkovic, Dina; Kotecha, Shrinal; Patel, Shreena; Lakhani, Anjali; Reimann-Dubbers, Katharina; Shah, Shreya; Jafree, Daniyal; Mitrasinovic, Stefan; Whitten, Melissa

    2016-01-01

    Previous qualitative studies suggest a lack of maternal confidence in care of their newborn child upon discharge into the community. This observation was supported by discussion with healthcare professionals and mothers at University College London Hospital (UCLH), highlighting specific areas of concern, in particular identifying and managing common neonatal presentations. The aim of this study was to design and introduce a checklist, addressing concerns, to increase maternal confidence in care of their newborn child. Based on market research, an 8-question checklist was designed, assessing maternal confidence in: feeding, jaundice, nappy care, rashes and dry skin, umbilical cord care, choking, bowel movements, and vomiting. Mothers were assessed as per the checklist, and received a score representative of their confidence in neonatal care. Mothers were followed up with a telephone call, and were assessed after a 7-day-period. Checklist scores before as compared to after the follow-up period were analysed. This process was repeated for three study cycles, with the placement of information posters on the ward prior to the second study cycle, and the stapling of the checklist to the mother's personal child health record (PCHR) prior to the third study cycle. A total of 99 mothers on the Maternity Care Unit at UCLH were enrolled in the study, and 92 were contactable after a 7-day period. During all study cycles, a significant increase in median checklist score was observed after, as compared to before, the 7-day follow up period (p < 0.001). The median difference in checklist score from baseline was greatest for the third cycle. These results suggest that introduction of a simple checklist can be successfully utilised to improve confidence of mothers in being able to care for their newborn child. Further investigation is indicated, but this intervention has the potential for routine application in postnatal care. PMID:27335642

  20. Movement as Medicine for Type 2 Diabetes: protocol for an open pilot study and external pilot clustered randomised controlled trial to assess acceptability, feasibility and fidelity of a multifaceted behavioural intervention targeting physical activity in primary care

    PubMed Central

    2014-01-01

    Background Physical activity (PA) and nutrition are the cornerstones of diabetes management. Several reviews and meta-analyses report that PA independently produces clinically important improvements in glucose control in people with Type 2 diabetes. However, it remains unclear what the optimal strategies are to increase PA behaviour in people with Type 2 diabetes in routine primary care. Methods This study will determine whether an evidence-informed multifaceted behaviour change intervention (Movement as Medicine for Type 2 Diabetes) targeting both consultation behaviour of primary healthcare professionals and PA behaviour in adults with Type 2 diabetes is both acceptable and feasible in the primary care setting. An open pilot study conducted in two primary care practices (phase one) will assess acceptability, feasibility and fidelity. Ongoing feedback from participating primary healthcare professionals and patients will provide opportunities for systematic adaptation and refinement of the intervention and study procedures. A two-arm parallel group clustered pilot randomised controlled trial with patients from participating primary care practices in North East England will assess acceptability, feasibility, and fidelity of the intervention (versus usual clinical care) and trial processes over a 12-month period. Consultation behaviour involving fidelity of intervention delivery, diabetes and PA related knowledge, attitudes/beliefs, intentions and self-efficacy for delivering a behaviour change intervention targeting PA behaviour will be assessed in primary healthcare professionals. We will rehearse the collection of outcome data (with the focus on data yield and quality) for a future definitive trial, through outcome assessment at baseline, one, six and twelve months. An embedded qualitative process evaluation and treatment fidelity assessment will explore issues around intervention implementation and assess whether intervention components can be reliably and

  1. Developing a community-based neonatal care intervention: a health facility assessment to inform intervention design.

    PubMed

    Howe, Laura D; Manu, Alexander; Tawiah-Agyemang, Charlotte; Kirkwood, Betty R; Hill, Zelee

    2011-03-01

    Community-based interventions are an important way of improving health in low-income countries. A necessary prerequisite for the design of such interventions is an understanding of the local health system. This will inform intervention design, help ensure the community-intervention forms part of a continuum of care, and provide information about health system strengthening activities that may be necessary for success. Such formative research processes, however, are seldom reported in the literature. We present the results of a health facility assessment used in the design stage of Newhints, a community-based intervention to improve neonatal survival in rural Ghana. We illustrate the methodology, findings and how these were used to inform the design and implementation of Newhints. The assessment involved key informant interviews with staff members at seven health facilities within the study area, including a brief inventory of available drugs and equipment. The key informant interviews identified that practices and health promotion messages at the health facilities were not consistent with one of the key target behaviours of the Newhints intervention - thermal care through delayed infant bathing. Health workers were bathing neonates soon after delivery and also advising women to do the same, which is a potential cause of hypothermia for the newborn. We found that health centres other than large district hospitals were ill-equipped to treat serious complications of labour or illness in the newborn, which had implications for advice on health seeking behaviour within the intervention. As a result of the health facility assessment, it was deemed necessary to undertake both health worker training and sensitisation activities. We demonstrate that important information can be yielded from a relatively simple health facility assessment involving key informant interviews.

  2. Referral interventions from primary to specialist care: a systematic review of international evidence

    PubMed Central

    Blank, Lindsay; Baxter, Susan; Woods, Helen Buckley; Goyder, Elizabeth; Lee, Andrew; Payne, Nick; Rimmer, Melanie

    2014-01-01

    Background Demand management defines any method used to monitor, direct, or regulate patient referrals. Strategies have been developed to manage the referral of patients to secondary care, with interventions that target primary care, specialist services, or infrastructure. Aim To review the international evidence on interventions to manage referral from primary to specialist care. Design and setting Systematic review. Method Iterative, systematic searches of published and unpublished sources public health, health management, management, and grey literature databases from health care and other industries were undertaken to identify recent, relevant studies. A narrative synthesis of the data was completed to structure the evidence into groups of similar interventions. Results The searches generated 8327 unique results, of which 140 studies were included. Interventions were grouped into four intervention categories: GP education (n = 50); process change (n = 49); system change (n = 38); and patient-focused (n = 3). It is clear that there is no ‘magic bullet’ to managing demand for secondary care services: although some groups of interventions may have greater potential for development, given the existing evidence that they can be effective in specific contexts. Conclusions To tackle demand management of primary care services, the focus cannot be on primary care alone; a whole-systems approach is needed because the introduction of interventions in primary care is often just the starting point of the referral process. In addition, more research is needed to develop and evaluate interventions that acknowledge the role of the patient in the referral decision. PMID:25452541

  3. A feasibility study of low-cost, self-administered skin care interventions in patients with head and neck cancer receiving chemoradiation.

    PubMed

    Mannix, Catherine Marie; Bartholomay, Marian Mahin; Doherty, Carol S; Lewis, Maryellen; Bilodeau, Mary-Liz Connors

    2012-06-01

    Current evidence for the management of radiation skin toxicities demonstrates equivocal outcomes using a variety of interventions, leaving substantial gaps in knowledge. Skin toxicities can lead to treatment delays, infection, pain, and increased costs for the patient. Patients with head and neck cancers receiving chemoradiation (N = 100), a population particularly vulnerable to disruptions in skin integrity, were enrolled into a prospective, descriptive study. Data collection was conducted and photographs were taken at baseline and weekly throughout treatment. Patients received skin care kits, instructions, and a diary to record adherence. Skin toxicity was measured and validated by at least three observers using serial photographs with 100% interrater agreement. Data were analyzed using descriptive statistics, graphs, and bivariate analysis. Adherence to both washing and moisturizing was consistently high. Although a correlation existed between the radiation dose and skin toxicity at week 6, no correlation existed between skin toxicity and adherence. Given the rate of grade 3 toxicities at week 6 and product costs, this proved to be an affordable regimen to which patients could easily adhere. Positive patient outcomes can be promoted through teaching and reinforcement of self-care measures to reduce skin toxicity.

  4. Strategic targeting of advance care planning interventions: the Goldilocks phenomenon.

    PubMed

    Billings, J Andrew; Bernacki, Rachelle

    2014-04-01

    Strategically selecting patients for discussions and documentation about limiting life-sustaining treatments-choosing the right time along the end-of-life trajectory for such an intervention and identifying patients at high risk of facing end-of-life decisions-can have a profound impact on the value of advance care planning (ACP) efforts. Timing is important because the completion of an advance directive (AD) too far from or too close to the time of death can lead to end-of-life decisions that do not optimally reflect the patient's values, goals, and preferences: a poorly chosen target patient population that is unlikely to need an AD in the near future may lead to patients making unrealistic, hypothetical choices, while assessing preferences in the emergency department or hospital in the face of a calamity is notoriously inadequate. Because much of the currently studied ACP efforts have led to a disappointingly small proportion of patients eventually benefitting from an AD, careful targeting of the intervention should also improve the efficacy of such projects. A key to optimal timing and strategic selection of target patients for an ACP program is prognostication, and we briefly highlight prognostication tools and studies that may point us toward high-value AD interventions. PMID:24493203

  5. Strategic targeting of advance care planning interventions: the Goldilocks phenomenon.

    PubMed

    Billings, J Andrew; Bernacki, Rachelle

    2014-04-01

    Strategically selecting patients for discussions and documentation about limiting life-sustaining treatments-choosing the right time along the end-of-life trajectory for such an intervention and identifying patients at high risk of facing end-of-life decisions-can have a profound impact on the value of advance care planning (ACP) efforts. Timing is important because the completion of an advance directive (AD) too far from or too close to the time of death can lead to end-of-life decisions that do not optimally reflect the patient's values, goals, and preferences: a poorly chosen target patient population that is unlikely to need an AD in the near future may lead to patients making unrealistic, hypothetical choices, while assessing preferences in the emergency department or hospital in the face of a calamity is notoriously inadequate. Because much of the currently studied ACP efforts have led to a disappointingly small proportion of patients eventually benefitting from an AD, careful targeting of the intervention should also improve the efficacy of such projects. A key to optimal timing and strategic selection of target patients for an ACP program is prognostication, and we briefly highlight prognostication tools and studies that may point us toward high-value AD interventions.

  6. The Effectiveness of a Brief Asthma Education Intervention for Child Care Providers and Primary School Teachers

    ERIC Educational Resources Information Center

    Neuharth-Pritchett, Stacey; Getch, Yvette Q.

    2016-01-01

    Limited information exists about management of asthma in child care settings and primary school classrooms. The goal of this study was to evaluate a brief asthma management intervention for child care providers and primary school teachers. Child care providers and primary school teachers were recruited to participate in two 3-h workshops on asthma…

  7. Communication between Older People and Their Health Care Agents: Results of an Intervention

    ERIC Educational Resources Information Center

    Gutheil, Irene A.; Heyman, Janna C.

    2005-01-01

    This study examined an intervention to help high-functioning community-dwelling older people communicate their wishes for care at the end of life with someone they would trust to make health care decisions for them if necessary. Groups consisted of dyads of older people and their potential or designated health care agents randomly assigned to the…

  8. Health-Care Workers' Perspectives on Ebola Virus Vaccine: A Focus Group and In-Depth Interview Interventional Study.

    PubMed

    Esangbedo, Dorothy O; Ughasoro, Maduka D; Tagbo, Beckie N; Olowu, Adebiyi; Anikene, Chukwuemeka; Iwegbulam, Chimaobi C

    2016-09-01

    Health-care workers (HCWs) will require Ebola virus vaccine (EVV) when it is introduced because of the high risk of exposure to the disease. Evaluations of factors that facilitate or limit vaccine uptake are critical for a successful vaccine program. Nigerian HCWs were interviewed to evaluate their knowledge, levels of acceptance, determinants of acceptance, and willingness to pay for EVV. The significance level was set at P ≤ 0.05. None of the 193 participating HCWs had correct knowledge of EVV; 34.7% (67/193) of workers thought that EVV was an extract of the serum of Ebola virus patients. About 77.3% (51/66) of workers in a region that reported Ebola cases (Lagos) were willing to be vaccinated, compared with 4.7% (3/61) in Enugu and 13.6% (9/66) in Abia (P = 0.0001). After health education, the proportion of HCWs willing to receive EVV increased (P = 0.006) except for doctors (P < 0.1). The percentage of HCWs willing to pay for EVV was 86.4%, 72.1%, and 59% in Lagos, Enugu, and Abia, respectively. The workers had fears about EVV based on nonfactual assumptions. Therefore, the EVV introduction strategy should include a strong awareness campaign with adequate explanation about the content of EVV. PMID:27382077

  9. Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review

    PubMed Central

    2016-01-01

    Background People who are homeless encounter barriers to primary care despite having greater needs for health care, on average, than people who are not homeless. We evaluated the effectiveness of interventions to improve access to primary care for people who are homeless. Methods We performed a systematic review to identify studies in English published between January 1, 1995, and July 8, 2015, comparing interventions to improve access to a primary care provider with usual care among people who are homeless. The outcome of interest was access to a primary care provider. The risk of bias in the studies was evaluated, and the quality of the evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. Results From a total of 4,047 citations, we identified five eligible studies (one randomized controlled trial and four observational studies). With the exception of the randomized trial, the risk of bias was considered high in the remaining studies. In the randomized trial, people who were homeless, without serious mental illness, and who received either an outreach intervention plus clinic orientation or clinic orientation alone, had improved access to a primary care provider compared with those receiving usual care. An observational study that compared integration of primary care and other services for people who are homeless with usual care did not observe any difference in access to a primary care provider between the two groups. A small observational study showed improvement among participants with a primary care provider after receiving an intervention consisting of housing and supportive services compared with the period before the intervention. The quality of the evidence was considered moderate for both the outreach plus clinic orientation and clinic orientation alone, and low to very low for the other interventions. Despite limitations, the literature identified reports of

  10. Effectiveness of eHealth Interventions and Information Needs in Palliative Care: A Systematic Literature Review

    PubMed Central

    Ganzinger, Matthias; Perez-Lu, Jose; Knaup, Petra

    2014-01-01

    Background One of the key components in palliative care is communication. eHealth technologies can be an effective way to support communications among participants in the process of palliative care. However, it is unclear to what extent information technology has been established in this field. Objective Our goal was to systematically identify studies and analyze the effectiveness of eHealth interventions in palliative care and the information needs of people involved in the palliative care process. Methods We conducted a systematic literature search using PubMed, Embase, and LILACS according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We collected and analyzed quantitative and qualitative data regarding effectiveness of eHealth interventions and users’ information needs in palliative care. Results Our search returned a total of 240 articles, 17 of which met our inclusion criteria. We found no randomized controlled trial studying the effects of eHealth interventions in palliative care. Studies tended to be observational, noncontrolled studies, and a few quasi-experimental studies. Overall there was great heterogeneity in the types of interventions and outcome assessments; some studies reported some improvement on quality of care, documentation effort, cost, and communications. The most frequently reported information need concerned pain management. Conclusions There is limited evidence around the effectiveness of eHealth interventions for palliative care patients, caregivers, and health care professionals. Focused research on information needs and high-quality clinical trials to assess their effectiveness are needed. PMID:24610324

  11. Identifying Care Coordination Interventions Provided to Community-Dwelling Older Adults Using Electronic Health Records.

    PubMed

    Kim, Tae Youn; Marek, Karen D; Coenen, Amy

    2016-07-01

    Although care coordination is a popular intervention, there is no standard method of delivery. Also little is known about who benefits most, or characteristics that predict the amount of care coordination needed, especially with chronically ill older adults. The purpose of this study was to identify types and amount of nurse care coordination interventions provided to 231 chronically ill older adults who participated in a 12-month home care medication management program in the Midwest. For each participant, the nurse care coordinator spent an average of 134 min/mo providing in-person home care, 48 min/mo of travel, and 18 min/mo of indirect care occurring outside the home visit. This accounted for 67.2%, 23.8%, and 9.0% of nursing time, respectively, for home visits, travel, and indirect care. Four of 11 nursing interventions focused on medication management were provided to all participants. Seven of the 11 main interventions were individualized according to each person's special needs. Wide variations were observed in time provided with in-person home care and communications with multiple stakeholders. Study findings indicate the importance of individualizing interventions and the variability in the amount of nursing time needed to provide care coordination to chronically ill older adults.

  12. Identifying Care Coordination Interventions Provided to Community-Dwelling Older Adults Using Electronic Health Records.

    PubMed

    Kim, Tae Youn; Marek, Karen D; Coenen, Amy

    2016-07-01

    Although care coordination is a popular intervention, there is no standard method of delivery. Also little is known about who benefits most, or characteristics that predict the amount of care coordination needed, especially with chronically ill older adults. The purpose of this study was to identify types and amount of nurse care coordination interventions provided to 231 chronically ill older adults who participated in a 12-month home care medication management program in the Midwest. For each participant, the nurse care coordinator spent an average of 134 min/mo providing in-person home care, 48 min/mo of travel, and 18 min/mo of indirect care occurring outside the home visit. This accounted for 67.2%, 23.8%, and 9.0% of nursing time, respectively, for home visits, travel, and indirect care. Four of 11 nursing interventions focused on medication management were provided to all participants. Seven of the 11 main interventions were individualized according to each person's special needs. Wide variations were observed in time provided with in-person home care and communications with multiple stakeholders. Study findings indicate the importance of individualizing interventions and the variability in the amount of nursing time needed to provide care coordination to chronically ill older adults. PMID:26985762

  13. Interventions to reduce bullying in health care organizations: a scoping review.

    PubMed

    Quinlan, Elizabeth; Robertson, Susan; Miller, Natasha; Robertson-Boersma, Danielle

    2014-01-01

    The problem of staff-to-staff bullying and its consequences in the health care sector has given rise to urgent knowledge needs among health care employers, union representatives, and professional associations. The purpose of this scoping review is to increase the uptake and application of synthesized research results of interventions designed to address bullying among coworkers within health care workplaces. The scoping review's methodology uses an adapted version of the Arksey and O'Malley framework to locate and review empirical studies involving interventions designed to address bullying in health care workplaces. The findings of the review reveal eight articles from three countries discussing interventions that included educative programming, bullying champions/advocates, and zero-tolerance policies. The reported evaluations extend beyond bullying to include organizational culture, trust in management, retention rates, and psychosocial health. The most promising reported outcomes are from participatory interventions. The results of the review make a compelling case for bullying interventions based on participatory principles.

  14. A multifaceted intervention to reduce inappropriate polypharmacy in primary care: research co-creation opportunities in a pilot study.

    PubMed

    Anderson, Kristen; Foster, Michele M; Freeman, Christopher R; Scott, Ian A

    2016-04-18

    Co-creation (or co-design) represents the highest form of stakeholder engagement, but it can be infeasible to co-create with all stakeholders through all stages of a research project. The choice of stakeholders for co-design will depend on the study purpose and context of change. For this deprescribing pilot study, general practitioners were recognised as a critical gateway for co-creation, with patients' perspectives of the deprescribing process to be assessed in the evaluation of the pilot.

  15. Expectations, experiences and attitudes of patients and primary care health professionals regarding online psychotherapeutic interventions for depression: protocol for a qualitative study

    PubMed Central

    2013-01-01

    Background In the year 2020, depression will cause the second highest amount of disability worldwide. One quarter of the population will suffer from depression symptoms at some point in their lives. Mental health services in Western countries are overburdened. Therefore, cost-effective interventions that do not involve mental health services, such as online psychotherapy programs, have been proposed. These programs demonstrate satisfactory outcomes, but the completion rate for patients is low. Health professionals’ attitudes towards this type of psychotherapy are more negative than the attitudes of depressed patients themselves. The aim of this study is to describe the profile of depressed patients who would benefit most from online psychotherapy and to identify expectations, experiences, and attitudes about online psychotherapy among both patients and health professionals that can facilitate or hinder its effects. Methods A parallel qualitative design will be used in a randomised controlled trial on the efficiency of online psychotherapeutic treatment for depression. Through interviews and focus groups, the experiences of treated patients, their reasons for abandoning the program, the expectations of untreated patients, and the attitudes of health professionals will be examined. Questions will be asked about training in new technologies, opinions of online psychotherapy, adjustment to therapy within the daily routine, the virtual and anonymous relationship with the therapist, the process of online communication, information necessary to make progress in therapy, process of working with the program, motivations and attitudes about treatment, expected consequences, normalisation of this type of therapy in primary care, changes in the physician-patient relationship, and resources and risks. A thematic content analysis from the grounded theory for interviews and an analysis of the discursive positions of participants based on the sociological model for focus groups

  16. Complex interventions in midwifery care: reflections on the design and evaluation of an algorithm for the diagnosis of labour.

    PubMed

    Dowding, Dawn W; Cheyne, Helen L; Hundley, Vanora

    2011-10-01

    Randomised controlled trials are the 'gold standard' for evaluating the effectiveness of interventions in health-care settings. However, in midwifery care, many interventions are 'complex', comprising a number of different elements which may have an effect on the impact of the intervention in health-care settings. In this paper we reflect on our experience of designing and evaluating a complex intervention (a decision tool to assist with the diagnosis of labour in midwifery care), examining some of the issues that our study raises for future research in complex interventions.

  17. The implementation of life space crisis intervention in residential care and special education for children and adolescents with EBD: an effect study.

    PubMed

    Soenen, Bram; Volckaert, Annelies; D'Oosterlinck, Franky; Broekaert, Eric

    2014-09-01

    When working with children and adolescents with emotional and behavioural disorders, conflicts are a part of daily life. At present, a variety of conflict resolution or conflict management programs, that can be divided into three categories, are described in the literature. A first category contains programs that focus on training for children and adolescents, and are often curriculum-based. The second category focuses on training for parents, and the third category contains programs that focus on training for professionals. The presents study was designed to evaluated the effectiveness of Life Space Crisis Intervention (LSCI), a therapeutic and verbal strategy developed by Long that fits into this third category of conflict management programs. Throughout a four-year project, al staff in a Flemish centre offering residential care and special education were trained in LSCI. On a yearly basis, data with regard to time in program, academic achievement, behavioural problems and anxiety problems were collected. The results show an increase in time spent in program and in academic achievement, and a decrease in youths' anxiety, indicating that the implementation of LSCI contributes constructively to the treatment of children and adolescents with EBD.

  18. Challenging logics of complex intervention trials: community perspectives of a health care improvement intervention in rural Uganda.

    PubMed

    Okwaro, Ferdinand M; Chandler, Clare I R; Hutchinson, Eleanor; Nabirye, Christine; Taaka, Lilian; Kayendeke, Miriam; Nayiga, Susan; Staedke, Sarah G

    2015-04-01

    Health systems in many African countries are failing to provide populations with access to good quality health care. Morbidity and mortality from curable diseases such as malaria remain high. The PRIME trial in Tororo, rural Uganda, designed and tested an intervention to improve care at health centres, with the aim of reducing ill-health due to malaria in surrounding communities. This paper presents the impact and context of this trial from the perspective of community members in the study area. Fieldwork was carried out for a year from the start of the intervention in June 2011, and involved informal observation and discussions as well as 13 focus group discussions with community members, 10 in-depth interviews with local stakeholders, and 162 context descriptions recorded through quarterly interviews with community members, health workers and district officials. Community members observed a small improvement in quality of care at most, but not all, intervention health centres. However, this was diluted by other shortfalls in health services beyond the scope of the intervention. Patients continued to seek care at health centres they considered inadequate as well as positioning themselves and their children to access care through other sources such as research and nongovernmental organization (NGO) projects. These findings point to challenges of designing and delivering interventions within a paradigm that requires factorial (reduced to predictable factors) problem definition with easily actionable and evaluable solutions by small-scale projects. Such requirements mean that interventions often work on the periphery of a health system rather than tackling the murky political and economic realities that shape access to care but are harder to change or evaluate with randomized controlled trials. Highly projectified settings further reduce the ability to genuinely 'control' for different health care access scenarios. We argue for a raised consciousness of how

  19. Transtheoretical Model-Based Dietary Interventions in Primary Care: A Review of the Evidence in Diabetes

    ERIC Educational Resources Information Center

    Salmela, Sanna; Poskiparta, Marita; Kasila, Kirsti; Vahasarja, Kati; Vanhala, Mauno

    2009-01-01

    The objective of this study was to review the evidence concerning stage-based dietary interventions in primary care among persons with diabetes or an elevated diabetes risk. Search strategies were electronic databases and manual search. Selection criteria were randomized controlled studies with stage-based dietary intervention, conducted in…

  20. Veterans’ Perspectives on Interventions to Improve Retention in HIV Care

    PubMed Central

    Kertz, Barbara L.; Cully, Jeffery A.; Stanley, Melinda A.; Davila, Jessica A.; Dang, Bich N.; Rodriguez-Barradas, Maria C.; Giordano, Thomas P.

    2016-01-01

    Poor retention in HIV medical care is associated with increased mortality among patients with HIV/AIDS. Developing new interventions to improve retention in HIV primary care is needed. The Department of Veteran Affairs (VA) is the largest single provider of HIV care in the US. We sought to understand what veterans would want in an intervention to improve retention in VA HIV care. We conducted 18 one-on-one interviews and 15 outpatient focus groups with 46 patients living with HIV infection from the Michael E. DeBakey VAMC (MEDVAMC). Analysis identified three focus areas for improving retention in care: developing an HIV friendly clinic environment, providing mental health and substance use treatment concurrent with HIV care and encouraging peer support from other Veterans with HIV. PMID:26829641

  1. Processes of change in an asthma self-care intervention.

    PubMed

    Denford, Sarah; Campbell, John L; Frost, Julia; Greaves, Colin J

    2013-10-01

    In this article, we present a qualitative exploration of the psychological and communication processes that occur within an intervention to improve self-care for people with asthma. In the context of a primary-care-based trial of the intervention, we collected data at three time points for 21 patients, comprising 2 audiotaped consultations (nurse and patient together) and individual semistructured interviews 3 months after the second consultation. Using framework analysis, we identified both psychological processes (illness understanding, affective response to asthma, and reasoned motivation) and patient-provider interactions (active patient involvement and individual tailoring). We use these findings to extend and refine the pre-existing theoretical model of behavior change underpinning the intervention, in particular with relation to patient-provider interaction processes. We conclude that it is important for developers and providers of asthma self-care interventions to attend to the style of delivery as well as the behavior change techniques involved. PMID:24062418

  2. Brief intervention for anxiety in primary care patients

    PubMed Central

    Roy-Byrne, Peter; Veitengruber, Jason P.; Bystritsky, Alexander; Edlund, Mark J.; Sullivan, Greer; Craske, Michelle G.; Welch, Stacy Shaw; Stein, Murray B.

    2010-01-01

    In order to address the difficulty of assessing and managing multiple anxiety disorders in the primary care setting, this paper provides a simple, easy to learn, unified approach to the diagnosis, care management and pharmacotherapy of the four most common anxiety disorders (panic, generalized, and social anxiety disorders, and PTSD) in primary care. This evidence-based approach was developed for an ongoing NIMH-funded study designed to improve the delivery of evidence-based medication and psychotherapy treatment to primary care patients with these anxiety disorders. The paper presents a simple, validated method to screen for the four major disorders, which emphasizes identifying other medical or psychiatric comorbidities which can complicate treatment; an approach for initial education of the patient and discussion about treatment, including provision of some simple CBT skills, based on motivational interviewing/brief intervention approaches previously used for substance use disorders; a validated method for monitoring treatment outcome; an algorithmic approach for selection of initial medication treatment, selection of alternative or adjunctive treatments when the initial approach has not produced optimal results, and indications for mental health referral. PMID:19264941

  3. Do antenatal care interventions improve neonatal survival in India?

    PubMed

    Singh, Abhishek; Pallikadavath, Saseendran; Ram, Faujdar; Alagarajan, Manoj

    2014-10-01

    Although antenatal care (ANC) interventions have been in place for a long time, there is hardly any systematic evidence on the association between ANC interventions and neonatal mortality in India. The present study attempts to investigate the association between ANC interventions and neonatal mortality in India using data from the District Level Household Survey conducted in India during 2007-8. The ANC interventions included in the analysis are at least four antenatal visits, consumption of 90 or more iron-folic acid (IFA) tablets, and uptake of two or more tetanus toxoid (TT) injections. We have used discrete-time logistic regression models to investigate the association between ANC interventions and neonatal mortality. Risk of neonatal mortality was significantly lower for infants of mothers who availed four or more antenatal visits [odds ratio (OR): 0.69; 95% confidence interval (CI): 0.60-0.81], consumed 90 or more IFA tablets (OR: 0.85; 95% CI: 0.73-0.99), received two or more TT injections (OR: 0.73; 95% CI: 0.63-0.83). When we analysed different combinations of antenatal visits, IFA supplementation and TT injections, TT injections provided the main protective effect-the risk of neonatal mortality was significantly lower in newborns of women who received two or more TT injections but did not consume 90 or more IFA tablets (OR: 0.69; 95% CI: 0.60-0.78), or who received two or more TT injections but did not avail four or more antenatal visits (OR: 0.75; 95% CI: 0.66-0.86). In the statistical model, 6% (95% CI: 4-8%) of the neonatal deaths in India could be attributed to a lack of at least two TT injections during pregnancy. Indian public health programmes must ensure that every pregnant woman receives two or more TT injections during antenatal visits.

  4. [Correspondence among care prescriptions for patients with orthopedic problems and the Nursing Interventions Classification].

    PubMed

    Almeida, Miriam de Abreu; Longaray, Vanessa Kenne; De Cezaro, Paula; Barilli, Sofia Louise Santin

    2007-12-01

    The objective of this work was to compare the care prescribed by nurses for orthopedic surgery patients after surgery with the interventions and activities proposed by the Nursing Interventions Classification (NIC), in order to verify its agreement. The study was carried out at the Hospital de Clinicas de Porto Alegre (a University hospital in the south of Brazil), using the mapping technique. Data on the 170 studied patients were obtained by the Computerized Nursing Prescription System. The 52 care forms related to nursing diagnosis (ND) Self-Care Deficit--bath and/or hygiene, Impaired Physical Mobility and Risk of Infection--were mapped with 33 nursing interventions, contained in 14 classes and 4 Domains. The comparison between nursing prescriptions and the interventions proposed by the NIC for the 3 ND studied evidenced there is agreement among them. We considered that the NIC may become an important source of consultation to improve and to base nursing care.

  5. Impacting late life depression: integrating a depression intervention into primary care.

    PubMed

    Oishi, Sabine M; Shoai, Rebecca; Katon, Wayne; Callahan, Christopher; Unützer, Jürgen; Arean, Patricia; Callahan, Christopher; Della Penna, Richard; Harpole, Linda; Hegel, Mark; Noel, Polly Hitchcock; Hoffing, Marc; Hunkeler, Enid M; Katon, Wayne; Levine, Stuart; Lin, Elizabeth H B; Oddone, Eugene; Oishi, Sabine; Unützer, Jürgen; Williams, John

    2003-01-01

    groups and semi-structured individual interviews with all Depression Clinical Specialists (DCSs) working with Project IMPACT (Improving Mood: Promoting Access to Collaborative Treatment), a study testing a collaborative care intervention for late life depression, to examine integration of the intervention model into primary care. DCSs described key intervention components, including supervision from a psychiatrist and a liaison primary care provider, weekly team meetings, computerized patient tracking, and outcomes assessment tools as effective in supporting patient care. DCSs discussed details of protocols, training, environmental set-up, and interpersonal factors that seemed to facilitate integration. DCSs also identified research-related factors that may need to be preserved in the real world. Basic elements of the IMPACT model seem to support integration of late life depression care into primary care. Research-related components may need modification for dissemination.

  6. Type 2 diabetes–related foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature

    PubMed Central

    Bonner, Timethia; Foster, Margaret; Spears-Lanoix, Erica

    2016-01-01

    Introduction The purpose of this systematic literature review is to review published studies on foot care knowledge and foot care practice interventions as part of diabetic foot care self-management interventions. Methods Medline, CINAHL, CENTRAL, and Cochrane Central Register of Controlled Trials databases were searched. References from the included studies were reviewed to identify any missing studies that could be included. Only foot care knowledge and foot care practice intervention studies that focused on the person living with type 2 diabetes were included in this review. Author, study design, sample, intervention, and results were extracted. Results Thirty studies met the inclusion criteria and were classified according to randomized controlled trial (n=9), survey design (n=13), cohort studies (n=4), cross-sectional studies (n=2), qualitative studies (n=2), and case series (n=1). Improving lower extremity complications associated with type 2 diabetes can be done through effective foot care interventions that include foot care knowledge and foot care practices. Conclusion Preventing these complications, understanding the risk factors, and having the ability to manage complications outside of the clinical encounter is an important part of a diabetes foot self-care management program. Interventions and research studies that aim to reduce lower extremity complications are still lacking. Further research is needed to test foot care interventions across multiple populations and geographic locations. PMID:26899439

  7. Economic analysis of health care interventions.

    PubMed

    Konski, Andre

    2008-07-01

    According to US government statistics, health care expenditures approached $2 trillion in 2005 or $6,697/person, with spending expected to exceed $4.1 trillion by 2016 (http://www.cms.hhs.gov/NationalHealthExpendData/). Total Centers for Medicare and Medicaid Services spending (including Medicaid, State Children's Health Insurance Program (SCHIP), and Medicare) was $660.7 million in 2005. Despite the decline in the growth rate of health care spending growth over the past 4 years, health care spending increased 6.9% from 2004 to 2005 and was 16% of the gross domestic product (GDP) in 2005 and forecasted to be 19.6% of the GDP by 2016. Although the percentage of GDP may not concern providers of health care products or services, it has an affect on the rest of the economy. Spending on health care by employers or patients increases the cost of the products produced, making goods produced here in the United States less attractive to world markets in the age of globalization in addition to leaving less money for patients to spend on other goods and services or save.

  8. Preventing violence through primary care intervention.

    PubMed

    Roberts, C; Quillian, J

    1992-08-01

    Homicide was the United States' second leading cause of death among people aged 15 to 24 in 1988; non-fatal assaults occur 100 times more frequently. Yet as a society, we have ignored the problem. Risk factors for violent injuries comprise sociological, developmental/psychological and neurophysiological elements. Providers of primary care for children, young adults and their families can help parents develop healthy parenting techniques in child-rearing, help the grade-school-aged child develop non-violent conflict-resolution skills, and help young people learn to avoid violence and potentially violent activities and situations. Health care providers are able to reduce the incidence of violent injuries by addressing the issue of violence in periodic examination visits with both parents and children. Familiarity with risk indicators enables the health care provider to intervene early when needed. An anticipatory guidance outline and a violence-induced injury-visit form are included. PMID:1294082

  9. Using Complexity Theory to Build Interventions that Improve Health Care Delivery in Primary Care

    PubMed Central

    Litaker, David; Tomolo, Anne; Liberatore, Vincenzo; Stange, Kurt C; Aron, David

    2006-01-01

    Previous observational research confirms abundant variation in primary care practice. While variation is sometimes viewed as problematic, its presence may also be highly informative in uncovering ways to enhance health care delivery when it represents unique adaptations to the values and needs of people within the practice and interactions with the local community and health care system. We describe a theoretical perspective for use in developing interventions to improve care that acknowledges the uniqueness of primary care practices and encourages flexibility in the form of intervention implementation, while maintaining fidelity to its essential functions. PMID:16637958

  10. Essential interventions: implementation strategies and proposed packages of care

    PubMed Central

    2014-01-01

    In an effort to accelerate progress towards achieving Millennium Development Goal (MDG) 4 and 5, provision of essential reproductive, maternal, newborn and child health (RMNCH) interventions is being considered. Not only should a state-of-the-art approach be taken for services delivered to the mother, neonate and to the child, but services must also be deployed across the household to hospital continuum of care approach and in the form of packages. The paper proposed several packages for improved maternal, newborn and child health that can be delivered across RMNCH continuum of care. These packages include: supportive care package for women to promote awareness related to healthy pre-pregnancy and pregnancy interventions; nutritional support package for mother to improve supplementation of essential nutrients and micronutrients; antenatal care package to detect, treat and manage infectious and noninfectious diseases and promote immunization; high risk care package to manage preeclampsia and eclampsia in pregnancy; childbirth package to promote support during labor and importance of skilled birth attendance during labor; essential newborn care package to support healthy newborn care practices; and child health care package to prevent and manage infections. This paper further discussed the implementation strategies for employing these interventions at scale. PMID:25178110

  11. Essential interventions: implementation strategies and proposed packages of care.

    PubMed

    Lassi, Zohra S; Kumar, Rohail; Mansoor, Tarab; Salam, Rehana A; Das, Jai K; Bhutta, Zulfiqar A

    2014-01-01

    In an effort to accelerate progress towards achieving Millennium Development Goal (MDG) 4 and 5, provision of essential reproductive, maternal, newborn and child health (RMNCH) interventions is being considered. Not only should a state-of-the-art approach be taken for services delivered to the mother, neonate and to the child, but services must also be deployed across the household to hospital continuum of care approach and in the form of packages. The paper proposed several packages for improved maternal, newborn and child health that can be delivered across RMNCH continuum of care. These packages include: supportive care package for women to promote awareness related to healthy pre-pregnancy and pregnancy interventions; nutritional support package for mother to improve supplementation of essential nutrients and micronutrients; antenatal care package to detect, treat and manage infectious and noninfectious diseases and promote immunization; high risk care package to manage preeclampsia and eclampsia in pregnancy; childbirth package to promote support during labor and importance of skilled birth attendance during labor; essential newborn care package to support healthy newborn care practices; and child health care package to prevent and manage infections. This paper further discussed the implementation strategies for employing these interventions at scale. PMID:25178110

  12. Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review

    PubMed Central

    Coast, Ernestina; Jones, Eleri; Lattof, Samantha R; Portela, Anayda

    2016-01-01

    Addressing cultural factors that affect uptake of skilled maternity care is recognized as an important step in improving maternal and newborn health. This article describes a systematic review to examine the evidence available on the effects of interventions to provide culturally appropriate maternity care on the use of skilled maternity care during pregnancy, for birth or in the postpartum period. Items published in English, French and/or Spanish between 1 January 1990 and 31 March 2014 were considered. Fifteen studies describing a range of interventions met the inclusion criteria. Data were extracted on population and intervention characteristics; study design; definitions and data for relevant outcomes; and the contexts and conditions in which interventions occurred. Because most of the included studies focus on antenatal care outcomes, evidence of impact is particularly limited for care seeking for birth and after birth. Evidence in this review is clustered within a small number of countries, and evidence from low- and middle-income countries is notably lacking. Interventions largely had positive effects on uptake of skilled maternity care. Cultural factors are often not the sole factor affecting populations’ use of maternity care services. Broader social, economic, geographical and political factors interacted with cultural factors to affect targeted populations’ access to services in included studies. Programmes and policies should seek to establish an enabling environment and support respectful dialogue with communities to improve use of skilled maternity care. Whilst issues of culture are being recognized by programmes and researchers as being important, interventions that explicitly incorporate issues of culture are rarely evaluated. PMID:27190222

  13. Psychological Intervention in Primary Care After Earthquakes in Lorca, Spain

    PubMed Central

    Garriga, Ascensión; Egea, Carmen

    2015-01-01

    Objective: After the earthquakes that occurred in Lorca, Spain, on May 11, 2011, the regional mental health management employed 2 clinical psychologists for 6 months to provide care to people referred by primary care physicians. The objective was to address the expected increased demand for treatment of mental disorders, notably posttraumatic stress disorder (PTSD) and adjustment disorders. Method: Referred individuals were evaluated and treated according to a clinical protocol designed ad hoc from June 12, 2011, to November 30, 2011. The protocol provided a stepped intervention guided by clinical and psychometric assessment using “normalization” for those with no psychiatric diagnosis, brief group treatment for mild to moderate PTSD or adjustment disorders, individual treatment for more severe PTSD, and referral to the local mental health center for other mental health disorders. Standard adult and child scales to assess posttraumatic, depression, and anxiety symptoms and resilience were used at initial assessment to guide treatment allocation and repeated to assess outcome status. Psychologists also provided a clinical assessment of symptom resolution at the end of the study. Results: Rates of symptom resolution and improvements on all scales (PTSD, depression, anxiety, and resilience) demonstrated clinically and statistically significant improvement in all treatment groups (P = .000). Dropout was low. Medications were prescribed frequently to adults; no child received medication as a result of the earthquakes. No case of mental disorder related to the earthquakes was referred to the local mental health center during the 6 months of psychologist intervention. Conclusion:The structured intervention resulted in a high resolution of cases and low dropout, allowing treatment of a larger number of people with optimal frequency (weekly), devoting more time to the most severe cases and less to those moderately or mildly affected. PMID:26137356

  14. Risk factors associated with children lost to care in a state early childhood intervention program.

    PubMed

    Giannoni, Peggy P; Kass, Philip H

    2010-01-01

    A retrospective cohort study was conducted to identify risk factors associated with children lost to care, and their families, compared to those not lost to care within the California Early Start Program. The cohort included data on 8987 children enrolled in the Early Start Program in 1998. This cohort consisted of 2443 children lost to care, 6363 children not lost to care, and 187 children that were lost to follow-up due to death or moving outside the state of California. Premature birth was the only medical risk factor in this study related to an increased risk of loss. Family risk factors exert a significant effect on loss to care. Risk factors that are predictive of loss to care include mother's age and educational level, Medi-Cal ineligibility, and lack of transportation. By identifying and examining risk factors for loss to care, interventions may be strengthened to promote continued family participation in early intervention services.

  15. Electronically delivered, multicomponent intervention to reduce unnecessary antibiotic prescribing for respiratory infections in primary care: a cluster randomised trial using electronic health records—REDUCE Trial study original protocol

    PubMed Central

    Juszczyk, Dorota; Charlton, Judith; McDermott, Lisa; Soames, Jamie; Sultana, Kirin; Ashworth, Mark; Fox, Robin; Hay, Alastair D; Little, Paul; Moore, Michael V; Yardley, Lucy; Prevost, A Toby; Gulliford, Martin C

    2016-01-01

    Introduction Respiratory tract infections (RTIs) account for about 60% of antibiotics prescribed in primary care. This study aims to test the effectiveness, in a cluster randomised controlled trial, of electronically delivered, multicomponent interventions to reduce unnecessary antibiotic prescribing when patients consult for RTIs in primary care. The research will specifically evaluate the effectiveness of feeding back electronic health records (EHRs) data to general practices. Methods and analysis 2-arm cluster randomised trial using the EHRs of the Clinical Practice Research Datalink (CPRD). General practices in England, Scotland, Wales and Northern Ireland are being recruited and the general population of all ages represents the target population. Control trial arm practices will continue with usual care. Practices in the intervention arm will receive complex multicomponent interventions, delivered remotely to information systems, including (1) feedback of each practice's antibiotic prescribing through monthly antibiotic prescribing reports estimated from CPRD data; (2) delivery of educational and decision support tools; (3) a webinar to explain and promote effective usage of the intervention. The intervention will continue for 12 months. Outcomes will be evaluated from CPRD EHRs. The primary outcome will be the number of antibiotic prescriptions for RTIs per 1000 patient years. Secondary outcomes will be: the RTI consultation rate; the proportion of consultations for RTI with an antibiotic prescribed; subgroups of age; different categories of RTI and quartiles of intervention usage. There will be more than 80% power to detect an absolute reduction in antibiotic prescription for RTI of 12 per 1000 registered patient years. Total healthcare usage will be estimated from CPRD data and compared between trial arms. Ethics and dissemination Trial protocol was approved by the National Research Ethics Service Committee (14/LO/1730). The pragmatic design of the trial

  16. Health care personnel's experiences of a bereavement follow-up intervention for grieving parents.

    PubMed

    Liisa, Aho Anna; Marja-Terttu, Tarkka; Päivi, Åstedt-Kurki; Marja, Kaunonen

    2011-06-01

    The aim of this study is to investigate the experiences of health care personnel of a bereavement follow-up intervention for grieving parents and of the ways to develop it. The intervention included three components: a support package for grieving parents, peer supporters' and health care personnel's contact with parents. The sample included 29 health professionals. Data were collected via open-format questionnaires and telephone interviews from health care personnel. Content analysis was used as a means of data analysis. The support package for grieving parents was considered important and versatile. Health care personnel perceived the intervention and its viability as mostly good. Parents' willingness to receive support, health care personnel's good resources and organizational preconditions were important for the follow-up contact. The intervention clarified the policy related to supporting grieving parents. It was enabled by a good attitude, shift arrangements and co-worker support. However, the implementation was considered difficult because of scarce resources. Parental support engendered negative feelings in health care personnel and they desired systematic supervision to deal with these. Follow-up care of grieving parents is a demanding task. Continuous education about bereavement follow-up care and systematic supervision to health care personnel is needed. Family-focused care in supporting grieving families after leaving from hospital should be increased. Inter-organizational cooperation in supporting parents is important and feasible. PMID:21039718

  17. Collaborative Interventions for Circulation and Depression (COINCIDE): study protocol for a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease

    PubMed Central

    2012-01-01

    Background Depression is up to two to three times as common in people with long-term conditions. It negatively affects medical management of disease and self-care behaviors, and leads to poorer quality of life and high costs in primary care. Screening and treatment of depression is increasingly prioritized, but despite initiatives to improve access and quality of care, depression remains under-detected and under-treated, especially in people with long-term conditions. Collaborative care is known to positively affect the process and outcome of care for people with depression and long-term conditions, but its effectiveness outside the USA is still relatively unknown. Furthermore, collaborative care has yet to be tested in settings that resemble more naturalistic settings that include patient choice and the usual care providers. The aim of this study was to test the effectiveness of a collaborative-care intervention, for people with depression and diabetes/coronary heart disease in National Health Service (NHS) primary care, in which low-intensity psychological treatment services are delivered by the usual care provider - Increasing Access to Psychological Therapies (IAPT) services. The study also aimed to evaluate the cost-effectiveness of the intervention over 6 months, and to assess qualitatively the extent to which collaborative care was implemented in the intervention general practices. Methods This is a cluster randomized controlled trial of 30 general practices allocated to either collaborative care or usual care. Fifteen patients per practice will be recruited after a screening exercise to detect patients with recognized depression (≥10 on the nine-symptom Patient Health Questionnaire; PHQ-9). Patients in the collaborative-care arm with recognized depression will be offered a choice of evidence-based low-intensity psychological treatments based on cognitive and behavioral approaches. Patients will be case managed by psychological well-being practitioners

  18. Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers

    PubMed Central

    2013-01-01

    Background Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers. Methods/design The Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years. Discussion The intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes). Trial registration Clinical Trials Identifier: NCT01485627 PMID:23570278

  19. Considering care-seeking behaviors reveals important differences among HIV-positive women not engaged in care: implications for intervention.

    PubMed

    Blackstock, Oni J; Blank, Arthur E; Fletcher, Jason J; Verdecias, Niko; Cunningham, Chinazo O

    2015-01-01

    We sought to examine characteristics of HIV-positive women with varying levels of engagement in care and care-seeking behaviors. From 2010 to 2013, in a multi-site US-based study of engagement in care among HIV-positive women, we conducted baseline interviews, which included socio-demographic, clinical, and risk behavior characteristics, and barriers to care. We used multinomial logistic regression to compare differences among three distinct categories of 748 women: engaged in care; not engaged in care, but seeking care ("seekers"); and not engaged in care and not seeking care ("non-seekers"). Compared with women in care, seekers were more likely to be uninsured and to report fair or poor health status. In contrast, non-seekers were not only more likely to be uninsured, but, also, to report current high-risk drug use and sexual behaviors, and less likely to report transportation as a barrier to care. Examining care-seeking behaviors among HIV-positive women not engaged in care revealed important differences in high-risk behaviors. Because non-seekers represent a particularly vulnerable population of women who are not engaged in care, interventions targeting this population likely need to address drug use and be community-based given their limited interaction with the health care system. PMID:25561307

  20. The Role of a Caring-Based Intervention in a Physical Activity Setting

    ERIC Educational Resources Information Center

    Newton, Maria; Watson, Doris L.; Gano-Overway, Lori; Fry, Mary; Kim, Mi-Sook; Magyar, Michelle

    2007-01-01

    This preliminary study examined the effect of a caring-based versus a traditionally-focused physical activity intervention on underserved adolescents' perceptions of the caring climate, the motivational climate, empathetic concern, enjoyment, and future anticipated participation. Multiethnic youth (N = 353) aged 9 to 17 involved in two National…

  1. Young Adult Outcomes of the Abecedarian and CARE Early Childhood Educational Interventions

    ERIC Educational Resources Information Center

    Campbell, Frances A.; Wasik, Barbara H.; Pungello, Elizabeth; Burchinal, Margaret; Barbarin, Oscar; Kainz, Kirsten; Sparling, Joseph J.; Ramey, Craig T.

    2008-01-01

    Adult benefits for participants in Project CARE were compared with those of the Abecedarian Project, a closely related randomized study of early childhood educational intervention for children from low-income families who were at risk of developmental delays and school failure. CARE replicated Abecedarian's young adult treatment-related…

  2. The PRESLO study: evaluation of a global secondary low back pain prevention program for health care personnel in a hospital setting. Multicenter, randomized intervention trial

    PubMed Central

    2012-01-01

    Background Common low back pain represents a major public health problem in terms of its direct cost to health care and its socio-economic repercussions. Ten percent of individuals who suffer from low back pain evolve toward a chronic case and as such are responsible for 75 to 80% of the direct cost of low back pain. It is therefore imperative to highlight the predictive factors of low back pain chronification in order to lighten the economic burden of low back pain-related invalidity. Despite being particularly affected by low back pain, Hospices Civils de Lyon (HCL) personnel have never been offered a specific, tailor-made treatment plan. The PRESLO study (with PRESLO referring to Secondary Low Back Pain Prevention, or in French, PREvention Secondaire de la LOmbalgie), proposed by HCL occupational health services and the Centre Médico-Chirurgical et de Réadaptation des Massues – Croix Rouge Française, is a randomized trial that aims to evaluate the feasibility and efficiency of a global secondary low back pain prevention program for the low back pain sufferers among HCL hospital personnel, a population at risk for recurrence and chronification. This program, which is based on the concept of physical retraining, employs a multidisciplinary approach uniting physical activity, cognitive education about low back pain and lumbopelvic morphotype analysis. No study targeting populations at risk for low back pain chronification has as yet evaluated the efficiency of lighter secondary prevention programs. Methods/Design This study is a two-arm parallel randomized controlled trial proposed to all low back pain sufferers among HCL workers, included between October 2008 and July 2011 and followed over two years. The personnel following their usual treatment (control group) and those following the global prevention program in addition to their usual treatment (intervention group) are compared in terms of low back pain recurrence and the impairments measured at the

  3. Satisfaction with Hospital Care and Interventions after Pregnancy Loss.

    ERIC Educational Resources Information Center

    Lasker, Judith N.; Toedter, Lori J.

    1994-01-01

    Conducted longitudinal study of 194 women and men who experienced miscarriage, ectopic pregnancy, stillbirth, or newborn death to examine recommended interventions. Subjects were more satisfied if they had experienced intervention than if they had not, but having experienced more total interventions was not associated with lower grief or greater…

  4. [Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units].

    PubMed

    Bambi, Stefano; Lucchini, Alberto; Solaro, Massimo; Lumini, Enrico; Rasero, Laura

    2014-01-01

    Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units. Over the past 15 years, the model of medical and nursing care changed from being exclusively oriented to the diagnosis and treatment of acute illness, to the achievement of outcomes by preventing iatrogenic complications (Hospital Acquired Conditions). Nursing Sensitive Outcomes show as nursing is directly involved in the development and prevention of these complications. Many of these complications, including falls from the bed, use of restraints, urinary catheter associated urinary infections and intravascular catheter related sepsis, are related to basic nursing care. Ten years ago in critical care, a school of thought called get back to the basics, was started for the prevention of errors and risks associated with nursing. Most of these nursing practices involve hygiene and mobilization. On the basis of these reflections, Kathleen Vollman developed a model of nursing care in critical care area, defined Interventional Patient Hygiene (IPH). The IPH model provides a proactive plan of nursing interventions to strengthen the patients' through the Evidence-Based Nursing Care. The components of the model include interventions of oral hygiene, mobilization, dressing changes, urinary catheter care, management of incontinence and bed bath, hand hygiene and skin antisepsis. The implementation of IPH model follows the steps of Deming cycle, and requires a deep reflection on the priorities of nursing care in ICU, as well as the effective teaching of the importance of the basic nursing to new generations of nurses.

  5. Design and Feasibility of a Randomized Behavioral Intervention to Reduce Distributive Injection Risk and Improve Health-Care Access Among hepatitisC virus Positive Injection Drug Users: The Study to Reduce Intravenous Exposures (STRIVE)

    PubMed Central

    Latka, Mary H.; Hagan, Holly; Golub, Elizabeth T.; Campbell, Jennifer V.; Coady, Micaela H.; Garfein, Richard S.; Thomas, David L.; Bonner, Sebastian; Thiel, Thelma; Strathdee, Steffanie A.

    2007-01-01

    Hepatitis C virus (HCV) is hyperendemic among injection drug users (IDUs). However, few scientifically proven interventions to prevent secondary transmission of HCV from infected IDUs to others exist. This report describes the design, feasibility, and baseline characteristics of participants enrolled in the Study to Reduce Intravenous Exposure (STRIVE). STRIVE was a multisite, randomized-control trial to test a behavioral intervention developed to reduce distribution of used injection equipment (needles, cookers, cottons, and rinse water) and increase health-care utilization among antibody HCV (anti-HCV) positive IDUs. STRIVE enrolled anti-HCV positive IDU in Baltimore, New York City, and Seattle; participants completed behavioral assessments and venipuncture for HIV, HCV-RNA, and liver function tests (LFTs) and were randomized to attend either a six-session, small-group, peer-mentoring intervention workshop or a time-matched, attention-control condition. Follow-up visits were conducted at 3 and 6 months. At baseline, of the 630 HCV-positive IDUs enrolled (mean age of 26 years, 60% white, 76% male), 55% reported distributive needle sharing, whereas 74, 69, and 69% reported sharing cookers, cottons, and rinse water, respectively. Health-care access was low, with 41% reporting an emergency room as their main source of medical care. Among those enrolled, 66% (418/630) were randomized: 53% (222/418) and 47% (196/418) to the intervention and control conditions, respectively. Follow-up rates were 70 and 73% for the 3- and 6-month visits, respectively. As distributive sharing of used injection equipment was common while reports of receiving HCV care were low, these findings indicate an urgent need for HCV-related interventions with IDUs and demonstrate the acceptability and feasibility to do so. PMID:17200799

  6. Technology-based interventions in health care.

    PubMed

    Kane, J M

    2014-12-01

    There are several converging forces that create a particularly opportune time for technological solutions to enhance cost efficiency in healthcare. Health care costs are unsustainable, yet many patients do not have adequate access to state-of-the-art treatments or to ongoing disease management. Consumerism is an increasingly powerful force in healthcare and the emphasis on personalised medicine will help to define future research and clinical treatment strategies. At the same time, the phenomenal advances in internet utilisation and mobile device applications provide possibilities that have never before existed. We have reason to be very optimistic about these opportunities, but appropriate research will be required to develop scalable and sustainable methods as well as determine expected outcomes. PMID:25154596

  7. Maternity Care Services and Culture: A Systematic Global Mapping of Interventions

    PubMed Central

    Coast, Ernestina; Jones, Eleri; Portela, Anayda; Lattof, Samantha R.

    2014-01-01

    Background A vast body of global research shows that cultural factors affect the use of skilled maternity care services in diverse contexts. While interventions have sought to address this issue, the literature on these efforts has not been synthesised. This paper presents a systematic mapping of interventions that have been implemented to address cultural factors that affect women's use of skilled maternity care. It identifies and develops a map of the literature; describes the range of interventions, types of literature and study designs; and identifies knowledge gaps. Methods and Findings Searches conducted systematically in ten electronic databases and two websites for literature published between 01/01/1990 and 28/02/2013 were combined with expert-recommended references. Potentially eligible literature included journal articles and grey literature published in English, French or Spanish. Items were screened against inclusion and exclusion criteria, yielding 96 items in the final map. Data extracted from the full text documents are presented in tables and a narrative synthesis. The results show that a diverse range of interventions has been implemented in 35 countries to address cultural factors that affect the use of skilled maternity care. Items are classified as follows: (1) service delivery models; (2) service provider interventions; (3) health education interventions; (4) participatory approaches; and (5) mental health interventions. Conclusions The map provides a rich source of information on interventions attempted in diverse settings that might have relevance elsewhere. A range of literature was identified, from narrative descriptions of interventions to studies using randomised controlled trials to evaluate impact. Only 23 items describe studies that aim to measure intervention impact through the use of experimental or observational-analytic designs. Based on the findings, we identify avenues for further research in order to better document and measure

  8. Behavioral interventions for office-based care: interventions in the family medicine setting.

    PubMed

    Larzelere, Michele McCarthy

    2014-03-01

    The practice of family medicine includes the care of many patients with mental health or behavior change needs. Patients in mild to moderate distress may benefit from brief interventions performed in the family physician's office. Patients in more extreme distress may be helped by referral to behavioral health clinicians for short-term or open-ended therapies. Electronic therapy programs and bibliotherapy are also useful resources. The transition to the patient-centered medical home model may allow for more widespread integration of behavioral health care clinicians into primary care, in person and through telemental health care. Integrated care holds the promise of improved access, greater effectiveness of behavioral health service provision, and enhanced efficiency of primary care for patients with behavioral health care needs.

  9. Cancer Health Empowerment for Living without Pain (Ca-HELP): study design and rationale for a tailored education and coaching intervention to enhance care of cancer-related pain

    PubMed Central

    2009-01-01

    Background Cancer-related pain is common and under-treated. This article describes a study designed to test the effectiveness of a theory-driven, patient-centered coaching intervention to improve cancer pain processes and outcomes. Methods/Design The Cancer Health Empowerment for Living without Pain (Ca-HELP) Study is an American Cancer Society sponsored randomized trial conducted in Sacramento, California. A total of 265 cancer patients with at least moderate pain severity (Worst Pain Numerical Analog Score >=4 out of 10) or pain-related impairment (Likert score >= 3 out of 5) were randomly assigned to receive tailored education and coaching (TEC) or educationally-enhanced usual care (EUC); 258 received at least one follow-up assessment. The TEC intervention is based on social-cognitive theory and consists of 6 components (assess, correct, teach, prepare, rehearse, portray). Both interventions were delivered over approximately 30 minutes just prior to a scheduled oncology visit. The majority of visits (56%) were audio-recorded for later communication coding. Follow-up data including outcomes related to pain severity and impairment, self-efficacy for pain control and for patient-physician communication, functional status and well-being, and anxiety were collected at 2, 6, and 12 weeks. Discussion Building on social cognitive theory and pilot work, this study aims to test the hypothesis that a brief, tailored patient activation intervention will promote better cancer pain care and outcomes. Analyses will focus on the effects of the experimental intervention on pain severity and impairment (primary outcomes); self-efficacy and quality of life (secondary outcomes); and relationships among processes and outcomes of cancer pain care. If this model of coaching by lay health educators proves successful, it could potentially be implemented widely at modest cost. Trial Registration [Clinical Trials Identifier: NCT00283166] PMID:19737424

  10. Reductions in Inpatient Mortality following Interventions to Improve Emergency Hospital Care in Freetown, Sierra Leone

    PubMed Central

    Clark, Matthew; Spry, Emily; Daoh, Kisito; Baion, David; Skordis-Worrall, Jolene

    2012-01-01

    Background The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children's hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated. Methods and Findings A team of local and international staff developed a plan to improve emergency care for children arriving at The Ola During Children's Hospital, Freetown, Sierra Leone. Following focus group discussions, five priority areas were identified to improve emergency care; staff training, hospital layout, staff allocation, medical equipment, and medical record keeping. A team of international volunteers worked with local staff for six months to design and implement improvements in these five priority areas. The improvements were evaluated collectively rather than individually. Before the intervention, the inpatient mortality rate was 12.4%. After the intervention this improved to 5.9%. The relative risk of dying was 47% (95% CI 0.369–0.607) lower after the intervention. The estimated number of lives saved in the first two months after the intervention was 103. The total cost of the intervention was USD 29 714, the estimated cost per death averted was USD 148. There are two main limitation of the study. Firstly, the brevity of the study and secondly, the assumed homogeneity of the clinical cases that presented to the hospital before and after the intervention. Conclusions This study demonstarted a signficant reductuion in inpatient mortality rate after an intervention to improve emergency hospital care If the findings of this paper could be reproduced in a larger more rigorous study, improving the quality of care in hospitals would be a very cost effective strategy to save children's lives in low resource settings. PMID:23028427

  11. From Efficacy to Effectiveness and Beyond: What Next for Brief Interventions in Primary Care?

    PubMed Central

    O’Donnell, Amy; Wallace, Paul; Kaner, Eileen

    2014-01-01

    Background: Robust evidence supports the effectiveness of screening and brief alcohol interventions in primary healthcare. However, lack of understanding about their “active ingredients” and concerns over the extent to which current approaches remain faithful to their original theoretical roots has led some to demand a cautious approach to future roll-out pending further research. Against this background, this paper provides a timely overview of the development of the brief alcohol intervention evidence base to assess the extent to which it has achieved the four key levels of intervention research: efficacy, effectiveness, implementation, and demonstration. Methods: Narrative overview based on (1) the results of a review of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare and (2) synthesis of the findings of key additional primary studies on the improvement and evaluation of brief alcohol intervention implementation in routine primary healthcare. Results: The brief intervention field seems to constitute an almost perfect example of the evaluation of a complex intervention. Early evaluations of screening and brief intervention approaches included more tightly controlled efficacy trials and have been followed by more pragmatic trials of effectiveness in routine clinical practice. Most recently, attention has shifted to dissemination, implementation, and wider-scale roll-out. However, delivery in routine primary health remains inconsistent, with an identified knowledge gap around how to successfully embed brief alcohol intervention approaches in mainstream care, and as yet unanswered questions concerning what specific intervention component prompt the positive changes in alcohol consumption. Conclusion: Both the efficacy and effectiveness of brief alcohol interventions have been comprehensively demonstrated, and intervention effects seem replicable and stable over time, and across different study

  12. The role of conversation in health care interventions: enabling sensemaking and learning

    PubMed Central

    Jordan, Michelle E; Lanham, Holly J; Crabtree, Benjamin F; Nutting, Paul A; Miller, William L; Stange, Kurt C; McDaniel, Reuben R

    2009-01-01

    Background Those attempting to implement changes in health care settings often find that intervention efforts do not progress as expected. Unexpected outcomes are often attributed to variation and/or error in implementation processes. We argue that some unanticipated variation in intervention outcomes arises because unexpected conversations emerge during intervention attempts. The purpose of this paper is to discuss the role of conversation in shaping interventions and to explain why conversation is important in intervention efforts in health care organizations. We draw on literature from sociolinguistics and complex adaptive systems theory to create an interpretive framework and develop our theory. We use insights from a fourteen-year program of research, including both descriptive and intervention studies undertaken to understand and assist primary care practices in making sustainable changes. We enfold these literatures and these insights to articulate a common failure of overlooking the role of conversation in intervention success, and to develop a theoretical argument for the importance of paying attention to the role of conversation in health care interventions. Discussion Conversation between organizational members plays an important role in the success of interventions aimed at improving health care delivery. Conversation can facilitate intervention success because interventions often rely on new sensemaking and learning, and these are accomplished through conversation. Conversely, conversation can block the success of an intervention by inhibiting sensemaking and learning. Furthermore, the existing relationship contexts of an organization can influence these conversational possibilities. We argue that the likelihood of intervention success will increase if the role of conversation is considered in the intervention process. Summary The generation of productive conversation should be considered as one of the foundations of intervention efforts. We suggest

  13. Partners in Dementia Care: A Care Coordination Intervention for Individuals with Dementia and Their Family Caregivers

    ERIC Educational Resources Information Center

    Judge, Katherine S.; Bass, David M.; Snow, A. Lynn; Wilson, Nancy L.; Morgan, Robert; Looman, Wendy J.; McCarthy, Catherine; Kunik, Mark E.

    2011-01-01

    Purpose: This article provides a detailed description of a telephone-based care coordination intervention, Partners in Dementia Care (PDC), for veterans with dementia and their family caregivers. Essential features of PDC included (a) formal partnerships between Veterans Affairs (VA) medical centers and Alzheimer's Association Chapters; (b) a…

  14. Development of the Serious Illness Care Program: a randomised controlled trial of a palliative care communication intervention

    PubMed Central

    Bernacki, Rachelle; Hutchings, Mathilde; Vick, Judith; Smith, Grant; Paladino, Joanna; Lipsitz, Stuart; Gawande, Atul A; Block, Susan D

    2015-01-01

    Introduction Ensuring that patients receive care that is consistent with their goals and values is a critical component of high-quality care. This article describes the protocol for a cluster randomised controlled trial of a multicomponent, structured communication intervention. Methods and analysis Patients with advanced, incurable cancer and life expectancy of <12 months will participate together with their surrogate. Clinicians are enrolled and randomised either to usual care or the intervention. The Serious Illness Care Program is a multicomponent, structured communication intervention designed to identify patients, train clinicians to use a structured guide for advanced care planning discussion with patients, ‘trigger’ clinicians to have conversations, prepare patients and families for the conversation, and document outcomes of the discussion in a structured format in the electronic medical record. Clinician satisfaction with the intervention, confidence and attitudes will be assessed before and after the intervention. Self-report data will be collected from patients and surrogates approximately every 2 months up to 2 years or until the patient's death; patient medical records will be examined at the close of the study. Analyses will examine the impact of the intervention on the patient receipt of goal-concordant care, and peacefulness at the end of life. Secondary outcomes include patient anxiety, depression, quality of life, therapeutic alliance, quality of communication, and quality of dying and death. Key process measures include frequency, timing and quality of documented conversations. Ethics and dissemination This study was approved by the Dana-Farber Cancer Institute Institutional Review Board. Results will be reported in peer-reviewed publications and conference presentations. Trial registration number Protocol identifier NCT01786811; Pre-results. PMID:26443662

  15. The integration of behavioral health interventions in children's health care: services, science, and suggestions.

    PubMed

    Kolko, David J; Perrin, Ellen

    2014-01-01

    Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.

  16. Cost-effectiveness of a Multicondition Collaborative Care Intervention

    PubMed Central

    Katon, Wayne; Russo, Joan; Lin, Elizabeth H. B.; Schmittdiel, Julie; Ciechanowski, Paul; Ludman, Evette; Peterson, Do; Young, Bessie; Von Korff, Michael

    2013-01-01

    Context Patients with depression and poorly controlled diabetes mellitus, coronary heart disease (CHD), or both have higher medical complication rates and higher health care costs, suggesting that more effective care management of psychiatric and medical disease control might also reduce medical service use and enhance quality of life. Objective To evaluate the cost-effectiveness of a multicondition collaborative treatment program (TEAM-care) compared with usual primary care (UC) in outpatients with depression and poorly controlled diabetes or CHD. Design Randomized controlled trial of a systematic care management program aimed at improving depression scores and hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) levels. Setting Fourteen primary care clinics of an integrated health care system. Patients Population-based screening identified 214 adults with depressive disorder and poorly controlled diabetes or CHD. Intervention Physician-supervised nurses collaborated with primary care physicians to provide treatment of multiple disease risk factors. Main Outcome Measures Blinded assessments evaluated depressive symptoms, SBP, and HbA1c at baseline and at 6, 12, 18, and 24 months. Fasting LDL-C concentration was assessed at baseline and at 12 and 24 months. Health plan accounting records were used to assess medical service costs. Quality-adjusted life-years (QALYs) were assessed using a previously developed regression model based on intervention vs UC differences in HbA1c, LDL-C, and SBP levels over 24 months. Results Over 24 months, compared with UC controls, intervention patients had a mean of 114 (95% CI, 79 to 149) additional depression-free days and an estimated 0.335 (95% CI, −0.18 to 0.85) additional QALYs. Intervention patients also had lower mean outpatient health costs of $594 per patient (95% CI, −$3241 to $2053) relative to UC patients. Conclusions For adults with depression and poorly controlled

  17. The effects of early foster care intervention on attention biases in previously institutionalized children in Romania.

    PubMed

    Troller-Renfree, Sonya; McDermott, Jennifer Martin; Nelson, Charles A; Zeanah, Charles H; Fox, Nathan A

    2015-09-01

    Children raised in institutions experience psychosocial deprivation that can negatively impact attention skills and emotion regulation, which subsequently may influence behavioral regulation and social relationships. The current study examined visual attention biases in 8-year-old children who were part of the Bucharest Early Intervention Project (BEIP). Relations among attention biases and concurrent social outcomes were also investigated. In early childhood, 136 children abandoned at birth or shortly thereafter into institutional care were randomized to receive a high-quality foster care intervention or care-as-usual within the context of the Bucharest Early Intervention Project (BEIP). At 8 years of age, 50 care-as-usual, 55 foster care, and 52 community controls performed a behavioral dot-probe task, and indices of attention biases to threat and positive stimuli were calculated. Concurrent data on social behavior were collected. Children placed into the foster care intervention had a significant attention bias toward positive stimuli, while children who received care-as-usual had a significant bias toward threat. Children in the foster care intervention had a significantly larger positive bias when compared to the care-as-usual group. A positive bias was related to more social engagement, more prosocial behavior, less externalizing disorders, and less emotionally withdrawn behavior. The magnitude of positive bias was predicted by age of placement into foster care among children with a history of institutionalization. An attention bias towards positive stimuli was associated with reduced risk for behavioral problems amongst children who experienced early psychosocial deprivation. Research assessing attention biases in children experiencing early environmental stress may refine our understanding of the mechanisms underlying risk for later psychiatric and social disorders and inform prevention efforts.

  18. A Review of Primary Care-Based Childhood Obesity Prevention and Treatment Interventions

    PubMed Central

    Olson-Bullis, Barbara A.; Bredeson, Dani M.; Hayes, Marcia G.; Sherwood, Nancy E.

    2015-01-01

    Effective obesity prevention and treatment interventions targeting children and their families are needed to help curb the obesity epidemic. Pediatric primary care is a promising setting for these interventions, and a growing number of studies are set in this context. This review aims to identify randomized controlled trials of pediatric primary care-based obesity interventions. A literature search of 3 databases retrieved 2947 publications, of which 2899 publications were excluded after abstract (n=2722) and full-text review (n=177). Forty-eight publications, representing 31 studies, were included in the review. Eight studies demonstrated a significant intervention effect on child weight outcomes (e.g., BMI z-score, weight-for-length percentile). Effective interventions were mainly treatment interventions, and tended to focus on multiple behaviors, contain weight management components, and include monitoring of weight-related behaviors (e.g., dietary intake, physical activity, or sedentary behaviors). Overall, results demonstrate modest support for the efficacy of obesity treatment interventions set in primary care. PMID:26213643

  19. The Implementation of an Evidence-Based Bundle for Bloodstream Infections in Neonatal Intensive Care Units in Germany: A Controlled Intervention Study to Improve Patient Safety.

    PubMed

    Salm, Florian; Schwab, Frank; Geffers, Christine; Gastmeier, Petra; Piening, Brar

    2016-07-01

    OBJECTIVE To improve the patient safety of very-low-birthweight infants in neonatal departments in Germany. DESIGN Multicenter cohort study with a baseline (24 months), an intervention (12 months), and a postinterventional follow-up period (12 months) and time series analysis. STUDY POPULATION Very-low-birthweight patients from 32 neonatal departments in Germany. METHODS Neonatal departments showing a standardized infection ratio of bloodstream infection 10% higher than the expected number (standardized infection ratio ≥1.1) were invited to participate in the study. To reduce the occurrence of primary bloodstream infections, evidence-based bundles to improve catheter maintenance routines, insertion practice, and hand-hygiene compliance were implemented in the participating infirmaries. RESULTS Thirty-four departments participated in the study and 32 reported data. In total, 6,222 very-low-birthweight infants with 231,868 patient-days and 1,405 cases of bloodstream infections were analyzed. In the baseline period the pooled mean bloodstream infection rate was 6.63 (95% CI, 6.17-7.12) per 1,000 patient-days. The bloodstream infection rate decreased in the intervention period to 5.68 (relative risk, 0.86 [95% CI, 0.76-0.97]) and in the 1-year follow-up period to 5.31 per 1,000 patient-days (relative risk, 0.80 [95% CI, 0.70-0.92]). The multivariable time series analysis of monthly aggregated data showed a significant change in the slope for the frequency of bloodstream infections from the start to the end of the intervention (change in slope incidence rate ratio, 0.97; P=.001). CONCLUSION The implementation of an intervention bundle is feasible and can reduce bloodstream infections in neonatal departments. Infect Control Hosp Epidemiol 2016;37:798-804.

  20. Interventional pain management in the palliative care patient.

    PubMed

    McHugh, Marlene E; Miller-Saultz, Debbie; Wuhrman, Elsa; Kosharskyy, Boleslav

    2012-09-01

    For the majority of patients, cancer pain can be treated using the World Health Organization cancer pain guidelines; however, for 10-20% of patients with advanced cancer, adequate pain control cannot be achieved using these methods owing to disease pathophysiology preventing administration/absorption of pain medications or intolerance due to opioid toxicities. The need to expand analgesic treatment when oral, transdermal, and intravenous therapies fail requires exploration of interventional pain management techniques such as neuraxial (e.g. epidural and intrathecal) infusion therapies and neurolytic interventions. Nurses caring for patients with cancer pain should develop their knowledge of these multimodal approaches to cancer pain management.

  1. Music therapy in critical care: indications and guidelines for intervention.

    PubMed

    Chlan, L; Tracy, M F

    1999-06-01

    Music therapy is an effective intervention for critically ill patients for such purposes as anxiety reduction and stress management. The therapy is readily accepted by patients and is an intervention patients thoroughly enjoy. The MAIT is one resource that nurses caring for critically ill patients can use to implement music therapy in clinical practice. Patients can be given the opportunity to select a musical tape they prefer and to negotiate with the nurse for uninterrupted music-listening periods. Allowing patients control over music selection and providing uninterrupted time for music listening gives the patients an enhanced sense of control in an environment that often controls them.

  2. Successful GP intervention with frequent attenders in primary care: randomised controlled trial

    PubMed Central

    Bellón, Juan Ángel; Rodríguez-Bayón, Antonina; de Dios Luna, Juan; Torres-González, Francisco

    2008-01-01

    Background Frequent attenders to GP clinics can place an unnecessary burden on primary care. Interventions to reduce frequent attendance have had mixed results. Aim To assess the effectiveness of a GP intervention to reduce frequent-attender consultations. Design of study Randomised controlled trial with frequent attenders divided into an intervention group and two control groups (one control group was seen by GPs also providing care to patients undergoing the intervention). Setting A health centre in southern Spain. Method Six GPs and 209 randomly-selected frequent attenders participated. Three GPs were randomly allocated to perform the new intervention: of the 137 frequent attenders registered with these three GPs, 66 were randomly allocated to receive the intervention (IG) and 71 to a usual care control group (CG2). The other three GPs offered usual care to the other 72 frequent attenders (CG1). The main outcome measure was the total number of consultations 1 year post-intervention. Baseline measurements were recorded of sociodemographic characteristics, provider–user interface, chronic illnesses, and psychosocial variables. GPs allocated to the new intervention received 15 hours' training which incorporated biopsychosocial, organisational, and relational approaches. After 1 year of follow-up frequent attenders were contacted. An intention-to-treat analysis was used. Results A multilevel model was built with three factors: time, patient, and doctor. After adjusting for covariates, the mean number of visits at 1 year in IG was 13.10 (95% confidence interval [CI] = 11.39 to 14.94); in the CG1 group was 19.37 (95% CI = 17.31 to 21.55); and in the CG2 group this was 16.72 (95% CI =14.84 to 18.72). Conclusion The new intervention with GPs resulted in a significant and relevant reduction in frequent-attender consultations. Although further trials are needed, this intervention is recommended to GPs interested in reducing consultations by their frequent attenders

  3. Issues in health care: interventional pain management at the crossroads.

    PubMed

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2007-03-01

    Emerging strategies in health care are extremely important for interventional pain physicians, as well as with the payors in various categories. While most Americans, including the US Congress and Administration, are looking for ways to provide affordable health care, the process of transformation and emerging health care strategies are troubling for physicians in general, and interventional pain physicians in particular. With the new Congress, only new issues rather than absolute solutions seem to emerge. Interventional pain physicians will continue to face the very same issues in the coming years that they have faced in previous years including increasing national health care spending, physician payment reform, ambulatory surgery center reform, and pay for performance. The national health expenditure data continue to extend the spending pattern that has characterized the 21st century, with US health spending continuing to outpace inflation and accounting for a growing share of the national economy. Health care spending in 2005 was $2.0 trillion or $6,697 per person and represented 16% of the gross domestic product. In 2005, Medicare spending reached $342 billion, while Medicaid spending was $315 billion. Physician and clinical services occupied approximately 21% of all US health care spending in 2005, reaching $421.2 billion. Overall, health spending in the US is expected to double to $4.1 trillion by 2016, then consuming 20% of the nation's gross domestic product, up from the current 16%. It is predicted that by 2016 the government will be paying 48.7% of the nation's health care bill, up from 38% in 1970 and 40% in 1990. The Medicare Physician Payment system based on the Sustainable Growth Rate (SGR) formula continues to be a major issue for physicians. The Congressional Budget Office has projected budget implications of change in the SGR mechanism, with consideration for allowing payment rates to increase by the amount of medical inflation, costing Medicare an

  4. Effect of Foster Care on Language Learning at Eight Years: Findings from the Bucharest Early Intervention Project

    ERIC Educational Resources Information Center

    Windsor, Jennifer; Moraru, Ana; Nelson, Charles A., III.; Fox, Nathan A.; Zeanah, Charles H.

    2013-01-01

    This study reports on language outcomes at eight years from the Bucharest Early Intervention Project, a randomized controlled study of foster care. We previously have shown that children placed in foster care by age two have substantially stronger preschool language outcomes than children placed later and children remaining in institutional care.…

  5. Educational Intervention in End-of-Life Care: An Evidence-Based Analysis

    PubMed Central

    Nevis, I

    2014-01-01

    Background End-of-life care is a complex service. The education of health care providers, patients nearing end of life, and informal caregivers plays a vital role in increasing knowledge about the care options available. This review looks at whether education helps improve outcomes for patients nearing the end of life and for their informal caregivers. Objectives To systematically review and study the effectiveness of educational interventions for health care providers, patients nearing the end of life, and informal caregivers to improve patient and informal caregiver outcomes. Data Sources We performed a literature search using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews for studies published from January 1, 2003, to October 31, 2013. Review Methods We conducted this review according to published guidelines and using a prespecified protocol. We included primary studies that evaluated any educational intervention in end-of-life care for health care providers, patients, or informal caregivers and measured patient or informal caregiver quality of life using validated scales. Results The database search yielded 2,468 citations; we included 6 studies in the review. Studies reported on educational interventions for health care providers, patients nearing the end of life, and informal caregivers. After an educational intervention, patients nearing the end of life had better symptom control and informal caregivers had improved quality of life. However, there was no significant change in patient quality of life or pain control, or in informal caregiver or health care provider satisfaction. There was no decrease in resource utilization. Limitations Most studies did not report data adequately, did not define “routine care” and were not blinded. Allocation concealment was also inadequately reported. Conclusions Based on moderate quality evidence

  6. A systematic review of psychosocial interventions for family carers of palliative care patients

    PubMed Central

    2010-01-01

    Background Being a family carer to a patient nearing the end of their life is a challenging and confronting experience. Studies show that caregiving can have negative consequences on the health of family carers including fatigue, sleep problems, depression, anxiety and burnout. One of the goals of palliative care is to provide psychosocial support to patients and families facing terminal illness. A systematic review of interventions for family carers of cancer and palliative care patients conducted at the start of this millennium demonstrated that there was a dearth of rigorous inquiry on this topic and consequently limited knowledge regarding the types of interventions likely to be effective in meeting the complex needs of family carers. We wanted to discern whether or not the evidence base to support family carers has improved. Furthermore, undertaking this review was acknowledged as one of the priorities for the International Palliative Care Family Carer Research Collaboration http://www.centreforpallcare.org. Methods A systematic review was undertaken in order to identify developments in family carer support that have occurred over the last decade. The focus of the review was on interventions that targeted improvements in the psychosocial support of family carers of palliative care patients. Studies were graded to assess their quality. Results A total of fourteen studies met the inclusion criteria. The focus of interventions included psycho-education, psychosocial support, carer coping, symptom management, sleep promotion and family meetings. Five studies were randomised controlled trials, three of which met the criteria for the highest quality evidence. There were two prospective studies, five pre-test/post-test projects and two qualitative studies. Conclusions The systematic review identified a slight increase in the quality and quantity of psychosocial interventions conducted for family carers in the last decade. More rigorous intervention research is

  7. Primary Care Interventions to Prevent or Treat Traumatic Stress in Childhood: A Systematic Review

    PubMed Central

    Flynn, Anna; Fothergill, Kate E.; Wilcox, Holly C.; Coleclough, Elizabeth; Horwitz, Russell; Ruble, Anne; Burkey, Matthew D.; Wissow, Lawrence

    2015-01-01

    Background Primary care interventions addressing child traumatic stress exist but their range and effectiveness is unclear. Objectives To systematically assess the evidence base for prevention and treatment of child traumatic stress in primary care settings. Data Sources PubMed, Embase, PsycINFO, Scopus, Academic Search Complete, CINAHL, Web of Science, Cochrane Library, the National Registry of Evidence-based Programs and Practices, the National Child Traumatic Stress Network website, Google search. Study Eligibility Criteria, Participants, and Interventions Studies were eligible for inclusion if they described the results of intervention studies in a primary care setting addressing child traumatic stress. Study participants could include primary care providers, pediatric patients, and their parents or other caregivers. Study Appraisal and Synthesis Methods Each study was assessed for inclusion and each included study was assessed for risk of bias by two reviewers. Results We found 12 articles describing 10 different studies that met the inclusion criteria. The intervention approaches taken in the studies were diverse and included the implementation of screening programs/tools, training clinicians to recognize and discuss psychosocial issues with patients and their families, and providing primary care professionals with community resource lists. Nine out of 10 studies included in the review reported favorable results. Limitations Studies included in the review had relatively short follow-up periods and the diversity of studies identified precluded the possibility of conducting a meta-analysis. Conclusions and Implications of Key Findings Findings suggest that interventions in pediatric primary care settings are feasible and can favorably impact clinical practices and families’ outcomes. PMID:26344717

  8. Managing Depression Among Homeless Mothers: Pilot Testing an Adapted Collaborative Care Intervention

    PubMed Central

    Weinreb, Linda; Upshur, Carole C.; Fletcher-Blake, Debbian; Reed, George; Frisard, Christine

    2016-01-01

    Objective Although depression is common among homeless mothers, little progress has been made in testing treatment strategies for this group. We describe pilot test results of an adapted collaborative care model for homeless mothers with depression. Method We conducted a pilot intervention study of mothers screening positive for depression in 2 randomly selected shelter-based primary care clinics in New York over 18 months in 2010–2012. Study participants completed a psychosocial, health, and mental health assessment at baseline, 3 months, and 6 months. Results One-third of women screened positive for depression (123 of 328 women). Sixty-seven women (63.2% of the eligible sample) enrolled in the intervention. At 6 months, compared to usual-care women, intervention group women were more likely to be receiving depression treatment (40.0% vs 5.9%, P = .01) and antidepressant medication (73.3% vs 5.9%, P = .001, respectively) and had more primary care physician and care manager visits at both 3 months (74.3% vs 53.3%, P = .009 and 91.4% vs 26.7%, P < .001, respectively) and 6 months (46.7% vs 23.5%, P = .003 and 70% vs 17.7%, P = .001, respectively). More women in the intervention group compared to usual-care women reported ≥ 50% improvement in depression symptoms at 6 months (30% vs 5.9%, P = .07). Conclusions This pilot study found that implementing an adapted collaborative care intervention was feasible in a shelter-based primary care clinic and had promising results that require further testing. Trial Registration ClinicalTrials.gov identifier: NCT02723058 PMID:27486545

  9. Health care barriers and interventions for battered women.

    PubMed Central

    Loring, M T; Smith, R W

    1994-01-01

    Family violence is a major public health problem. Battered women present with multiple physical injuries in hospital emergency rooms, clinics, and personal physicians' offices. Yet, they are often not identified as battered and fail to receive appropriate treatment for the nonphysical effects of these events. Instead, only discrete physical injuries are identified. The authors explore the literature to identify barriers in recognizing and treating battered women. These barriers are viewed as a microcosm of the larger public health problem in which battered women fear identifying themselves and often are not recognized by public health professionals. Some barriers pertain to the victims themselves; others can be attributed to the attitudes of medical care providers in emergency rooms, clinics, and private physicians' offices. The many faceted needs of victims require a variety of interventions including medical models, criminal justice intervention systems, and social models for change. Some intervention strategies that are currently being employed in various programs in the United States are described. PMID:8190856

  10. Effects of Orem-based nursing intervention on nutritional self-care of myocardial infarction patients.

    PubMed

    Aish, A E; Isenberg, M

    1996-06-01

    The purpose of the study was to investigate the effect of nursing care based on Orem's nursing theory on nutritional self-care of myocardial infarction patients. Self-efficacy was explored as a disposition which may motivate behavioral change. One hundred and four subjects were randomly assigned to treatment or control groups. The nursing intervention, which took place during the first 6 weeks following hospital discharge, was effective in supporting healthy low-fat eating behavior. Nursing care influenced patients' self-care agency but lacked impact on self-efficacy for healthy eating. PMID:8736471

  11. Effects of Orem-based nursing intervention on nutritional self-care of myocardial infarction patients.

    PubMed

    Aish, A E; Isenberg, M

    1996-06-01

    The purpose of the study was to investigate the effect of nursing care based on Orem's nursing theory on nutritional self-care of myocardial infarction patients. Self-efficacy was explored as a disposition which may motivate behavioral change. One hundred and four subjects were randomly assigned to treatment or control groups. The nursing intervention, which took place during the first 6 weeks following hospital discharge, was effective in supporting healthy low-fat eating behavior. Nursing care influenced patients' self-care agency but lacked impact on self-efficacy for healthy eating.

  12. Developing a theory driven text messaging intervention for addiction care with user driven content.

    PubMed

    Muench, Frederick; Weiss, Rebecca A; Kuerbis, Alexis; Morgenstern, Jon

    2013-03-01

    The number of text messaging interventions designed to initiate and support behavioral health changes have been steadily increasing over the past 5 years. Messaging interventions can be tailored and adapted to an individual's needs in their natural environment-fostering just-in-time therapies and making them a logical intervention for addiction continuing care. This study assessed the acceptability of using text messaging for substance abuse continuing care and the intervention preferences of individuals in substance abuse treatment in order to develop an interactive mobile text messaging intervention. Fifty individuals enrolled in intensive outpatient substance abuse treatment completed an assessment battery relating to preferred logistics of mobile interventions, behavior change strategies, and types of messages they thought would be most helpful to them at different time points. Results indicated that 98% participants were potentially interested in using text messaging as a continuing care strategy. Participants wrote different types of messages that they perceived might be most helpful, based on various hypothetical situations often encountered during the recovery process. Although individuals tended to prefer benefit driven over consequence driven messages, differences in the perceived benefits of change among individuals predicted message preference. Implications for the development of mobile messaging interventions for the addictions are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  13. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings

    PubMed Central

    Soubhi, Hassan; Fortin, Martin; Hudon, Catherine; O’Dowd, Tom

    2012-01-01

    Objective To determine the effectiveness of interventions designed to improve outcomes in patients with multimorbidity in primary care and community settings. Design Systematic review. Data sources Medline, Embase, CINAHL, CAB Health, Cochrane central register of controlled trials, the database of abstracts of reviews of effectiveness, and the Cochrane EPOC (effective practice and organisation of care) register (searches updated in April 2011). Eligibility criteria Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series analyses reporting on interventions to improve outcomes for people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. Outcomes included any validated measure of physical or mental health and psychosocial status, including quality of life outcomes, wellbeing, and measures of disability or functional status. Also included were measures of patient and provider behaviour, including drug adherence, utilisation of health services, acceptability of services, and costs. Data selection Two reviewers independently assessed studies for eligibility, extracted data, and assessed study quality. As meta-analysis of results was not possible owing to heterogeneity in participants and interventions, a narrative synthesis of the results from the included studies was carried out. Results 10 studies examining a range of complex interventions totalling 3407 patients with multimorbidity were identified. All were randomised controlled trials with a low risk of bias. Two studies described interventions for patients with specific comorbidities. The remaining eight studies focused on multimorbidity, generally in older patients. Consideration of the impact of socioeconomic deprivation was minimal. All studies involved complex interventions with multiple components. In six of the 10 studies the predominant component was

  14. "I miss the care even though I know it's just a machine": an explorative study of the relationship between an Internet-based smoking cessation intervention and its participants.

    PubMed

    Brandt, Caroline L; Dalum, Peter; Thomsen, Tine T

    2013-09-01

    This study aimed to investigate how users perceive the different elements of an internet based smoking cessation intervention and to see if the program meet needs and expectations of people in a smoking cessation process. Nine semi-structured interviews were conducted in February 2010. Participants were recruited via the homepage of the smoking cessation program Dit Digitale Stopprogram (Your Digital Quit Program) operated by the Danish Cancer Society. The main result was that participants established a relationship to the program which influenced their smoking cessation process. Participants perceived the program as caring and found it supportive. However, the program also created feelings of frustration, disappointment and anger. Some participants in the last phase of cessation experienced text messages from the program as smoking cues. The study concluded that individual interpretations of the different elements in an Internet-based smoking cessation intervention can have both positive and negative impact on the smoking cessation process of participants.

  15. Interprofessional teamwork and team interventions in chronic care: A systematic review.

    PubMed

    Körner, Mirjam; Bütof, Sarah; Müller, Christian; Zimmermann, Linda; Becker, Sonja; Bengel, Jürgen

    2016-01-01

    To identify key features of teamwork and interventions for enhancing interprofessional teamwork (IPT) in chronic care and to develop a framework for further research, we conducted a systematic literature review of IPT in chronic care for the years 2002-2014. Database searches yielded 3217 abstracts, 21 of which fulfilled inclusion criteria. We identified two more studies on the topic by scanning the reference lists of included articles, which resulted in a final total of 23 included studies. The key features identified in the articles (e.g., team member characteristics, common task, communication, cooperation, coordination, responsibility, participation, staff satisfaction, patient satisfaction, and efficiency) were structured in line with the input-process-output model, and evaluated interventions, such as tools, workshops, and changes in team structure, were added to the model. The most frequently evaluated team interventions were complex intervention programs. All but one of the 14 evaluation studies resulted in enhancement of teamwork and/or staff-related, patient-related, and organization-related outcome criteria. To date, there is no consensus about the main features of IPT and the most effective team interventions in chronic care. However, the findings may be used to standardize the implementation and evaluation of IPT and team interventions in practice and for further research.

  16. Adapting and Testing Telephone Based Depression Care Management Intervention for Adolescent Mothers

    PubMed Central

    Logsdon, M. Cynthia; Pinto-Foltz, Melissa D.; Stein, Bradley; Usui, Wayne; Josephson, Allan

    2011-01-01

    Purpose and Methods This Phase 1 clinical trial combined qualitative and quantitative methods to modify a collaborative care, telephone based, depression care management intervention for adolescent mothers, and to determine the acceptability, feasibility, and initial efficacy of the intervention in a sample of adolescent mothers (n=97) who were recruited from a Teen Parent Program. Outcomes included measures of depressive symptoms, functioning, and use of mental health services. Results Acceptability of the intervention was demonstrated, but feasibility issues related to the complex life challenges confronting the adolescent mother. Although only four adolescent mothers received mental health treatment, there was a trend for improved depressive symptoms over time. Conclusion Results of the study provide data for the need of further refinement of the intervention before a large clinical trial is conducted for adolescent mothers with symptoms of depression. PMID:20020164

  17. Music Therapy as a Caring Intervention: Swedish Musicians Learning a New Professional Field

    ERIC Educational Resources Information Center

    Petersson, Gunnar; Nystrom, Maria

    2011-01-01

    The question of competence in providing music therapy has rarely been the focus of interest in empirical research, as most music therapy research aims at measuring outcomes. Therefore, the aim of this study is to analyse and describe musicians' learning processes when they study music therapy as a caring intervention. An initial presumption is…

  18. Adherence to Self-Care Interventions for Depression or Anxiety: A Systematic Review

    ERIC Educational Resources Information Center

    Simco, Russell; McCusker, Jane; Sewitch, Maida

    2014-01-01

    Objective: The objective of this study was to synthesise and describe adherence to intervention in published studies of supported self-care for depression or anxiety, and to identify participant characteristics associated with higher adherence. Methods: We searched the databases EMBASE, MEDLINE, CINAHL, and PSYCINFO for the period from January…

  19. Reducing Medical Errors in Primary Care Using a Pragmatic Complex Intervention.

    PubMed

    Khoo, Ee Ming; Sararaks, Sondi; Lee, Wai Khew; Liew, Su May; Cheong, Ai Theng; Abdul Samad, Azah; Maskon, Kalsom; Hamid, Maimunah A

    2015-09-01

    This study aimed to develop an intervention to reduce medical errors and to determine if the intervention can reduce medical errors in public funded primary care clinics. A controlled interventional trial was conducted in 12 conveniently selected primary care clinics. Random samples of outpatient medical records were selected and reviewed by family physicians for documentation, diagnostic, and management errors at baseline and 3 months post intervention. The intervention package comprised educational training, structured process change, review methods, and patient education. A significant reduction was found in overall documentation error rates between intervention (Pre 98.3% [CI 97.1-99.6]; Post 76.1% [CI 68.1-84.1]) and control groups (Pre 97.4% [CI 95.1-99.8]; Post 89.5% [85.3-93.6]). Within the intervention group, overall management errors reduced from 54.0% (CI 49.9-58.0) to 36.6% (CI 30.2-43.1) and medication error from 43.2% (CI 39.2-47.1) to 25.2% (CI 19.9-30.5). This low-cost intervention was useful to reduce medical errors in resource-constrained settings.

  20. Screening and brief intervention for hazardous drinking in an HMO: effects on medical care utilization.

    PubMed

    Freeborn, D K; Polen, M R; Hollis, J F; Senft, R A

    2000-11-01

    This study examined whether a brief intervention to reduce hazardous alcohol consumption among primary care patients reduced use of medical care. In a parent, randomized controlled trial, at-risk drinkers identified in HMO outpatient waiting rooms were randomly assigned to receive usual care or brief clinician advice plus a 15-minute motivational counseling session. The current study (n = 514) examined the groups' use of outpatient and inpatient medical services during two years after intervention. Although the intervention reduced alcohol consumption at six-month follow-up, intervention and control groups made similar numbers of outpatient visits (M = 17.7 vs. 18.3, respectively; p = .47), were equally likely to be hospitalized (21.2% vs. 22.0%; p = .81), and among those hospitalized, had similar lengths of stay (4.7 vs. 6.6 days; p = .37). Although brief interventions to reduce hazardous drinking may potentially reduce medical care utilization, more evidence is needed to substantiate their practicality and cost-effectiveness. PMID:11070638

  1. Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals -- interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies

    PubMed Central

    2011-01-01

    Background We have reported the results of a cluster randomized trial of rural Kenyan hospitals evaluating the effects of an intervention to introduce care based on best-practice guidelines. In parallel work we described the context of the study, explored the process and perceptions of the intervention, and undertook a discrete study on health worker motivation because this was felt likely to be an important contributor to poor performance in Kenyan public sector hospitals. Here, we use data from these multiple studies and insights gained from being participants in and observers of the intervention process to provide our explanation of how intervention effects were achieved as part of an effort to better understand implementation in low-income hospital settings. Methods Initial hypotheses were generated to explain the variation in intervention effects across place, time, and effect measure (indicator) based on our understanding of theory and informed by our implementation experience and participant observations. All data sources available for hospitals considered as cases for study were then examined to determine if hypotheses were supported, rejected, or required modification. Data included transcriptions of interviews and group discussions, field notes and that from the detailed longitudinal quantitative investigation. Potentially useful explanatory themes were identified, discussed by the implementing and research team, revised, and merged as part of an iterative process aimed at building more generic explanatory theory. At the end of this process, findings were mapped against a recently reported comprehensive framework for implementation research. Results A normative re-educative intervention approach evolved that sought to reset norms and values concerning good practice and promote 'grass-roots' participation to improve delivery of correct care. Maximal effects were achieved when this strategy and external support supervision helped create a soft-contract with

  2. The Quik Fix study: a randomised controlled trial of brief interventions for young people with alcohol-related injuries and illnesses accessing emergency department and crisis support care

    PubMed Central

    2014-01-01

    Background Alcohol is a major preventable cause of injury, disability and death in young people. Large numbers of young people with alcohol-related injuries and medical conditions present to hospital emergency departments (EDs). Access to brief, efficacious, accessible and cost effective treatment is an international health priority within this age group. While there is growing evidence for the efficacy of brief motivational interviewing (MI) for reducing alcohol use in young people, there is significant scope to increase its impact, and determine if it is the most efficacious and cost effective type of brief intervention available. The efficacy of personality-targeted interventions (PIs) for alcohol misuse delivered individually to young people is yet to be determined or compared to MI, despite growing evidence for school-based PIs. This study protocol describes a randomized controlled trial comparing the efficacy and cost-effectiveness of telephone-delivered MI, PI and an Assessment Feedback/Information (AF/I) only control for reducing alcohol use and related harm in young people. Methods/design Participants will be 390 young people aged 16 to 25 years presenting to a crisis support service or ED with alcohol-related injuries and illnesses (including severe alcohol intoxication). This single blinded superiority trial randomized young people to (i) 2 sessions of MI; (ii) 2 sessions of a new PI or (iii) a 1 session AF/I only control. Participants are reassessed at 1, 3, 6 and 12 months on the primary outcomes of alcohol use and related problems and secondary outcomes of mental health symptoms, functioning, severity of problematic alcohol use, alcohol injuries, alcohol-related knowledge, coping self-efficacy to resist using alcohol, and cost effectiveness. Discussion This study will identify the most efficacious and cost-effective telephone-delivered brief intervention for reducing alcohol misuse and related problems in young people presenting to crisis support

  3. Assessment of the Quality of Antenatal Care Services Provided by Health Workers Using a Mobile Phone Decision Support Application in Northern Nigeria: A Pre/Post-Intervention Study

    PubMed Central

    McNabb, Marion; Chukwu, Emeka; Ojo, Oluwayemisi; Shekhar, Navendu; Gill, Christopher J.; Salami, Habeeb; Jega, Farouk

    2015-01-01

    Background Given the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs) are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre. Methods Using the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care. Results Overall, the quality score increased from 13.3 at baseline to 17.2 at endline (p<0.0001), out of a total possible score of 25, with the most significant improvements related to health counseling, technical services provided, and quality of health education. Conclusion These study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes. PMID:25942018

  4. Improving the governance of patient safety in emergency care: a systematic review of interventions

    PubMed Central

    Hesselink, Gijs; Berben, Sivera; Beune, Thimpe

    2016-01-01

    Objectives To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. Design A systematic review of the literature. Methods PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings. Results Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively. Conclusions Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an

  5. Enhancing the population impact of collaborative care interventions: Mixed method development and implementation of stepped care targeting posttraumatic stress disorder and related comorbidities after acute trauma

    PubMed Central

    Zatzick, Douglas; Rivara, Frederick; Jurkovich, Gregory; Russo, Joan; Trusz, Sarah Geiss; Wang, Jin; Wagner, Amy; Stephens, Kari; Dunn, Chris; Uehara, Edwina; Petrie, Megan; Engel, Charles; Davydow, Dimitri; Katon, Wayne

    2011-01-01

    Objective To develop and implement a stepped collaborative care intervention targeting PTSD and related co-morbidities to enhance the population impact of early trauma-focused interventions. Method We describe the design and implementation of the Trauma Survivors Outcomes & Support Study (TSOS II). An interdisciplinary treatment development team was comprised of trauma surgical, clinical psychiatric and mental health services “change agents” who spanned the boundaries between front-line trauma center clinical care and acute care policy. Mixed method clinical epidemiologic and clinical ethnographic studies informed the development of PTSD screening and intervention procedures. Results Two-hundred and seven acutely injured trauma survivors with high early PTSD symptom levels were randomized into the study. The stepped collaborative care model integrated care management (i.e., posttraumatic concern elicitation and amelioration, motivational interviewing, and behavioral activation) with cognitive behavioral therapy and pharmacotherapy targeting PTSD. The model was feasibly implemented by front-line acute care MSW and ARNP providers. Conclusions Stepped care protocols targeting PTSD may enhance the population impact of early interventions developed for survivors of individual and mass trauma by extending the reach of collaborative care interventions to acute care medical settings and other non-specialty posttraumatic contexts. PMID:21596205

  6. Results and Lessons Learned from a Nurse Practitioner-Guided Dementia Care Intervention for Primary Care Patients and Their Family Caregivers

    PubMed Central

    Fortinsky, Richard H.; Delaney, Colleen; Harel, Ofer; Pasquale, Karen; Schjavland, Elena; Lynch, John; Kleppinger, Alison; Crumb, Suzanne

    2014-01-01

    Older adults with dementia care needs often visit primary care physicians (PCPs), but PCP dementia care limitations are widely documented. This study tested the value of employing a nurse practitioner (NP) with geropsychiatric expertise to augment PCP care for newly and recently diagnosed patients and family caregivers. Twenty-one dyads received the NP intervention; 10 dyads were controls. Outcomes included patient neuropsychiatric symptom and quality of life changes, and caregiver depression, burden, and self-efficacy changes. Intervention acceptability by patients, caregivers, and PCPs was determined. No outcome differences were found; however, the NP intervention was deemed highly satisfactory by all stakeholders. Patients experienced no significant cognitive decline during their 12-month study period, helping explain why outcomes did not change. Given widespread acceptability, future tests of this PCP-enhancing intervention should include patients with more progressive cognitive decline at study entry. NPs with geropsychiatric expertise are ideal interventionists for this rapidly growing target population. PMID:24444453

  7. An Investigation of Nurses' Interaction Styles with Physicians and Suggested Patient Care Interventions.

    ERIC Educational Resources Information Center

    Redland, Alice R.

    The purpose of this study was to identify relations between nurses' interaction styles and patient care interventions (PCI) that occurred after nurse-doctor interactions. A nonparticipant observer recorded interactions of 48 female registered nurses with physicians. Transcripts were coded and assigned to one of five theoretical nurse interaction…

  8. Barriers to the Uptake of Eye Care Services in Developing Countries: A Systematic Review of Interventions

    ERIC Educational Resources Information Center

    Abdullah, Khadija Nowaira; Al-Sharqi, Omar Zayan; Abdullah, Muhammad Tanweer

    2013-01-01

    Objective: This research identifies effective and ineffective interventions for reducing barriers to the uptake of eye care services in developing countries. Design: Systematic literature review. Setting: Only research studies done in developing countries were included. Method: The review is restricted to English-language articles published…

  9. Supervisory Intervention: Improving Data Reporting by Direct-Care Staff at a Child Services Program

    ERIC Educational Resources Information Center

    Flood, William A.; Luiselli, James K.

    2012-01-01

    We report a study that addressed behavior data recording by direct-care staff at a child services program. In response to a decreasing percentage of daily data recording in two community-based group homes, a supervisory intervention was implemented, consisting of a revised data recording form and providing performance feedback to the direct-care…

  10. Perspectives of Therapist's Role in Care Coordination between Medical and Early Intervention Services

    ERIC Educational Resources Information Center

    Ideishi, Roger I.; O'Neil, Margaret E.; Chiarello, Lisa A.; Nixon-Cave, Kim

    2010-01-01

    This study explored perspectives of therapist's role in care coordination between early intervention (EI) and medical services, and identified strategies for improving service delivery. Fifty adults participated in one of six focus groups. Participants included parents, pediatricians, and therapists working in hospital and EI programs. Structured…

  11. A Qualitative Analysis of an Advanced Practice Nurse-Directed Transitional Care Model Intervention

    ERIC Educational Resources Information Center

    Bradway, Christine; Trotta, Rebecca; Bixby, M. Brian; McPartland, Ellen; Wollman, M. Catherine; Kapustka, Heidi; McCauley, Kathleen; Naylor, Mary D.

    2012-01-01

    Purpose: The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs). Design and Methods: APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An…

  12. An Integrated Web-Based Mental Health Intervention of Assessment-Referral-Care to Reduce Stress, Anxiety, and Depression in Hospitalized Pregnant Women With Medically High-Risk Pregnancies: A Feasibility Study Protocol of Hospital-Based Implementation

    PubMed Central

    Janes-Kelley, Selikke; Tyrrell, Janie; Clark, Lorna; Hamza, Deena; Holmes, Penny; Parkes, Cheryl; Moyo, Nomagugu; McDonald, Sheila; Austin, Marie-Paule

    2015-01-01

    Background At prevalence rates of up to 40%, rates of depression and anxiety among women with medically complex pregnancies are 3 times greater than those in community-based samples of pregnant women. However, mental health care is not a component of routine hospital-based antenatal care for medically high-risk pregnant women. Objective The purpose of this study is to evaluate the effectiveness and feasibility of the hospital-based implementation of a Web-based integrated mental health intervention comprising psychosocial assessment, referral, and cognitive behavioral therapy (CBT) for antenatal inpatients. Methods This study is a quasi-experimental design. Pregnant women are eligible to participate if they are (1) <37 weeks gestation, (2) admitted to the antenatal inpatient unit for >72 hours, (3) able to speak and read English or be willing to use a translation service to assist with completion of the questionnaires and intervention, (4) able to complete follow-up email questionnaires, (5) >16 years of age, and (6) not actively suicidal. Women admitted to the unit for induction (eg, <72-hour length of stay) are excluded. A minimum sample of 54 women will be recruited from the antenatal high-risk unit of a large, urban tertiary care hospital. All women will complete a Web-based psychosocial assessment and 6 Web-based CBT modules. Results of the psychosocial assessment will be used by a Web-based clinical decision support system to generate a clinical risk score and clinician prompts to provide recommendations for the best treatment and referral options. The primary outcome is self-reported prenatal depression, anxiety, and stress symptoms at 6-8 weeks postrecruitment. Secondary outcomes are postpartum depression, anxiety, and stress symptoms; self-efficacy; mastery; self-esteem; sleep; relationship quality; coping; resilience; Apgar score; gestational age; birth weight; maternal-infant attachment; infant behavior and development; parenting stress/competence at 3

  13. Evaluation of Changes in Equine Care and Limb-Related Abnormalities in Working Horses in Jaipur, India, as Part of a Two Year Participatory Intervention Study

    PubMed Central

    Whay, Helen R.; Dikshit, Amit K.; Hockenhull, Jo; Parker, Richard M. A.; Banerjee, Anindo; Hughes, Sue I.; Pritchard, Joy C.; Reix, Christine E.

    2015-01-01

    Background Previous studies have found the prevalence of lameness in working horses to be 90–100%. Risk factors for lameness in this important equine population, together with risk-reduction strategies adopted by their owners, are poorly understood. The objective was to uncover risk factors for lameness and limb abnormalities in working horses, by associating clinical lameness examination findings on three occasions over two years with owner reported changes in equine management and work practices over this period. Methodology/Principal Findings Twenty-one communities of horse owners in Jaipur, India, took part in a participatory intervention (PI) project aiming to reduce risk factors for poor welfare, particularly lameness and limb problems. Associations between quantitative measures of equine lameness/limb abnormalities and reported changes in management and work practices were compared with 21 control (C) communities of owners where no intervention had taken place. Key findings from ‘complete cases’, where the same horse stayed with the same owner for the whole study period (PI group = 73 owners of 83 horses, C group = 58 owners of 66 horses), were that more positive statements of change in equine management and work practices were made by PI group owners than C group owners. A mixed picture of potential risk factors emerged: some reported management improvements, for example reducing the weight of the load for cart animals, were associated with improved limbs and lameness, and others, such as making improvements in shoeing and increasing the age at which their animals started work, with negative outcomes. Conclusions/Significance This study illustrates the complexity and interacting nature of risk factors for lameness in working horses, and highlights the importance of longitudinal investigations that recognise and address this. PI group owners found the project useful and requested similar inputs in future. Our findings demonstrate the value of

  14. Patient-centeredness and quality management in Dutch diabetes care organizations after a 1-year intervention

    PubMed Central

    Campmans-Kuijpers, Marjo JE; Lemmens, Lidwien C; Baan, Caroline A; Rutten, Guy EHM

    2016-01-01

    Background More focus on patient-centeredness in care for patients with type 2 diabetes requests increasing attention to diabetes quality management processes on patient-centeredness by managers in primary care groups and outpatient clinics. Although patient-centered care is ultimately determined by the quality of interactions between patients and clinicians at the practice level, it should be facilitated at organizational level too. This nationwide study aimed to assess the state of diabetes quality management on patient-centeredness at organizational level and its possibilities to improve after a tailored intervention. Methods This before–after study compares the quality management on patient-centeredness within Dutch diabetes care groups and outpatient clinics before and after a 1-year stepwise intervention. At baseline, managers of 51 diabetes primary care groups and 28 outpatient diabetes clinics completed a questionnaire about the organization’s quality management program. Patient-centeredness (0%–100%) was operationalized in six subdomains: facilitating self-management support, individualized care plan support, patients’ access to medical files, patient education policy, safeguarding patients’ interests, and formal patient involvement. The intervention consisted of feedback and benchmark and if requested a telephone call and/or a consultancy visit. After 1 year, the managers completed the questionnaire again. The 1-year changes were examined by dependent (non) parametric tests. Results Care groups improved significantly on patient-centeredness (from 47.1% to 53.3%; P=0.002), and on its subdomains “access to medical files” (from 42.0% to 49.4%), and “safeguarding patients’ interests” (from 58.1% to 66.2%). Outpatient clinics, which scored higher at baseline (66.7%) than care groups, did not improve on patient-centeredness (65.6%: P=0.54) or its subdomains. “Formal patient involvement” remained low in both care groups (23.2%) and

  15. Primary care interventions to improve transition of youth with chronic health conditions from paediatric to adult healthcare: a systematic review

    PubMed Central

    Bhawra, Jasmin; Toulany, Alene; Cohen, Eyal; Moore Hepburn, Charlotte; Guttmann, Astrid

    2016-01-01

    Objective To determine effective interventions to improve primary care provider involvement in transitioning youth with chronic conditions from paediatric to adult care. Design Systematic review. Multiple electronic databases were searched including Ovid MEDLINE, EMBASE and Web of Science (from 1 January 1947 to 5 August 2015). Evidence quality was assessed using a 36-point scoring system for disparate study designs. Setting Studies with paediatric-to-adult transition programmes and interventions involving primary care providers or in primary care settings. Participants Youth aged 16 years and over. Outcomes Relevant outcomes were grouped into 3 main domains based on the Triple Aim Framework: experience of care, population health, cost. Results A total of 1888 unique citations were identified, yielding 3 studies for inclusion. Overall, primary care provider roles were not well defined. 2 studies used case managers to facilitate referrals to primary care, and the remaining study was the only 1 situated in a primary care setting. None of the studies examined transition in all 3 Triple Aim Framework domains. The most commonly reported outcomes were in the cost domain. Conclusions There is limited empiric evidence to guide primary care interventions to improve transition outcomes for youth with chronic conditions. Future research and policy should focus on developing and evaluating coordinated transition interventions to better integrate primary care for high need populations. PMID:27150188

  16. Understanding the implementation of complex interventions in health care: the normalization process model

    PubMed Central

    May, Carl; Finch, Tracy; Mair, Frances; Ballini, Luciana; Dowrick, Christopher; Eccles, Martin; Gask, Linda; MacFarlane, Anne; Murray, Elizabeth; Rapley, Tim; Rogers, Anne; Treweek, Shaun; Wallace, Paul; Anderson, George; Burns, Jo; Heaven, Ben

    2007-01-01

    Background The Normalization Process Model is a theoretical model that assists in explaining the processes by which complex interventions become routinely embedded in health care practice. It offers a framework for process evaluation and also for comparative studies of complex interventions. It focuses on the factors that promote or inhibit the routine embedding of complex interventions in health care practice. Methods A formal theory structure is used to define the model, and its internal causal relations and mechanisms. The model is broken down to show that it is consistent and adequate in generating accurate description, systematic explanation, and the production of rational knowledge claims about the workability and integration of complex interventions. Results The model explains the normalization of complex interventions by reference to four factors demonstrated to promote or inhibit the operationalization and embedding of complex interventions (interactional workability, relational integration, skill-set workability, and contextual integration). Conclusion The model is consistent and adequate. Repeated calls for theoretically sound process evaluations in randomized controlled trials of complex interventions, and policy-makers who call for a proper understanding of implementation processes, emphasize the value of conceptual tools like the Normalization Process Model. PMID:17880693

  17. Impact of a Social Work Care Coordination Intervention on Hospital Readmission: A Randomized Controlled Trial.

    PubMed

    Bronstein, Laura R; Gould, Paul; Berkowitz, Shawn A; James, Gary D; Marks, Kris

    2015-07-01

    This study assessed how a social work-led care coordination intervention would reduce the within-30-day hospital readmission rate among moderate- and high-risk patients age 50 years or older. Authors ran a randomized controlled trial to determine whether there was a significant difference in within-30-day readmission rates between patients receiving usual care post-discharge and those receiving intervention from an MSW intern (one home visit and one to two phone calls). Results were obtained using a sample of hospitalized patients with a LACE index score of 7 or higher (N = 89). Analysis suggests that the intervention improved the likelihood of not being readmitted by some 22 percent (RR = 1.222; 95% CI = 1.063-1.405). The risk improvement with the intervention was highly statistically significant (p = .003). This study shows that a time-efficient care coordination intervention by MSW interns may decrease hospital readmission rates. Replications of this study in other communities, with more diverse populations, and with larger numbers of patients will indicate whether results are generalizable.

  18. Pediatricians, Well-Baby Visits, and Video Intervention Therapy: Feasibility of a Video-Feedback Infant Mental Health Support Intervention in a Pediatric Primary Health Care Setting

    PubMed Central

    Facchini, Sergio; Martin, Valentina; Downing, George

    2016-01-01

    This case series study evaluated the feasibility and acceptability of a behavioral/cognitive psychological intervention in a pediatric primary health care setting during standard well-baby visits. The aim of the intervention was to support caregivers’ sensitivity and mentalization in order to promote infant mental health (IMH). Four neonates from birth to 8 months were consecutively enrolled to test a short video-feedback intervention (Primary Care – Video Intervention Therapy, an adaptation of George Downing’s Video Intervention Therapy to primary care) conducted by a pediatrician. The 5 min interaction recording and the video-feedback session were performed during the same well-baby visit and in the same pediatrician’s office where the physical examination was conducted. During the study period, six video-feedback sessions were performed for each baby at different ages (1, 2, 3, 4, 6, 8 months). A series of different interactional situations were filmed and discussed: touch, cry, affective matching, descriptive language, feeding, separation and autonomy. The intervention was easily accepted and much appreciated by all four families enrolled. This study aimed to answer a dilemma which pediatric providers generally face: if the provider wishes to respond not only to physical but also IMH issues, how on a practical level can this be done? This case series study indicates that Primary Care – Video Intervention Therapy can be a promising new tool for such a purpose. PMID:26909063

  19. Proactive intervention dentistry: a model for oral care through life.

    PubMed

    Goldstep, Fay

    2012-06-01

    Tools and techniques are available to oral care providers that have been found to be effective in reversing and controlling the caries process. In addition to fluoride, these tools include new remineralization therapies that can be incorporated into solutions, creams, and dentifrices, and bioactive restorative materials that work effectively with dental hard tissues. By incorporating such "proactive interventions" into their practice and educating patients on maintaining a daily oral hygiene regimen, clinicians can inhibit the multifactorial disease process of demineralization and caries before more extensive treatment becomes necessary.

  20. A mental health intervention strategy for low-income, trauma-exposed Latina immigrants in primary care

    PubMed Central

    Kaltman, Stacey; de Mendoza, Alejandra Hurtado; Serrano, Adriana; Gonzales, Felisa A.

    2016-01-01

    Latinos in the United States face significant mental health disparities related to access to care, quality of care, and outcomes. Prior research suggests that Latinos prefer to receive care for common mental health problems (e.g., depression and anxiety disorders) in primary care settings, suggesting a need for evidence-based mental health services designed for delivery in these settings. This study sought to develop and preliminarily evaluate a mental health intervention for trauma-exposed Latina immigrants with depression and/or PTSD for primary care clinics that serve the uninsured. The intervention was designed to be simultaneously responsive to patients’ preferences for individual psychotherapy, to the needs of safety-net primary care clinics for efficient services, and to address the social isolation that is common to the Latina immigrant experience. Developed based on findings from the research team’s formative research, the resulting intervention incorporated individual and group sessions and combined evidence-based interventions to reduce depression and PTSD symptoms, increase group readiness, and improve perceived social support. Twenty-eight trauma-exposed low-income Latina immigrant women who screened positive for depression and/or PTSD participated in an open pilot trial of the intervention at a community primary care clinic. Results indicated that the intervention was feasible, acceptable, and safe. A randomized controlled trial of the intervention is warranted. PMID:26913774

  1. Health system and community level interventions for improving antenatal care coverage and health outcomes

    PubMed Central

    Mbuagbaw, Lawrence; Medley, Nancy; Darzi, Andrea J; Richardson, Marty; Habiba Garga, Kesso; Ongolo-Zogo, Pierre

    2015-01-01

    Background The World Health Organization (WHO) recommends at least four antenatal care (ANC) visits for all pregnant women. Almost half of pregnant women worldwide, and especially in developing countries do not receive this amount of care. Poor attendance of ANC is associated with delivery of low birthweight babies and more neonatal deaths. ANC may include education on nutrition, potential problems with pregnancy or childbirth, child care and prevention or detection of disease during pregnancy. This review focused on community-based interventions and health systems-related interventions. Objectives To assess the effects of health system and community interventions for improving coverage of antenatal care and other perinatal health outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 June 2015) and reference lists of retrieved studies. Selection criteria We included randomised controlled trials (RCTs), quasi-randomised trials and cluster-randomised trials. Trials of any interventions to improve ANC coverage were eligible for inclusion. Trials were also eligible if they targeted specific and related outcomes, such as maternal or perinatal death, but also reported ANC coverage. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Main results We included 34 trials involving approximately 400,000 women. Some trials tested community-based interventions to improve uptake of antenatal care (media campaigns, education or financial incentives for pregnant women), while other trials looked at health systems interventions (home visits for pregnant women or equipment for clinics). Most trials took place in low- and middle-income countries, and 29 of the 34 trials used a cluster-randomised design. We assessed 30 of the 34 trials as of low or unclear overall risk of bias. Comparison 1: One intervention versus no intervention We

  2. Nursing interventions in pediatric care: a contribution to measuring workload.

    PubMed

    Assis, Melissa Nardini de; Andrade, Ana Caroline Ramirez de; Rogenski, Karin Emília; Castilho, Valéria; Fugulin, Fernanda Maria Togeiro

    2015-12-01

    Objective To identify and validate interventions/activities developed by a nursing team in a Brazilian pediatric unit. Method A descriptive, cross-sectional, and observational study was developed in the pediatric clinic of the university hospital of University of São Paulo, São Paulo, Brazil. It was organized in the following stages: identifying activities carried out by the team (from records in patient charts and from direct observation); mapping out and validating activities identified in interventions according to the Nursing Intervention Classification (NIC). Results The 275 identified activities were mapped out into 63 interventions, 22 NIC classes and 7 NIC domains, and 25 associated and 13 personal activities. After validation, the number of activities decreased to 244, corresponding to 53 interventions, 20 NIC classes and 6 NIC domains, and 30 associated activities and 9 personal activities. Conclusion Identifying the interventions/activities performed by the nursing team can help measure workload and is an important contribution to overcoming difficulties when it comes to operationalizing the process of sizing professional teams in the field of pediatrics. PMID:26959158

  3. A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care

    PubMed Central

    Geldsetzer, Pascal; Yapa, H Manisha N; Vaikath, Maria; Ogbuoji, Osondu; Fox, Matthew P; Essajee, Shaffiq M; Negussie, Eyerusalem K; Bärnighausen, Till

    2016-01-01

    Introduction The World Health Organization recommends lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV. Effective transitioning from maternal and child health to ART services, and long-term retention in ART care postpartum is crucial to the successful implementation of lifelong ART for pregnant women. This systematic review aims to determine which interventions improve (1) retention within prevention of mother-to-child HIV transmission (PMTCT) programmes after birth, (2) transitioning from PMTCT to general ART programmes in the postpartum period, and (3) retention of postpartum women in general ART programmes. Methods We searched Medline, Embase, ISI Web of Knowledge, the regional World Health Organization databases and conference abstracts for data published between 2002 and 2015. The quality of all included studies was assessed using the GRADE criteria. Results and Discussion After screening 8324 records, we identified ten studies for inclusion in this review, all of which were from sub-Saharan Africa except for one from the United Kingdom. Two randomized trials found that phone calls and/or text messages improved early (six to ten weeks) postpartum retention in PMTCT. One cluster-randomized trial and three cohort studies found an inconsistent impact of different levels of integration between antenatal care/PMTCT and ART care on postpartum retention. The inconsistent results of the four identified studies on care integration are likely due to low study quality, and heterogeneity in intervention design and outcome measures. Several randomized trials on postpartum retention in HIV care are currently under way. Conclusions Overall, the evidence base for interventions to improve postpartum retention in HIV care is weak. Nevertheless, there is some evidence that phone-based interventions can improve retention in PMTCT in the first one to three months postpartum. PMID:27118443

  4. An integrative literature review on nursing interventions aimed at increasing self-care among heart failure patients 1

    PubMed Central

    Boisvert, Sophie; Proulx-Belhumeur, Alexandra; Gonçalves, Natalia; Doré, Michel; Francoeur, Julie; Gallani, Maria Cecilia

    2015-01-01

    Abstract Objective: to analyze and summarize knowledge concerning critical components of interventions that have been proposed and implemented by nurses with the aim of optimizing self-care by heart failure patients. Methods: PubMed and CINAHL were the electronic databases used to search full peer-reviewed papers, presenting descriptions of nursing interventions directed to patients or to patients and their families and designed to optimize self-care. Forty-two studies were included in the final sample (n=4,799 patients). Results: this review pointed to a variety and complexity of nursing interventions. As self-care encompasses several behaviors, interventions targeted an average of 3.6 behaviors. Educational/counselling activities were combined or not with cognitive behavioral strategies, but only about half of the studies used a theoretical background to guide interventions. Clinical assessment and management were frequently associated with self-care interventions, which varied in number of sessions (1 to 30); length of follow-up (2 weeks to 12 months) and endpoints. Conclusions: these findings may be useful to inform nurses about further research in self-care interventions in order to propose the comparison of different modalities of intervention, the use of theoretical background and the establishment of endpoints to evaluate their effectiveness. PMID:26444179

  5. Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

    PubMed Central

    Okelo, Sande O.; Butz, Arlene M.; Sharma, Ritu; Diette, Gregory B.; Pitts, Samantha I.; King, Tracy M.; Linn, Shauna T.; Reuben, Manisha; Chelladurai, Yohalakshmi

    2013-01-01

    BACKGROUND AND OBJECTIVE: Health care provider adherence to asthma guidelines is poor. The objective of this study was to assess the effect of interventions to improve health care providers’ adherence to asthma guidelines on health care process and clinical outcomes. METHODS: Data sources included Medline, Embase, Cochrane CENTRAL Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Center, PsycINFO, and Research and Development Resource Base in Continuing Medical Education up to July 2012. Paired investigators independently assessed study eligibility. Investigators abstracted data sequentially and independently graded the evidence. RESULTS: Sixty-eight eligible studies were classified by intervention: decision support, organizational change, feedback and audit, clinical pharmacy support, education only, quality improvement/pay-for-performance, multicomponent, and information only. Half were randomized trials (n = 35). There was moderate evidence for increased prescriptions of controller medications for decision support, feedback and audit, and clinical pharmacy support and low-grade evidence for organizational change and multicomponent interventions. Moderate evidence supports the use of decision support and clinical pharmacy interventions to increase provision of patient self-education/asthma action plans. Moderate evidence supports use of decision support tools to reduce emergency department visits, and low-grade evidence suggests there is no benefit for this outcome with organizational change, education only, and quality improvement/pay-for-performance. CONCLUSIONS: Decision support tools, feedback and audit, and clinical pharmacy support were most likely to improve provider adherence to asthma guidelines, as measured through health care process outcomes. There is a need to evaluate health care provider-targeted interventions with standardized outcomes. PMID:23979092

  6. Psychiatric home care: a new tool for crisis intervention.

    PubMed

    Spiro, A H

    1994-03-01

    The cost of psychiatric care has been rapidly increasing in recent years. Between 1984 and 1987, there was a 46 percent increase in psychiatric hospitals beds and a 60 percent increase in psychiatric units in general hospitals. This reflected a recognition by many health care systems that psychiatric patients were a good source of revenue. With this push toward more and more inpatient programs, crucial aspects of psychiatric care were left behind. Specifically, the limitations of inpatient therapy have not been recognized. Within the past five years, a new program has been developed and pioneered to use home care to prevent psychiatric hospitalizations and to also prevent the difficult transitions for psychiatric patients. Over a two-year period, this program was studied for its impact on the quality and cost of psychiatric care.

  7. Psychiatric home care: a new tool for crisis intervention.

    PubMed

    Spiro, A H

    1994-03-01

    The cost of psychiatric care has been rapidly increasing in recent years. Between 1984 and 1987, there was a 46 percent increase in psychiatric hospitals beds and a 60 percent increase in psychiatric units in general hospitals. This reflected a recognition by many health care systems that psychiatric patients were a good source of revenue. With this push toward more and more inpatient programs, crucial aspects of psychiatric care were left behind. Specifically, the limitations of inpatient therapy have not been recognized. Within the past five years, a new program has been developed and pioneered to use home care to prevent psychiatric hospitalizations and to also prevent the difficult transitions for psychiatric patients. Over a two-year period, this program was studied for its impact on the quality and cost of psychiatric care. PMID:10132548

  8. Translating the SLIM diabetes prevention intervention into SLIMMER: implications for the Dutch primary health care.

    PubMed

    Duijzer, Geerke; Jansen, Sophia C; Haveman-Nies, Annemien; van Bruggen, Rykel; Ter Beek, Josien; Hiddink, Gerrit J; Feskens, Edith J M

    2012-04-01

    All over the world, prevalence and incidence rates of type 2 diabetes mellitus are rising rapidly. Several trials have demonstrated that prevention by lifestyle intervention is (cost-) effective. This calls for translation of these trials to primary health care. This article gives an overview of the translation of the SLIM diabetes prevention intervention to a Dutch real-life setting and discusses the role of primary health care in implementing lifestyle intervention programmes. Currently, a 1-year pilot study, consisting of a dietary and physical activity part, performed by three GPs, three practice nurses, three dieticians and four physiotherapists is being conducted. The process of translating the SLIM lifestyle intervention to regular primary health care is measured by means of the process indicators: reach, acceptability, implementation integrity, applicability and key factors for success and failure of the intervention. Data will be derived from programme records, observations, focus groups and interviews. Based on these results, our programme will be adjusted to fit the role conception of the professionals and the organization structure in which they work.

  9. A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors

    PubMed Central

    2012-01-01

    Background To evaluate the effectiveness of interventions used in primary care to improve health literacy for change in smoking, nutrition, alcohol, physical activity and weight (SNAPW). Methods A systematic review of intervention studies that included outcomes for health literacy and SNAPW behavioral risk behaviors implemented in primary care settings. We searched the Cochrane Library, Johanna Briggs Institute, Medline, Embase, CINAHL, Psychinfo, Web of Science, Scopus, APAIS, Australasian Medical Index, Google Scholar, Community of Science and four targeted journals (Patient Education and Counseling, Health Education and Behaviour, American Journal of Preventive Medicine and Preventive Medicine). Study inclusion criteria: Adults over 18 years; undertaken in a primary care setting within an Organisation for Economic Co-operation and Development (OECD) country; interventions with at least one measure of health literacy and promoting positive change in smoking, nutrition, alcohol, physical activity and/or weight; measure at least one outcome associated with health literacy and report a SNAPW outcome; and experimental and quasi-experimental studies, cohort, observational and controlled and non-controlled before and after studies. Papers were assessed and screened by two researchers (JT, AW) and uncertain or excluded studies were reviewed by a third researcher (MH). Data were extracted from the included studies by two researchers (JT, AW). Effectiveness studies were quality assessed. A typology of interventions was thematically derived from the studies by grouping the SNAPW interventions into six broad categories: individual motivational interviewing and counseling; group education; multiple interventions (combination of interventions); written materials; telephone coaching or counseling; and computer or web based interventions. Interventions were classified by intensity of contact with the subjects (High ≥ 8 points of contact/hours; Moderate >3 and <8; Low

  10. Acceptability, Usability, and Views on Deployment of Peek, a Mobile Phone mHealth Intervention for Eye Care in Kenya: Qualitative Study

    PubMed Central

    Karanja, Sarah; Lees, Shelley; Bastawrous, Andrew

    2016-01-01

    Background The Portable Eye Examination Kit (Peek) is a mobile phone–based ophthalmic testing system that has been developed to perform comprehensive eye examinations. Shortages in ophthalmic personnel, the high cost, and the difficulty in transporting equipment have made it challenging to offer services, particularly in rural areas. Peek offers a solution for overcoming barriers of limited access to traditional ophthalmic testing methods and has been pilot tested on adults in Nakuru, Kenya, and compared with traditional eye examination tools. Objective This qualitative study evaluated the acceptability and usability of Peek in addition to perceptions regarding its adoption and nationwide deployment. Methods Semistructured interviews were conducted with patients and analyzed using a framework approach. This included analysis of interviews from 20 patients, 8 health care providers (HCPs), and 4 key decision makers in ophthalmic health care provision in Kenya. The participants were purposefully sampled. The coding structure involved predefined themes for assessing the following: (1) the context, that is, environment, user, task, and technology; (2) patient acceptability, that is, patients' perceived benefits, patient preference, and patient satisfaction; (3) usability, that is, efficiency, effectiveness, learnability, and flexibility and operability of Peek; and (4) the benefits of Peek in strengthening eye care provision, that is, capabilities enhancer, opportunity creator, social enabler, and knowledge generator. Emerging themes relating to the objectives were explored from the data using thematic analysis. Results Patients found Peek to be acceptable because of its benefits in overcoming the barriers to accessing ophthalmic services. Most thought it to be fast, convenient, and able to reach a large population. All patients expressed being satisfied with Peek. The HCPs perceived it to satisfy the criteria for usability and found Peek to be acceptable based on the

  11. Interventions for Children Affected by War: An Ecological Perspective on Psychosocial Support and Mental Health Care

    PubMed Central

    Betancourt, Theresa S.; Meyers-Ohki, Sarah E.; Charrow, Alexandra P.; Tol, Wietse A.

    2014-01-01

    Background Children and adolescents exposed to armed conflict are at high risk of developing mental health problems. To date, a range of psychosocial approaches and clinical/psychiatric interventions has been used to address mental health needs in these groups. Aims To provide an overview of peer-reviewed psychosocial and mental health interventions designed to address mental health needs of conflict-affected children, and to highlight areas in which policy and research need strengthening. Methods We used standard review methodology to identify interventions aimed at improving or treating mental health problems in conflict-affected youth. An ecological lens was used to organize studies according to the individual, family, peer/school, and community factors targeted by each intervention. Interventions were also evaluated for their orientation toward prevention, treatment, or maintenance, and for the strength of the scientific evidence of reported effects. Results Of 2305 studies returned from online searches of the literature and 21 sources identified through bibliography mining, 58 qualified for full review, with 40 peer-reviewed studies included in the final narrative synthesis. Overall, the peer-reviewed literature focused largely on school-based interventions. Very few family and community-based interventions have been empirically evaluated. Only two studies assessed multilevel or stepped-care packages. Conclusions The evidence base on effective and efficacious interventions for conflict-affected youth requires strengthening. Postconflict development agendas must be retooled to target the vulnerabilities characterizing conflict-affected youth, and these approaches must be collaborative across bodies responsible for the care of youth and families. PMID:23656831

  12. Testing Self-Efficacy as a Pathway that Supports Self-Care among Family Caregivers in a Psychoeducational Intervention

    ERIC Educational Resources Information Center

    Savundranayagam, Marie Y.; Brintnall-Peterson, Mary

    2010-01-01

    This study investigated the extent to which a psychoeducational intervention supports family-centered care by influencing health risk and self-care behaviors of caregivers of individuals with Alzheimer's disease (N = 325). Moreover, this study investigated the extent to which changes in self-efficacy explained changes in health risk and self-care…

  13. The Effects of a Teacher-Child Play Intervention on Classroom Compliance in Young Children in Child Care Settings

    ERIC Educational Resources Information Center

    Levine, Darren G.; Ducharme, Joseph M.

    2013-01-01

    The current study evaluated the effects of a teacher-conducted play intervention on preschool-aged children's compliance in child care settings. Study participants included 8 children ranging in age from 3 to 5 years and 5 early childhood education teachers within 5 classrooms across 5 child care centers. A combination ABAB and multiple baseline…

  14. Building the mental health care network for children and adolescents: interventions in the territory.

    PubMed

    Tszesnioski, Luíse de Cássia; da Nóbrega, Keise Bastos Gomes; de Lima, Maria Luiza Lopes Timóteo; Facundes, Vera Lúcia Dutra

    2015-02-01

    Children with mental disorders may develop serious adverse effects in their functional performance. A structured care network may favor psychosocial components, such as self-confidence and problem solving capacity. This work seeks to identify the care network for children with mental disorders and develop interventions in the territory, highlighting changes achieved from these actions. This is a descriptive study based on the action research methood using an eco-Map for data presentation. The results indicate that the majority of children have stressful relationships within the family, and relationships of greater intensity and quality with the Community Health Workers, Primary Care and Education, with childcare, compared with specialist health services. The interventions were based on the guidelines of Family Health, Support Center and stressed the strengthening of family ties, and liaison with health services and schools/ daycare centers. PMID:25715130

  15. [Trials for early intervention in Mie Prefectural Mental Care Center].

    PubMed

    Harada, Masanori; Adachi, Takako; Iwasa, Takashi; Kurita, Kouji; Nakamura, Tomoki; Hama, Yukinobu; Yamamoto, Ayako; Maegawa, Sanae

    2013-01-01

    Mie Prefectural Mental Care Center is a public psychiatric hospital that has 400 beds and 250 outpatients a day. The main catchment area is Tsu City (population: 290,000). Our hospital started early intervention in Aug 2008, and opened the Youth Mental Support Center MIE (YMSC MIE) in Oct 2008. This article reports an early intervention trial in a regional area of Japan. The mission of YMSC MIE is the education, consultation, staff training, and intervention for mental health problems and early psychosis of youths. In Jul 2009, we set up the Youth Assist Clinic (YAC) to support youths with mental health problems and early psychoses. Our activities consist of school-based, community-based, and hospital-based approaches. Specific programs are as follows: 1) School-based approaches: Outreach consultation to school. Mental health lessens. Creating mental health textbooks. Education for parents and teachers. 2) Community-based approaches: To enlighten primary physicians and mental clinic psychiatrists about the importance of early psychosis. To survey their concerns regarding early psychosis. Promoting awareness of community staff and the general public. 3) Hospital-based approaches: YAC. Case manager system. Family meetings for the family including the young with mental disorders. Peer group. Looking back over our 3-year trials, especially in school and the community, we find several problems, as follows: 1) Lack of consultation skills of medical staff outside the hospital. 2) Limiting number of schools which have mental support system. 3) Support for school attendance and learning. 4) Lack of concern about early psychosis of primary physicians and mental clinic psychiatrists. 5) Staff training for early intervention. We are now getting close to improving these issues.

  16. The Effect of a Personalized Dementia Care Intervention for Caregivers From Australian Minority Groups.

    PubMed

    Xiao, Lily Dongxia; De Bellis, Anita; Kyriazopoulos, Helena; Draper, Brian; Ullah, Shahid

    2016-02-01

    Most caregiver interventions in a multicultural society are designed to target caregivers from the mainstream culture and exclude those who are unable to speak English. This study addressed the gap by testing the hypothesis that personalized caregiver support provided by a team led by a care coordinator of the person with dementia would improve competence for caregivers from minority groups in managing dementia. A randomised controlled trial was utilised to test the hypothesis. Sixty-one family caregivers from 10 minority groups completed the trial. Outcome variables were measured prior to the intervention, at 6 and 12 months after the commencement of trial. A linear mixed effect model was used to estimate the effectiveness of the intervention. The intervention group showed a significant increase in the caregivers' sense of competence and mental components of quality of life. There were no significant differences in the caregivers' physical components of quality of life.

  17. Washington's Infant Toddler Early Intervention Program Study: Enrollment of Washington Children with Disabilities and Special Health Care Needs in Washington State Public Programs on December 1, 1995.

    ERIC Educational Resources Information Center

    Keenan, Trisha; And Others

    This document presents tables, graphs, and narrative text providing information on the number and characteristics of infants and toddlers, under the age of 3, with disabilities and special health problems who were enrolled in Washington State's infant and toddler early intervention program in 1995. Major findings of the report include the…

  18. Effects of a psycho-educational intervention on direct care workers' communicative behaviors with residents with dementia.

    PubMed

    Barbosa, Ana; Marques, Alda; Sousa, Liliana; Nolan, Mike; Figueiredo, Daniela

    2016-01-01

    This study assessed the effects of a person-centered care-based psycho-educational intervention on direct care workers' communicative behaviors with people with dementia living in aged-care facilities. An experimental study with a pretest-posttest control-group design was conducted in four aged-care facilities. Two experimental facilities received an 8-week psycho-educational intervention aiming to develop workers' knowledge about dementia, person-centered care competences, and tools for stress management. Control facilities received education only, with no support to deal with stress. In total, 332 morning care sessions, involving 56 direct care workers (female, mean age 44.72 ± 9.02 years), were video-recorded before and 2 weeks after the intervention. The frequency and duration of a list of verbal and nonverbal communicative behaviors were analyzed. Within the experimental group there was a positive change from pre- to posttest on the frequency of all workers' communicative behaviors. Significant treatment effects in favor of the experimental group were obtained for the frequency of inform (p < .01, η(2)partial = 0.09) and laugh (p < .01, η(2)partial = 0.18). Differences between groups emerged mainly in nonverbal communicative behaviors. The findings suggest that a person-centered care-based psycho-educational intervention can positively affect direct care workers' communicative behaviors with residents with dementia. Further research is required to determine the extent of the benefits of this approach.

  19. A rational model for assessing and evaluating complex interventions in health care

    PubMed Central

    May, Carl

    2006-01-01

    Background Understanding how new clinical techniques, technologies and other complex interventions become normalized in practice is important to researchers, clinicians, health service managers and policy-makers. This paper presents a model of the normalization of complex interventions. Methods Between 1995 and 2005 multiple qualitative studies were undertaken. These examined: professional-patient relationships; changing patterns of care; the development, evaluation and implementation of telemedicine and related informatics systems; and the production and utilization of evidence for practice. Data from these studies were subjected to (i) formative re-analysis, leading to sets of analytic propositions; and to (ii) a summative analysis that aimed to build a robust conceptual model of the normalization of complex interventions in health care. Results A normalization process model that enables analysis of the conditions necessary to support the introduction of complex interventions is presented. The model is defined by four constructs: interactional workability; relational integration; skill set workability and contextual integration. This model can be used to understand the normalization potential of new techniques and technologies in healthcare settings Conclusion The normalization process model has face validity in (i) assessing the potential for complex interventions to become routinely embedded in everyday clinical work, and (ii) evaluating the factors that promote or inhibit their success and failure in practice. PMID:16827928

  20. No Evidence of the Effect of the Interventions to Combat Health Care Fraud and Abuse: A Systematic Review of Literature

    PubMed Central

    Rashidian, Arash; Joudaki, Hossein; Vian, Taryn

    2012-01-01

    Background Despite the importance of health care fraud and the political, legislative and administrative attentions paid to it, combating fraud remains a challenge to the health systems. We aimed to identify, categorize and assess the effectiveness of the interventions to combat health care fraud and abuse. Methods The interventions to combat health care fraud can be categorized as the interventions for ‘prevention’ and ‘detection’ of fraud, and ‘response’ to fraud. We conducted sensitive search strategies on Embase, CINAHL, and PsycINFO from 1975 to 2008, and Medline from 1975–2010, and on relevant professional and organizational websites. Articles assessing the effectiveness of any intervention to combat health care fraud were eligible for inclusion in our review. We considered including the interventional studies with or without a concurrent control group. Two authors assessed the studies for inclusion, and appraised the quality of the included studies. As a limited number of studies were found, we analyzed the data using narrative synthesis. Findings The searches retrieved 2229 titles, of which 221 full-text studies were assessed. We found no studies using an RCT design. Only four original articles (from the US and Taiwan) were included: two studies within the detection category, one in the response category, one under the detection and response categories, and no studies under the prevention category. The findings suggest that data-mining may improve fraud detection, and legal interventions as well as investment in anti-fraud activities may reduce fraud. Discussion Our analysis shows a lack of evidence of effect of the interventions to combat health care fraud. Further studies using robust research methodologies are required in all aspects of dealing with health care fraud and abuse, assessing the effectiveness and cost-effectiveness of methods to prevent, detect, and respond to fraud in health care. PMID:22936981

  1. Behind the scenes of the PRIME intervention: designing a complex intervention to improve malaria care at public health centres in Uganda

    PubMed Central

    DiLiberto, Deborah D.; Staedke, Sarah G.; Nankya, Florence; Maiteki-Sebuguzi, Catherine; Taaka, Lilian; Nayiga, Susan; Kamya, Moses R.; Haaland, Ane; Chandler, Clare I. R.

    2015-01-01

    Background In Uganda, health system challenges limit access to good quality healthcare and contribute to slow progress on malaria control. We developed a complex intervention (PRIME), which was designed to improve quality of care for malaria at public health centres. Objective Responding to calls for increased transparency, we describe the PRIME intervention's design process, rationale, and final content and reflect on the choices and challenges encountered during the design of this complex intervention. Design To develop the intervention, we followed a multistep approach, including the following: 1) formative research to identify intervention target areas and objectives; 2) prioritization of intervention components; 3) review of relevant evidence; 4) development of intervention components; 5) piloting and refinement of workshop modules; and 6) consolidation of the PRIME intervention theories of change to articulate why and how the intervention was hypothesized to produce desired outcomes. We aimed to develop an intervention that was evidence-based, grounded in theory, and appropriate for the study context; could be evaluated within a randomized controlled trial; and had the potential to be scaled up sustainably. Results The process of developing the PRIME intervention package was lengthy and dynamic. The final intervention package consisted of four components: 1) training in fever case management and use of rapid diagnostic tests for malaria (mRDTs); 2) workshops in health centre management; 3) workshops in patient-centred services; and 4) provision of mRDTs and antimalarials when stocks ran low. Conclusions The slow and iterative process of intervention design contrasted with the continually shifting study context. We highlight the considerations and choices made at each design stage, discussing elements we included and why, as well as those that were ultimately excluded. Reflection on and reporting of ‘behind the scenes’ accounts of intervention design may

  2. Effect of public health nurses’ educational intervention on self-care of the patients with type 2 diabetes

    PubMed Central

    Zandiyeh, Zahra; Hedayati, Batool; Zare, Elahe

    2015-01-01

    Background: Diabetes is the most common metabolic disease and the sixth cause of mortality in the world. Most of the conducted studies show that the only way to control this disease and prevent its disabling complications is constant administration of self-care. Aim: This study was conducted with the goal of determining the effect of public health nurses’ educational intervention on the self-care of the patients with type 2 diabetes who referred to Hazrat Ali clinic in Isfahan. Materials and Methods: This is a two-group two-step clinical trial with a before–after intervention design in which 50 patients with type 2 diabetes and with a mean age of 40–70 years were selected and assigned to study (n = 25) and control (n = 25) groups by allotting them even and add numbers. Educational intervention was conducted in the study group through seven educational sessions. Mean scores of self-care before and after interventions were compared by Toobert and Glasgow brief self-care activities questionnaire. Results: Results showed no significant difference in the self-care scores before intervention in the two groups (P = 0.67, z = 0.43), but the mean score of self-care showed a significant increase after intervention in the study group, compared to the control group (P = 0.002, z = 3.14). Conclusion: Based on the obtained results, it is suggested to provide constant education of self-care for diabetic patients in health care centers, with more emphasis on a change in self-care skills and behavior. PMID:27462630

  3. Improving glycaemic control and life skills in adolescents with type 1 diabetes: A randomised, controlled intervention study using the Guided Self-Determination-Young method in triads of adolescents, parents and health care providers integrated into routine paediatric outpatient clinics

    PubMed Central

    2011-01-01

    Background Adolescents with type 1 diabetes face demanding challenges due to conflicting priorities between psychosocial needs and diabetes management. This conflict often results in poor glycaemic control and discord between adolescents and parents. Adolescent-parent conflicts are thus a barrier for health care providers (HCPs) to overcome in their attempts to involve both adolescents and parents in improvement of glycaemic control. Evidence-based interventions that involve all three parties (i.e., adolescents, parents and HCPs) and are integrated into routine outpatient clinic visits are lacking. The Guided Self-Determination method is proven effective in adult care and has been adapted to adolescents and parents (Guided Self-Determination-Young (GSD-Y)) for use in paediatric diabetes outpatient clinics. Our objective is to test whether GSD-Y used in routine paediatric outpatient clinic visits will reduce haemoglobin A1c (HbA1c) concentrations and improve adolescents' life skills compared with a control group. Methods/Design Using a mixed methods design comprising a randomised controlled trial and a nested qualitative evaluation, we will recruit 68 adolescents age 13 - 18 years with type 1 diabetes (HbA1c > 8.0%) and their parents from 2 Danish hospitals and randomise into GSD-Y or control groups. During an 8-12 month period, the GSD-Y group will complete 8 outpatient GSD-Y visits, and the control group will completes an equal number of standard visits. The primary outcome is HbA1c. Secondary outcomes include the following: number of self-monitored blood glucose values and levels of autonomous motivation, involvement and autonomy support from parents, autonomy support from HCPs, perceived competence in managing diabetes, well-being, and diabetes-related problems. Primary and secondary outcomes will be evaluated within and between groups by comparing data from baseline, after completion of the visits, and again after a 6-month follow-up. To illustrate how GSD

  4. Interventions to Improve Care for Patients with Limited Health Literacy

    PubMed Central

    Sudore, Rebecca L.; Schillinger, Dean

    2009-01-01

    Objective To propose a framework and describe best practices for improving care for patients with limited health literacy (LHL). Methods Review of the literature. Results Approximately half of the U.S. adult population has LHL. Because LHL is associated with poor health outcomes and contributes to health disparities, the adoption of evidence-based best practices is imperative. Feasible interventions at the clinician-patient level (eg, patient-centered communication, clear communication techniques, teach-to-goal methods, and reinforcement), at the system-patient level (eg, clear health education materials, visual aids, clear medication labeling, self-management support programs, and shame-free clinical environments), and at the community-patient level (eg, adult education referrals, lay health educators, and harnessing the mass media) can improve health outcomes for patients with LHL. Conclusion Because LHL is prevalent, and because the recommended communication strategies can benefit patients of all literacy levels, clinicians, health system planners, and health policy leaders should promote the uptake of these strategies into routine care. PMID:20046798

  5. Strengthening the Late-Life Care Process: Effects of Two Forms of a Care-Receiver Efficacy Intervention

    ERIC Educational Resources Information Center

    Cox, Enid O.; Green, Kathy E.; Hobart, Katharine; Jang, Li-Ju; Seo, Honglan

    2007-01-01

    Purpose: The primary goal of the Care-Receiver Efficacy Intervention (CREI) was to increase the capacity of cognitively able elderly care receivers to effectively manage their own care and optimize relationships with caregivers. To accomplish this, two forms of the CREI were created: an individual and a small-group form. The purpose of this study…

  6. Tailored weight loss intervention in obese adults within primary care practice: rationale, design, and methods of Choose to Lose.

    PubMed

    Hartman, Sheri J; Risica, Patricia M; Gans, Kim M; Marcus, Bess H; Eaton, Charles B

    2014-07-01

    Although there are efficacious weight loss interventions that can improve health and delay onset of diabetes and hypertension, these interventions have not been translated into clinical practice. The primary objective of this study is to evaluate the effectiveness and cost effectiveness of a tailored lifestyle intervention in primary care patients. Patients were recruited by their primary care physicians and eligible participants were randomized to an enhanced intervention or standard intervention. All participants met with a lifestyle counselor to set calorie and physical activity goals and to discuss behavioral strategies at baseline, 6 and 12 months. During the first year, enhanced intervention participants receive monthly counseling phone calls to assist in attaining and maintaining their goals. Enhanced intervention participants also receive weekly mailings consisting of tailored and non-tailored print materials and videos focusing on weight loss, physical activity promotion and healthy eating. The second year focuses on maintenance with enhanced intervention participants receiving tailored and non-tailored print materials and videos regularly throughout the year. Standard intervention participants receive five informational handouts on weight loss across the two years. This enhanced intervention that consists of multiple modalities of print, telephone, and video with limited face-to-face counseling holds promise for being effective for encouraging weight loss, increasing physical activity and healthy eating, and also for being cost effective and generalizable for wide clinical use. This study will fill an important gap in our knowledge regarding the translation and dissemination of research from efficacy studies to best practices in clinical settings. PMID:24937016

  7. Tailored weight loss intervention in obese adults within primary care practice: rationale, design, and methods of Choose to Lose.

    PubMed

    Hartman, Sheri J; Risica, Patricia M; Gans, Kim M; Marcus, Bess H; Eaton, Charles B

    2014-07-01

    Although there are efficacious weight loss interventions that can improve health and delay onset of diabetes and hypertension, these interventions have not been translated into clinical practice. The primary objective of this study is to evaluate the effectiveness and cost effectiveness of a tailored lifestyle intervention in primary care patients. Patients were recruited by their primary care physicians and eligible participants were randomized to an enhanced intervention or standard intervention. All participants met with a lifestyle counselor to set calorie and physical activity goals and to discuss behavioral strategies at baseline, 6 and 12 months. During the first year, enhanced intervention participants receive monthly counseling phone calls to assist in attaining and maintaining their goals. Enhanced intervention participants also receive weekly mailings consisting of tailored and non-tailored print materials and videos focusing on weight loss, physical activity promotion and healthy eating. The second year focuses on maintenance with enhanced intervention participants receiving tailored and non-tailored print materials and videos regularly throughout the year. Standard intervention participants receive five informational handouts on weight loss across the two years. This enhanced intervention that consists of multiple modalities of print, telephone, and video with limited face-to-face counseling holds promise for being effective for encouraging weight loss, increasing physical activity and healthy eating, and also for being cost effective and generalizable for wide clinical use. This study will fill an important gap in our knowledge regarding the translation and dissemination of research from efficacy studies to best practices in clinical settings.

  8. You Asked, but Will Not Listen: (Re)framing a Phenomenological Study about (Dis)connections between Special Education Early Intervention and Foster Care

    ERIC Educational Resources Information Center

    Palladino, John M.; Giesler, Mark A.

    2011-01-01

    Within the United States a significant population of foster care infants and toddlers access early special education services under the parameters of the "Individuals with Disabilities Education Act" (IDEA)-Part C (United States Congress 2004). A dearth of literature exists about special education interventionists' services for this particular…

  9. [Intervention in situations of psychic crisis: challenges and suggestions of a prehospital care staff].

    PubMed

    Almeida, Alexsandro Barreto; do Nascimento, Eliane Regina Pereira; Rodrigues, Jeferson; Schweitzer, Gabriela

    2014-01-01

    A qualitative and descriptive research, aimed at knowing how the pre-hospital care professionals perceive the interventions towards people in mental crisis. The study was developed in Santa Catarina with four teams of basic life support units of the Department of Mobile Emergency Care, during April to June 2011. The Collective Subject Discourse was used as the method of analysis. Two themes emerged: Awareness of the difficulties in meeting a person in mental crisis and Suggestions in the search for a closer attention to the person in mental crisis. The difficulties mentioned were related to the lack of training and a local to forward the patients, suggesting a better training and systematization of care. We conclude that it is necessary to invest in the educational process, based on new care strategies guided by the principles of SUS and of the psychosocial paradigm, and revisit the strategy of protocols as guidelines and not as standardizing systems.

  10. Targeted Interventions Improve Shared Agreement of Daily Goals in the Pediatric Intensive Care Unit

    PubMed Central

    Rehder, Kyle J; Uhl, Tammy L; Meliones, Jon N; Turner, David A; Smith, P Brian; Mistry, Kshitij P

    2011-01-01

    Objective To improve communication during daily rounds using sequential interventions. Design Prospective cohort study Setting Multidisciplinary pediatric intensive care unit in a university hospital. Subjects The multidisciplinary rounding team in the pediatric intensive care unit, including attending physicians, physician trainees, and nurses. Interventions Daily rounds on 736 patients were observed over a nine month period. Sequential interventions were timed 8–12 weeks apart: (1) Implementing a new resident daily progress note format, (2) creating a performance improvement `dashboard,' and (3) documenting patients' daily goals on bedside whiteboards. Measurements and Main Results Following all interventions, team agreement with the attending physician's stated daily goals increased from 56.9% to 82.7% (p < 0.0001). Mean agreement increased for each provider category: 65.2% to 88.8% for fellows (p < 0.0001), 55.0% to 83.8% for residents (p < 0.0001), and 54.1% to 77.4% for nurses (p < 0.0001). In addition, significant improvements were noted in provider behaviors following interventions. Barriers to communication (bedside nurse multitasking during rounds, interruptions during patient presentations, and group disassociation) were reduced, and the use of communication facilitators (review of the prior day's goals, inclusion of bedside nurse input, and order read back) increased. The percentage of providers reporting being `very satisfied' or `satisfied' with rounds increased from 42.6% to 78.3%, (p < 0.0001). Conclusions Shared agreement of patients' daily goals among key healthcare providers can be increased through process-oriented interventions. Improved agreement will potentially lead to improved quality of patient care and reduced medical errors. PMID:21478796

  11. RCT of a Care Manager Intervention for Major Depression in Primary Care: 2-Year Costs for Patients With Physical vs Psychological Complaints

    PubMed Central

    Dickinson, L. Miriam; Rost, Kathryn; Nutting, Paul A.; Elliott, Carl E.; Keeley, Robert D.; Pincus, Harold

    2005-01-01

    PURPOSE Depression care management for primary care patients results in sustained improvement in clinical outcomes with diminishing costs over time. Clinical benefits, however, are concentrated primarily in patients who report to their primary care clinicians psychological rather than exclusively physical symptoms. This study proposes to determine whether the intervention affects outpatient costs differentially when comparing patients who have psychological with patients who have physical complaints. METHODS We undertook a group-randomized controlled trial (RCT) of depression comparing intervention with usual care in 12 primary care practices. Intervention practices encouraged depressed patients to engage in active treatment, using nurses to provide regularly scheduled care management for 24 months. The study sample included 200 adults beginning a new depression treatment episode where patient presentation style could be identified. Outpatient costs were defined as intervention plus outpatient treatment costs for the 2 years. Cost-offset analysis used general linear mixed models, 2-part models, and bootstrapping to test hypotheses regarding a differential intervention effect by patients’ style, and to obtain 95% confidence intervals for costs. RESULTS Intervention effects on outpatient costs over time differed by patient style (P <.05), resulting in a $980 cost decrease for depressed patients who complain of psychological symptoms and a $1,378 cost increase for depressed patients who complain of physical symptoms only. CONCLUSIONS Depression intervention for a 2-year period produced observable clinical benefit with decreased outpatient costs for depressed patients who complain of psychological symptoms. It produced limited clinical benefit with increased costs, however, for depressed patients who complain exclusively of physical symptoms, suggesting the need for developing new intervention approaches for this group. PMID:15671186

  12. [Effects of Ward Interventions on Repeated Critical Incidents in Child and Adolescent Psychiatric Inpatient Care].

    PubMed

    Ulke, Christine; Klein, Annette M; von Klitzing, Kai

    2014-01-01

    Effects of Ward Interventions on Repeated Critical Incidents in Child and Adolescent Psychiatric Inpatient Care. The aim of this study was to evaluate the effects of several ward interventions (transition to an open ward concept, individualized treatment plans, tiered crisis-management, staff training, quality control) on repeated critical incidents, non-restrictive and restrictive measures. The outcome variables were compared in two time periods, 2007 and 2011. The study included 74 critical incident reports of 51 child and adolescent inpatients that had at least one hospital stay and one critical incident in the selected time periods. Aggressive, self-harming, and absconding incidents were included. The quantitative results suggest that ward interventions can contribute to a reduction of repeated critical incidents and restrictive measures. The qualitative evaluation suggests a cultural change of crisis management.

  13. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers

    PubMed Central

    Kimmel, Allison L.; Wang, Jichuan; Scott, Rachel; Briggs, Linda; Lyon, Maureen E.

    2016-01-01

    Although the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered Advance Care Planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18-month post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥21 years of age; surrogates will be ≥18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS. PMID:26044463

  14. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers.

    PubMed

    Kimmel, Allison L; Wang, Jichuan; Scott, Rachel K; Briggs, Linda; Lyon, Maureen E

    2015-07-01

    Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥ 21 years of age; surrogates will be ≥ 18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.

  15. Effect of foster care on language learning at eight years: findings from the Bucharest Early Intervention Project.

    PubMed

    Windsor, Jennifer; Moraru, Ana; Nelson, Charles A; Fox, Nathan A; Zeanah, Charles H

    2013-06-01

    This study reports on language outcomes at eight years from the Bucharest Early Intervention Project, a randomized controlled study of foster care. We previously have shown that children placed in foster care by age two have substantially stronger preschool language outcomes than children placed later and children remaining in institutional care. One hundred and five children participated in the current study, fifty-four originally assigned to foster care and fifty-one to continued institutional care. Even though current placements varied, children originally in foster care had longer sentences and stronger sentence repetition and written word identification. Children placed in foster care by age two had significant advantages in word identification and nonword repetition; children placed by age 1 ; 3 performed equivalently to community peers. The results show the continuing adverse effects of early poor institutional care on later language development and the key importance of age of placement in a more optimal environment.

  16. Systematic review of mental health interventions for patients with common somatic symptoms: can research evidence from secondary care be extrapolated to primary care?

    PubMed Central

    Raine, Rosalind; Haines, Andy; Sensky, Tom; Hutchings, Andrew; Larkin, Kirsten; Black, Nick

    2002-01-01

    Objectives To determine the strength of evidence for the effectiveness of mental health interventions for patients with three common somatic conditions (chronic fatigue syndrome, irritable bowel syndrome, and chronic back pain). To assess whether results obtained in secondary care can be extrapolated to primary care and suggest how future trials should be designed to provide more rigorous evidence. Design Systematic review. Data sources Five electronic databases, key texts, references in the articles identified, and citations from expert clinicians. Study selection Randomised controlled trials including participants with one of the three conditions for which no physical cause could be found. Two reviewers screened sources and independently extracted data and assessed quality. Results Sixty one studies were identified; 20 were classified as primary care and 41 as secondary care. For some interventions, such as brief psychodynamic interpersonal therapy, little research was identified. However, results of meta-analyses and of randomised controlled trials suggest that cognitive behaviour therapy and behaviour therapy are effective for chronic back pain and chronic fatigue syndrome and that antidepressants are effective for irritable bowel syndrome. Cognitive behaviour therapy and behaviour therapy were effective in both primary and secondary care in patients with back pain, although the evidence is more consistent and the effect size larger for secondary care. Antidepressants seem effective in irritable bowel syndrome in both settings but ineffective in chronic fatigue syndrome. Conclusions Treatment seems to be more effective in patients in secondary care than in primary care. This may be because secondary care patients have more severe disease, they receive a different treatment regimen, or the intervention is more closely supervised. However, conclusions of effectiveness should be considered in the light of the methodological weaknesses of the studies. Large

  17. [Nursing interventions on the physical environment of Neonatal Intensive Care Units].

    PubMed

    Miquel Capó Rn, I

    2016-01-01

    The objectives of this study are to analyse nursing interventions regarding noise and lighting that influence neurodevelopment of the preterm infant in the Neonatal Intensive Care Unit. A review of the literature was performed using the databases: Cuiden Plus, PubMed, IBECS and Cochrane Library Plus. The inclusion and exclusion criteria were established in accordance with the objectives and limits used in each database. Of the 35 articles used, most were descriptive quantitative studies based on the measurement of sound pressure levels and lighting in the Neonatal Intensive Care Units. The countries included in this study are Brazil and the United States, and the variables analysed were the recording the times of light and noise. Based on the high levels of light and noise recorded in the Neonatal Intensive Care Units, nursing interventions that should be carried out to reduce them are described. The evidence indicates that after the implementation of these interventions, the high levels of both environmental stimuli are reduced significantly. Despite the extensive literature published on this problem, the levels of light and noise continue to exceed the recommended limits. Therefore, nurses need to increase and enhance their efforts in this environment, in order to positively influence neurodevelopment of premature newborn.

  18. Do Interventions that Promote Awareness of Rights Increase Use of Maternity Care Services? A Systematic Review

    PubMed Central

    George, Asha S.; Branchini, Casey; Portela, Anayda

    2015-01-01

    Twenty years after the rights of women to go through pregnancy and childbirth safely were recognized by governments, we assessed the effects of interventions that promote awareness of these rights to increase use of maternity care services. Using inclusion and exclusion criteria defined in a peer-reviewed protocol, we searched published and grey literature from one database of studies on maternal health, two search engines, an internet search and contact with experts. From the 707 unique documents found, 219 made reference to rights, with 22 detailing interventions promoting awareness of rights for maternal and newborn health. Only four of these evaluated effects on health outcomes. While all four interventions promoted awareness of rights, they did so in different ways. Interventions included highly-scripted dissemination meetings with educational materials and other visual aids, participatory approaches that combined raising awareness of rights with improving accountability of services, and broader multi-stakeholder efforts to improve maternal health. Study quality ranged from weak to strong. Measured health outcomes included increased antenatal care and facility birth. Improvements in human rights outcomes such as availability, acceptability, accessibility, quality of care, as well as the capacity of rights holders and duty bearers were also reported to varying extents. Very little information on costs and almost no information on harms or risks were described. Despite searching multiple sources of information, while some studies did report on activities to raise awareness of rights, few detailed how they did so and very few measured effects on health outcomes. Promoting awareness of rights is one element of increasing demand for and use of quality maternity care services for women during pregnancy, birth and after birth. To date efforts have not been well documented in the literature and the program theories, processes and costs, let alone health effects have

  19. Do Interventions that Promote Awareness of Rights Increase Use of Maternity Care Services? A Systematic Review.

    PubMed

    George, Asha S; Branchini, Casey; Portela, Anayda

    2015-01-01

    Twenty years after the rights of women to go through pregnancy and childbirth safely were recognized by governments, we assessed the effects of interventions that promote awareness of these rights to increase use of maternity care services. Using inclusion and exclusion criteria defined in a peer-reviewed protocol, we searched published and grey literature from one database of studies on maternal health, two search engines, an internet search and contact with experts. From the 707 unique documents found, 219 made reference to rights, with 22 detailing interventions promoting awareness of rights for maternal and newborn health. Only four of these evaluated effects on health outcomes. While all four interventions promoted awareness of rights, they did so in different ways. Interventions included highly-scripted dissemination meetings with educational materials and other visual aids, participatory approaches that combined raising awareness of rights with improving accountability of services, and broader multi-stakeholder efforts to improve maternal health. Study quality ranged from weak to strong. Measured health outcomes included increased antenatal care and facility birth. Improvements in human rights outcomes such as availability, acceptability, accessibility, quality of care, as well as the capacity of rights holders and duty bearers were also reported to varying extents. Very little information on costs and almost no information on harms or risks were described. Despite searching multiple sources of information, while some studies did report on activities to raise awareness of rights, few detailed how they did so and very few measured effects on health outcomes. Promoting awareness of rights is one element of increasing demand for and use of quality maternity care services for women during pregnancy, birth and after birth. To date efforts have not been well documented in the literature and the program theories, processes and costs, let alone health effects have

  20. Health Status and Self-care Outcomes Following an Education-Support Intervention for People with Chronic Heart Failure

    PubMed Central

    Clark, Angela P.; McDougall, Graham; Riegel, Barbara; Joiner-Rogers, Glenda; Innerarity, Sheri; Meraviglia, Martha; Delville, Carol; Davila, Ashley

    2014-01-01

    Background The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination. Objective The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I-III HF. Our secondary purpose was to explore participants’ subjective perceptions of the intervention. Methods This study used a randomized, 2 group design. Fifty people were enrolled for 9 months and tested at 4 time points—baseline; following a 3-month education-support intervention; at 6 months, following 3-months of telephone/email support; and 9 months, following a 3-month period of no contact. Advanced practice registered nurses (APRNs) delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention’s effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study. Results The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%), and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy and quality of life (Kansas City Cardiomyopathy Questionnaire-KCCQ); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire-MIA); self-care knowledge (HF Knowledge Test-HFKT); and self-care (Self-Care in Heart Failure Index—SCHFI). Participants in both

  1. Studying nursing interventions in acutely ill, cognitively impaired older adults

    PubMed Central

    McCauley, Kathleen; Bradway, Christine; Hirschman, Karen B; Naylor, Mary D

    2015-01-01

    Background Between one and two of every five hospitalized older adults have cognitive deficits, often not accurately assessed or well managed. Cognitive impairment adds substantially to the complexity of these patients’ care, places them at high risk for poor outcomes and increases the cost of health care. Methods We describe three evidence-based interventions, each capitalizing on the unique contributions of nurses and designed to improve outcomes of hospitalized older adults who have cognitive deficits. Interventions of varying intensity were compared across three hospitals (Phase I) and subsequently within the same hospitals (Phase II). All enrolled patients were screened during their index hospitalizations and cognitive deficits were communicated to relevant health care team members (Augmented Standard Care-ASC, lowest intensity). At one hospital, ASC was the only intervention. Patients at a second hospital also had care influenced by specially prepared registered nurses (Resource Nurse Care-RNC, medium intensity). Finally, patients at third hospital also received advanced practice nurse coordinated care (Transitional Care Model-TCM, higher intensity). In Phase II, newly enrolled patients at these same hospitals all received the TCM. We summarize major themes from review of multiple data sources and researcher recollections related to facilitators and barriers to implementing a complex research study. Findings Effective implementation of the three intervention strategies depended on clinician engagement and communication; degree of participation by nurses in the educational program with subsequent practice improvement; and success of advanced practice nurses in implementing the TCM with both with patients, family caregivers and clinicians. Implications Based on lessons learned in implementing complex research studies within the “real world” of clinical practice settings, recommendations focus on strengthening facilitators, minimizing barriers and gaining

  2. Cultural Leverage: Interventions Using Culture to Narrow Racial Disparities in Health Care

    PubMed Central

    Fisher, Thomas L.; Burnet, Deborah L.; Huang, Elbert S.; Chin, Marshall H.; Cagney, Kathleen A.

    2008-01-01

    The authors reviewed interventions using cultural leverage to narrow racial disparities in health care. Thirty-eight interventions of three types were identified: interventions that modified the health behaviors of individual patients of color, that increased the access of communities of color to the existing health care system, and that modified the health care system to better serve patients of color and their communities. Individual-level interventions typically tapped community members’ expertise to shape programs. Access interventions largely involved screening programs, incorporating patient navigators and lay educators. Health care interventions focused on the roles of nurses, counselors, and community health workers to deliver culturally tailored health information. These interventions increased patients’ knowledge for self-care, decreased barriers to access, and improved providers’ cultural competence. The delivery of processes of care or intermediate health outcomes was significantly improved in 23 interventions. Interventions using cultural leverage show tremendous promise in reducing health disparities, but more research is needed to understand their health effects in combination with other interventions. PMID:17881628

  3. Increasing the Screening and Counseling of Adolescents for Risky Health Behaviors: A Primary Care Intervention

    ERIC Educational Resources Information Center

    Ozer, Elizabeth M.; Adams, Sally H.; Lustig, Julie L.; Gee, Scott; Garber, Andrea K.; Gardner, Linda Rieder; Rehbein, Michael; Addison, Louise; Irwin, Charles E., Jr.

    2005-01-01

    Objective: To determine whether a systems intervention for primary care providers resulted in increased preventive screening and counseling of adolescent patients, compared with the usual standard of care. Methods: The intervention was conducted in 2 out-patient pediatric clinics; 2 other pediatric clinics in the same health maintenance…

  4. Advancing Coordinated Care in Four Provincial Healthcare Systems: Evaluating a Knowledge-Exchange Intervention

    PubMed Central

    Lyons, Renee; Parker, Victoria; Phillips, Stephen

    2011-01-01

    Objectives: This research project created and evaluated a knowledge-exchange intervention designed to facilitate an increase in organizational readiness for implementing coordinated stroke care in four primarily rural provincial healthcare systems. Intervention: Knowledge brokers were linked to networks within, across and outside the provinces to support, inform and disseminate best practice recommendations for coordinated stroke care within the provincial healthcare systems. Findings: The intervention increased awareness and dissemination of recommendations, which stimulated the implementation of coordinated stroke care. Similar knowledge-exchange interventions might work in other healthcare jurisdictions with similar demographics, to promote evidence-informed improvements in healthcare. PMID:22851988

  5. Day Care as a Long-Term Care Service Study.

    ERIC Educational Resources Information Center

    Zaki, Gamel; Zaki, Sylvia

    Day care is a growing service in the field of long-term care, increasing the options available to the impaired elderly. To study the development of adult day care centers in southeastern New England, and to identify the relationship of day care centers to the long term care network of services, the 11 day care centers in the catchment area of the…

  6. Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence

    PubMed Central

    Garrett, Sue; Elley, C Raina; Rose, Sally B; O'Dea, Des; Lawton, Beverley A; Dowell, Anthony C

    2011-01-01

    Background The health and economic burden of physical inactivity is well documented. A wide range of primary care and community-based interventions are available to increase physical activity. It is important to identify which components of these interventions provide the best value for money. Aim To assess the cost-effectiveness of physical activity interventions in primary care and the community. Design of study Systematic review of cost-effectiveness studies based on randomised controlled trials of interventions to increase adult physical activity that were based in primary health care or the community, completed between 2002 and 2009. Method Electronic databases were searched to identify relevant literature. Results and study quality were assessed by two researchers, using Drummond's checklist for economic evaluations. Cost-effectiveness ratios for moving one person from inactive to active, and costutility ratios (cost per quality-adjusted life-year [QALY]) were compared between interventions. Results Thirteen studies fulfilled the inclusion criteria. Eight studies were of good or excellent quality. Interventions, study populations, and study designs were heterogeneous, making comparisons difficult. The cost to move one person to the ‘active’ category at 12 months was estimated for four interventions ranging from €331 to €3673. The cost-utility was estimated in nine studies, and varied from €348 to €86 877 per QALY. Conclusion Most interventions to increase physical activity were cost-effective, especially where direct supervision or instruction was not required. Walking, exercise groups, or brief exercise advice on prescription delivered in person, or by phone or mail appeared to be more cost-effective than supervised gym-based exercise classes or instructor-led walking programmes. Many physical activity interventions had similar cost-utility estimates to funded pharmaceutical interventions and should be considered for funding at a similar level

  7. A Randomized Control Trial of a Chronic Care Intervention for Homeless Women with Alcohol Use Problems

    PubMed Central

    Upshur, Carole; Weinreb, Linda; Bharel, Monica; Reed, George; Frisard, Christine

    2014-01-01

    A clinician-randomized trial was conducted using the chronic care model for disease management for alcohol use problems among n=82 women served in a health care for the homeless clinic. Women with problem alcohol use received either usual care or an intervention consisting of a Primary Care Provider (PCP) brief intervention, referral to addiction services, and on-going support from a Care Manager (CM) for 6 months. Both groups significantly reduced their alcohol consumption, with a small effect size favoring intervention at 3 months, but there were no significant differences between groups in reductions in drinking or in housing stability, or mental or physical health. However, intervention women had significantly more frequent participation in substance use treatment services. Baseline differences and small sample size limit generalizability, although substantial reductions in drinking for both groups suggest screening and PCP brief treatment are promising interventions for homeless women with alcohol use problems. PMID:25488504

  8. Using a Mobile Health Intervention to Support HIV Treatment Adherence and Retention Among Patients at Risk for Disengaging with Care.

    PubMed

    Rana, Aadia I; van den Berg, Jacob J; Lamy, Eric; Beckwith, Curt G

    2016-04-01

    Less than half of the 1.2 million HIV-infected individuals in the United States are in consistent medical care, with only a third receiving treatment resulting in viral suppression. Novel interventions to improve engagement are necessary to ensure medical adherence, improve long-term outcomes, and reduce HIV transmission. Mobile health (mHealth) strategies including cell phone and text messaging have shown success in the developing world for medical adherence, yet mHealth interventions have not been developed and evaluated to improve retention in HIV care in the United States. We conducted a 6-month pilot study investigating the use of a clinic-based bi-directional texting intervention to enhance engagement in HIV care among those with higher risk of loss to follow up, including those with a recent HIV diagnosis or those re-engaging in HIV care at a large urban clinic in New England. PMID:27028183

  9. A New Look at Care in Pregnancy: Simple, Effective Interventions for Neglected Populations

    PubMed Central

    Hodgins, Stephen; Tielsch, James; Rankin, Kristen; Robinson, Amber; Kearns, Annie; Caglia, Jacquelyn

    2016-01-01

    Background Although this is beginning to change, the content of antenatal care has been relatively neglected in safe-motherhood program efforts. This appears in part to be due to an unwarranted belief that interventions over this period have far less impact than those provided around the time of birth. In this par, we review available evidence for 21 interventions potentially deliverable during pregnancy at high coverage to neglected populations in low income countries, with regard to effectiveness in reducing risk of: maternal mortality, newborn mortality, stillbirth, prematurity and intrauterine growth restriction. Selection was restricted to interventions that can be provided by non-professional health auxiliaries and not requiring laboratory support. Methods In this narrative review, we included relevant Cochrane and other systematic reviews and did comprehensive bibliographic searches. Inclusion criteria varied by intervention; where available randomized controlled trial evidence was insufficient, observational study evidence was considered. For each intervention we focused on overall contribution to our outcomes of interest, across varying epidemiologies. Results In the aggregate, achieving high effective coverage for this set of interventions would very substantially reduce risk for our outcomes of interest and reduce outcome inequities. Certain specific interventions, if pushed to high coverage have significant potential impact across many settings. For example, reliable detection of pre-eclampsia followed by timely delivery could prevent up to ¼ of newborn and stillbirth deaths and over 90% of maternal eclampsia/pre-eclampsia deaths. Other interventions have potent effects in specific settings: in areas of high P falciparum burden, systematic use of insecticide-treated nets and/or intermittent presumptive therapy in pregnancy could reduce maternal mortality by up to 10%, newborn mortality by up to 20%, and stillbirths by up to 25–30%. Behavioral

  10. A Qualitative Analysis of an Advanced Practice Nurse–Directed Transitional Care Model Intervention

    PubMed Central

    Bradway, Christine; Trotta, Rebecca; Bixby, M.Brian; McPartland, Ellen; Wollman, M. Catherine; Kapustka, Heidi; McCauley, Kathleen; Naylor, Mary D.

    2012-01-01

    Purpose: The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs). Design and Methods: APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An exploratory, qualitative directed content analysis examined 15 narrative case summaries written by APNs and fieldnotes from biweekly case conferences. Results: Three central themes emerged: patients and caregivers having the necessary information and knowledge, care coordination, and the caregiver experience. An additional category was also identified, APNs going above and beyond. Implications: APNs implemented individualized approaches and provided care that exceeds the type of care typically staffed and reimbursed in the American health care system by applying a Transitional Care Model, advanced clinical judgment, and doing whatever was necessary to prevent negative outcomes. Reimbursement reform as well as more formalized support systems and resources are necessary for APNs to consistently provide such care to patients and their caregivers during this vulnerable time of transition. PMID:21908805

  11. A chronic grief intervention for dementia family caregivers in long-term care.

    PubMed

    Paun, Olimpia; Farran, Carol J; Fogg, Louis; Loukissa, Dimitra; Thomas, Peggy E; Hoyem, Ruby

    2015-01-01

    Dementia caregivers do not relinquish their role after placing family members in long-term care and they experience increased chronic grief. The Chronic Grief Management Intervention (CGMI) is a12-week group-based program that uses guided discussion to deliver knowledge of Alzheimer's or a related dementia and teach skills in communication, conflict resolution, and chronic grief management in dementia caregivers who placed their family members in long-term care. Using a quasi-experimental design, 83 caregivers from 15 long-term care facilities received either the CGMI (n = 34) or a comparison condition consisting of two check-in calls (n = 49). In this pilot study, we examined the feasibility of implementing the CGMI and evaluated the effects of the intervention on caregivers' knowledge and skill and their chronic grief and depression. The intervention was feasible and resulted in significant improvement in caregivers' heartfelt sadness and longing at 3 months and a significant drop in their guilt at the 6-month follow-up. PMID:24510968

  12. mHealth self-care interventions: managing symptoms following breast cancer treatment

    PubMed Central

    Fu, Mei R.; Axelrod, Deborah; Guth, Amber A.; Rampertaap, Kavita; El-Shammaa, Nardin; Hiotis, Karen; Scagliola, Joan; Yu, Gary; Wang, Yao

    2016-01-01

    Background Many women suffer from daily distressing symptoms related to lymphedema following breast cancer treatment. Lymphedema, an abnormal accumulation of lymph fluid in the ipsilateral body area or upper limb, remains an ongoing major health problem affecting more than 40% of 3.1 million breast cancer survivors in the United States. Patient-centered care related to lymphedema symptom management is often inadequately addressed in clinical research and practice. mHealth plays a significant role in improving self-care, patient-clinician communication, and access to health information. The-Optimal-Lymph-Flow health IT system (TOLF) is a patient-centered, web-and-mobile-based educational and behavioral mHealth interventions focusing on safe, innovative, and pragmatic electronic assessment and self-care strategies for lymphedema symptom management. The purpose of this paper is to describe the development and test of TOLF system. Methods The development of TOLF was guided by the Model of Self-Care for Lymphedema Symptom Management and designed based on principles fostering accessibility, convenience, and efficiency of mHealth system to enhance training and motivating assessment of and self-care for lymphedema symptoms. Test of TOLF was accomplished by conducting a psychometric study to evaluate reliability, validity, and efficiency of the electronic version of Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI), a usability testing and a pilot feasibility testing of mHealth self-care interventions. Results Findings from the psychometric study with 355 breast cancer survivors demonstrated high internal consistency of the electronic version of the instrument: a Cronbach’s alpha coefficient of 0.959 for the total scale, 0.919 for symptom occurrence, and 0.946 for symptom distress. Discriminant validity of the instrument was supported by a significant difference in symptom occurrence (z=−6.938, P<0.000), symptom distress (z=−5.894, P<0.000), and total

  13. A pilot randomised controlled trial of personalised care after treatment for prostate cancer (TOPCAT-P): nurse-led holistic-needs assessment and individualised psychoeducational intervention: study protocol

    PubMed Central

    Stanciu, Marian Andrei; Morris, Caroline; Makin, Matt; Watson, Eila; Bulger, Jenna; Evans, Richard; Hiscock, Julia; Hoare, Zoë; Edwards, Rhiannon Tudor; Neal, Richard David; Wilkinson, Clare

    2015-01-01

    Introduction Prostate cancer is common and the incidence is increasing, but more men are living longer after diagnosis, and die with their disease rather than of it. Nonetheless, specific and substantial physical, sexual, emotional and mental health problems often lead to a poor quality of life. Urology services increasingly struggle to cope with the demands of follow-up care, and primary care is likely to play the central role in long-term follow-up. The present phase II trial will evaluate the feasibility and acceptability of a nurse-led, person-centred psychoeducational intervention, delivered in community or primary care settings. Methods and analysis Prostate cancer survivors diagnosed in the past 9–48 months and currently biochemically stable will be identified from hospital records by their treating clinician. Eligible men would have either completed radical treatment, or would be followed up with prostate specific antigen monitoring and symptom reporting. We will recruit 120 patients who will be randomised to receive either an augmented form of usual care, or an additional nurse-led intervention for a period of 36 weeks. Following the health policy in Wales, the intervention is offered by a key worker, is promoting prudent healthcare and is using a holistic needs assessment. Outcome measures will assess physical symptoms, psychological well-being, confidence in managing own health and quality of life. Healthcare service use will be measured over 36 weeks. Feedback interviews with patients and clinicians will further inform the acceptability of the intervention. Recruitment, attrition, questionnaire completion rates and outcome measures variability will be assessed, and results will inform the design of a future phase III trial and accompanying economic evaluation. Ethics and dissemination Ethics approval was granted by Bangor University and North Wales REC (13/WA/0291). Results will be reported in peer-reviewed publications, at scientific

  14. Feasibility and impact of a post–discharge geriatric evaluation and management service for patients from residential care: the Residential Care Intervention Program in the Elderly (RECIPE)

    PubMed Central

    2014-01-01

    Background Geriatric evaluation and management has become standard care for community dwelling older adults following an acute admission to hospital. It is unclear whether this approach is beneficial for the frailest older adults living in permanent residential care. This study was undertaken to evaluate (1) the feasibility and consumer satisfaction with a geriatrician-led supported discharge service for older adults living in residential care facilities (RCF) and (2) its impact on the uptake of Advanced Care Planning (ACP) and acute health care service utilisation. Methods In 2002–4 a randomised controlled trial was conducted in Melbourne, Australia comparing the geriatrician–led outreach service to usual care for RCF residents. Patients were recruited during their acute hospital stay and followed up at the RCF for six months. The intervention group received a post-discharge home visit within 96 hours, at which a comprehensive geriatric assessment was performed and a care plan developed. Participants and their families were also offered further meetings to discuss ACPs and document Advanced Directives (AD). Additional reviews were made available for assessment and management of intercurrent illness within the RCF. Consumer satisfaction was surveyed using a postal questionnaire. Results The study included 116 participants (57 intervention and 59 controls) with comparable baseline characteristics. The service was well received by consumers demonstrated by higher satisfaction with care in the intervention group compared to controls (95% versus 58%, p = 0.006). AD were completed by 67% of participants/proxy decision makers in the intervention group compared to 13% of RCF residents prior to service commencement. At six months there was a significant reduction in outpatient visits (intervention 21 (37%) versus controls 45 (76%), (p < 0.001), but no difference in readmissions rates (39% intervention versus 34% control, p = 0.6). There was a trend towards

  15. Effects of an intervention addressing information, motivation, and behavioral skills on HIV care adherence in a southern clinic cohort.

    PubMed

    Konkle-Parker, Deborah J; Amico, K Rivet; McKinney, Venetra E

    2014-01-01

    Multiple studies have shown that subtherapeutic appointment adherence and medication adherence are associated with worse clinical outcomes for people living with HIV disease. Thus, poor appointment and medication adherence diminish individual and community HIV control and transmission. Yet not enough is known about interventions that can improve retention in HIV care. The purpose of this study was to test an intervention to improve retention and/or medication adherence in a public clinic in the Deep South. One hundred participants with retention or medication adherence difficulties were randomized to either a six-month intervention or usual care, and followed longitudinally for one year. The intervention was multidimensional, based on the Information-Motivation-Behavioral Skills (IMB) model. The intervention addressed information about HIV and the importance of retention/adherence, motivation to be retained and/or adhere to medications, and the behavioral skills needed to manage and maintain these healthy behaviors in a combination of face-to-face and telephone sessions. The proportion of those with at least one visit in each four-month block (third) of the year increased in those with minimal exposure to the intervention (three out of eight intervention contacts) as compared to those with less intervention exposure (p = 0.098). Those with at least this minimal exposure averaged a significantly higher number of thirds that included a clinic visit as compared to those with less intervention exposure (p = 0.013). The intervention did not demonstrate a significant effect on medication adherence, though this is contradictory to a previous study testing a version of this intervention designed to address only medication adherence. Further study to increase uptake of the intervention is needed to increase its efficacy.

  16. A Community-based Eye Care Intervention in Southern Egypt: Impact on Trachomatous Trichiasis Surgical Coverage

    PubMed Central

    Mousa, Ahmed; Courtright, Paul; Kazanjian, Arminee; Bassett, Ken

    2015-01-01

    Purpose: The purpose of this study was to measure the impact of a community-based intervention on uptake of trichiasis surgery in Southern Egypt. Methods: Four villages where trachoma is endemic were randomly selected in the Samalout district, Egypt. Two villages were selected for intervention (intervention villages) and two matched villages for nonintervention (nonintervention villages). The intervention model provided community information sessions, door-to-door health education, screening, and improvements in the clinical capacity of eye care providers. The intervention was evaluated through two pre- and post-intervention community-based surveys that included the prevalence of trachoma and the utilization of eye care services at local hospitals. All patients with trichiasis answered a questionnaire regarding surgical utilization and barriers. Results: In the baseline survey, the trachomatous trichiasis (TT) surgical coverage was 22.7% (38.9% males, 16.7% females) in all villages. Following the intervention, the TT surgical coverage increased to 68% in villages that received the intervention (81.5% males, 60% females). Nonintervention villages had a TT surgical coverage of 26.1% (37.5% males, 20% females). In the intervention villages, the prevalence of TT significantly decreased from 9.4% (5.7% males, 11.8% females) to 3.8% (1.9% males, 5.1% females) (P = 0.013), in 2008. In nonintervention villages, there was a slight, but insignificant decrease in TT from 10.1% (3.1% males, 14.4% females) to 8.2% (3% males, 11.5% females) (P = 0.580). The major barriers to uptake of TT surgical services were: “Feeling no problem” (17.3%), “fear of surgery” (12.7%) and “cost” (12.7%). Conclusion: A community-based eye health education program with door-to-door screening significantly increased the uptake of TT surgical services. Although improvements to the delivery of surgical service are essential, they did not lead to any significant improvements in the

  17. Integrating Biopsychosocial Intervention Research in a Changing Health Care Landscape

    ERIC Educational Resources Information Center

    Ell, Kathleen; Oh, Hyunsung; Wu, Shinyi

    2016-01-01

    Objective: Safety net care systems are experiencing unprecedented change from the "Affordable Care Act," Patient-Centered Medical Home (PCMH) uptake, health information technology application, and growing of mental health care integration within primary care. This article provides a review of previous and current efforts in which social…

  18. Practice-based interventions to improve health care for Latinos with diabetes.

    PubMed

    Cleghorn, G Dean; Nguyen, Meeta; Roberts, Blair; Duran, Gilda; Tellez, Trinidad; Alecon, Migna

    2004-01-01

    This study examined diabetes-related health disparities in a Latino population in terms of prevalence of the disease, and the extent to which practice-based interventions improve health care and health for the Latinos who have diabetes. Previous research has shown that Latinos, overall, are at greater risk for diabetes, but less is known for those of Puerto Rican and Dominican origin. Two interventions were implemented in a large primary care practice: an ADA-recognized Diabetes Self Management Education program, and clinical information feedback loops to providers regarding adherence to the Massachusetts Guidelines for the Care of Diabetes. The study identified the prevalence of diabetes to be 13.7% among Puerto Ricans, and 9.1% among Dominicans, rates 2-to-3 times that for the general population. Latino patients (N=567) who participated in a Diabetes Self Management Education Program maintained lower Hb A1c values than did a comparison group (N=432). For a random sample of Latinos with diabetes (N=98) in this study, 6 measures of health care improved significantly from 2001 to 2003. Areas of improvement among healthcare providers were: ordering a microalbumin level measurement when appropriate, prescribing ACE inhibitors as needed, providing pneumococcal and influenza vaccines, reviewing activity status and exercise, identifying smoking status, and prescribing lipid-lowering agents, as appropriate. Body mass index (BMI) for the 98 patients remained the same for both measurement periods at 32.8. Although this initial study spanned only 2 years, improvements in health care and health indices for the population are encouraging. Further study is underway to expand on these gains.

  19. A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes

    PubMed Central

    Low, Lee-Fay; Fletcher, Jennifer; Goodenough, Belinda; Jeon, Yun-Hee; Etherton-Beer, Christopher; MacAndrew, Margaret; Beattie, Elizabeth

    2015-01-01

    Background We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes. Methods Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure. Results Sixty-three unique studies were broadly grouped according to clinical domain—oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics). Conclusion Changing staff practice in nursing homes is possible but complex

  20. Impact of financial and educational interventions on maternity care: results of cluster randomized trials in rural China, CHIMACA.

    PubMed

    Hemminki, Elina; Long, Qian; Zhang, Wei-Hong; Wu, Zhuochun; Raven, Joanna; Tao, Fangbiao; Yan, Hong; Wang, Yang; Klemetti, Reija; Zhang, Tuohong; Regushevskaya, Elena; Tang, Shenglan

    2013-02-01

    To report on the design and basic outcomes of three interventions aimed at improving the use and quality of maternity care in rural China: financial interventions, training in clinical skills, and training in health education. Community-based cluster randomized trials were carried out in one central and two western provinces between 2007 and 2009: (1) financial interventions covered part of women's costs for prenatal and postnatal care, (2) training of midwives in clinical skills was given by local maternity care experts in two- or three-group training courses, (3) health education training for midwives and village doctors were given by local experts in health education in two- or three-group training courses. A survey was conducted in a stratified random sample of women who had been pregnant in the study period. 73% of women (n = 3,673) were interviewed within 1-10 months of giving birth. Outcomes were compared by the different intervention and control groups. Adjusted odds ratios were calculated by logistic regression to adjust for varying maternal characteristics. Most of the differences found between the groups were small and some varied between provinces. The financial intervention did not influence the number of visits, but was associated with increased caesarean sections and a decrease in many ultrasound tests. The clinical intervention influenced some indicators of care content. There was no consistent finding for the health education intervention. Financial and training interventions have the potential to improve maternity care, but better implementation is required. Unintended consequences, including overuse of technology, are possible.

  1. Application of Nursing Interventions Classification (NIC) in a cardiovascular critical care unit.

    PubMed

    Robbins, B T

    1997-01-01

    The nursing profession is moving toward developing a standardized language. Benefits of such a language are outlined. Nursing Interventions Classification (NIC) (Iowa Intervention Project, 1992), a standardized language for nursing interventions, has been recently developed by the Iowa Intervention Project. This article describes how NIC was incorporated into a nursing care plan in a tertiary acute care facility. Teaching strategies, which include aspects of adult learning theory and motivational theory, are discussed. Utilization of creativity and variability in the planning and implementation of a unit based inservice program were the most beneficial strategies used.

  2. Care Management by Oncology Nurses To Address Palliative Care Needs: A Pilot Trial To Assess Feasibility, Acceptability, and Perceived Effectiveness of the CONNECT Intervention

    PubMed Central

    White, Douglas; Rosenzweig, Margaret; Chu, Edward; Moore, Charity; Ellis, Peter; Nikolajski, Peggy; Ford, Colleen; Tiver, Greer; McCarthy, Lauren; Arnold, Robert

    2015-01-01

    Abstract Background: Specialty palliative care is not accessible for many patients with advanced cancer. There is a need to find alternative palliative care strategies in oncology clinics. Objective: The objective of the study was to assess the feasibility, acceptability, and perceived effectiveness of an oncology nurse-led care management approach to improve primary palliative care. Methods: The study design was a single-arm pilot trial of the Care Management by Oncology Nurses (CONNECT) intervention, in which registered oncology nurses receive specialized training and work closely with oncologists to (1) address symptom needs; (2) engage patients and caregivers in advance care planning; (3) provide emotional support; and (4) coordinate care. The subjects were 23 patients with advanced cancer, 19 caregivers, and 5 oncologists from a community oncology clinic in western Pennsylvania. Feasibility was assessed through enrollment rates, outcome assessment rates, and visit checklists. Patients, caregivers, and oncologists completed three-month assessments of acceptability and perceived effectiveness. Results: The consent-to-approach rate was 86% and enrolled-to-consent rate, 77%. CONNECT was implemented according to protocol for all participants. No participants withdrew after enrollment. Four patients died during the study; three-month outcome assessments were completed with all remaining participants (83%). Patients and caregivers reported high satisfaction with CONNECT and perceived the intervention as helpful in addressing symptoms (85%), coping (91%), and planning for the future (82%). Oncologists unanimously agreed that CONNECT improved the quality of care provided for patients with advanced cancer. Conclusion: An oncology nurse-led care management intervention is feasible, acceptable, and was perceived to be effective for improving provision of primary palliative care. A randomized trial of CONNECT is warranted. PMID:25517219

  3. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions

    PubMed Central

    Downs, S. H.; Black, N.

    1998-01-01

    OBJECTIVE: To test the feasibility of creating a valid and reliable checklist with the following features: appropriate for assessing both randomised and non-randomised studies; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting, internal validity (bias and confounding) and power, but also for external validity. DESIGN: A pilot version was first developed, based on epidemiological principles, reviews, and existing checklists for randomised studies. Face and content validity were assessed by three experienced reviewers and reliability was determined using two raters assessing 10 randomised and 10 non- randomised studies. Using different raters, the checklist was revised and tested for internal consistency (Kuder-Richardson 20), test-retest and inter-rater reliability (Spearman correlation coefficient and sign rank test; kappa statistics), criterion validity, and respondent burden. MAIN RESULTS: The performance of the checklist improved considerably after revision of a pilot version. The Quality Index had high internal consistency (KR-20: 0.89) as did the subscales apart from external validity (KR-20: 0.54). Test-retest (r 0.88) and inter-rater (r 0.75) reliability of the Quality Index were good. Reliability of the subscales varied from good (bias) to poor (external validity). The Quality Index correlated highly with an existing, established instrument for assessing randomised studies (r 0.90). There was little difference between its performance with non-randomised and with randomised studies. Raters took about 20 minutes to assess each paper (range 10 to 45 minutes). CONCLUSIONS: This study has shown that it is feasible to develop a checklist that can be used to assess the methodological quality not only of randomised controlled trials but also non-randomised studies. It has also shown that it is possible to produce a checklist that provides a profile of the paper, alerting reviewers to its particular

  4. Tailored weight loss intervention in obese adults within primary care practice: Rationale, design, and methods of Choose to Lose

    PubMed Central

    Hartman, Sheri J.; Risica, Patricia M.; Gans, Kim M.; Marcus, Bess H.; Eaton, Charles B.

    2014-01-01

    Although there are efficacious weight loss interventions that can improve health and delay onset of diabetes and hypertension, these interventions have not been translated into clinical practice. The primary objective of this study is to evaluate the effectiveness and cost effectiveness of a tailored lifestyle intervention in primary care patients. Patients were recruited by their primary care physicians and eligible participants were randomized to an enhanced intervention or augmented usual care. All participants met with a lifestyle counselor to set calorie and physical activity goals and to discuss behavioral strategies at baseline, 6 and 12 months. During the first year, enhanced intervention participants receive monthly counseling phone calls to assist in attaining and maintaining their goals. Enhanced intervention participants also receive weekly mailings consisting of tailored and non-tailored print materials and videos focusing on weight loss, physical activity promotion and healthy eating. The second year focuses on maintenance with enhanced intervention participants receiving tailored and non-tailored print materials and videos regularly throughout the year. Augmented usual care participants receive five informational handouts on weight loss across the two years. This enhanced intervention that consists of multiple modalities of print, telephone, and video with limited face-to-face counseling holds promise for being effective for encouraging weight loss, increasing physical activity and healthy eating, and also for being cost effective and generalizable for wide clinical use. This study will fill an important gap in our knowledge regarding the translation and dissemination of research from efficacy studies to best practices in clinical settings. PMID:24937016

  5. Stepped-Care, Community Clinic Interventions to Promote Mammography Use among Low-Income Rural African American Women

    ERIC Educational Resources Information Center

    West, Delia Smith; Greene, Paul; Pulley, LeaVonne; Kratt, Polly; Gore, Stacy; Weiss, Heidi; Siegfried, Nicole

    2004-01-01

    Few studies have investigated community clinic-based interventions to promote mammography screening among rural African American women. This study randomized older low-income rural African American women who had not participated in screening in the previous 2 years to a theory-based, personalized letter or usual care; no group differences in…

  6. Community participation in rural primary health care: intervention or approach?

    PubMed

    Preston, Robyn; Waugh, Hilary; Larkins, Sarah; Taylor, Judy

    2010-01-01

    Community participation is considered important in primary health care development and there is some evidence to suggest it results in positive health outcomes. Through a process of synthesising existing evidence for the effectiveness of community participation in terms of health outcomes we identified several conceptual areas of confusion. This paper builds on earlier work to disentangle the conceptual gaps in this area, and clarify our common understanding of community participation. We conducted a research synthesis of 689 empirical studies in the literature linking rural community participation and health outcomes. The 37 final papers were grouped and analysed according to: contextual factors; the conceptual approach to community participation (using a modification of an existing typology); community participation process; level of evidence; and outcomes reported. Although there is some evidence of benefit of community participation in terms of health outcomes, we found only a few studies demonstrating higher levels of evidence. However, it is clear that absence of evidence of effect is not necessarily the same as absence of an effect. We focus on areas of debate and lack of clarity in the literature. Improving our understanding of community participation and its role in rural primary health care service design and delivery will increase the likelihood of genuine community-health sector partnerships and more responsive health services for rural communities.

  7. Modeling the impact of interventions against Acinetobacter baumannii transmission in intensive care units

    PubMed Central

    Doan, Tan N; Kong, David CM; Marshall, Caroline; Kirkpatrick, Carl MJ; McBryde, Emma S

    2016-01-01

    The efficacy of infection control interventions against Acinetobacter baumannii remains unclear, despite such information being critical for effective prevention of the transmission of this pathogen. Mathematical modeling offers an alternative to clinical trials, which may be prohibitively expensive, unfeasible or unethical, in predicting the impact of interventions. Furthermore, it allows the ability to ask key “what if” questions to evaluate which interventions have the most impact. We constructed a transmission dynamic model to quantify the effects of interventions on reducing A. baumannii prevalence and the basic reproduction ratio (R0) in intensive care units (ICUs). We distinguished between colonization and infection, and incorporated antibiotic exposure and transmission from free-living bacteria in the environment. Under the assumptions and parameterization in our model, 25% and 18% of patients are colonized and infected with A. baumannii, respectively; and R0 is 1.4. Improved compliance with hand hygiene (≥87%), enhanced environmental cleaning, reduced length of ICU stay of colonized patients (≤ 10 days), shorter durations of antibiotic treatment of A. baumannii (≤6 days), and isolation of infected patients combined with cleaning of isolation rooms are effective, reducing R0 to below unity. In contrast, expediting the recovery of the intestinal microbiota (e.g. use of probiotics) is not effective. This study represents a biologically realistic model of the transmission dynamics of A. baumannii, and the most comprehensive analysis of the effectiveness of interventions against this pathogen. Our study provides important data for designing effective infection control interventions. PMID:26252184

  8. Interventions geared towards strengthening the health system of Namibia through the integration of palliative care.

    PubMed

    Freeman, Rachel; Luyirika, Emmanuel Bk; Namisango, Eve; Kiyange, Fatia

    2016-01-01

    The high burden of non-communicable diseases and communicable diseases in Africa characterised by late presentation and diagnosis makes the need for palliative care a priority from the point of diagnosis to death and through bereavement. Palliative care is an intervention that requires a multidisciplinary team to address the multifaceted needs of the patient and family. Thus, its development takes a broad approach that involves engaging all key stakeholders ranging from policy makers, care providers, educators, the public, patients, and families. The main focus of stakeholder engagement should address some core interventions geared towards improving knowledge and awareness, strengthening skills and attitudes about palliative care. These interventions include educating health and allied healthcare professionals on the palliative care-related problems of patients and best practices for care, explaining palliative care as a clinical and holistic discipline and demonstrating its effectiveness, the need to include palliative care into national policies, strategic plans, training curriculums of healthcare professionals and the engagement of patients, families, and communities. Interventions from a five-year programme that was aimed at strengthening the health system of Namibia through the integration of palliative care for people living with HIV and AIDS and cancer in Namibia are shared. This article illustrates how a country can implement the World Health Organisation's public health strategy for developing palliative care services, which recommends four pillars: government policy, education, drug availability, and implementation. PMID:27563348

  9. Interventions geared towards strengthening the health system of Namibia through the integration of palliative care

    PubMed Central

    Freeman, Rachel; Luyirika, Emmanuel BK; Namisango, Eve; Kiyange, Fatia

    2016-01-01

    The high burden of non-communicable diseases and communicable diseases in Africa characterised by late presentation and diagnosis makes the need for palliative care a priority from the point of diagnosis to death and through bereavement. Palliative care is an intervention that requires a multidisciplinary team to address the multifaceted needs of the patient and family. Thus, its development takes a broad approach that involves engaging all key stakeholders ranging from policy makers, care providers, educators, the public, patients, and families. The main focus of stakeholder engagement should address some core interventions geared towards improving knowledge and awareness, strengthening skills and attitudes about palliative care. These interventions include educating health and allied healthcare professionals on the palliative care-related problems of patients and best practices for care, explaining palliative care as a clinical and holistic discipline and demonstrating its effectiveness, the need to include palliative care into national policies, strategic plans, training curriculums of healthcare professionals and the engagement of patients, families, and communities. Interventions from a five-year programme that was aimed at strengthening the health system of Namibia through the integration of palliative care for people living with HIV and AIDS and cancer in Namibia are shared. This article illustrates how a country can implement the World Health Organisation’s public health strategy for developing palliative care services, which recommends four pillars: government policy, education, drug availability, and implementation. PMID:27563348

  10. Pharmaceutical intervention in the care of cystic fibrosis patients.

    PubMed

    Ramström, H; Erwander, I; Mared, L; Kornfält, R; Seiving, B

    2000-12-01

    In a prospective, randomised, cross-over study including cystic fibrosis patients with indications for HIVAT (home intravenous antibiotic treatment) the prospect of pharmaceutical intervention was investigated. A comparison between the use of disposable infusion devices with antibiotics from the pharmacy and when the patients prepared the drugs themselves was performed. During a first treatment course the patients received either infusion devices during 5 days or reconstituted the drugs themselves during 5 days, or vice versa. During a second treatment course the order was the reversed. Eight patients were included, out of which six completed the original design as a cross-over study, yielding a total of 550 doses of antibiotics. The patients preferred infusion devices from the pharmacy prepared according to GMP (Good Manufacturing Practice) as opposed to reconstituting the antibiotics themselves. Points of view presented included no anxiety over the correct dosage of drugs and less disruption of family and social life. In a practical sense, portable devices are more expensive than the preparation of the drugs by the patients themselves. However, when comparing with in-hospital treatment the direct costs for a hospital stay exceed that of the devices. Another part of the study evaluated the quality of life using a modified form of SEIQoL-DW (Schedule for the Evaluation of Individual Quality of Life - Direct Weighting). Twenty patients took part in the study and the overall quality of life scores increased significantly when patients received infusion devices compared to reconstituting the drugs themselves.

  11. Testing a Dynamic Automated Substance Use Intervention Model for Youths Exiting Foster Care

    PubMed Central

    Braciszewski, Jordan M.; Stout, Robert L.; Tzilos, Golfo K.; Moore, Roland S.; Bock, Beth C.; Chamberlain, Patricia

    2015-01-01

    With an ever increasing gap between need and availability for substance use services, more scalable and efficient interventions are needed. For youth in the foster care system, this gap is dramatic and expands as they leave care. Effective prevention services are strongly needed for this group of vulnerable young people. We propose a novel technology-driven intervention for preventing problematic substance use among youth receiving foster care services. This intervention approach would extend the work in brief computerized interventions by adding a text message-based booster, dynamically tailored to each individual’s readiness to change. It also combats many barriers to service receipt. Dynamically tailored interventions delivered through technologies commonly used by adolescents and young adults have the strong potential to reduce the burden of problematic substance use. PMID:27081290

  12. The use of selected interventions in monitoring primary health care implementation in rural Nigeria.

    PubMed

    Egwu, I N

    1992-03-01

    Nigeria's Primary Health Care (PHC)-based health system development aims to strengthen PHC in the local government areas (LGA) through technical planning and implementation that emphasize maternal and child health services. Convenient variables, including expanded programme on immunization (EPI), antenatal care (ANC) utilization and attended births, were selected as interventions to monitor the progress of implementation of PHC activities during 1985-90 in Odukpani LGA. Analysis of available data at the LGA showed that immunization coverage for most EPI antigens increased; ANC services showed increased utilization; health worker-attended births increased as traditional birth deliveries declined during the period. Some of the increases were modest but are considered important. The study offers a pilot approach to monitoring implementation of PHC activities in Odukpani LGA. The implications of the findings for similar studies are discussed. PMID:1589661

  13. A Review of Design and Policy Interventions to Promote Nurses' Restorative Breaks in Health Care Workplaces.

    PubMed

    Nejati, Adeleh; Shepley, Mardelle; Rodiek, Susan

    2016-02-01

    The nursing profession in the United States is on the precipice of a crisis. Nurses are essential to the health care industry, and maintaining quality nursing care is a primary concern of today's health care managers. Health care facilities report high rates of staff burnout and turnover, and interest in the nursing profession among younger students is declining. Health care leaders must improve nurses' job satisfaction, performance, and retention. However, they often overlook the need for nurses' respite and underestimate the value of well-designed staff break areas. An exhaustive and systematic literature search was conducted in the summer of 2014, and all studies found on the topic were reviewed for their relevance and quality of evidence. The existing literature about the main causes of nurses' fatigue, barriers that prevent nurses from taking restorative breaks, and consequences of nurses' fatigue for staff, patient, and facility outcomes demonstrates the pressing need for interventions that improve nurses' working conditions. Additional literature on the restorative effects of breaks and the value of well-designed break areas indicates that efforts to improve breakroom design can play an important role in improving nurses' job satisfaction and performance. PMID:26814229

  14. Methadone induction in primary care (ANRS-Methaville): a phase III randomized intervention trial

    PubMed Central

    2012-01-01

    Background In France, the rapid scale-up of buprenorphine, an opioid maintenance treatment (OMT), in primary care for drug users has led to an impressive reduction in HIV prevalence among injecting drug users (IDU) but has had no major effect on Hepatitis C incidence. To date, patients willing to start methadone can only do so in a methadone clinic (a medical centre for drug and alcohol dependence (CSAPA) or a hospital setting) and are referred to primary care physicians after dose stabilization. This study aims to assess the effectiveness of methadone in patients who initiated treatment in primary care compared with those who initiated it in a CSAPA, by measuring abstinence from street opioid use after one year of treatment. Methods/Design The ANRS-Methaville study is a randomized multicenter non-inferiority control trial comparing methadone induction (lasting approximately 2 weeks) in primary care and in CSAPA. The model of care chosen for methadone induction in primary care was based on study-specific pre-training of all physicians, exclusion criteria and daily supervision of methadone during the initiation phase. Between January 2009 and January 2011, 10 sites each having one CSAPA and several primary care physicians, were identified to recruit patients to be randomized into two groups, one starting methadone in primary care (n = 147), the other in CSAPA (n = 48). The primary outcome of the study is the proportion of participants abstinent from street opioids after 1 year of treatment i.e. non-inferiority of primary care model in terms of the proportion of patients not using street opioids compared with the proportion observed in those starting methadone in a CSAPA. Discussion The ANRS-Methaville study is the first in France to use an interventional trial to improve access to OMT for drug users. Once the non-inferiority results become available, the Ministry of Health and agency for the safety of health products may change the the New Drug Application

  15. Field experiment of a very brief worksite intervention to improve nutrition among health care workers.

    PubMed

    Armitage, Christopher J

    2015-08-01

    Despite the potential of worksite interventions to boost productivity and save insurance costs, they tend to be costly and tested in nonrandomized trials. The aim of the present study was to test the ability of a very brief worksite intervention based on implementation intentions to improve nutrition among health care workers. Seventy-nine health care workers were randomly allocated to a control condition or to form implementation intentions using standard instructions or with a supporting tool. Fruit intake and metacognitive processing (operationalized as awareness of standards, self-monitoring and self-regulatory effort) were measured at baseline and follow-up. Participants who formed implementation intentions ate significantly more fruit and engaged in significantly more metacognitive processing at follow-up than did participants in the control condition (ds > .70). The findings support the efficacy of implementation intentions for increasing fruit intake in health care workers and preliminary support for the utility of a tool to support implementation intention formation. PMID:25822117

  16. Time for living and caring: an intervention to make respite more effective for caregivers.

    PubMed

    Lund, Dale A; Utz, Rebecca L; Caserta, Michael S; Wright, Scott D; Llanque, Sarah M; Lindfelt, Chris; Shon, Herb; Whitlatch, Carol J; Montoro-Rodriguez, Julian

    2014-01-01

    This article presents the rationale for and description of a promising intervention, Time for Living and Caring (TLC), designed to enhance the effectiveness of respite services for family caregivers. It is guided by the theoretical principles of the Selective Optimization with Compensation (SOC) model, which individually coaches caregivers on how to assess their personal circumstances, identify their greatest needs and preferences, and engage in goal setting and attainment strategies to make better use of their respite time. Focusing on respite activities that match caregivers' unique needs is likely to result in improved well-being. We report on a pilot study examining TLC's feasibility and potential benefits and how caregivers viewed their participation. While additional research is needed to test and refine the intervention, we need to find more creative ways to enhance respite services. PMID:25536704

  17. Development of a post-simulation debriefing intervention to prepare nurses and nursing students to care for deteriorating patients.

    PubMed

    Lavoie, Patrick; Pepin, Jacinthe; Cossette, Sylvie

    2015-05-01

    To provide optimal care, nurses need to be prepared to recognize signs and symptoms of patient deterioration so they can obtain assistance from appropriate respondents and initiate rescue interventions when needed. In this paper, we describe the development of a post-simulation educational intervention aimed at improving nurses' and nursing students' recognition and response to patient deterioration. This intervention takes the form of a debriefing after a simulated patient deterioration experience. Following the Medical Research Council's guidance on complex interventions, we reviewed empirical studies of existing educational interventions for content, teaching strategies, and outcomes, as well as for frameworks, theoretical underpinnings, and rationale. Based on those results, we reviewed theoretical literature (Tanner's clinical judgment model and Dewey's theory of experiential learning) that might inform our understanding of our intervention's intended effect (learning outcomes) and of the mechanisms by which the intervention could lead to it. Integrating results from the empirical and theoretical phases helped us define the new intervention's rationale and develop its components according to relevant standards of best practices. The resulting educational intervention, REsPoND, consists in a reflective debriefing after a patient deterioration simulation. It will be tested in an upcoming mixed methods study.

  18. Understanding dissemination and implementation of a new intervention in assisted living settings: the case of function-focused care.

    PubMed

    Resnick, Barbara; Galik, Elizabeth; Gruber-Baldini, Ann; Zimmerman, Sheryl

    2013-04-01

    Function-focused care (FFC) was developed to change the philosophy of care in assisted living (AL) to one in which nurses, direct care workers (DCWs) and other members of the health care team work with residents to optimize function and time spent in physical activities. The purpose of this article is to describe dissemination and implementation of FFC within the two assisted living communities in Maryland that were randomized to our FFC for assisted living intervention (FFC-AL). The reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) model was used to evaluate dissemination and implementation of FFC in these communities. A total of 171 residents and 96 DCWs consented to participate in the study and outcomes based on data collected from the participants as well as evidence for dissemination and implementation at the site level are provided. Findings can be used to guide others in dissemination and implementation of similar interventions in AL communities.

  19. Self-Efficacy, Planning and Action Control in an Oral Self-Care Intervention

    ERIC Educational Resources Information Center

    Zhou, Guangyu; Sun, Caiyun; Knoll, Nina; Hamilton, Kyra; Schwarzer, Ralf

    2015-01-01

    To evaluate a theory-guided intervention on oral self-care and examine the possible mechanisms among self-regulatory factors, two brief intervention arms were compared, an information-based education treatment and a self-regulation treatment focusing on planning and action control. Young adults (N = 284; aged 18-29 years) were assessed at baseline…

  20. Evaluation of an Intervention to Reduce Playground Hazards in Atlanta Child-Care Centers.

    ERIC Educational Resources Information Center

    Sacks, Jeffrey J.; And Others

    1992-01-01

    Revisits 58 child care centers in Atlanta (Georgia) that had received interventions alerting directors to playground safety hazards. Comparison with 71 control centers randomly selected found averages of 9.4 hazards at intervention center playgrounds and 8.0 hazards at control centers. These results indicate the ineffectiveness of the…

  1. Health system and community level interventions for improving antenatal care coverage and health outcomes

    PubMed Central

    Mbuagbaw, Lawrence; Medley, Nancy; Darzi, Andrea J; Richardson, Marty; Habiba Garga, Kesso; Ongolo-Zogo, Pierre

    2015-01-01

    Background The World Health Organization (WHO) recommends at least four antenatal care (ANC) visits for all pregnant women. Almost half of pregnant women worldwide, and especially in developing countries do not receive this amount of care. Poor attendance of ANC is associated with delivery of low birthweight babies and more neonatal deaths. ANC may include education on nutrition, potential problems with pregnancy or childbirth, child care and prevention or detection of disease during pregnancy. This review focused on community-based interventions and health systems-related interventions. Objectives To assess the effects of health system and community interventions for improving coverage of antenatal care and other perinatal health outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 June 2015) and reference lists of retrieved studies. Selection criteria We included randomised controlled trials (RCTs), quasi-randomised trials and cluster-randomised trials. Trials of any interventions to improve ANC coverage were eligible for inclusion. Trials were also eligible if they targeted specific and related outcomes, such as maternal or perinatal death, but also reported ANC coverage. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Main results We included 34 trials involving approximately 400,000 women. Some trials tested community-based interventions to improve uptake of antenatal care (media campaigns, education or financial incentives for pregnant women), while other trials looked at health systems interventions (home visits for pregnant women or equipment for clinics). Most trials took place in low- and middle-income countries, and 29 of the 34 trials used a cluster-randomised design. We assessed 30 of the 34 trials as of low or unclear overall risk of bias. Comparison 1: One intervention versus no intervention We

  2. Effectiveness of a new health care organization model in primary care for chronic cardiovascular disease patients based on a multifactorial intervention: the PROPRESE randomized controlled trial

    PubMed Central

    2013-01-01

    Background To evaluate the effectiveness of a new multifactorial intervention to improve health care for chronic ischemic heart disease patients in primary care. The strategy has two components: a) organizational for the patient/professional relationship and b) training for professionals. Methods/design Experimental study. Randomized clinical trial. Follow-up period: one year. Study setting: primary care, multicenter (15 health centers). For the intervention group 15 health centers are selected from those participating in ESCARVAL study. Once the center agreed to participate patients are randomly selected from the total amount of patients with ischemic heart disease registered in the electronic health records. For the control group a random sample of patients with ischemic heart disease is selected from all 72 health centers electronic records. Intervention components: a) Organizational intervention on the patient/professional relationship. Centered on the Chronic Care Model, the Stanford Expert Patient Program and the Kaiser Permanente model: Teamwork, informed and active patient, decision making shared with the patient, recommendations based on clinical guidelines, single electronic medical history per patient that allows the use of indicators for risk monitoring and stratification. b) Formative strategy for professionals: 4 face-to-face training workshops (one every 3 months), monthly update clinical sessions, online tutorial by a cardiologist, availability through the intranet of the action protocol and related documents. Measurements: Blood pressure, blood glucose, HbA1c, lipid profile and smoking. Frequent health care visits. Number of hospitalizations related to vascular disease. Therapeutic compliance. Drug use. Discussion This study aims to evaluate the efficacy of a multifactorial intervention strategy involving patients with ischemic heart disease for the improvement of the degree of control of the cardiovascular risk factors and of the quality of life

  3. Behavioral Interventions to Reduce Sexual Risk Behavior in Adults with HIV/AIDS Receiving HIV Care: A Systematic Review.

    PubMed

    Laisaar, Kaja-Triin; Raag, Mait; Rosenthal, Marika; Uusküla, Anneli

    2015-05-01

    Regular interactions with people living with HIV/AIDS (PLWHA) who are receiving care provide caregivers opportunities to deliver interventions to reduce HIV-related risks. We conducted a systematic review of behavioral interventions for PLWHA (provided at individual level by caregivers at HIV care settings) to determine their efficacy in reducing sexual risk behavior. Conference websites and biomedical literature databases were searched for studies from 1981 to 2013. Randomized and quasi-randomized controlled trials (with standard-of-care control groups), considering at least one of a list of HIV-related behavioral or biological outcomes in PLWHA aged ≥18 receiving HIV care with at least 3-month follow-up were included. No language or publication status restrictions were set. Standardized search, data abstraction, and evaluation methods were used. Five randomized controlled trials were included in the review. We found limited evidence that sexual risk reduction interventions increase condom use consistency in HIV transmission risk acts, and reduce the number of (casual) sexual partners. We still believe that regular interactions between HIV care providers and PLWHA provide valuable opportunities for theory-based sexual risk reduction interventions to restrain the spread of HIV. PMID:25844941

  4. Implication of the recent positive endovascular intervention trials for organizing acute stroke care: European perspective.

    PubMed

    Tatlisumak, Turgut

    2015-06-01

    Timely recanalization leads to improved patient outcomes in acute ischemic stroke. Recent trial results demonstrated a strong benefit for endovascular therapies over standard medical care in patients with acute ischemic stroke and a major intracranial artery occlusion≤6 hours or even beyond from symptom onset and independent of patients' age. Previous studies have shown the benefit of intravenous thrombolysis that had gradually, albeit slowly, reshaped acute stroke care worldwide. Now, given the superior benefits of endovascular intervention, the whole structure of acute stroke care needs to be reorganized to meet patient needs and to deliver evidence-based treatments effectively. However, a blueprint for success with novel stroke treatments should be composed of numerous elements and requires efforts from various parties. Regarding the endovascular therapies, the strengths of Europe include highly organized democratic society structures, high rate of urbanization, well-developed revenue-based healthcare systems, and high income levels, whereas the obstacles include the east-west disparity in wealth, the ongoing economic crisis hindering spread of fairly costly new treatments, and the quickly aging population putting more demands on health care in general. Regional and national plans for covering whole population with 24/7 adequate acute stroke care are necessary in close cooperation of professionals and decision-makers. Europe-wide new training programs for expert physicians in stroke care should be initiated shortly. European Stroke Organisation has a unique role in providing expertise, consultation, guidelines, and versatile training in meeting new demands in stroke care. This article discusses the current situation, prospects, and challenges in Europe offering personal views on potential solutions.

  5. Prevalence and Predictors of Need for Seating Intervention and Mobility for Persons in Long-Term Care

    ERIC Educational Resources Information Center

    Bourbonniere, Melissa C.; Fawcett, Laura M.; Miller, William C.; Garden, Jennifer; Mortenson, William B.

    2007-01-01

    A descriptive cross-sectional study was conducted to (a) determine the prevalence of need for wheel-chair seating intervention in two long-term care facilities in Vancouver, BC, (b) determine the extent of the residents' independent mobility within these facilities, and (c) explore the relationship between proper wheel-chair seating and…

  6. A Systematic Review of Recent Smartphone, Internet and Web 2.0 Interventions to Address the HIV Continuum of Care

    PubMed Central

    Muessig, Kathryn E.; Nekkanti, Manali; Bauermeister, Jose; Bull, Sheana

    2015-01-01

    eHealth, mHealth and “Web 2.0” social media strategies can effectively reach and engage key populations in HIV prevention across the testing, treatment, and care continuum. To assess how these tools are currently being used within the field of HIV prevention and care, we systematically reviewed recent (2013–2014) published literature, conference abstracts, and funded research. Our searches identified 23 published intervention studies and 32 funded projects underway. In this synthesis we describe the technology modes applied and the stages of the HIV care cascade addressed, including both primary and secondary prevention activities. Overall trends include use of new tools including social networking sites, provision of real-time assessment and feedback, gamification and virtual reality. While there has been increasing attention to use of technology to address the care continuum, gaps remain around linkage to care, retention in care, and initiation of antiretroviral therapy. PMID:25626718

  7. A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care.

    PubMed

    Muessig, Kathryn E; Nekkanti, Manali; Bauermeister, Jose; Bull, Sheana; Hightow-Weidman, Lisa B

    2015-03-01

    eHealth, mHealth and "Web 2.0" social media strategies can effectively reach and engage key populations in HIV prevention across the testing, treatment, and care continuum. To assess how these tools are currently being used within the field of HIV prevention and care, we systematically reviewed recent (2013-2014) published literature, conference abstracts, and funded research. Our searches identified 23 published intervention studies and 32 funded projects underway. In this synthesis we describe the technology modes applied and the stages of the HIV care cascade addressed, including both primary and secondary prevention activities. Overall trends include use of new tools including social networking sites, provision of real-time assessment and feedback, gamification and virtual reality. While there has been increasing attention to use of technology to address the care continuum, gaps remain around linkage to care, retention in care, and initiation of antiretroviral therapy. PMID:25626718

  8. A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care.

    PubMed

    Muessig, Kathryn E; Nekkanti, Manali; Bauermeister, Jose; Bull, Sheana; Hightow-Weidman, Lisa B

    2015-03-01

    eHealth, mHealth and "Web 2.0" social media strategies can effectively reach and engage key populations in HIV prevention across the testing, treatment, and care continuum. To assess how these tools are currently being used within the field of HIV prevention and care, we systematically reviewed recent (2013-2014) published literature, conference abstracts, and funded research. Our searches identified 23 published intervention studies and 32 funded projects underway. In this synthesis we describe the technology modes applied and the stages of the HIV care cascade addressed, including both primary and secondary prevention activities. Overall trends include use of new tools including social networking sites, provision of real-time assessment and feedback, gamification and virtual reality. While there has been increasing attention to use of technology to address the care continuum, gaps remain around linkage to care, retention in care, and initiation of antiretroviral therapy.

  9. [Nursing interventions for the care of patients with arthritis: an integrative review].

    PubMed

    dos Santos, Daniella Soares; de Carvalho, Emília Campos

    2012-01-01

    This integrative review aimed to analyze the scientific literature related to nursing care for patients with arthritis. Twelve experimental studies were included, randomized and controlled, published in CINAHL, MEDLINE, SciELO and LILACS databases, using the controlled keywords "arthritis" and "nursing". The results indicated the effectiveness of music therapy, neuromuscular electrical stimulation, therapeutic touch and guided imagery associated with relaxation, for the treatment of pain. Being treated by a specialist nurse increased satisfaction with care, improved the impact of the disease and increased the demand for health services. Specific educational programs for people with arthritis stimulated the practice of physical exercises and those targeted to people with chronic conditions in general were effective to control pain and functional disability. We conclude that there is a set of interventions that can support the practice of evidence-based nursing for the elderly people with arthritis. PMID:23559181

  10. Implementation experience during an eighteen month intervention to improve paediatric and newborn care in Kenyan district hospitals

    PubMed Central

    Nzinga, Jacinta; Ntoburi, Stephen; Wagai, John; Mbindyo, Patrick; Mbaabu, Lairumbi; Migiro, Santau; Wamae, Annah; Irimu, Grace; English, Mike

    2009-01-01

    Background We have conducted an intervention study aiming to improve hospital care for children and newborns in Kenya. In judging whether an intervention achieves its aims, an understanding of how it is delivered is essential. Here, we describe how the implementation team delivered the intervention over 18 months and provide some insight into how health workers, the primary targets of the intervention, received it. Methods We used two approaches. First, a description of the intervention is based on an analysis of records of training, supervisory and feedback visits to hospitals, and brief logs of key topics discussed during telephone calls with local hospital facilitators. Record keeping was established at the start of the study for this purpose with analyses conducted at the end of the intervention period. Second, we planned a qualitative study nested within the intervention project and used in-depth interviews and small group discussions to explore health worker and facilitators' perceptions of implementation. After thematic analysis of all interview data, findings were presented, discussed, and revised with the help of hospital facilitators. Results Four hospitals received the full intervention including guidelines, training and two to three monthly support supervision and six monthly performance feedback visits. Supervisor visits, as well as providing an opportunity for interaction with administrators, health workers, and facilitators, were often used for impromptu, limited refresher training or orientation of new staff. The personal links that evolved with senior staff seemed to encourage local commitment to the aims of the intervention. Feedback seemed best provided as open meetings and discussions with administrators and staff. Supervision, although sometimes perceived as fault finding, helped local facilitators become the focal point of much activity including key roles in liaison, local monitoring and feedback, problem solving, and orientation of new staff

  11. Evaluation of the feasibility and acceptability of the ‘Care for Stroke’ intervention in India, a smartphone-enabled, carer-supported, educational intervention for management of disability following stroke

    PubMed Central

    Sureshkumar, K; Murthy, GVS; Natarajan, S; Naveen, C; Goenka, S; Kuper, H

    2016-01-01

    Objectives (1) To identify operational issues encountered by study participants in using the ‘Care for Stroke’ intervention; (2) to evaluate the feasibility and acceptability of the intervention. Design Mixed-methods research design. Setting Participant's home. Participants were selected from a tertiary hospital in Chennai, South India. Participants Sixty stroke survivors treated and discharged from the hospital, and their caregivers. InterventionCare for Stroke’ is a smartphone-enabled, educational intervention for management of physical disabilities following stroke. It is delivered through a web-based, smartphone-enabled application. It includes inputs from stroke rehabilitation experts in a digitised format. Methods Evaluation of the intervention was completed in two phases. In the first phase, the preliminary intervention was field-tested with 30 stroke survivors for 2 weeks. In the second phase, the finalised intervention was provided to a further 30 stroke survivors to be used in their homes with support from their carers for 4 weeks. Primary and secondary outcome measures Primary outcomes: (1) operational difficulties in using the intervention; (2) feasibility and acceptability of the intervention in an Indian setting. Disability and dependency were assessed as secondary outcomes. Results Field-testing identified operational difficulties related to connectivity, video-streaming, picture clarity, quality of videos, and functionality of the application. The intervention was reviewed, revised and finalised before pilot-testing. Findings from the pilot-testing showed that the ‘Care for Stroke’ intervention was feasible and acceptable. Over 90% (n=27) of the study participants felt that the intervention was relevant, comprehensible and useful. Over 96% (n=29) of the stroke survivors and all the caregivers (100%, n=30) rated the intervention as excellent and very useful. These findings were supported by qualitative interviews. Conclusions

  12. Screening and brief interventions for hazardous and harmful alcohol use in primary care: a cluster randomised controlled trial protocol

    PubMed Central

    Kaner, Eileen; Bland, Martin; Cassidy, Paul; Coulton, Simon; Deluca, Paolo; Drummond, Colin; Gilvarry, Eilish; Godfrey, Christine; Heather, Nick; Myles, Judy; Newbury-Birch, Dorothy; Oyefeso, Adenekan; Parrott, Steve; Perryman, Katherine; Phillips, Tom; Shenker, Don; Shepherd, Jonathan

    2009-01-01

    Background There have been many randomized controlled trials of screening and brief alcohol intervention in primary care. Most trials have reported positive effects of brief intervention, in terms of reduced alcohol consumption in excessive drinkers. Despite this considerable evidence-base, key questions remain unanswered including: the applicability of the evidence to routine practice; the most efficient strategy for screening patients; and the required intensity of brief intervention in primary care. This pragmatic factorial trial, with cluster randomization of practices, will evaluate the effectiveness and cost-effectiveness of different models of screening to identify hazardous and harmful drinkers in primary care and different intensities of brief intervention to reduce excessive drinking in primary care patients. Methods and design GPs and nurses from 24 practices across the North East (n = 12), London and South East (n = 12) of England will be recruited. Practices will be randomly allocated to one of three intervention conditions: a leaflet-only control group (n = 8); brief structured advice (n = 8); and brief lifestyle counselling (n = 8). To test the relative effectiveness of different screening methods all practices will also be randomised to either a universal or targeted screening approach and to use either a modified single item (M-SASQ) or FAST screening tool. Screening randomisation will incorporate stratification by geographical area and intervention condition. During the intervention stage of the trial, practices in each of the three arms will recruit at least 31 hazardous or harmful drinkers who will receive a short baseline assessment followed by brief intervention. Thus there will be a minimum of 744 patients recruited into the trial. Discussion The trial will evaluate the impact of screening and brief alcohol intervention in routine practice; thus its findings will be highly relevant to clinicians working in primary care in the UK. There will

  13. Improved Prevention Counseling by HIV Care Providers in a Multisite, Clinic-Based Intervention: Positive STEPs

    ERIC Educational Resources Information Center

    Thrun, Mark; Cook, Paul F.; Bradley-Springer, Lucy A.; Gardner, Lytt; Marks, Gary; Wright, Julie; Wilson, Tracey E.; Quinlivan, E. Byrd; O'Daniels, Christine; Raffanti, Stephen; Thompson, Melanie; Golin, Carol

    2009-01-01

    The Centers for Disease Control and Prevention have recommended that HIV care clinics incorporate prevention into clinical practice. This report summarizes HIV care providers' attitudes and counseling practices before and after they received training to deliver a counseling intervention to patients. Providers at seven HIV clinics received training…

  14. Psychosocial Interventions for Children and Adolescents in Foster Care: Review of Research Literature

    ERIC Educational Resources Information Center

    Landsverk, John A.; Burns, Barbara J.; Stambaugh, Leyla Faw; Rolls Reutz, Jennifer A.

    2009-01-01

    Between one-half and three-fourths of children entering foster care exhibit behavioral or social-emotional problems warranting mental health care. This paper, condensed and updated from a technical report prepared for Casey Family Programs in 2005, reviews evidence-based and promising interventions for the most prevalent mental conditions found…

  15. Benefits and Challenges of the Passport Broadcast Intervention in Long-Term Care

    ERIC Educational Resources Information Center

    Wittenberg-Lyles, Elaine; Oliver, Debra Parker; Demiris, George; Shaunfield, Sara

    2012-01-01

    Creative activities are a challenge for long-term care facilities. The Passport intervention uses web-based video technology to provide long-term care residents with a virtual travel experience. Passport broadcasts were conducted and staff and residents were interviewed about the experience. A thematic analysis of interviews was used to discern…

  16. Development and pilot testing of an intervention to promote care engagement and adherence among HIV-positive Kenyan MSM

    PubMed Central

    Graham, Susan M.; Micheni, Murugi; Kombo, Bernadette; Van Der Elst, Elisabeth M.; Mugo, Peter M.; Kivaya, Esther; Aunon, Frances; Kutner, Bryan; Sanders, Eduard J.; Simoni, Jane M.

    2016-01-01

    Objectives In many African settings, MSM are a stigmatized group whose access to and engagement in HIV care may be challenging. Our aim was to design a targeted, culturally appropriate intervention to promote care engagement and antiretroviral therapy (ART) adherence for MSM in coastal Kenya, and describe intervention safety, feasibility, and acceptability based upon a small pilot study. Design Based on qualitative work including in-depth interviews with HIV-positive MSM and focus groups with providers, we developed a tailored intervention and conducted a pilot test to refine intervention materials and procedures. Methods The Shikamana intervention combines modified Next-Step Counseling by trained providers, support from a trained peer navigator, and tailored use of SMS messaging, phone calls, and discrete pill carriers. Providers, including counselors and clinicians, work together with peer navigators as a case management team. Results Forty HIV-positive MSM aged 19–51 participated in intervention development and testing. Six counselors, three clinical officers, and four MSM peers were trained in intervention procedures. Of 10 ART-naïve participants who enrolled in the pilot, eight completed follow-up with no adverse events reported. One participant was lost to follow-up after 2 months and another failed to initiate ART despite ongoing counseling. No adverse events were reported. Staff feedback and exit interviews rated the intervention as feasible and acceptable. Conclusion This adherence support intervention tailored for Kenyan MSM was well tolerated, feasible, and acceptable in the pilot phase. A randomized controlled trial of a scaled-up programme to estimate intervention efficacy is ongoing. PMID:26562813

  17. Implementation Process of a Canadian Community-based Nurse Mentorship Intervention in HIV Care.

    PubMed

    Caine, Vera; Mill, Judy; O'Brien, Kelly; Solomon, Patricia; Worthington, Catherine; Dykeman, Margaret; Gahagan, Jacqueline; Maina, Geoffrey; De Padua, Anthony; Arneson, Cheryl; Rogers, Tim; Chaw-Kant, Jean

    2016-01-01

    We describe salient individual and organizational factors that influenced engagement of registered nurses in a 12-month clinical mentorship intervention on HIV care in Canada. The intervention included 48 nurses and 8 people living with HIV (PLWH) who were involved in group-based and one-on-one informal mentorship informed by transformative learning theory. We evaluated the process of implementing the mentorship intervention using qualitative content analysis. The inclusion of PLWH as mentors, the opportunities for reciprocal learning, and the long-term commitment of individual nurses and partner organizations in HIV care were major strengths. Challenges included the need for multiple ethical approvals, the lack of organizational support at some clinical sites, and the time commitment required by participants. We recommend that clinical mentorship interventions in HIV care consider organizational support, adhere to the Greater Involvement of People Living with HIV/AIDS principles, and explore questions of professional obligations. PMID:26644019

  18. Implementation Process of a Canadian Community-based Nurse Mentorship Intervention in HIV Care

    PubMed Central

    Caine, Vera; Mill, Judy; O’Brien, Kelly; Solomon, Patricia; Worthington, Catherine; Dykeman, Margaret; Gahagan, Jacqueline; Maina, Geoffrey; De Padua, Anthony; Arneson, Cheryl; Rogers, Tim; Chaw-Kant, Jean

    2016-01-01

    We describe salient individual and organizational factors that influenced engagement of registered nurses in a 12-month clinical mentorship intervention on HIV care in Canada. The intervention included 48 nurses and 8 people living with HIV (PLWH) who were involved in group-based and one-on-one informal mentorship informed by transformative learning theory. We evaluated the process of implementing the mentorship intervention using qualitative content analysis. The inclusion of PLWH as mentors, the opportunities for reciprocal learning, and the long-term commitment of individual nurses and partner organizations in HIV care were major strengths. Challenges included the need for multiple ethical approvals, the lack of organizational support at some clinical sites, and the time commitment required by participants. We recommend that clinical mentorship interventions in HIV care consider organizational support, adhere to the Greater Involvement of People Living with HIV/AIDS principles, and explore questions of professional obligations. PMID:26644019

  19. [From early detection to early care: intervention strategies based on prospective screening].

    PubMed

    Canal-Bedia, Ricardo; García-Primo, Patricia; Hernández-Fabián, Aránzazu; Magán-Maganto, María; Sánchez, Ana B; Posada-De la Paz, Manuel

    2015-02-25

    INTRODUCTION. The challenge of early detection can be tackled from an evolutionary perspective. Early intervention treatments have shown themselves to be effective provided that they are applied systematically as part of the strategic planning of the treatment. AIMS. The aim of this study is to provide an updated review in response to the criticism targeted towards early detection and to offer some considerations on the intervention strategy. Our research is based on a review of the early care techniques that are commonly used within the field of autism and it intends to reflect the most significant aspects that can be deduced from the experiments and studies carried out to date. CONCLUSIONS. From the findings of the review it can be concluded that early detection may be more efficient if carried out within the framework of developmental surveillance, which also offers the opportunity to provide guidance on the child's development. Early care is an effective resource for attending to the needs of children with autism. Professionals have the duty to assess the work they do on available treatments with a reflexive, judicious attitude, taking into account the values and preferences of the families. Programmes must focus on the core symptoms and apply the active ingredients of the treatment.

  20. Nutritional interventions through primary health care: impact of the ICDS projects in India.

    PubMed Central

    Tandon, B. N.

    1989-01-01

    In 1975 the Government of India initiated an integrated approach for the delivery of health care as well as nutrition and education services for deprived populations at the village level and in urban slums through centres, each of which was run by a local part-time female worker (anganwadi) who was paid an honorarium and had a helper. This national programme, known as the Integrated Child Development Services (ICDS), began with 33 projects but, by March 1986, had expanded to 1611 projects covering 23% of the country's population and representing about 50% of the population in the socioeconomically backward areas. The ICDS can therefore be considered to function as a primary health care programme for preschool children (under 6 years old), pregnant women, and lactating mothers. The present study investigated the impact on the nutritional status of the target population after 3-5 years and after 8 years of ICDS interventions, compared with the nutritional status of non-ICDS (control) groups. The results showed that the ICDS nutrition intervention programmes achieved better coverage of the target population and led to a significant decline in malnutrition among preschool children in the ICDS population, compared with the non-ICDS groups that received nutrition, health care and education through separate programmes. This example may lead other developing countries to introduce integrated programmes with certain modifications to suit local conditions. International agencies and national governments should strive to bring about the integration of nutritional services with primary health care and development programmes for children because of the good results in terms of child survival and child development. PMID:2706729

  1. A Method to Determine the Impact of Patient-Centered Care Interventions in Primary Care

    PubMed Central

    Daaleman, Timothy P.; Shea, Christopher M.; Halladay, Jacqueline; Reed, David

    2014-01-01

    INTRODUCTION The implementation of patient-centered care (PCC) innovations continues to be poorly understood. We used the implementation effectiveness framework to pilot a method for measuring the impact of a PCC innovation in primary care practices. METHODS We analyzed data from a prior study that assessed the implementation of an electronic geriatric quality-of-life (QOL) module in 3 primary care practices in central North Carolina in 2011–12. Patients responded to the items and the subsequent patient-provider encounter was coded using the Roter Interaction Analysis System (RIAS) system. We developed an implementation effectiveness measure specific to the QOL module (i.e., frequency of usage during the encounter) using RIAS and then tested if there were differences with RIAS codes using analysis of variance. RESULTS A total of 60 patient-provider encounters examined differences in the uptake of the QOL module (i.e., implementation-effectiveness measure) with the frequency of RIAS codes during the encounter (i.e., patient-centeredness measure). There was a significant association between the effectiveness measure and patient-centered RIAS codes. CONCLUSION The concept of implementation effectiveness provided a useful framework determine the impact of a PCC innovation. PRACTICE IMPLICATIONS A method that captures real-time interactions between patients and care staff over time can meaningfully evaluate PCC innovations. PMID:25269410

  2. When the caregiver has HIV: early intervention through home care.

    PubMed

    D'Arrigo, T

    1994-05-01

    Many informal caregivers of AIDS patients, by virtue of being or having been their sexual partners, are infected with HIV but are not yet sick. Home care providers have an excellent opportunity to educate these caregivers during home visits.

  3. Selecting control interventions for clinical outcome studies.

    PubMed

    Barkauskas, Violet H; Lusk, Sally L; Eakin, Brenda L

    2005-04-01

    In the current research environment the design and management of control groups is becoming more complex. The selection of a control group design is dependent on study goals, presence and quality of existing interventions, urgency of the problem or issue being addressed by the intervention, and factors related to the study site. The purpose of the presentation is to identify various approaches to the design of control groups in experimental studies and to identify their strengths, limitations, and applications. A case study exemplifies the issues associated with control group selection and design.

  4. A Mixed-Methods Outcome Evaluation of a Mentorship Intervention for Canadian Nurses in HIV Care

    PubMed Central

    Worthington, Catherine A.; O’Brien, Kelly K.; Mill, Judy; Caine, Vera; Solomon, Patty; Chaw-Kant, Jean

    2016-01-01

    We assessed the impact of an HIV care mentorship intervention on knowledge, attitudes, and practices with nurses and people living with HIV (PLWH) in Canada. We implemented the intervention in two urban and two rural sites with 16 mentors (eight experienced HIV nurses and eight PLWH) and 40 mentees (nurses with limited HIV experience). The 6- to 12-month intervention included face-to-face workshops and monthly meetings. Using a mixed-methods approach, participants completed pre- and postintervention questionnaires and engaged in semistructured interviews at intervention initiation, mid-point, and completion. Data from 28 mentees (70%) and 14 mentors (87%) were included in the quantitative analysis. We analyzed questionnaire data using McNemar test, and interview data using content analysis. Results indicated positive changes in knowledge, attitudes, and practices among nurse mentees, with qualitative interviews highlighting mechanisms by which change occurred. Mentorship interventions have the potential to engage and educate nurses in HIV treatment and care. PMID:27039195

  5. [Dietary interventions and social care for treating obesity in children].

    PubMed

    Wiegand, S; Bau, A-M; Babitsch, B

    2011-05-01

    The prevalence of obesity and associated comorbidities among children and adolescents has risen worldwide throughout the past 3 decades. To break this trend, population-based activities in health promotion/prevention and health care are necessary. Studies showed that long-term eating behavior improvement with the cooperation of the patient's family together with child-friendly organization support both individual therapeutic improvements as well as a relevant reduction of obesity prevalence. A significant BMI reduction can be achieved with a normal varied diet, whose energetic value is 300-400 kcal/day below the patient's daily energetic needs, due to the lower consumption of fat and sugar. This requires, however, that the entire family be willing to change their unhealthy eating behaviors (e.g., soft drinks and fast food) and to introduce regular meals into their daily routine. Sensibly, most therapies combine diet therapy with increased physical activity and parental training. Controlled media consumption, active leisure-time behavior, and a structured daily routine are further conditions for successful weight reduction. The high-risk groups for pediatric obesity, i.e., families with migration background and/or low socioeconomic status, have been poorly reached by established programs. PMID:21547643

  6. A theory-based primary health care intervention for women who have left abusive partners.

    PubMed

    Ford-Gilboe, Marilyn; Merritt-Gray, Marilyn; Varcoe, Colleen; Wuest, Judith

    2011-01-01

    Although intimate partner violence is a significant global health problem, few tested interventions have been designed to improve women's health and quality of life, particularly beyond the crisis of leaving. The Intervention for Health Enhancement After Leaving is a comprehensive, trauma informed, primary health care intervention, which builds on the grounded theory Strengthening Capacity to Limit Intrusion and other research findings. Delivered by a nurse and a domestic violence advocate working collaboratively with women through 6 components (safeguarding, managing basics, managing symptoms, cautious connecting, renewing self, and regenerating family), this promising intervention is in the early phases of testing. PMID:21654310

  7. Involvement of informal caregivers in supporting patients with COPD: a review of intervention studies

    PubMed Central

    Bryant, Jamie; Mansfield, Elise; Boyes, Allison W; Waller, Amy; Sanson-Fisher, Rob; Regan, Timothy

    2016-01-01

    Caregivers of individuals with COPD have a key role in maintaining patient adherence and optimizing patient function. However, no systematic review has examined how the caregiver role has been operationalized in interventions to improve outcomes of individuals with COPD or the quality or effectiveness of these interventions. The aims of this review were to 1) determine whether caregivers have been involved as part of interventions to improve outcomes of individuals with COPD; 2) determine the risk of bias within included intervention studies; and 3) examine the effectiveness of interventions that have involved caregivers in improving outcomes of individuals with COPD. The electronic databases of Medline, Embase, PsycINFO, and Cochrane Library were searched from January 2000 to November 2015. Experimental studies testing interventions that involved a caregiver to improve COPD patient outcomes were eligible. Nine studies involving caregivers met inclusion criteria. No studies reported any intervention components targeted solely at caregivers, with most instead including caregivers in dyadic or group education sessions about COPD delivered by health care professionals. The risk of bias identified in included studies was mixed. Seven of the nine studies were effective in improving a broad range of outcomes. These findings highlight that there is an urgent need for methodologically rigorous interventions to examine the effectiveness of strategies to assist caregivers to provide direct care, encourage adherence to health care provider recommendations, act as a health care advocate, and provide emotional and psychosocial support to individuals with COPD. PMID:27478372

  8. Nutritional Intervention Using Nutrition Care Process in a Malnourished Patient with Chemotherapy Side Effects

    PubMed Central

    Lee, Jung-Joo

    2015-01-01

    In this case study, the process of nutritional diagnosis and intervention conducted at a hospital on a malnourished patient who underwent treatment for a chronic illness (chemotherapy for cancer treatment) was recorded. The patient received his first round of chemotherapy for colorectal cancer, and then a second round after the cancer metastasized to the liver. The patient was malnourished and had experienced weight loss (17% loss in the most recent 3 months) due to side effects of chemotherapy including stomatitis, nausea, and vomiting. Nutritional diagnosis and intervention via the nutrition care process were implemented through two screening rounds, and the quantity of oral intake increased from 28% to 62% of the recommended daily intake. The patient required continuous monitoring and outpatient care after hospital discharge. It is speculated that if a more active patient education and dietary regimen with respect to chemotherapy side effects had been offered after the patient's first chemotherapy cycle, it might have been possible to treat ingestion problems due to stomatitis during the second cycle of chemotherapy and prevent the weight loss. Henceforth, patients receiving chemotherapy should be educated about nutrition management methods and monitored continuously to prevent malnutrition. PMID:25713794

  9. Nutritional intervention using nutrition care process in a malnourished patient with chemotherapy side effects.

    PubMed

    Lee, Hye-Ok; Lee, Jung-Joo

    2015-01-01

    In this case study, the process of nutritional diagnosis and intervention conducted at a hospital on a malnourished patient who underwent treatment for a chronic illness (chemotherapy for cancer treatment) was recorded. The patient received his first round of chemotherapy for colorectal cancer, and then a second round after the cancer metastasized to the liver. The patient was malnourished and had experienced weight loss (17% loss in the most recent 3 months) due to side effects of chemotherapy including stomatitis, nausea, and vomiting. Nutritional diagnosis and intervention via the nutrition care process were implemented through two screening rounds, and the quantity of oral intake increased from 28% to 62% of the recommended daily intake. The patient required continuous monitoring and outpatient care after hospital discharge. It is speculated that if a more active patient education and dietary regimen with respect to chemotherapy side effects had been offered after the patient's first chemotherapy cycle, it might have been possible to treat ingestion problems due to stomatitis during the second cycle of chemotherapy and prevent the weight loss. Henceforth, patients receiving chemotherapy should be educated about nutrition management methods and monitored continuously to prevent malnutrition.

  10. Effects of Educational Interventions for Chronic Airway Disease on Primary Care.

    PubMed

    Lee, Jung Yeon; Yoo, Kwang Ha; Kim, Deog Kyeom; Kim, Sang-Ha; Kim, Tae-Eun; Kim, Tae-Hyung; Rhee, Chin Kook; Park, Yong Bum; Yoon, Hyoung Kyu; Yum, Ho-Kee

    2016-07-01

    Education has been known to essential for management of chronic airway diseases. However the real benefits remain unclear. We evaluated the effectiveness of an organized educational intervention for chronic airway diseases directed at primary care physicians and patients. The intervention was a 1-month education program of three visits, during which subjects were taught about their disease, an action plan in acute exacerbation and inhaler technique. Asthma control tests (ACT) for asthma and, chronic obstructive pulmonary disease (COPD) assessment tests (CAT) for COPD subjects were compared before and after education as an index of quality of life. Educational effectiveness was also measured associated with improvement of their knowledge for chronic airway disease itself, proper use of inhaler technique, and satisfaction of the subjects and clinicians before and after education. Among the 285 participants, 60.7% (n = 173) were men and the mean age was 62.2 ± 14.7. ACT for asthma and CAT in COPD patients were significantly improved by 49.7% (n = 79) and 51.2% (n = 65) more than MCID respectively after education (P < 0.05). In all individual items, knowledge about their disease, inhaler use and satisfaction of the patients and clinicians were also improved after education (P < 0.05). This study demonstrates the well-organized education program for primary care physicians and patients is a crucial process for management of chronic airway diseases.

  11. Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care

    PubMed Central

    Chien, Wai Tong; Leung, Sau Fong; Yeung, Frederick KK; Wong, Wai Kit

    2013-01-01

    Schizophrenia is a disabling psychiatric illness associated with disruptions in cognition, emotion, and psychosocial and occupational functioning. Increasing evidence shows that psychosocial interventions for people with schizophrenia, as an adjunct to medications or usual psychiatric care, can reduce psychotic symptoms and relapse and improve patients’ long-term outcomes such as recovery, remission, and illness progression. This critical review of the literature was conducted to identify the common approaches to psychosocial interventions for people with schizophrenia. Treatment planning and outcomes were also explored and discussed to better understand the effects of these interventions in terms of person-focused perspectives such as their perceived quality of life and satisfaction and their acceptability and adherence to treatments or services received. We searched major health care databases such as EMBASE, MEDLINE, and PsycLIT and identified relevant literature in English from these databases. Their reference lists were screened, and studies were selected if they met the criteria of using a randomized controlled trial or systematic review design, giving a clear description of the interventions used, and having a study sample of people primarily diagnosed with schizophrenia. Five main approaches to psychosocial intervention had been used for the treatment of schizophrenia: cognitive therapy (cognitive behavioral and cognitive remediation therapy), psychoeducation, family intervention, social skills training, and assertive community treatment. Most of these five approaches applied to people with schizophrenia have demonstrated satisfactory levels of short- to medium-term clinical efficacy in terms of symptom control or reduction, level of functioning, and/or relapse rate. However, the comparative effects between these five approaches have not been well studied; thus, we are not able to clearly understand the superiority of any of these interventions. With the

  12. Behavioral interventions for office-based care: behavior change.

    PubMed

    Delfino, Matthew; Larzelere, Michele McCarthy

    2014-03-01

    Family physicians play an important role in identifying and treating the behavioral etiologies of morbidity and mortality. Changing behavior is a challenging process that begins with identifying a patient's readiness to change. Interventions, such as motivational interviewing, are used to increase a patient's desire to change, and cognitive behavioral therapy can be initiated to increase a patient's likelihood of change, particularly if barriers are identified. After patients embark on change, family physicians are uniquely positioned to connect them to self-help programs, more intensive psychotherapy, and newer technology-based support programs, and to provide repeated, brief, positive reinforcement. Specific behavioral interventions that can be effective include computerized smoking cessation programs; electronic reminders and support delivered by family physicians or other clinicians for weight loss; linkage to community-based programs for seniors; increased length and demands of in-school programs to support exercise participation by children; and access reduction education to prevent firearm injury. PMID:24628011

  13. Variables Affecting Pharmacy Students’ Patient Care Interventions during Advanced Pharmacy Practice Experiences

    PubMed Central

    Patterson, Brandon J.; Sen, Sanchita; Bingham, Angela L.; Bowen, Jane F.; Ereshefsky, Benjamin; Siemianowski, Laura A.

    2016-01-01

    Objective. To identify the temporal effect and factors associated with student pharmacist self-initiation of interventions during acute patient care advanced pharmacy practice experiences (APPE). Methods. During the APPE, student pharmacists at an academic medical center recorded their therapeutic interventions and who initiated the intervention throughout clinical rotations. At the end of the APPE student pharmacists completed a demographic survey. Results. Sixty-two student pharmacists were included. Factors associated with lower rates of self-initiated interventions were infectious diseases and pediatrics APPEs and an intention to pursue a postgraduate residency. Timing of the APPE, previous specialty elective course completion, and previous hospital experience did not result in any significant difference in self-initiated recommendations. Conclusion. Preceptors should not base practice experience expectations for self-initiated interventions on previous student experience or future intentions. Additionally, factors leading to lower rates of self-initiated interventions on infectious diseases or pediatrics APPEs should be explored. PMID:27756924

  14. Health care providers' perspectives on a weekly text-messaging intervention to engage HIV-positive persons in care (WelTel BC1).

    PubMed

    Murray, Melanie C M; O'Shaughnessy, Sara; Smillie, Kirsten; Van Borek, Natasha; Graham, Rebecca; Maan, Evelyn J; van der Kop, Mia L; Friesen, Karen; Albert, Arianne; Levine, Sarah; Pick, Neora; Ogilvie, Gina; Money, Deborah; Lester, Richard

    2015-10-01

    Though evidence shows that Mobile health (mHealth) interventions can improve adherence and viral load in HIV-positive persons, few have studied the health care providers' (HCP) perspective. We conducted a prospective mixed methods pilot study using the WelTel intervention wherein HIV-positive participants (n = 25) received weekly interactive text messages for 6 months. Text message response rate and topic data were collected to illustrate the HCP experience. The aim of this study is to explore intervention acceptability and feasibility from the HCP perspective through a baseline focus group and end of study interviews with HCP impacted by the intervention. Interview data were thematically coded using the Technology Acceptance Model. HCPs identified that the WelTel intervention engaged patients in building relationships, while organizing and streamlining existing mHealth efforts and dealing with privacy issues. HCPs recognized that although workload would augment initially, intervention benefits were many, and went beyond simply improving HIV viral load.

  15. Integrative health care model for climacteric stage women: design of the intervention

    PubMed Central

    2011-01-01

    Background Climacteric stage women experience significant biological, psychological and social changes. With demographic changes being observed in the growing number of climacteric stage women in Mexico, it is important to improve their knowledge about the climacteric stage and its potential associated problems, encourage their participation in screening programs, and promote the acquisition of healthy lifestyles. At Mexican health care institutions the predominant health care model for climacteric stage women has a biomedical perspective. Medical doctors provide mostly curative services and have limited support from other health professionals. This study aims to design an integrative health care model (IHCM: bio-psycho-social, multidisciplinary and women-centered) applicable in primary care services aimed at climacteric stage women. Methods/Design We present the design, inclusion criteria and detailed description of an IHCM. The IHCM consists of collaborative and coordinated provision of services by a health team, which is involves a family doctor, nurse, psychologist, and the woman herself. The health team promotes the empowerment of women through individual and group counseling on the climacteric stage and health related self-care. The intervention lasts three months followed by a three-month follow-up period to evaluate the effectiveness of the model. The effectiveness of the model will be evaluated through the following aspects: health-related quality of life (HR-QoL), empowerment, self-efficacy and knowledge regarding the climacteric stage and health-related self-care activities, use of screening services, and improvement in lifestyles (regular leisure time physical activity and healthy diet). Discussion Participation in preventive activities should be encouraged among women in Mexico. Designing and evaluating the effectiveness of an integrative health care model for women at the climacteric stage, based on the empowerment approach and focus on health

  16. Group Patient Education: Effectiveness of a Brief Intervention in People with Type 2 Diabetes Mellitus in Primary Health Care in Greece: A Clinically Controlled Trial

    ERIC Educational Resources Information Center

    Merakou, K.; Knithaki, A.; Karageorgos, G.; Theodoridis, D.; Barbouni, A.

    2015-01-01

    This study aims to assess the impact of a brief patient group education intervention in people with type 2 diabetes mellitus. The sample, 193 people with type 2 diabetes mellitus who were patients at the diabetic clinic of a primary health care setting in Attica, was assigned to two groups, intervention (138 individuals) and control group (55…

  17. The use and utility of specific nonpharmacological interventions for behavioral symptoms in dementia: an exploratory study

    PubMed Central

    Cohen-Mansfield, Jiska; Marx, Marcia S.; Dakheel-Ali, Maha; Thein, Khin

    2014-01-01

    OBJECTIVE This study compares different non-pharmacological interventions for persons with behavioral symptoms and dementia on frequency of use and perceived efficacy in terms of change in behavior and interest. METHODS Participants were 89 nursing home residents from 6 Maryland nursing homes with a mean age of 85.9 years (SD=8.6). Research assistants presented interventions tailored to the participants` needs and preferences in a pre-intervention trial phase and in an intervention phase. The impact of each intervention on behavioral symptoms and on the person’s interest was rated immediately after the intervention by a research assistant. RESULTS The most utilized interventions in both trial and treatment phases were the social intervention of one-on-one interaction, simulated social interventions such as a lifelike doll and respite video, the theme intervention of magazine, and the sensory stimulation intervention of music. In contrast, the least utilized interventions in both phases were sewing, fabric book, and flower arrangement. Interventions with the highest impact on behavioral symptoms included one-on one social interaction, hand massage, music, video, care, and folding towels. Other high impact interventions included walking, going outside, flower arranging, food or drink, sewing, group activity, book presentation ball toss, coloring or painting, walking, and family video. CONCLUSIONS The results provide initial directions for choosing specific interventions for persons with dementia and also demonstrate a methodology for increasing knowledge through ongoing monitoring of practice. PMID:25081819

  18. Adolescent suicidal and self-destructive behavior. Results of an intervention study.

    PubMed

    Deykin, E Y; Hsieh, C C; Joshi, N; McNamarra, J J

    1986-03-01

    This study evaluates an intervention program designed to reduce suicidal, self-destructive behavior among high-risk adolescents aged 13- to 17 years. The intervention combined a program of community education and direct service to youth who had required emergency care for self-inflicted injuries. The intervention program was effective in increasing subjects' compliance with medical regimen. To a lesser degree, the intervention also facilitated early help seeking among adolescents with suicidal thoughts and appeared to diminish slightly the overall occurrence of emergency room admissions for suicidal behaviors. However, the intervention program had no demonstrable effect on the occurrence of repeat suicidal episodes.

  19. The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation

    PubMed Central

    O'Brien, Rosaleen; Fitzpatrick, Bridie; Higgins, Maria; Guthrie, Bruce; Watt, Graham; Wyke, Sally

    2016-01-01

    Objectives To develop and optimise a primary care-based complex intervention (CARE Plus) to enhance the quality of life of patients with multimorbidity in the deprived areas. Methods Six co-design discussion groups involving 32 participants were held separately with multimorbid patients from the deprived areas, voluntary organisations, general practitioners and practice nurses working in the deprived areas. This was followed by piloting in two practices and further optimisation based on interviews with 11 general practitioners, 2 practice nurses and 6 participating multimorbid patients. Results Participants endorsed the need for longer consultations, relational continuity and a holistic approach. All felt that training and support of the health care staff was important. Most participants welcomed the idea of additional self-management support, though some practitioners were dubious about whether patients would use it. The pilot study led to changes including a revised care plan, the inclusion of mindfulness-based stress reduction techniques in the support of practitioners and patients, and the stream-lining of the written self-management support material for patients. Discussion We have co-designed and optimised an augmented primary care intervention involving a whole-system approach to enhance quality of life in multimorbid patients living in the deprived areas. CARE Plus will next be tested in a phase 2 cluster randomised controlled trial. PMID:27068113

  20. Managing Malnutrition in Older Persons Residing in Care Homes: Nutritional and Clinical Outcomes Following a Screening and Intervention Program.

    PubMed

    Mountford, Christopher G; Okonkwo, Arthur C O; Hart, Kathryn; Thompson, Nick P

    2016-01-01

    This study aimed to establish prevalence of malnutrition in older adult care home residents and investigate whether a nutritional screening and intervention program could improve nutritional and clinical outcomes. A community-based cohort study was conducted in five Newcastle care homes. 205 participants entered; 175 were followed up. Residents already taking oral nutritional supplements (ONS) were excluded from interventions. Those with Malnutrition Universal Screening Tool (MUST) score of 1 received dietetic advice and ≥2 received dietetic advice and were prescribed ONS (220 ml, 1.5 kcal/ml) twice daily for 12 weeks. Body mass index (BMI), MUST, mini nutritional assessment score (MNA)®, mid upper arm muscle circumference (MAMC), and Geriatric Depression Scale (GDS) were recorded at baseline and 12 weeks. Malnutrition prevalence was 36.6% ± 6.6 (95% CI). A higher MUST was associated with greater mortality (p = 0.004). Type of intervention received was significantly associated with change in MUST score (p < 0.001); dietetic advice resulting in the greatest improvement. There were no significant changes in BMI (p = 0.445), MAMC (p = 0.256), or GDS (p = 0.385) following the interventions. Dietitian advice may slow the progression of nutritional decline. In this study oral nutritional supplements over a 3-month period did not significantly improve nutritional status in malnourished care home residents.

  1. PACE-UP (Pedometer and consultation evaluation - UP) – a pedometer-based walking intervention with and without practice nurse support in primary care patients aged 45–75 years: study protocol for a randomised controlled trial

    PubMed Central

    2013-01-01

    Background Most adults do not achieve the 150 minutes weekly of at least moderate intensity activity recommended for health. Adults’ most common physical activity (PA) is walking, light intensity if strolling, moderate if brisker. Pedometers can increase walking; however, most trials have been short-term, have combined pedometer and support effects, and have not reported PA intensity. This trial will investigate whether pedometers, with or without nurse support, can help less active 45–75 year olds to increase their PA over 12 months. Methods/design Design: Primary care-based 3-arm randomized controlled trial with 12-month follow-up and health economic and qualitative evaluations. Participants: Less active 45–75 year olds (n = 993) will be recruited by post from six South West London general practices, maximum of two per household and households randomised into three groups. Step-count and time spent at different PA intensities will be assessed for 7 days at baseline, 3 and 12 months by accelerometer. Questionnaires and anthropometric assessments will be completed. Intervention: The pedometer-alone group will be posted a pedometer (Yamax Digi-Walker SW-200), handbook and diary detailing a 12-week pedometer-based walking programme, using targets from their baseline assessment. The pedometer-plus-support group will additionally receive three practice nurse PA consultations. The handbook, diary and consultations include behaviour change techniques (e.g., self-monitoring, goal-setting, relapse prevention planning). The control group will receive usual care. Outcomes: Changes in average daily step-count (primary outcome), time spent sedentary and in at least moderate intensity PA weekly at 12 months, measured by accelerometry. Other outcomes include change in body mass index, body fat, self-reported PA, quality of life, mood and adverse events. Cost-effectiveness will be assessed by the incremental cost of the intervention to the National Health Service

  2. Effectiveness of a pharmacist-led educational intervention to reduce the use of high-risk abbreviations in an acute care setting in Saudi Arabia: a quasi-experimental study

    PubMed Central

    Haseeb, Abdul; Winit-Watjana, Win; Bakhsh, Abdul-Rahman R; Elrggal, Mahmoud E; Hadi, Muhammad Abdul; Mously, Alaa A; Gadibalban, Asmaa Z; Al-Ibraheem, Bashayir F; Almubark, Rasha A; Ekram, Rawan A; Khan, Tahir Mehmood

    2016-01-01

    Objectives To evaluate the effectiveness of a pharmacist-led educational intervention to reduce the use of high-risk abbreviations (HRAs) by healthcare professionals. Design Quasi-experimental study consisting of a single group before-and-after study design. Setting A public emergency hospital in Mecca, Saudi Arabia. Participants 660 (preintervention) and then 498 (postintervention) handwritten physician orders, medication administration records (MRAs) and pharmacy dispensing sheets of 482 and 388 patients, respectively, from emergency wards, inpatient settings and the pharmacy department were reviewed. Intervention The intervention consisted of a series of interactive lectures delivered by an experienced clinical pharmacist to all hospital staff members and dissemination of educational tools (flash cards, printed list of HRAs, awareness posters) designed in line with the recommendations of the Institute for Safe Medical Practices and the US Food and Drug Administration. The duration of intervention was from April to May 2011. Main outcome Reduction in the incidence of HRAs use from the preintervention to postintervention study period. Findings The five most common abbreviations recorded prior to the interventions were ‘IJ for injection’ (28.6%), ‘SC for subcutaneous’ (17.4%), drug name and dose running together (9.7%), ‘OD for once daily’ (5.8%) and ‘D/C for discharge’ (4.3%). The incidence of the use of HRAs was highest in discharge prescriptions and dispensing records (72.7%) followed by prescriptions from in-patient wards (47.3%). After the intervention, the overall incidence of HRA was significantly reduced by 52% (ie, 53.6% vs 25.5%; p=0.001). In addition, there was a statistically significant reduction in the incidence of HRAs across all three settings: the pharmacy department (72.7% vs 39.3%), inpatient settings (47.3% vs 23.3%) and emergency wards (40.9% vs 10.7%). Conclusions Pharmacist-led educational interventions can significantly

  3. Patient-centered care interventions for the management of alcohol use disorders: a systematic review of randomized controlled trials

    PubMed Central

    Barrio, Pablo; Gual, Antoni

    2016-01-01

    Issues Patient-centered care (PCC) is increasingly accepted as an integral component of good health care, including addiction medicine. However, its implementation has been controversial in people with alcohol use disorders. Approach A systematic search strategy was devised to find completed randomized controlled trials enrolling adults (>18 years) with alcohol use disorders. Studies had to use a PCC approach such that they should have been individualized, respectful to the patients’ own goals, and empowering. Studies until September 2015 were searched using PubMed, Scopus, the Cochrane Library, PsychINFO, and Web of Knowledge. Key findings In total, 40 studies enrolling 16,020 patients met the inclusion criteria. Assessment revealed two main categories of study: psychosocial (n=35 based on motivational interviewing) and pharmacological (n=5 based on an as needed dosing regimen). Psychosocial interventions were further classified according to the presence or absence of an active comparator. When no active comparator was present, studies were classified according to the number of sessions (≥1). Results from single sessions of motivational interviewing showed no clear benefit on alcohol consumption outcomes, with few studies indicating benefit of PCC versus control. Although the results for studies of multiple sessions of counseling were also mixed, many did show a significant benefit of the PCC intervention. By contrast, studies consistently demonstrated a benefit of pharmacologically supported PCC interventions, with most of the differences reaching statistical significance. Implications PCC-based interventions may be beneficial for reducing alcohol consumption in people with alcohol use disorders. PMID:27695301

  4. Patient-centered care interventions for the management of alcohol use disorders: a systematic review of randomized controlled trials

    PubMed Central

    Barrio, Pablo; Gual, Antoni

    2016-01-01

    Issues Patient-centered care (PCC) is increasingly accepted as an integral component of good health care, including addiction medicine. However, its implementation has been controversial in people with alcohol use disorders. Approach A systematic search strategy was devised to find completed randomized controlled trials enrolling adults (>18 years) with alcohol use disorders. Studies had to use a PCC approach such that they should have been individualized, respectful to the patients’ own goals, and empowering. Studies until September 2015 were searched using PubMed, Scopus, the Cochrane Library, PsychINFO, and Web of Knowledge. Key findings In total, 40 studies enrolling 16,020 patients met the inclusion criteria. Assessment revealed two main categories of study: psychosocial (n=35 based on motivational interviewing) and pharmacological (n=5 based on an as needed dosing regimen). Psychosocial interventions were further classified according to the presence or absence of an active comparator. When no active comparator was present, studies were classified according to the number of sessions (≥1). Results from single sessions of motivational interviewing showed no clear benefit on alcohol consumption outcomes, with few studies indicating benefit of PCC versus control. Although the results for studies of multiple sessions of counseling were also mixed, many did show a significant benefit of the PCC intervention. By contrast, studies consistently demonstrated a benefit of pharmacologically supported PCC interventions, with most of the differences reaching statistical significance. Implications PCC-based interventions may be beneficial for reducing alcohol consumption in people with alcohol use disorders.

  5. The gap between policy and practice: a systematic review of patient-centred care interventions in chronic heart failure.

    PubMed

    Kane, P M; Murtagh, F E M; Ryan, K; Mahon, N G; McAdam, B; McQuillan, R; Ellis-Smith, C; Tracey, C; Howley, C; Raleigh, C; O'Gara, G; Higginson, I J; Daveson, B A

    2015-11-01

    Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II-IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included 'patient-centred care', 'quality of life' and 'shared decision making'. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations. PMID:26435042

  6. [PRIMARY CARE INTERVENTIONS FOR PEDIATRIC OVERWEIGHT OR OBESITY].

    PubMed

    Jouret, Béatrice; Haupp, Augustin

    2015-12-01

    Obesity is a slow progressive chronic disease, for the complications as well as efficacy of the care. A long-term success requires a comprehensive educational diagno- sis that explores the various dimensions of the child and his family, thus allowing to define the care project. Both the motivational Interviewing that is based on the technics of therapeutic patient education and the parents' implication are the key factors for the success of the care. They allow, from the assessment of competencies of parents and child to propose, according to child's situation, the best targeted management. The follow up will be step by step, in long-term concerted interdisciplinarity, with in each visit the possibility of choosing a new objective or reinforcing some objectives suitable for the child, in combination with strategies that frequently involve the parents. Negotiation between caregiver(s), the child and his family are suitable. The greatest flexibility on both sides will allow to go forward together to reach the chosen aim. PMID:26979021

  7. Combining propensity score-based stratification and weighting to improve causal inference in the evaluation of health care interventions.

    PubMed

    Linden, Ariel

    2014-12-01

    When a randomized controlled trial is not feasible, a key strategy in observational studies is to ensure that intervention and control groups are comparable on observed characteristics and assume that the remaining unmeasured characteristics will not bias the results. In the past few years, propensity score-based techniques such as matching, stratification and weighting have become increasingly popular for evaluating health care interventions. Recently, marginal mean weighting through stratification (MMWS) has been introduced as a flexible pre-processing approach that combines the salient features of propensity score stratification and weighting to remove imbalances of pre-intervention characteristics between two or more groups under study. The weight is then used within the appropriate outcome model to provide unbiased estimates of treatment effects. In this paper, the MMWS technique is introduced by illustrating its implementation in three typical experimental conditions: a binary treatment (treatment versus control), an ordinal level treatment (varying doses) and nominal treatments (multiple independent arms). These methods are demonstrated in the context of health care evaluations by examining the pre-post difference in hospitalizations following the implementation of a disease management program for patients with congestive heart failure. Because of the flexibility and wide application of MMWS, it should be considered as an alternative procedure for use with observational data to evaluate the effectiveness of health care interventions.

  8. Sample size calculations for intervention trials in primary care randomizing by primary care group: an empirical illustration from one proposed intervention trial.

    PubMed

    Eldridge, S; Cryer, C; Feder, G; Underwood, M

    2001-02-15

    Because of the central role of the general practice in the delivery of British primary care, intervention trials in primary care often use the practice as the unit of randomization. The creation of primary care groups (PCGs) in April 1999 changed the organization of primary care and the commissioning of secondary care services. PCGs will directly affect the organization and delivery of primary, secondary and social care services. The PCG therefore becomes an appropriate target for organizational and educational interventions. Trials testing these interventions should involve randomization by PCG. This paper discusses the sample size required for a trial in primary care assessing the effect of a falls prevention programme among older people. In this trial PCGs will be randomized. The sample size calculations involve estimating intra-PCG correlation in primary outcome: fractured femur rate for those 65 years and over. No data on fractured femur rate were available at PCG level. PCGs are, however, similar in size and often coterminous with local authorities. Therefore, intra-PCG correlation in fractured femur rate was estimated from the intra-local authority correlation calculated from routine data. Three alternative trial designs are considered. In the first design, PCGs are selected for inclusion in the trial from the total population of England (eight regions). In the second design, PCGs are selected from two regions only. The third design is similar to the second except that PCGs are stratified by region and baseline value of fracture rate. Intracluster correlation is estimated for each of these designs using two methods: an approximation which assumes cluster sizes are equal and an alternative method which takes account of the fact that cluster sizes vary. Estimates of sample size required vary between 26 and 7 PCGs in each intervention group, depending on the trial design and the method used to calculate sample size. Not unexpectedly, stratification by baseline

  9. Motivational Interviewing: A Practical Intervention for School Nurses to Engage in Trauma Informed Care.

    PubMed

    Sypniewski, Rebekah

    2016-01-01

    This article provides an overview of motivational interviewing (MI) as an effective intervention for trauma informed care. It offers a description of trauma and its most commonly associated negative side effects in the school setting. Within this context, basic theoretical concepts of MI are discussed. The article closes by examining the need for future research regarding MI as an effective, school-based intervention for adolescents. PMID:26739933

  10. Evaluation of an eHealth Intervention in Chronic Care for Frail Older People: Why Adherence is the First Target

    PubMed Central

    Perry, Marieke; Robben, Sarah HM; Schers, Henk J; Heinen, Maud M; Olde Rikkert, Marcel GM; Melis, René F

    2014-01-01

    Background Older people suffering from frailty often receive fragmented chronic care from multiple professionals. According to the literature, there is an urgent need for coordination of care. Objective The objective of this study was to investigate the effectiveness of an online health community (OHC) intervention for older people with frailty aimed at facilitating multidisciplinary communication. Methods The design was a controlled before-after study with 12 months follow-up in 11 family practices in the eastern part of the Netherlands. Participants consisted of frail older people living in the community requiring multidisciplinary (long-term) care. The intervention used was the health and welfare portal (ZWIP): an OHC for frail elderly patients, their informal caregivers and professionals. ZWIP contains a secure messaging system supplemented by a shared electronic health record. Primary outcomes were scores on the Instrumental Activities of Daily Living scale (IADL), mental health, and social activity limitations. Results There were 290 patients in the intervention group and 392 in the control group. Of these, 76/290 (26.2%) in the intervention group actively used ZWIP. After 12 months follow-up, we observed no significant improvement on primary patient outcomes. ADL improved in the intervention group with a standardized score of 0.21 (P=.27); IADL improved with 0.50 points, P=.64. Conclusions Only a small percentage of frail elderly people in the study intensively used ZWIP, our newly developed and innovative eHealth tool. The use of this OHC did not significantly improve patient outcomes. This was most likely due to the limited use of the OHC, and a relatively short follow-up time. Increasing actual use of eHealth intervention seems a precondition for large-scale evaluation, and earlier adoption before frailty develops may improve later use and effectiveness of ZWIP. PMID:24966146

  11. Internet Applications for Screening and Brief Interventions for Alcohol in Primary Care Settings – Implementation and Sustainability

    PubMed Central

    Wallace, Paul; Bendtsen, Preben

    2014-01-01

    Screening and brief interventions head the list of effective evidence-based interventions for the prevention and treatment of alcohol use disorders in healthcare settings. However, healthcare professionals have been reluctant to engage with this kind of activity both because of the sensitive nature of the subject and because delivery is potentially time-consuming. Digital technologies for behavioral change are becoming increasingly widespread and their low delivery costs make them highly attractive. Internet and mobile technologies have been shown to be effective for the treatment of depression, anxiety, and smoking cessation in healthcare settings, and have the potential to add substantial value to the delivery of brief intervention for alcohol. Online alcohol questionnaires have been shown to elicit reliable responses on alcohol consumption and compared with conventional prevention techniques, digital alcohol interventions delivered in various settings have been found to be as effective in preventing alcohol-related harms. The last decade has seen the emergence of a range of approaches to the implementation in health care settings of referral to Internet-based applications for screening and brief interventions (eSBI) for alcohol. Research in this area is in its infancy, but there is a small body of evidence providing early indications about implementation and sustainability, and a number of studies are currently underway. This paper examines some of the evidence emerging from these and other studies and assesses the implications for the future of eSBI delivery in primary care settings. PMID:25400593

  12. Effectiveness of a low-threshold physical activity intervention in residential aged care – results of a randomized controlled trial

    PubMed Central

    Cichocki, Martin; Quehenberger, Viktoria; Zeiler, Michael; Adamcik, Tanja; Manousek, Matthias; Stamm, Tanja; Krajic, Karl

    2015-01-01

    Purpose Research on effectiveness of low-threshold mobility interventions that are viable for users of residential aged care is scarce. Low-threshold is defined as keeping demands on organizations (staff skills, costs) and participants (health status, discipline) rather low. The study explored the effectiveness of a multi-faceted, low-threshold physical activity program in three residential aged-care facilities in Austria. Main goals were enhancement of mobility by conducting a multi-faceted training program to foster occupational performance and thus improve different aspects of health-related quality of life (QoL). Participants and methods The program consisted of a weekly session of 60 minutes over a period of 20 weeks. A standardized assessment of mobility status and health-related QoL was applied before and after the intervention. A total of 222 of 276 participants completed the randomized controlled trial study (intervention group n=104, control group n=118; average age 84 years, 88% female). Results Subjective health status (EuroQoL-5 dimensions: P=0.001, d=0.36) improved significantly in the intervention group, and there were also positive trends in occupational performance (Canadian Occupational Performance Measure). No clear effects were found concerning the functional and cognitive measures applied. Conclusion Thus, the low-threshold approach turned out to be effective primarily on subjective health-related QoL. This outcome could be a useful asset for organizations offering low-threshold physical activity interventions. PMID:26056438

  13. The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: A systematic review

    PubMed Central

    Riordan, David O; Walsh, Kieran A; Galvin, Rose; Sinnott, Carol; Kearney, Patricia M; Byrne, Stephen

    2016-01-01

    Objective: To evaluate studies of pharmacist-led interventions on potentially inappropriate prescribing among community-dwelling older adults receiving primary care to identify the components of a successful intervention. Data sources: An electronic search of the literature was conducted using the following databases from inception to December 2015: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, MEDLINE (through Ovid), Trip, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, ISI Web of Science, ScienceDirect, ClinicalTrials.gov, metaRegister of Controlled Trials, ProQuest Dissertations & Theses Database (Theses in Great Britain, Ireland and North America). Review methods: Studies were included if they were randomised controlled trials or quasi-randomised studies involving a pharmacist-led intervention compared to usual/routine care which aimed to reduce potentially inappropriate prescribing in older adults in primary care. Methodological quality of the included studies was independently assessed. Results: A comprehensive literature search was conducted which identified 2193 studies following removal of duplicates. Five studies met the inclusion criteria. Four studies involved a pharmacist conducting a medication review and providing feedback to patients or their family physician. One randomised controlled trial evaluated the effect of a computerised tool that alerted pharmacists when elderly patients were newly prescribed potentially inappropriate medications. Four studies were associated with an improvement in prescribing appropriateness. Conclusion: Overall, this review demonstrates that pharmacist-led interventions may improve prescribing appropriateness in community-dwelling older adults. However, the quality of evidence is low. The role of a pharmacist working as part of a multidisciplinary primary care team requires further investigation to optimise prescribing in this group of patients. PMID

  14. Integrating family-centered developmental assessment and intervention into routine care in the neonatal intensive care unit.

    PubMed

    McGrath, J M; Conliffe-Torres, S

    1996-06-01

    Incorporating developmental intervention into routine practices requires time available during caregiving for continued infant assessment and intervention and requires time after and between caregiving for relief of infant distress. In an era of health-care reform, reorganization, and restructuring, this added caregiver time appears unavailable. However, nurses need to work together in meeting the developmental challenges of the NICU. Further research needs to be done to validate which interventions are appropriate for which babies and with what medical procedures. In addition, collaboration and sharing of responsibilities and resources with all care providers needs to be investigated. Moreover, research needs to be done that acknowledges that the environment of the NICU is also a world in which many adults work and live a large portion of their daily life. This environment must be supportive of their social needs as well as the needs of the high-risk infant. There are many pieces to the puzzle of providing developmentally supportive caregiving in the NICU. The number of different issues increases the complexity of changing the standard of care: Infant, family, environment. Each has its own challenges. However, with sensitivity, a collaborative approach, and a sincere effort to change, neonatal health-care professionals can integrate developmental practices into the NICU. PMID:8637813

  15. Costs and Cost Effectiveness of a Health Care Provider–Directed Intervention to Promote Colorectal Cancer Screening

    PubMed Central

    Shankaran, Veena; Luu, Thanh Ha; Nonzee, Narissa; Richey, Elizabeth; McKoy, June M.; Graff Zivin, Joshua; Ashford, Alfred; Lantigua, Rafael; Frucht, Harold; Scoppettone, Marc; Bennett, Charles L.; Sheinfeld Gorin, Sherri

    2009-01-01

    Purpose Colorectal cancer (CRC) screening remains underutilized in the United States. Prior studies reporting the cost effectiveness of randomized interventions to improve CRC screening have not been replicated in the setting of small physician practices. We recently conducted a randomized trial evaluating an academic detailing intervention in 264 small practices in geographically diverse New York City communities. The objective of this secondary analysis is to assess the cost effectiveness of this intervention. Methods A total of 264 physician offices were randomly assigned to usual care or to a series of visits from trained physician educators. CRC screening rates were measured at baseline and 12 months. The intervention costs were measured and the incremental cost-effectiveness ratio (ICER) was derived. Sensitivity analyses were based on varying cost and effectiveness estimates. Results Academic detailing was associated with a 7% increase in CRC screening with colonoscopy. The total intervention cost was $147,865, and the ICER was $21,124 per percentage point increase in CRC screening rate. Sensitivity analyses that varied the costs of the intervention and the average medical practice size were associated with ICERs ranging from $13,631 to $36,109 per percentage point increase in CRC screening rates. Conclusion A comprehensive, multicomponent academic detailing intervention conducted in small practices in metropolitan New York was clinically effective in improving CRC screening rates, but was not cost effective. PMID:19826133

  16. Preventive physiotherapy interventions for back care in children and adolescents: a meta-analysis

    PubMed Central

    2012-01-01

    Background Preventive interventions improve healthy behaviours and they also increase knowledge regarding back care in children and adolescents, but studies exhibit great variability in their contents, duration and number of sessions, and in the assessment methods. The purpose of this study was to review the empirical evidence regarding preventive physiotherapy interventions for back care in children and adolescents, and to ascertain the most efficacious treatments, in what way and under which circumstances. Methods Studies were located from computerized databases (Cochrane Library, Medline, PEDro, Web of Science and IME) and other sources. The search period extended to May 2012. To be included in the meta-analysis, studies had to use physical therapy methodologies of preventive treatment on children and adolescents, and to compare a treatment and a control group. Treatment, participant, methodological, and extrinsic characteristics of the studies were coded. Two researchers independently coded all of the studies. As effect size indices, standardized mean differences were calculated for measures of behaviours and knowledge, both in the posttest and in the follow-up. The random and mixed-effects models were used for the statistical analyses and sensitivity analyses were carried out in order to check the robustness of the meta-analytic results. Results A total of 19 papers fulfilled the selection criteria, producing 23 independent studies. On average, the treatments reached a statistically significant effectiveness in the behaviours acquired, both in the posttest and in the follow-up (d+ = 1.33 and d+ = 1.80, respectively), as well as in measures of knowledge (posttest; d+ = 1.29; follow-up: d+ = 0.76). Depending on the outcome measure, the effect sizes were affected by different moderator variables, such as the type of treatment, the type of postural hygiene, the teaching method, or the use of paraprofessionals as cotherapists. Conclusions The

  17. AIDS nursing care and standardized nursing language: an application of the nursing intervention classification.

    PubMed

    Davis, K A

    1995-01-01

    Standardized nursing language is recommended increasingly as a method to describe the work of nursing, adapt to computerized documentation, and establish a place for nursing in national data bases. Nursing diagnosis has become a standard label for assessment data. The Iowa Interventions Project Research Team proposes that Nursing Interventions Classification (NIC) be adopted to label nursing interventions. The author applies NIC to HIV/AIDS nursing care guidelines from the literature and concludes that NIC can be an important tool as HIV/AIDS nurses develop and describe their knowledge base.

  18. Improving sexual health for HIV patients by providing a combination of integrated public health and hospital care services; a one-group pre- and post test intervention comparison

    PubMed Central

    2012-01-01

    Background Hospital HIV care and public sexual health care (a Sexual Health Care Centre) services were integrated to provide sexual health counselling and sexually transmitted infections (STIs) testing and treatment (sexual health care) to larger numbers of HIV patients. Services, need and usage were assessed using a patient perspective, which is a key factor for the success of service integration. Methods The study design was a one-group pre-test and post-test comparison of 447 HIV-infected heterosexual individuals and men who have sex with men (MSM) attending a hospital-based HIV centre serving the southern region of the Netherlands. The intervention offered comprehensive sexual health care using an integrated care approach. The main outcomes were intervention uptake, patients’ pre-test care needs (n=254), and quality rating. Results Pre intervention, 43% of the patients wanted to discuss sexual health (51% MSM; 30% heterosexuals). Of these patients, 12% to 35% reported regular coverage, and up to 25% never discussed sexual health topics at their HIV care visits. Of the patients, 24% used our intervention. Usage was higher among patients who previously expressed a need to discuss sexual health. Most patients who used the integrated services were new users of public health services. STIs were detected in 13% of MSM and in none of the heterosexuals. The quality of care was rated good. Conclusions The HIV patients in our study generally considered sexual health important, but the regular counselling and testing at the HIV care visit was insufficient. The integration of public health and hospital services benefited both care sectors and their patients by addressing sexual health questions, detecting STIs, and conducting partner notification. Successful sexual health care uptake requires increased awareness among patients about their care options as well as a cultural shift among care providers. PMID:23270463

  19. Perioperative cardiovascular care for patients undergoing noncardiac surgical intervention.

    PubMed

    Eagle, Kim A; Vaishnava, Prashant; Froehlich, James B

    2015-05-01

    The field of perioperative medicine has garnered legitimacy during the past 3 decades. Adverse cardiovascular events in the perioperative period account for significant morbidity and mortality. Although testing patients preoperatively to detect ischemia and identify those who may benefit from modifications in care is a tempting strategy, risk assessment should account for posterior probability. Validated risk stratification tools, such as the Revised Cardiac Risk Index or the National Surgical Quality Improvement Program risk calculator, can assist in the identification of patients for whom preoperative noninvasive testing is justified and may change the plan of care. Furthermore, current guidelines emphasize that prophylactic coronary revascularization should not be performed exclusively for the purposes of reducing the risk of perioperative events. There has been enthusiasm for medical therapies that may reduce the risk of adverse cardiovascular events in the perioperative period. Current guidelines encourage the perioperative use of β-blockade in patients already receiving such therapy and caution against initiating such therapy on the day of the surgical procedure. Reduction of morbidity and mortality in the perioperative period relies on an understanding of the myriad physiological perturbations in this period and thoughtful selection of patients for further testing and treatment.

  20. Experimental studies in explicitly paradoxical interventions: results and implications.

    PubMed

    Strong, S R

    1984-09-01

    A dozen experimental studies have assessed the effectiveness of paradoxical interventions with agoraphobia, depression, insomnia and procrastination. The studies suggest that paradoxical interventions are more effective than no treatment and placebo treatment and are as effective and, in some instances, more effective than other behavioral interventions. Several studies show that the wording of paradoxical interventions affects their impact.

  1. An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms

    PubMed Central

    2014-01-01

    Background Depressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services. Methods A prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients’, nurses’, and personal support workers’ perceptions about the intervention’s appropriateness, benefits, and barriers and facilitators to implementation. Results Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period. Conclusions Our findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion

  2. Health Literacy and Weight Change in a Digital Health Intervention for Women: A Randomized Controlled Trial in Primary Care Practice.

    PubMed

    Lanpher, Michele G; Askew, Sandy; Bennett, Gary G

    2016-01-01

    In the United States, 90 million adults have low health literacy. An important public health challenge is developing obesity treatment interventions suitable for those with low health literacy. The objective of this study was to examine differences in sociodemographic and clinical characteristics as well as weight and intervention engagement outcomes by health literacy. We randomized 194 participants to usual care or to the Shape Program intervention, a 12-month digital health treatment aimed at preventing weight gain among overweight and Class I obese Black women in primary care practice. We administered the Newest Vital Sign instrument to assess health literacy. More than half (55%) of participants had low health literacy, which was more common among those with fewer years of education and lower income. There was no effect of health literacy on 12-month weight change or on intervention engagement outcomes (completion of coaching calls and interactive voice response self-monitoring calls). Low health literacy did not preclude successful weight gain prevention in the Shape Program intervention. Goal-focused behavior change approaches like that used in Shape may be particularly helpful for treating and engaging populations with low health literacy.

  3. Health Literacy and Weight Change in a Digital Health Intervention for Women: A Randomized Controlled Trial in Primary Care Practice.

    PubMed

    Lanpher, Michele G; Askew, Sandy; Bennett, Gary G

    2016-01-01

    In the United States, 90 million adults have low health literacy. An important public health challenge is developing obesity treatment interventions suitable for those with low health literacy. The objective of this study was to examine differences in sociodemographic and clinical characteristics as well as weight and intervention engagement outcomes by health literacy. We randomized 194 participants to usual care or to the Shape Program intervention, a 12-month digital health treatment aimed at preventing weight gain among overweight and Class I obese Black women in primary care practice. We administered the Newest Vital Sign instrument to assess health literacy. More than half (55%) of participants had low health literacy, which was more common among those with fewer years of education and lower income. There was no effect of health literacy on 12-month weight change or on intervention engagement outcomes (completion of coaching calls and interactive voice response self-monitoring calls). Low health literacy did not preclude successful weight gain prevention in the Shape Program intervention. Goal-focused behavior change approaches like that used in Shape may be particularly helpful for treating and engaging populations with low health literacy. PMID:27043756

  4. A lifestyle intervention for primary care patients with depression and anxiety: A randomised controlled trial.

    PubMed

    Forsyth, Adrienne; Deane, Frank P; Williams, Peter

    2015-12-15

    This study aimed to evaluate the efficacy of a diet and exercise lifestyle intervention on mental health outcomes for patients currently being treated for depression and/or anxiety in primary care. Patients (n=119) referred by general practitioners to the 12-week randomised controlled trial were assigned to either an intervention of six visits to a dual qualified dietitian/exercise physiologist (DEP) where motivational interviewing and activity scheduling were used to engage patients in individually-tailored lifestyle change (focussed on diet and physical activity), or an attention control with scheduled telephone contact. Assessments conducted at baseline (n=94) and 12 weeks (n=60) were analysed with an intent-to-treat approach using linear mixed modelling. Significant improvement was found for both groups on Depression, Anxiety and Stress Scale (DASS) scores, measures of nutrient intake and total Australian modified Healthy Eating Index (Aust-HEI) scores. Significant differences between groups over time were found only for iron intake and body mass index. Patients participating in individual consultations with a dietitian were more likely to maintain or improve diet quality than those participating in an attention control. This study provides initial evidence to support the role of dietitians in the management of patients with depression and/or anxiety.

  5. The effect of formal, neonatal communication-intervention training on mothers in kangaroo care

    PubMed Central

    van Rooyen, Elise

    2014-01-01

    Abstract Background Due to low-birth-weight, preterm birth, HIV and/or AIDS and poverty-related factors, South Africa presents with an increased prevalence of infants at risk of language delay. A Kangaroo Mother Care (KMC) unit offers unique opportunities for training. Aim The aim of the present study was to determine if formal, neonatal communication-intervention training had an effect on mothers’ knowledge and communication interaction with their high-risk infants. Methods Three groups of mothers participated: Group 1 was trained whilst practicing KMC; Group 2 was not trained but practiced KMC; and Group 3 was also not trained but practiced sporadic KMC. Ten mothers per group were matched for age, education level and birth order of their infants. The individual training was based on graded sensory stimulation and responsive mother-infant communication interaction, which emphasised talking and singing by the mother. Results Significant differences were found in mother-infant communication interaction between all three groups, which indicated a positive effect on Group 1 with training. Group 2, KMC without training, also had a positive effect on interaction. However, Group 1 mothers with training demonstrated better knowledge of their infants and were more responsive during interaction than the other two groups. Conclusion The present study suggests that neonatal communication-intervention training adds value to a KMC programme. PMID:26245414

  6. An Economic Evaluation of a Self-Care Intervention in Persons with Heart Failure and Diabetes

    PubMed Central

    Reilly, Carolyn Miller; Butler, Javed; Culler, Steven D.; Gary, Rebecca A.; Higgins, Melinda; Schindler, Peter; Butts, Brittany; Dunbar, Sandra B.

    2015-01-01

    Background Persons with concomitant heart failure (HF) and diabetes mellitus are a growing population whose quality of life is encumbered with worse clinical outcomes as well as high health resource use (HRU) and costs. Methods and Results Extensive data on HRU and costs were collected as part of a prospective cost effectiveness analysis of a self-care intervention to improve outcomes in persons with both HF and diabetes. HRU costs were assigned from a Medicare reimbursement perspective. Patients (n=134) randomized to the self-care intervention and those receiving usual care/attention control were followed for 6 months, revealing significant differences in the number of hospitalization days and associated costs between groups. The mean number of inpatient days (d) was 3d with bootstrapped bias corrected (BCa) confidence intervals (CI) of 1.8d – 4.4d) for intervention group and 7.3d (BCa CI 4.1d – 10.9d) in the control group; p= .044. Total direct HRU costs per participant were an estimated $9,065 (BCa CI $6,496 to $11,936) in the intervention and $16,712 (BCa CI 8,200 to $26,621) in the control group, for a mean difference of −$7,647 (BCa CI −$17,588 to $809, p= .21) in favor of the intervention, including intervention costs estimated to be $130.67 per patient. Conclusions The self-care intervention demonstrated dominance in lowering costs without sacrificing Quality Adjusted Life Years. Clinical Trial Registration– http://www.clinicaltrials.gov: NCT01606085 PMID:26164214

  7. A Randomized Stepped Care Intervention Trial Targeting Posttraumatic Stress Disorder for Surgically Hospitalized Injury Survivors

    PubMed Central

    Zatzick, Douglas; Jurkovich, Gregory; Rivara, Frederick P.; Russo, Joan; Wagner, Amy; Wang, Jin; Dunn, Chris; Lord, Sarah Peregrine; Petrie, Megan; O’Connor, Stephen S.; Katon, Wayne

    2013-01-01

    Objective To test the effectiveness of a stepped care intervention model targeting posttraumatic stress disorder (PTSD) symptoms after injury. Background Few investigations have evaluated interventions for injured patients with PTSD and related impairments that can be feasibly implemented in trauma surgical settings. Methods The investigation was a pragmatic effectiveness trial in which 207 acutely injured hospitalized trauma survivors were screened for high PTSD symptom levels and then randomized to a stepped combined, care management, psychopharmacology, and cognitive behavioral psychotherapy intervention (n = 104) or usual care control (n = 103) conditions. The symptoms of PTSD and functional limitations were reassessed at one-, three-, six-, nine-, and twelve-months after the index injury admission. Results Regression analyses demonstrated that over the course of the year after injury, intervention patients had significantly reduced PTSD symptoms when compared to controls (group by time effect, CAPS, F(2, 185) = 5.50, P < 0.01; PCL-C, F(4, 185) = 5.45, P < 0.001). Clinically and statistically significant PTSD treatment effects were observed at the six-, nine-, and twelve-month post-injury assessments. Over the course of the year after injury, intervention patients also demonstrated significant improvements in physical function (MOS SF-36 PCS main effect, F(1, 172) = 9.87, P < 0.01). Conclusion Stepped care interventions can reduce PTSD symptoms and improve functioning over the course of the year after surgical injury hospitalization. Orchestrated investigative and policy efforts could systematically introduce and evaluate screening and intervention procedures for PTSD at United States trauma centers. (Trial Registration: clinicaltrials.gov identifier: NCT00270959) PMID:23222034

  8. Effectiveness of mHealth Interventions Targeting Health Care Workers to Improve Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review

    PubMed Central

    Borgstein, Alexander Berend-Jan; Sondaal, Stephanie FV; Grobbee, Diederick E; Miltenburg, Andrea Solnes; Verwijs, Mirjam; Ansah, Evelyn K; Browne, Joyce L; Klipstein-Grobusch, Kerstin

    2016-01-01

    Background Low- and middle-income countries (LMICs) face the highest burden of maternal and neonatal deaths. Concurrently, they have the lowest number of physicians. Innovative methods such as the exchange of health-related information using mobile devices (mHealth) may support health care workers in the provision of antenatal, delivery, and postnatal care to improve maternal and neonatal outcomes in LMICs. Objective We conducted a systematic review evaluating the effectiveness of mHealth interventions targeting health care workers to improve maternal and neonatal outcomes in LMIC. Methods The Cochrane Library, PubMed, EMBASE, Global Health Library, and Popline were searched using predetermined search and indexing terms. Quality assessment was performed using an adapted Cochrane Risk of Bias Tool. A strength, weakness, opportunity, and threat analysis was performed for each included paper. Results A total of 19 studies were included for this systematic review, 10 intervention and 9 descriptive studies. mHealth interventions were used as communication, data collection, or educational tool by health care providers primarily at the community level in the provision of antenatal, delivery, and postnatal care. Interventions were used to track pregnant women to improve antenatal and delivery care, as well as facilitate referrals. None of the studies directly assessed the effect of mHealth on maternal and neonatal mortality. Challenges of mHealth interventions to assist health care workers consisted mainly of technical problems, such as mobile network coverage, internet access, electricity access, and maintenance of mobile phones. Conclusions mHealth interventions targeting health care workers have the potential to improve maternal and neonatal health services in LMICs. However, there is a gap in the knowledge whether mHealth interventions directly affect maternal and neonatal outcomes and future research should employ experimental designs with relevant outcome measures to

  9. Stress and burnout among critical care fellows: preliminary evaluation of an educational intervention

    PubMed Central

    Kashani, Kianoush; Carrera, Perliveh; De Moraes, Alice Gallo; Sood, Amit; Onigkeit, James A.; Ramar, Kannan

    2015-01-01

    Background Despite a demanding work environment, information on stress and burnout of critical care fellows is limited. Objectives To assess 1) levels of burnout, perceived stress, and quality of life in critical care fellows, and 2) the impact of a brief stress management training on these outcomes. Methods In a tertiary care academic medical center, 58 critical care fellows of varying subspecialties and training levels were surveyed to assess baseline levels of stress and burnout. Twenty-one of the 58 critical care fellows who were in the first year of training at the time of this initial survey participated in a pre-test and 1-year post-test to determine the effects of a brief, 90-min stress management intervention. Results Based on responses (n=58) to the abbreviated Maslach Burnout Inventory, reported burnout was significantly lower in Asian fellows (p=0.04) and substantially higher among graduating fellows (versus new and transitioning fellows) (p=0.02). Among the intervention cohort, burnout did not significantly improve – though two-thirds of fellows reported using the interventional techniques to deal with stressful situations. Fellows who participated in the intervention rated the effectiveness of the course as 4 (IQR=3.75–5) using the 5-point Likert scale. Conclusions In comparison with the new and transitioning trainees, burnout was highest among graduating critical care fellows. Although no significant improvements were found in first-year fellows’ burnout scores following the single, 90-min training intervention, participants felt the training did provide them with tools to apply during stressful situations. PMID:26208706

  10. Psychosocial Risk Factors, Interventions, and Comorbidity in Patients with Non-Specific Low Back Pain in Primary Care: Need for Comprehensive and Patient-Centered Care

    PubMed Central

    Ramond-Roquin, Aline; Bouton, Céline; Bègue, Cyril; Petit, Audrey; Roquelaure, Yves; Huez, Jean-François

    2015-01-01

    Non-specific low back pain (LBP) affects many people and has major socio-economic consequences. Traditional therapeutic strategies, mainly focused on biomechanical factors, have had moderate and short-term impact. Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP. Primary health care providers (HCPs) are involved in most of the management of people with LBP and they are skilled in providing comprehensive care, including consideration of psychosocial dimensions. This review aims to discuss three pieces of recent research focusing on psychosocial issues in LBP patients in primary care. In the first systematic review, the patients’ or HCPs’ overall judgment about the likely evolution of LBP was the factor most strongly linked to poor outcome, with predictive validity similar to that of multidimensional scales. This result may be explained by the implicit aggregation of many prognostic factors underlying this judgment and suggests the relevance of considering the patients from biopsychosocial and longitudinal points of view. The second review showed that most of the interventions targeting psychosocial factors in LBP in primary care have to date focused on the cognitive-behavioral factors, resulting in little impact. It is unlikely that any intervention focusing on a single factor would ever fit the needs of most patients; interventions targeting determinants from several fields (mainly psychosocial, biomechanical, and occupational) may be more relevant. Should multiple stakeholders be involved in such interventions, enhanced interprofessional collaboration would be critical to ensure the delivery of coordinated care. Finally, in the third study, the prevalence of psychosocial comorbidity in chronic LBP patients was not found to be significantly higher than in other patients consulting in primary care. Rather than specifically screening for psychosocial conditions

  11. Advance care planning for cancer patients in primary care: a feasibility study

    PubMed Central

    Boyd, Kirsty; Mason, Bruce; Kendall, Marilyn; Barclay, Stephen; Chinn, David; Thomas, Keri; Sheikh, Aziz; Murray, Scott A

    2010-01-01

    Background Advance care planning is being promoted as a central component of end-of-life policies in many developed countries, but there is concern that professionals find its implementation challenging. Aim To assess the feasibility of implementing advance care planning in UK primary care. Design of study Mixed methods evaluation of a pilot educational intervention. Setting Four general practices in south-east Scotland. Method Interviews with 20 GPs and eight community nurses before and after a practice-based workshop; this was followed by telephone interviews with nine other GPs with a special interest in palliative care from across the UK. Results End-of-life care planning for patients typically starts as an urgent response to clear evidence of a short prognosis, and aims to achieve a ‘good death’. Findings suggest that there were multiple barriers to earlier planning: prognostic uncertainty; limited collaboration with secondary care; a desire to maintain hope; and resistance to any kind of ‘tick-box’ approach. Following the workshop, participants' knowledge and skills were enhanced but there was little evidence of more proactive planning. GPs from other parts of the UK described confusion over terminology and were concerned about the difficulties of implementing inflexible, policy-driven care. Conclusion A clear divide was found between UK policy directives and delivery of end-of-life care in the community that educational interventions targeting primary care professionals are unlikely to address. Advance care planning has the potential to promote autonomy and shared decision making about end-of-life care, but this will require a significant shift in attitudes. PMID:21144189

  12. The contribution of behavioural science to primary care research: development and evaluation of behaviour change interventions.

    PubMed

    Sutton, Stephen

    2011-10-01

    Behavioural science is concerned with predicting, explaining and changing behaviour. Taking a personal perspective, this article aims to show how behavioural science can contribute to primary care research, specifically in relation to the development and evaluation of interventions to change behaviour. After discussing the definition and measurement of behaviour, the principle of compatibility and theories of behaviour change, the article outlines two examples of behaviour change trials (one on medication adherence and the other on physical activity), which were part of a research programme on prevention of chronic disease and its consequences. The examples demonstrate how, in a multidisciplinary context, behavioural science can contribute to primary care research in several important ways, including posing relevant research questions, defining the target behaviour, understanding the psychological determinants of behaviour, developing behaviour change interventions and selection or development of measures. The article concludes with a number of recommendations: (i) whether the aim is prediction, explanation or change, defining the target behaviour is a crucial first step; (ii) interventions should be explicitly based on theories that specify the factors that need to be changed in order to produce the desired change in behaviour; (iii) intervention developers need to be aware of the differences between different theories and select a theory only after careful consideration of the alternatives assessed against relevant criteria; and (iv) developers need to be aware that interventions can never be entirely theory based. PMID:22284944

  13. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes

    PubMed Central

    Baker, Richard; Camosso-Stefinovic, Janette; Gillies, Clare; Shaw, Elizabeth J; Cheater, Francine; Flottorp, Signe; Robertson, Noelle

    2014-01-01

    Background In the previous version of this review, the effectiveness of interventions tailored to barriers to change was found to be uncertain. Objectives To assess the effectiveness of interventions tailored to address identified barriers to change on professional practice or patient outcomes. Search methods For this update, in addition to the EPOC Register and pending files, we searched the following databases without language restrictions, from inception until August 2007: MEDLINE, EMBASE, CINAHL, BNI and HMIC. We searched the National Research Register to November 2007. We undertook further searches to October 2009 to identify potentially eligible published or ongoing trials. Selection criteria Randomised controlled trials (RCTs) of interventions tailored to address prospectively identified barriers to change that reported objectively measured professional practice or healthcare outcomes in which at least one group received an intervention designed to address prospectively identified barriers to change. Data collection and analysis Two reviewers independently assessed quality and extracted data. We undertook quantitative and qualitative analyses. The quantitative analyses had two elements. We carried out a meta-regression to compare interventions tailored to address identified barriers to change with either no interventions or an intervention(s) not tailored to the barriers.We carried out heterogeneity analyses to investigate sources of differences in the effectiveness of interventions. These included the effects of: risk of bias, concealment of allocation, rigour of barrier analysis, use of theory, complexity of interventions, and the reported presence of administrative constraints. Main results We included 26 studies comparing an intervention tailored to address identified barriers to change to no intervention or an intervention(s) not tailored to the barriers. The effect sizes of these studies varied both across and within studies. Twelve studies provided

  14. Evaluation of a primary care-oriented brief counselling intervention for obesity with and without orlistat

    Technology Transfer Automated Retrieval System (TEKTRAN)

    There is a significant need for an obesity treatment model suitable for the primary care environment. We examined the effectiveness of a brief counseling intervention alone, in combination with orlistat, and drug-alone in a 12-month randomized-clinical trial at a medical school obesity center. Parti...

  15. Mitigating the Effects of Family Poverty on Early Child Development through Parenting Interventions in Primary Care.

    PubMed

    Cates, Carolyn Brockmeyer; Weisleder, Adriana; Mendelsohn, Alan L

    2016-04-01

    Poverty related disparities in early child development and school readiness are a major public health crisis, the prevention of which has emerged in recent years as a national priority. Interventions targeting parenting and the quality of the early home language environment are at the forefront of efforts to address these disparities. In this article we discuss the innovative use of the pediatric primary care platform as part of a comprehensive public health strategy to prevent adverse child development outcomes through the promotion of parenting. Models of interventions in the pediatric primary care setting are discussed with evidence of effectiveness reviewed. Taken together, a review of this significant body of work shows the tremendous potential to deliver evidence-based preventive interventions to families at risk for poverty related disparities in child development and school readiness at the time of pediatric primary care visits. We also addresss considerations related to scaling and maximizing the effect of pediatric primary care parenting interventions and provide key policy recommendations. PMID:27044688

  16. Obesity Prevention Interventions in Early Childhood Education and Care Settings with Parental Involvement: A Systematic Review

    ERIC Educational Resources Information Center

    Morris, Heather; Skouteris, Helen; Edwards, Susan; Rutherford, Leonie

    2015-01-01

    Partnering early childhood education and care (ECEC) and the home together may be more effective in combating obesogenic risk factors in preschool children. Thus, an evaluation of ECEC obesity prevention interventions with a parental component was conducted, exploring parental engagement and its effect on obesity and healthy lifestyle outcomes. A…

  17. Multiple Balances in Workplace Dialogue: Experiences of an Intervention in Health Care

    ERIC Educational Resources Information Center

    Grill, Christina; Ahlborg, Gunnar, Jr.; Wikström, Ewa; Lindgren, Eva-Carin

    2015-01-01

    Purpose: This paper aims to illuminate and analyse the participants' experiences of the influences of a dialogue intervention. Cooperation and coordination in health care require planning of dialogically oriented communication to prevent stress and ill health and to promote health, well-being, learning, and efficiency in the organisation.…

  18. Feasibility of an obesity intervention for paediatric primary care targeting parenting and children: Helping HAND

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The primary care setting offers the opportunity to reach children and parents to encourage healthy lifestyle behaviours, and improve weight status among children. Our objective was to test the feasibility of Helping HAND (Healthy Activity and Nutrition Directions), an obesity intervention for 5- to...

  19. Dyadic Intervention for Family Caregivers and Care Receivers in Early-Stage Dementia

    ERIC Educational Resources Information Center

    Whitlatch, Carol J.; Judge, Katherine; Zarit, Steven H.; Femia, Elia

    2006-01-01

    Purpose: The Early Diagnosis Dyadic Intervention (EDDI) program provides a structured, time-limited protocol of one-on-one and dyadic counseling for family caregivers and care receivers who are in the early stages of dementia. The goals and procedures of EDDI are based on previous research suggesting that dyads would benefit from an intervention…

  20. Preventive Interventions under Managed Care: Mental Health and Substance Abuse Services. Special Report.

    ERIC Educational Resources Information Center

    Dorfman, Sharon L.

    Programs and services that prevent substance abuse and mental health disorders have the potential to lessen an enormous burden of suffering and to reduce both the cost of future treatment and lost productivity at work and home. The availability and accessibility of these interventions to Americans whose health care is provided by managed care…

  1. Care Coordination Practices among Illinois Pediatricians and Early Intervention Service Coordinators

    ERIC Educational Resources Information Center

    Baxter, Marissa

    2015-01-01

    Over the course of the past three decades, largely due to advances in technology, there has been growth in the fields of early intervention (EI) and pediatrics for infants/toddlers with special health care needs (SHCN). This growth has also brought about a change in the relationship between pediatricians and EI service coordinators, creating an…

  2. Improving osteoporosis care in high-risk home health patients through a high intensity intervention

    PubMed Central

    Outman, Ryan C.; Curtis, Jeffrey R.; Locher, Julie L.; Allison, Jeroan J.; Saag, Kenneth G.; Kilgore, Meredith L.

    2014-01-01

    Purpose We developed and tested a multi-modal intervention, delivered in the home health care setting, aimed at increasing osteoporosis treatment rates to prevent fractures. Material and Methods The intervention focused on home health nurses. Key components included: nursing education; development of a nursing care plan; patient teaching materials and creation of physician materials. Nursing education consisted of a lecture covering osteoporosis, fracture risks and prevention, and the effectiveness of anti-osteoporosis treatment options. Patients received education materials concerning osteoporosis and anti-osteoporosis medications. A pocket-sized treatment algorithm card and standardized order sets were prepared for physicians. Focus groups of physicians and nurses were conducted to obtain feedback on the materials and methods to facilitate effective nurse-physician communication. Successful application required nurses to identify patients with a fracture history, initiate the care plan, prompt physicians on risk status, and provide patient education. The intervention was piloted in one field office. Results In the year prior to the intervention, home health patients (n=92) with a fracture history were identified in the pilot field office and only 20 (22%) received osteoporosis prescription therapy. In the three months following the intervention, 21 newly enrolled patients were identified and 9 (43%) had received osteoporosis prescription medications. Conclusions Home health care provides a venue where patients and physicians can be informed by nurses about osteoporosis and fracture risks and, consequently, initiate appropriate therapy. This multi-modal intervention is easily transportable to other home health agencies and adaptable to other medical conditions and settings. PMID:22005175

  3. Step On It! Impact of a Workplace New York City Taxi Driver Health Intervention to Increase Necessary Health Care Access

    PubMed Central

    Gany, Francesca; Bari, Sehrish; Gill, Pavan; Loeb, Rebecca

    2015-01-01

    Objectives. We describe the impact of the Step On It! intervention to link taxi drivers, particularly South Asians, to health insurance enrollment and navigate them into care when necessary. Methods. Step On It! was a worksite initiative held for 5 consecutive days from September 28 to October 2, 2011, at John F. Kennedy International Airport in New York City. Data collected included sociodemographics, employment, health care access and use, height, weight, blood pressure, and random plasma glucose. Participants were given their results, counseled by a medical professional, and invited to participate in free workshops provided by partner organizations. Results. Of the 466 drivers participated, 52% were uninsured, and 49% did not have a primary care provider. Of 384 drivers who had blood pressure, glucose, or both measured, 242 (63%) required urgent or regular follow-up. Of the 77 (32%) requiring urgent follow-up, 50 (65%) sought medical care at least once, of whom 13 (26%) received a new diagnosis. Of the 165 (68%) requiring regular follow-up, 68 (41%) sought medical care at least once, of whom 5 (7%) received a new diagnosis. Conclusions. This study provides encouraging results about the potential impact of an easy-to-deliver, easily scalable workplace intervention with a large, vulnerable population. PMID:25211738

  4. The role of a critical time intervention on the experience of continuity of care among persons with severe mental illness after hospital discharge.

    PubMed

    Tomita, Andrew; Herman, Daniel B

    2015-01-01

    We investigated the impact of critical time intervention (CTI) on self-reported indicators of quality of continuity of care (COC) after discharge from inpatient psychiatric treatment with data from a randomized controlled trial that assessed the effectiveness of the intervention in reducing recurrent homelessness. Postdischarge COC outcome measures among previously homeless persons with severe mental illness randomly assigned to receive usual services only (n = 73) or 9 months of CTI in addition to usual services (n = 77) were compared. Those assigned to CTI had greater perceived access to care than the usual services group did, with this impact extending beyond the point at which the intervention ended. A time-limited care coordination intervention provided immediately after hospital discharge may improve COC, but further studies are needed to substantiate an effect of CTI on long-term continuity outcomes.

  5. The role of pharmacotherapy and managed care pharmacy interventions in the treatment of ADHD.

    PubMed

    Dopheide, Julie A

    2009-05-01

    Pharmacotherapy plays a primary role in the management of attention-deficit/hyperactivity disorder (ADHD), despite the availability of effective behavioral interventions. Psychostimulants are the most commonly prescribed form of pharmacotherapy for patients with ADHD and their benefits in managed care are severalfold, leading not only to symptom resolution and improved quality of life for patients, but also reduced costs for payers and purchasers. The use of these agents requires careful consideration and management by health plan stakeholders for optimal effectiveness. Concerns regarding medication adherence, in addition to the potential for diversion and abuse of psychostimulants, highlight the importance of effective pharmacotherapy management in patients with ADHD. Initiatives promoting medication adherence, such as patient/parent education, provider follow-up, and adverse effect management, are crucial for ensuring treatment success. Once-daily, extended-release formulations of stimulants may also contribute to improving medication adherence, as may managed care pharmacy interventions such as pharmacy database monitoring. PMID:19601689

  6. Effect of a Consumer-Directed Voucher and a Disease-Management-Health-Promotion Nurse Intervention on Home Care Use

    ERIC Educational Resources Information Center

    Meng, Hongdao; Friedman, Bruce; Wamsley, Brenda R.; Mukamel, Dana; Eggert, Gerald M.

    2005-01-01

    Purpose: We describe the impact of two interventions, a consumer-directed voucher for in-home supportive services and a chronic disease self-management-health-promotion nurse intervention, on the probability of use of two types of home care-skilled home health care and personal assistance services-received by functionally impaired Medicare…

  7. Effects on Sexual Risk Behavior and STD Rate of Brief HIV/STD Prevention Interventions for African American Women in Primary Care Settings

    PubMed Central

    Jemmott, Loretta Sweet; Jemmott, John B.; O’Leary, Ann

    2007-01-01

    Objectives. We tested the efficacy of brief HIV/sexually transmitted disease (STD) risk-reduction interventions for African American women in primary care settings. Methods. In a randomized controlled trial, 564 African American women recruited at a Newark, NJ, inner-city women’s health clinic were assigned to a 20-minute one-on-one HIV/STD behavioral skill-building intervention, 200-minute group HIV/STD behavioral skill-building intervention, 20-minute one-on-one HIV/STD information intervention, 200-minute group HIV/STD information intervention, or 200-minute health intervention control group. Primary outcomes were self-reported sexual behaviors in the previous 3 months; secondary outcome was STD incidence. Results. At 12-month follow-up, participants in the skill-building interventions reported less unprotected sexual intercourse than did participants in the information interventions (Cohen’s d [d]=0.23, P=.02), reported a greater proportion of protected sexual intercourse than did information intervention participants (d=0.21, P=.05) and control participants (d=0.24, P=.03), and were less likely to test positive for an STD than were control participants (d=0.20, P=.03). Conclusions. This study suggests that brief single-session, one-on-one or group skill-building interventions may reduce HIV/STD risk behaviors and STD morbidity among inner-city African American women in primary care settings. PMID:17463391

  8. Tackling the problem of blood culture contamination in the intensive care unit using an educational intervention.

    PubMed

    Alahmadi, Y M; McElnay, J C; Kearney, M P; Aldeyab, M A; Magee, F A; Hanley, J; Bailie, R; Donaldson, W; Johnston, K; Kinoulty, S; Doherty, A; Tate, A; Scott, M G

    2015-07-01

    Blood culture contamination (BCC) has been associated with unnecessary antibiotic use, additional laboratory tests and increased length of hospital stay thus incurring significant extra hospital costs. We set out to assess the impact of a staff educational intervention programme on decreasing intensive care unit (ICU) BCC rates to <3% (American Society for Microbiology standard). BCC rates during the pre-intervention period (January 2006-May 2011) were compared with the intervention period (June 2011-December 2012) using run chart and regression analysis. Monthly ICU BCC rates during the intervention period were reduced to a mean of 3.7%, compared to 9.5% during the baseline period (P < 0.001) with an estimated potential annual cost savings of about £250,100. The approach used was simple in design, flexible in delivery and efficient in outcomes, and may encourage its translation into clinical practice in different healthcare settings.

  9. Newborn care practices in rural Bangladesh: Implications for the adaptation of kangaroo mother care for community-based interventions.

    PubMed

    Hunter, Erin C; Callaghan-Koru, Jennifer A; Al Mahmud, Abdullah; Shah, Rashed; Farzin, Azadeh; Cristofalo, Elizabeth A; Akhter, Sadika; Baqui, Abdullah H

    2014-12-01

    Bangladesh has one of the world's highest rates of low birth weight along with prevalent traditional care practices that leave newborns highly vulnerable to hypothermia, infection, and early death. We conducted formative research to explore existing newborn care practices in rural Bangladesh with an emphasis on thermal protection, and to identify potential facilitators, barriers, and recommendations for the community level delivery of kangaroo mother care (CKMC). Forty in-depth interviews and 14 focus group discussions were conducted between September and December 2012. Participants included pregnant women and mothers, husbands, maternal and paternal grandmothers, traditional birth attendants, village doctors, traditional healers, pharmacy men, religious leaders, community leaders, and formal healthcare providers. Audio recordings were transcribed and translated into English, and the textual data were analyzed using the Framework Approach. We find that harmful newborn care practices, such as delayed wrapping and early initiation of bathing, are changing as more biomedical advice from formal healthcare providers is reaching the community through word-of-mouth and television campaigns. While the goal of CKMC was relatively easily understood and accepted by many of the participants, logistical and to a lesser extent ideological barriers exist that may keep the practice from being adopted easily. Women feel a sense of inevitable responsibility for household duties despite the desire to provide the best care for their new babies. Our findings showed that participants appreciated CKMC as an appropriate treatment method for ill babies, but were less accepting of it as a protective method of caring for seemingly healthy newborns during the first few days of life. Participants highlighted the necessity of receiving help from family members and witnessing other women performing CKMC with positive outcomes if they are to adopt the behavior themselves. Focusing intervention

  10. A pilot study of immune and mood outcomes of a community-based intervention for dementia caregivers: the PLST intervention.

    PubMed

    Garand, Linda; Buckwalter, Kathleen C; Lubaroff, David; Tripp-Reimer, Toni; Frantz, Rita A; Ansley, Timothy N

    2002-08-01

    Providing care to a family member with dementia is conceptualized as a chronic stressor with adverse psychological and physical effects. The purpose of this pilot study was to evaluate mood and immune outcomes of caregivers exposed to a community-based psychoeducational nursing intervention based on the progressively lowered stress threshold (PLST) model. The PLST intervention is designed to strengthen the psychological resources of dementia caregivers by teaching methods of preventing and/or managing behavioral problems exhibited by the person with dementia. Mood and immune outcomes were compared between caregivers randomly assigned to receive either the PLST or a comparison intervention. Results of this pilot study suggest that caregivers who received the PLST intervention showed significantly stronger T-cell proliferative responses to both PHA and ConA, indicating an improvement in T-cell immune function immediately after the in-home intervention (T2) and again after 6 months of telephone support for application of the PLST model (T3). Findings do not support the hypothesis that the PLST intervention had a significant effect on total mood disturbance or natural killer cell cytotoxicity over the course of the study.

  11. An Assessment of Intervention Fidelity in Published Social Work Intervention Research Studies

    ERIC Educational Resources Information Center

    Corley, Nicole A.; Kim, Irang

    2016-01-01

    Objectives: Intervention fidelity is a critical strategy to help advance the usefulness and integrity of social work research. This study assessed the extent to which a selected sample of published social work intervention researchers reported its intervention protocols. Methods: Six core social work journals were reviewed in this analysis. The…

  12. Effectiveness of interventions to promote healthy diet in primary care: systematic review and meta-analysis of randomised controlled trials

    PubMed Central

    2013-01-01

    Background A diet rich in fruit, vegetables and dietary fibre and low in fat is associated with reduced risk of chronic disease. This review aimed to estimate the effectiveness of interventions to promote healthy diet for primary prevention among participants attending primary care. Methods A systematic review of trials using individual or cluster randomisation of interventions delivered in primary care to promote dietary change over 12 months in healthy participants free from chronic disease or defined high risk states. Outcomes were change in fruit and vegetable intake, consumption of total fat and fibre and changes in serum cholesterol concentration. Results Ten studies were included with 12,414 participants. The design and delivery of interventions were diverse with respect to grounding in behavioural theory and intervention intensity. A meta-analysis of three studies showed an increase in fruit consumption of 0.25 (0.01 to 0.49) servings per day, with an increase in vegetable consumption of 0.25 (0.06 to 0.44) serving per day. A further three studies that reported on fruit and vegetable consumption together showed a pooled increment of 0.50 (0.13 to 0.87) servings per day. The pooled effect on consumption of dietary fibre, from four studies, was estimated to be 1.97 (0.43 to 3.52) gm fibre per day. Data from five studies showed a mean decrease in total fat intake of 5.2% of total energy (1.5 to 8.8%). Data from three studies showed a mean decrease in serum cholesterol of 0.10 (-0.19 to 0.00) mmol/L. Conclusion Presently-reported interventions to promote healthy diet for primary prevention in primary care, which illustrate a diverse range of intervention methods, may yield small beneficial changes in consumption of fruit, vegetables, fibre and fat over 12 months. The present results do not exclude the possibility that more effective intervention strategies might be developed. PMID:24355095

  13. Effectiveness of an intervention for prevention and treatment of burnout in primary health care professionals

    PubMed Central

    2013-01-01

    Background Burnout syndrome is an important health problem that affects many professionals and must be addressed globally, with both organizational measures and personal interventions. Burnout of health professionals can be prevented in order to avoid personal, familial, and social consequences, as well as repercussions for patients. Methods/design This work describes a protocol for a controlled, pragmatic, randomized clinical trial in 2 parallel groups: intervention and control. All health professionals from 7 health care centers will form the intervention group, and all health professionals from 7 different health care centers will form the control group. The intervention group will receive 16 hours of training at their work place. The Maslach's burnout inventory, the Cuestionario de Desgaste Profesional Médico or the Cuestionario de Desgaste Profesional de Enfermería, and the 28-item Goldberg's General Health Questionnaire, validated for our setting, will be used as measurement tools. Change in the average scores from the Maslach's burnout inventory emotional exhaustion scale will be compared between the intervention and control groups, measured as intention-to-treat, and the intervention will be considered effective if a minimum decrease of 20% is achieved. Discussion Due to the deleterious consequences of burnout syndrome for people suffering from it and for the organization where they work, it is necessary to evaluate the effectiveness of certain interventions for its prevention. Organizational measures are important for preventing burnout syndrome, but so is providing professionals with coping strategies, as this group intervention intends to do. Trial registration ClinicalTrials.gov processed this record on June 10, 2013. ClinicalTrials.gov Identifier: NCT01870154. PMID:24237937

  14. Alma-Ata: Rebirth and Revision 6 Interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make?

    PubMed

    Bhutta, Zulfiqar A; Ali, Samana; Cousens, Simon; Ali, Talaha M; Haider, Batool Azra; Rizvi, Arjumand; Okong, Pius; Bhutta, Shereen Z; Black, Robert E

    2008-09-13

    Several recent reviews of maternal, newborn, and child health (MNCH) and mortality have emphasised that a large range of interventions are available with the potential to reduce deaths and disability. The emphasis within MNCH varies, with skilled care at facility levels recommended for saving maternal lives and scale-up of community and household care for improving newborn and child survival. Systematic review of new evidence on potentially useful interventions and delivery strategies identifies 37 key promotional, preventive, and treatment interventions and strategies for delivery in primary health care. Some are especially suitable for delivery through community support groups and health workers, whereas others can only be delivered by linking community-based strategies with functional first-level referral facilities. Case studies of MNCH indicators in Pakistan and Uganda show how primary health-care interventions can be used effectively. Inclusion of evidence-based interventions in MNCH programmes in primary health care at pragmatic coverage in these two countries could prevent 20-30% of all maternal deaths (up to 32% with capability for caesarean section at first-level facilities), 20-21% of newborn deaths, and 29-40% of all postneonatal deaths in children aged less than 5 years. Strengthening MNCH at the primary health-care level should be a priority for countries to reach their Millennium Development Goal targets for reducing maternal and child mortality.

  15. Interprofessional Intervention to Support Mature Women: A Case Study.

    PubMed

    Pechacek, Judith M; Drake, Diana; Terrell, Carrie Ann; Torkelson, Carolyn

    2015-01-01

    Understanding the impact interprofessional teamwork has on patient outcomes is of great interest to health care providers, educators, and administrators. This article describes one clinical team, Women's Health Specialists, and their implementation of an interprofessional health intervention course: "Mindfulness and Well-being: The Mature Woman" (MW: MW) to support mature women's health needs in midlife (age 40-70 years) and empower patient involvement in self-care. The provider team works to understand how their interprofessional education and collaborative practice (IPECP) interventions focused on supporting midlife women are associated with improved quality and clinical outcomes. This case study describes the work of the Women's Health Specialists clinic in partnership with the National Center for Interprofessional Education and Collaborative Practice to study the impact an interprofessional team has on the health needs of women in midlife. This article summarizes the project structure, processes, outputs, and outcomes. Data collection, analysis, strategy, and next steps for future midlife women's projects are also discussed. PMID:26376571

  16. Effectiveness of a Care Coordination Model for Stroke Survivors: A Randomized Study

    ERIC Educational Resources Information Center

    Claiborne, Nancy

    2006-01-01

    This study evaluated the effectiveness of systematically integrating biopsychosocial interventions with coordinated delivery of care for outpatients recovering from stroke. Care coordination coordinates resources across the health care system and routinely addresses the psychological and social risks affecting patient outcomes, while monitoring…

  17. Comprehensive geriatric assessment, multifactorial interventions and nurse-led care coordination to prevent functional decline in community-dwelling older persons: protocol of a cluster randomized trial

    PubMed Central

    2012-01-01

    Background Functional decline in community-dwelling older persons is associated with the loss of independence, the need for hospital and nursing-home care and premature death. The effectiveness of multifactorial interventions in preventing functional decline remains controversial. The aim of this study is to investigate whether functional decline in community-dwelling older persons can be delayed or prevented by a comprehensive geriatric assessment, multifactorial interventions and nurse-led care coordination. Methods/Design In a cluster randomized controlled trial, with the general practice as the unit of randomization, 1281 participants from 25 general practices will be enrolled in each condition to compare the intervention with usual care. The intervention will focus on older persons who are at increased risk for functional decline, identified by an Identification of Seniors at Risk Primary Care (ISAR-PC) score (≥ 2). These older persons will receive a comprehensive geriatric assessment, an individually tailored care and treatment plan, consisting of multifactorial, evidence-based interventions and subsequent nurse-led care coordination. The control group will receive 'care as usual' by the general practitioner (GP). The main outcome after 12 months is the level of physical functioning on the modified Katz-15 index score. The secondary outcomes are health-related quality of life, psychological and social functioning, healthcare utilization and institutionalization. Furthermore, a process evaluation and cost-effectiveness analysis will be performed. Discussion This study will provide new knowledge regarding the effectiveness and feasibility of a comprehensive geriatric assessment, multifactorial interventions and nurse-led elderly care in general practice. Trial registration NTR2653 Grant Unrestricted grant 'The Netherlands Organisation for Health Research and development' no 313020201 PMID:22462516

  18. Mobile early detection and connected intervention to coproduce better care in severe mental illness.

    PubMed

    Whelan, Pauline; Machin, Matthew; Lewis, Shôn; Buchan, Iain; Sanders, Caroline; Applegate, Eve; Stockton, Charlotte; Preston, Sally; Bowen, Robert Andrew; Ze, Zhimin; Roberts, Chris; Davies, Linda; Wykes, Til; Tarrier, Nicholas; Kapur, Shitij; Ainsworth, John

    2015-01-01

    Current approaches to the management of severe mental illness have four major limitations: 1) symptom reporting is intermittent and subject to problems with reliability; 2) service users report feelings of disengagement from their care planning; 3) late detection of symptoms delay interventions and increase the risk of relapse; and 4) care systems are held back by the costs of unscheduled hospital admissions that could have been avoided with earlier detection and intervention. The ClinTouch system was developed to close the loop between service users and health professionals. ClinTouch is an end-to-end secure platform, providing a validated mobile assessment technology, a web interface to view symptom data and a clinical algorithm to detect risk of relapse. ClinTouch integrates high-resolution, continuous longitudinal symptom data into mental health care services and presents it in a form that is easy to use for targeting care where it is needed. The architecture and methodology can be easily extended to other clinical domains, where the paradigm of targeted clinical interventions, triggered by the early detection of decline, can improve health outcomes.

  19. HIV prevention and care services for female sex workers: efficacy of a targeted community-based intervention in Burkina Faso

    PubMed Central

    Traore, Isidore T; Meda, Nicolas; Hema, Noelie M; Ouedraogo, Djeneba; Some, Felicien; Some, Roselyne; Niessougou, Josiane; Sanon, Anselme; Konate, Issouf; Van De Perre, Philippe; Mayaud, Philippe; Nagot, Nicolas

    2015-01-01

    Introduction Although interventions to control HIV among high-risk groups such as female sex workers (FSW) are highly recommended in Africa, the contents and efficacy of these interventions are unclear. We therefore designed a comprehensive dedicated intervention targeting young FSW and assessed its impact on HIV incidence in Burkina Faso. Methods Between September 2009 and September 2011 we conducted a prospective, interventional cohort study of FSW aged 18 to 25 years in Ouagadougou, with quarterly follow-up for a maximum of 21 months. The intervention combined prevention and care within the same setting, consisting of peer-led education sessions, psychological support, sexually transmitted infections and HIV care, general routine health care and reproductive health services. At each visit, behavioural characteristics were collected and HIV, HSV-2 and pregnancy were tested. We compared the cohort HIV incidence with a modelled expected incidence in the study population in the absence of intervention, using data collected at the same time from FSW clients. Results The 321 HIV-uninfected FSW enrolled in the cohort completed 409 person-years of follow-up. No participant seroconverted for HIV during the study (0/409 person-years), whereas the expected modelled number of HIV infections were 5.05/409 person-years (95% CI, 5.01–5.08) or 1.23 infections per 100 person-years (p=0.005). This null incidence was related to a reduction in the number of regular partners and regular clients, and by an increase in consistent condom use with casual clients (adjusted odds ratio (aOR)=2.19; 95% CI, 1.16–4.14, p=0.01) and with regular clients (aOR=2.18; 95% CI, 1.26–3.76, p=0.005). Conclusions Combining peer-based prevention and care within the same setting markedly reduced the HIV incidence among young FSW in Burkina Faso, through reduced risky behaviours. PMID:26374604

  20. The impact of a citywide audit with educational intervention on the care of patients with epilepsy.

    PubMed

    Minshall, I; Smith, D

    2008-04-01

    The care of patients with epilepsy historically has been well documented to be poor. Previous attempts to improve care through education have been unsuccessful. The New GP Contract in the UK introduced epilepsy as a core quality indicator from April 2004. This prospective audit assesses the impact of an audit with educational intervention on the process of care of patients with epilepsy. The case notes of 610 patients, of all ages, with epilepsy on treatment, in 13 general practices serving Chester and surrounding area were reviewed before and 2 years after an intervention, comprising (a) the provision of a comprehensive template, (b) individualised categorisation for each patient and (c) an educational session led by a Neurologist. The overall review rate increased in the first year from 41 to 49% (p<0.0001) and by 2 years to 63% (p<0.0001). Documented remission rate increased from 29 to 43% (p<0.0001). Admissions to accident and emergency fell significantly (p=0.0026). There was no fall in the non-compliance rate. Forty five percent of patients with documented poor control were not under shared care. Issues highlighted in the audit generated 77 referrals. There were clear health gains in 62 (13%) individuals from referrals and practice interventions related to the audit. This original audit identified significant improvements in review rate, documented remission rate and beneficial outcomes in individual patients. The changes were attributable to both the educational intervention and the coincidental acceptance of the New GP Contract. Remaining problems include lack of shared care for patients with active epilepsy. PMID:17913517

  1. A Systematic Review Comparing Antiretroviral Adherence Descriptive and Intervention Studies

    PubMed Central

    Sandelowski, Margarete; Voils, Corrine I.; Chang, Yunkyung; Lee, Eun-Jeong

    2009-01-01

    We examined the extent to which studies aimed at testing interventions to improve antiretroviral adherence have targeted the facilitators of and barriers known to affect adherence. Of the 88 reports reviewed, 41 were reports of descriptive studies conducted with U.S. HIV-positive women and 47 were reports of intervention studies conducted with U.S. HIV-positive persons. We extracted from the descriptive studies all findings addressing any factor linked to antiretroviral adherence and from the intervention studies, information on the nature of the intervention, the adherence problem targeted, the persons targeted for the intervention, and the intervention outcomes desired. We discerned congruence between the prominence of substance abuse as a factor identified in the descriptive studies as a barrier to adherence and its prominence as the problem most addressed in those reports of intervention studies that specified the problems targeted for intervention. We also discerned congruence between the prominence of family and provider support as factors identified in the descriptive studies as facilitators of adherence and the presence of social support as an intervention component and outcome variable. Less discernible in the reports of intervention studies was specific attention to other factors prominent in the descriptive studies, which may be due to the complex nature of the problem, individualistic and rationalist slant of interventions, or simply the ways interventions were presented. Our review raises issues about niche standardization and intervention tailoring, targeting, and fidelity. PMID:20024751

  2. Tuberculosis care: an evaluability study

    PubMed Central

    Coelho, Ardigleusa Alves; Martiniano, Cláudia Santos; Brito, Ewerton Willian Gomes; Negrão, Oswaldo Gomes Corrêa; Arcêncio, Ricardo Alexandre; Uchôa, Severina Alice da Costa

    2014-01-01

    OBJECTIVE: to verify whether the tuberculosis control program (TCP) is evaluable and to examine the feasibility of building an evaluation model in apriority municipality for the control of tuberculosis. METHOD: this evaluability study was conducted in a municipality in northeastern Brazil. For data collection, documental analysis and interviews with key informants were performed. For indicator validation, the nominal group technique was adopted. RESULTS: the details of TCP were described, and both the logical model and the classification framework for indicators were developed and agreed up on, with the goal of characterizing the structural elements of the program, defining the structure and process indicators, and formulating the evaluation questions. CONCLUSION: TCP is evaluable. Based on logical operational analysis, it was possible to evaluate the adequacy of the program goals for the control of tuberculosis. Therefore, the performance of a summative evaluation is recommended, with a focus on the analysis of the effects of tuberculosis control interventions on decreasing morbidity and mortality. PMID:25493675

  3. [Rebuilding post-suicide interventions from a caring ethics perspective].

    PubMed

    Tzeng, Wen-Chii

    2006-12-01

    Suicide has become a critical mental health problem in Taiwan. Most studies on the issue are related to suicide rates and risk factors, and their relationships with mental illnesses. These findings help health professionals to understand what life might have been like for a suicide victim before the suicide, but not what life is like after a suicide attempt; how to detect the possibility of a subsequent suicide attempt, rather than how to help people who have attempted suicide to construct a good life. The purpose of this article is to encourage nurses to engage in dialogue with suicidal patients by understanding their explanatory models and by self-reflection. This not only enables suicidal patients to move from shame toward taking responsibility for themselves and others, but also enables nurses to rebuild their experiential knowledge.

  4. Low back pain in general practice: cost-effectiveness of a minimal psychosocial intervention versus usual care.

    PubMed

    Jellema, Petra; van der Roer, Nicole; van der Windt, Daniëlle A W M; van Tulder, Maurits W; van der Horst, Henriëtte E; Stalman, Wim A B; Bouter, Lex M

    2007-11-01

    An intervention that can prevent low back pain (LBP) becoming chronic, may not only prevent great discomfort for patients, but also save substantial costs for the society. Psychosocial factors appear to be of importance in the transition of acute to chronic LBP. The aim of this study was to compare the cost-effectiveness of an intervention aimed at psychosocial factors to usual care in patients with (sub)acute LBP. The study design was an economic evaluation alongside a cluster-randomized controlled trial, conducted from a societal perspective with a follow-up of 1 year. Sixty general practitioners in 41 general practices recruited 314 patients with non-specific LBP of less than 12 weeks' duration. General practitioners in the minimal intervention strategy (MIS) group explored and discussed psychosocial prognostic factors. Usual care (UC) was not protocolized. Clinical outcomes were functional disability (Roland-Morris Disability Questionnaire), perceived recovery and health-related quality of life (EuroQol). Cost data consisted of direct and indirect costs and were measured by patient cost diaries and general practitioner registration forms. Complete cost data were available for 80% of the patients. Differences in clinical outcomes between both the groups were small and not statistically significant. Differences in cost data were in favor of MIS. However, the complete case analysis and the sensitivity analyses with imputed cost data were inconsistent with regard to the statistical significance of this difference in cost data. This study presents conflicting points of view regarding the cost-effectiveness of MIS. We conclude that (Dutch) general practitioners, as yet, should not replace their usual care by this new intervention. PMID:17659363

  5. Cost-effectiveness of the ‘Walcheren Integrated Care Model’ intervention for community-dwelling frail elderly

    PubMed Central

    Looman, Wilhelmina M; Huijsman, Robbert; Bouwmans-Frijters, Clazien A M; Stolk, Elly A; Fabbricotti, Isabelle N

    2016-01-01

    Background. An important aim of integrated care for frail elderly is to generate more cost-effective health care. However, empirical research on the cost-effectiveness of integrated care for community-dwelling frail elderly is limited. Objective. This study reports on the cost-effectiveness of the Walcheren Integrated Care Model (WICM) after 12 months from a societal perspective. Methods. The design of this study was quasi-experimental. In total, 184 frail elderly patients from 3 GP practices that implemented the WICM were compared with 193 frail elderly patients of 5 GP practices that provided care as usual. Effects were determined by health-related quality of life (EQ-5D questionnaire). Costs were assessed based on questionnaires, GP files, time registrations and reports from multidisciplinary meetings. Average costs and effects were compared using t-tests. The incremental cost-effectiveness ratio (ICER) was calculated, and bootstrap methods were used to determine its reliability. Results. Neither the WICM nor care as usual resulted in a change in health-related quality of life. The average total costs of the WICM were higher than care as usual (17089 euros versus 15189 euros). The incremental effects were 0.00, whereas the incremental costs were 1970 euros, indicating an ICER of 412450 euros. Conclusions. The WICM is not cost-effective, and the costs per quality-adjusted life year are high. The costs of the integrated care intervention do not outweigh the limited effects on health-related quality of life after 12 months. More analyses of the cost-effectiveness of integrated care for community-dwelling frail elderly are recommended as well as consideration of the specific costs and effects. PMID:26811438

  6. A cluster randomised controlled trial of the community effectiveness of two interventions in rural Malawi to improve health care and to reduce maternal, newborn and infant mortality

    PubMed Central

    2010-01-01

    Background The UN Millennium Development Goals call for substantial reductions in maternal and child mortality, to be achieved through reductions in morbidity and mortality during pregnancy, delivery, postpartum and early childhood. The MaiMwana Project aims to test community-based interventions that tackle maternal and child health problems through increasing awareness and local action. Methods/Design This study uses a two-by-two factorial cluster-randomised controlled trial design to test the impact of two interventions. The impact of a community mobilisation intervention run through women's groups, on home care, health care-seeking behaviours and maternal and infant mortality, will be tested. The impact of a volunteer-led infant feeding and care support intervention, on rates of exclusive breastfeeding, uptake of HIV-prevention services and infant mortality, will also be tested. The women's group intervention will employ local female facilitators to guide women's groups through a four-phase cycle of problem identification and prioritisation, strategy identification, implementation and evaluation. Meetings will be held monthly at village level. The infant feeding intervention will select local volunteers to provide advice and support for breastfeeding, birth preparedness, newborn care and immunisation. They will visit pregnant and new mothers in their homes five times during and after pregnancy. The unit of intervention allocation will be clusters of rural villages of 2500-4000 population. 48 clusters have been defined and randomly allocated to either women's groups only, infant feeding support only, both interventions, or no intervention. Study villages are surrounded by 'buffer areas' of non-study villages to reduce contamination between intervention and control areas. Outcome indicators will be measured through a demographic surveillance system. Primary outcomes will be maternal, infant, neonatal and perinatal mortality for the women's group intervention, and

  7. "Getting me back on track": the role of outreach interventions in engaging and retaining people living with HIV/AIDS in medical care.

    PubMed

    Rajabiun, Serena; Mallinson, R Kevin; McCoy, Kate; Coleman, Sharon; Drainoni, Mari-Lynn; Rebholz, Casey; Holbert, Tim

    2007-01-01

    This qualitative study investigated the process of engagement in HIV medical care from the perspective of people living with HIV/AIDS (PLWHA). In-depth interviews were conducted with 76 participants in six cities. All participants were considered underserved because of histories of substance use, mental illness, incarceration, homelessness, or cultural barriers to the traditional health care system. A semistructured interview guide elicited narratives related to health care and the role of program interventions in facilitating access to care. Data analysis revealed that participants cycled in and out of care, a process that was influenced by (1) their level of acceptance of being diagnosed with HIV, (2) their ability to cope with substance use, mental illness, and stigma, (3) their health care provider relationships, (4) the presence of external support systems, and (5) their ability to overcome practical barriers to care. Outreach interventions played a role in connecting participants to care by dispelling myths and improving knowledge about HIV, facilitating access to HIV care and treatment, providing support, and reducing the barriers to care. The findings suggest that outreach programs can interrupt this cyclical process and foster sustained, regular HIV care for underserved PLWHA by conducting client-centered risk assessments to identify and reduce sources of instability and improve the quality of provider relationships; implementing strategies that promote healthy practices; creating a network of support services in the community; and supporting adherence through frequent follow-ups for medication and appointment keeping.

  8. Process evaluation for complex interventions in primary care: understanding trials using the normalization process model

    PubMed Central

    May, Carl R; Mair, Frances S; Dowrick, Christopher F; Finch, Tracy L

    2007-01-01

    Background The Normalization Process Model is a conceptual tool intended to assist in understanding the factors that affect implementation processes in clinical trials and other evaluations of complex interventions. It focuses on the ways that the implementation of complex interventions is shaped by problems of workability and integration. Method In this paper the model is applied to two different complex trials: (i) the delivery of problem solving therapies for psychosocial distress, and (ii) the delivery of nurse-led clinics for heart failure treatment in primary care. Results Application of the model shows how process evaluations need to focus on more than the immediate contexts in which trial outcomes are generated. Problems relating to intervention workability and integration also need to be understood. The model may be used effectively to explain the implementation process in trials of complex interventions. Conclusion The model invites evaluators to attend equally to considering how a complex intervention interacts with existing patterns of service organization, professional practice, and professional-patient interaction. The justification for this may be found in the abundance of reports of clinical effectiveness for interventions that have little hope of being implemented in real healthcare settings. PMID:17650326

  9. Care Orders as Successful Interventions: The Social Workers' Point of View

    ERIC Educational Resources Information Center

    Pösö, Tarja; Eronen, Tuija

    2014-01-01

    This article examines the outcomes of care orders from the point of view of social workers. The aim is to cast light on the "black box" of substitute care by analysing the practice-based view on outcome in order to contribute to the complex debate on the relations of care and outcome. The article is based on a study using a survey, focus…

  10. Empowering Staff in Dementia Long-Term Care: Towards a More Supportive Approach to Interventions

    ERIC Educational Resources Information Center

    Figueiredo, Daniela; Barbosa, Ana; Cruz, Joana; Marques, Alda; Sousa, Liliana

    2013-01-01

    This pilot-study aimed to assess a psychoeducational program for staff in care homes. The program was designed to increase knowledge regarding dementia care, promote skills to integrate motor and multisensory stimulation in daily care, and develop coping strategies to manage emotional work-related demands. Six staff members received eight…

  11. Risk Factors Associated with Children Lost to Care in a State Early Childhood Intervention Program

    ERIC Educational Resources Information Center

    Giannoni, Peggy P.; Kass, Philip H.

    2010-01-01

    A retrospective cohort study was conducted to identify risk factors associated with children lost to care, and their families, compared to those not lost to care within the California Early Start Program. The cohort included data on 8987 children enrolled in the Early Start Program in 1998. This cohort consisted of 2443 children lost to care, 6363…

  12. Implementing a quality improvement programme in palliative care in care homes: a qualitative study

    PubMed Central

    2011-01-01

    Background An increasing number of older people reach the end of life in care homes. The aim of this study is to explore the perceived benefits of, and barriers to, implementation of the Gold Standards Framework for Care Homes (GSFCH), a quality improvement programme in palliative care. Methods Nine care homes involved in the GSFCH took part. We conducted semi-structured interviews with nine care home managers, eight nurses, nine care assistants, eleven residents and seven of their family members. We used the Framework approach to qualitative analysis. The analysis was deductive based on the key tasks of the GSFCH, the 7Cs: communication, coordination, control of symptoms, continuity, continued learning, carer support, and care of the dying. This enabled us to consider benefits of, and barriers to, individual components of the programme, as well as of the programme as a whole. Results Perceived benefits of the GSFCH included: improved symptom control and team communication; finding helpful external support and expertise; increasing staff confidence; fostering residents' choice; and boosting the reputation of the home. Perceived barriers included: increased paperwork; lack of knowledge and understanding of end of life care; costs; and gaining the cooperation of GPs. Many of the tools and tasks in the GSFCH focus on improving communication. Participants described effective communication within the homes, and with external providers such as general practitioners and specialists in palliative care. However, many had experienced problems with general practitioners. Although staff described the benefits of supportive care registers, coding predicted stage of illness and advance care planning, which included improved communication, some felt the need for more experience of using these, and there were concerns about discussing death. Conclusions Most of the barriers described by participants are relevant to other interventions to improve end of life care in care homes

  13. Liquid versus gel handrub formulation: a prospective intervention study

    PubMed Central

    Traore, Ousmane; Hugonnet, Stéphane; Lübbe, Jann; Griffiths, William; Pittet, Didier

    2007-01-01

    Introduction Hand hygiene is one of the cornerstones of the prevention of health care-associated infection, but health care worker (HCW) compliance with good practices remains low. Alcohol-based handrub is the new standard for hand hygiene action worldwide and usually requires a system change for its successful introduction in routine care. Product acceptability by HCWs is a crucial step in this process. Methods We conducted a prospective intervention study to compare the impact on HCW compliance of a liquid (study phase I) versus a gel (phase II) handrub formulation of the same product during daily patient care. All staff (102 HCWs) of the medical intensive care unit participated. Compliance with hand hygiene was monitored by a single observer. Skin tolerance and product acceptability were assessed using subjective and objective scoring systems, self-report questionnaires, and biometric measurements. Logistic regression was used to estimate the association between predictors and compliance with the handrub formulation as the main explanatory variable and to adjust for potential risk factors. Results Overall compliance (phases I and II) with hand hygiene practices among nurses, physicians, nursing assistants, and other HCWs was 39.1%, 27.1%, 31.1%, and 13.9%, respectively (p = 0.027). Easy access to handrub improved compliance (35.3% versus 50.6%, p = 0.035). Nurse status, working on morning shifts, use of the gel formulation, and availability of the alcohol-based handrub in the HCW's pocket were independently associated with higher compliance. Immediate accessibility was the strongest predictor. Based on self-assessment, observer assessment, and the measurement of epidermal water content, the gel performed significantly better than the liquid formulation. Conclusion Facilitated access to an alcohol-based gel formulation leads to improved compliance with hand hygiene and better skin condition in HCWs. PMID:17477858

  14. Formative evaluation of a multi-component, education-based intervention to improve processes of end-of-life care.

    PubMed

    Williams, Beverly R; Woodby, Lesa L; Bailey, F Amos; Burgio, Kathryn L

    2014-01-01

    A multicomponent, palliative care, education-based intervention was implemented in six Veterans Affairs Medical Centers in the southeast United States. The intervention comprised onsite staff training plus supporting written materials, installation of an electronic order set, and follow-up consultations. Training included large-group didactic presentations, small-group clinical demonstrations, and one-on-one consultations. The intervention strategy was targeted broadly to hundreds of hospital providers, including physician, nursing, and ancillary staff. The purpose was to train staff in identifying actively dying patients and implementing best practices of home-based hospice care. A formative evaluation was conducted utilizing semistructured telephone interviews with key informants from each site. Qualitative data analysis revealed processes that facilitated or impeded uptake of the intervention. Results will be used to inform ongoing and future clinical initiatives and optimize future implementation of education-based interventions to improve adoption of best practices for end-of-life care within acute care settings.

  15. Health and Wellness Photovoice Project: Engaging Consumers With Serious Mental Illness in Health Care Interventions

    PubMed Central

    Cabassa, Leopoldo J.; Parcesepe, Angela; Nicasio, Andel; Baxter, Ellen; Tsemberis, Sam; Lewis-Fernández, Roberto

    2013-01-01

    People with serious mental illnesses (SMI) are at increased risk for cardiovascular disease and premature mortality. We used photovoice in two supportive housing agencies to engage consumers with SMI to inform the implementation of health care interventions. Sixteen consumers participated in six weekly sessions in which they took photographs about their health and discussed the meanings of these photographs in individual interviews and group sessions. We identified several implementation themes related to consumers’ preferences. Peer-based approaches were preferred more than clinician-driven models. Participants expressed a desire to learn practical skills through hands-on activities to modify health behaviors. Consumers expressed a desire to increase their physical activity. Participants revealed in their photographs and narratives the important role that communities’ food environments play in shaping eating habits. In this article, we show how photovoice can generate valuable community knowledge to inform the translation of health care interventions in supportive housing agencies. PMID:23258117

  16. Study Quality Assessment in Systematic Reviews of Research on Intervention Effects

    ERIC Educational Resources Information Center

    Wells, Kathleen; Littell, Julia H.

    2009-01-01

    Objective: The goal of this study is to advance an approach to the assessment of the quality of studies considered for inclusion in systematic reviews of the effects of social-care interventions. Method: To achieve this objective, quality is defined in relation to the widely accepted validity typology; prominent approaches to study quality…

  17. Improving management of type 2 diabetes in South Asian patients: a systematic review of intervention studies

    PubMed Central

    Bhurji, N; Javer, J; Gasevic, D; Khan, N A

    2016-01-01

    Objectives Optimal control of type 2 diabetes is challenging in many patient populations including in South Asian patients. We systematically reviewed studies on the effect of diabetes management interventions targeted at South Asian patients with type 2 diabetes on glycaemic control. Design Systematic review of MEDLINE, EMBASE and CINAHL databases for randomised controlled trials (RCTs) and pre-post-test studies (January 1990 to February 2014). Studies were stratified by where interventions were conducted (South Asia vs Western countries). Participants Patients originating from Pakistan, Bangladesh or India with type 2 diabetes. Primary outcome Change in glycated haemoglobin (HbA1c). Secondary end points included change in blood pressure, lipid levels, anthropomorphics and knowledge. Results 23 studies (15 RCTs) met criteria for analysis with 7 from Western countries (n=2532) and 16 from South Asia (n=1081). Interventions in Western countries included translated diabetes education, additional clinical care, written materials, visual aids, and bilingual community-based peers and/or health professionals. Interventions conducted in South Asia included yoga, meditation or exercise, community-based peers, health professionals and dietary education (cooking exercises). Among RCTs in India (5 trials; n=390), 4 demonstrated significant reductions in HbA1c in the intervention group compared with usual care (yoga and exercise interventions). Among the 4 RCTs conducted in Europe (n=2161), only 1 study, an education intervention of 113 patients, reported a significant reduction in HbA1c with the intervention. Lipids, blood pressure and knowledge improved in both groups with studies from India more often reporting reductions in body mass index and waist circumference. Conclusions Overall, there was little improvement in HbA1c level in diabetes management interventions targeted at South Asians living in Europe compared with usual care, although other outcomes did improve. The

  18. Effects of Community-Based Newborn Care Intervention on Neonate Health Status in a District of Tehran (Iran)

    PubMed Central

    Nayeri, Fatemeh; Dalili, Hosein; Shahzadeh Fazeli, Kazem; Delbarpoor Ahmadi, Shahnaz; Akrami, Frozan; Esmailnia, Tahereh; Habibelahi, Abbas; Shariat, Mamak

    2016-01-01

    Objective: To identify the effects of community-based interventions on the Neonatal Health Index in one district of Tehran-Iran. Materials and methods: A community and healthcare center-based study was carried out from January 2011 through September 2014. The population of the study included newborns from mothers residing in the 4th district of Tehran, Iran. Demographic data of mothers and infants were recorded in questionnaires before and after intervention. Interventions were implemented in hospitals, participants' homes, and health centers. The primary outcomes were comparison of mean birth weight, weight gain during the first 3-7 days, first week visit rate, hospitalization rate between the before and after intervention groups. Results: The populations in the before and after intervention groups were 274 and 250, respectively. A significant difference was seen between the gestational ages (P value = 0.007) of the two groups. Mean birth height in the first group was 50.35 ± 3.48 and in the second group was 55 ± 5.32 cm (P value = 0.04). Neonatal complications in the second group were 6.9% lower than in the first group (P value = 0.048). In the first group 41 neonates (15%) were hospitalized in the NICU while in the second group 12 cases (4.8%) were hospitalized (P value = 0.018). Seven cases (2.6%) in the first group and one case (0.4%) in the second group were resuscitated (P value = 0.0001). Conclusion: The results of implementing community-based newborn care strategies witnessed at the first week postnatal visit included improvements inneonatal gestational growth, management of neonates with potentially serious illnesses, diagnosis of warning signs and neonatal care practices. PMID:27648100

  19. Effects of Community-Based Newborn Care Intervention on Neonate Health Status in a District of Tehran (Iran)

    PubMed Central

    Nayeri, Fatemeh; Dalili, Hosein; Shahzadeh Fazeli, Kazem; Delbarpoor Ahmadi, Shahnaz; Akrami, Frozan; Esmailnia, Tahereh; Habibelahi, Abbas; Shariat, Mamak

    2016-01-01

    Objective: To identify the effects of community-based interventions on the Neonatal Health Index in one district of Tehran-Iran. Materials and methods: A community and healthcare center-based study was carried out from January 2011 through September 2014. The population of the study included newborns from mothers residing in the 4th district of Tehran, Iran. Demographic data of mothers and infants were recorded in questionnaires before and after intervention. Interventions were implemented in hospitals, participants' homes, and health centers. The primary outcomes were comparison of mean birth weight, weight gain during the first 3-7 days, first week visit rate, hospitalization rate between the before and after intervention groups. Results: The populations in the before and after intervention groups were 274 and 250, respectively. A significant difference was seen between the gestational ages (P value = 0.007) of the two groups. Mean birth height in the first group was 50.35 ± 3.48 and in the second group was 55 ± 5.32 cm (P value = 0.04). Neonatal complications in the second group were 6.9% lower than in the first group (P value = 0.048). In the first group 41 neonates (15%) were hospitalized in the NICU while in the second group 12 cases (4.8%) were hospitalized (P value = 0.018). Seven cases (2.6%) in the first group and one case (0.4%) in the second group were resuscitated (P value = 0.0001). Conclusion: The results of implementing community-based newborn care strategies witnessed at the first week postnatal visit included improvements inneonatal gestational growth, management of neonates with potentially serious illnesses, diagnosis of warning signs and neonatal care practices.

  20. Framing Disparities Along the Continuum of Care From Chronic Kidney Disease to Transplantation: Barriers and Interventions

    PubMed Central

    Ladin, Keren; Rodrigue, James R.; Hanto, Douglas W.

    2009-01-01

    Research in renal transplantation continues to document scores of disparities affecting vulnerable populations at various stages along the transplantation process. Given that both biological and environmental determinants contribute significantly to variation, identifying factors underlying an unfairly biased distribution of the disease burden is crucial. Confounded definitions and gaps in understanding causal pathways impede effectiveness of interventions aimed at alleviating disparities. This paper offers an operational definition of disparities in the context of a framework aimed at facilitating interventional research. Utilizing an original framework describing the entire continuum of the transplant process from diagnosis of chronic kidney disease through successful transplant, this paper explores the case of racial disparities, illustrating key factors predicting and perpetuating disparities. Though gaps in current research leave us unable to identify which stages of the transplant pathway adversely affect most people, by identifying key risk factors across the continuum of care, this paper highlights areas suited for targeted interventions and presents recommendations for improvement and future research. PMID:19344460

  1. Hymen care for unmarried Muslim females: role of the forensic consultant in gynaecology interventions.

    PubMed

    Abder-Rahman, H A

    2009-01-01

    This case series illustrates the role of the forensic consultant in hymen care for unmarried Muslim females exposed to gynaecology interventions. The age range of the 12 females attending University of Jordan Hospital in Amman was 35 days to 28 years. Gynaecology interventions included the use of a vaginoscope, circular resection of the hymen in cases of congenital imperforate hymen, evacuation of perineal abscess and evaluation of a torn hymen. The forensic consultant provides a valuable role in reassuring patients and parents about procedures used to avoid rupturing the hymen, and in protecting the gynaecologist's and patients' rights by providing reports of the status of the hymen before and after intervention in cases where damage is unavoidable.

  2. Framing disparities along the continuum of care from chronic kidney disease to transplantation: barriers and interventions.

    PubMed

    Ladin, K; Rodrigue, J R; Hanto, D W

    2009-04-01

    Research in renal transplantation continues to document scores of disparities affecting vulnerable populations at various stages along the transplantation process. Given that both biological and environmental determinants contribute significantly to variation, identifying factors underlying an unfairly biased distribution of the disease burden is crucial. Confounded definitions and gaps in understanding causal pathways impede effectiveness of interventions aimed at alleviating disparities. This article offers an operational definition of disparities in the context of a framework aimed at facilitating interventional research. Utilizing an original framework describing the entire continuum of the transplant process from diagnosis of chronic kidney disease through successful transplant, this article explores the case of racial disparities, illustrating key factors predicting and perpetuating disparities. Though gaps in current research leave us unable to identify which stages of the transplant pathway adversely affect most people, by identifying key risk factors across the continuum of care, this article highlights areas suited for targeted interventions and presents recommendations for improvement and future research.

  3. [Intervention to promote recognition of the rights of families of an elderly relative with dementia living in a long-term care facility].

    PubMed

    Lévesque, Louise; Ducharme, Francine; Legault, Alain; Giroux, Francine

    2004-06-01

    The rights of families of an institutionalized elderly relative with dementia have yet to be recognized. The results of our pilot study based on a participatory approach show, among other things, that family caregivers, women for the most part, have little input in the decisions regarding their relative's care and are uneasy to express their opinions to health care staff. As part of the pilot study, caregivers developed a group intervention program entitled "Taking Care of Myself" geared, among other things, towards increasing their competence in expressing their viewpoint to health care staff and in taking part in care-related decisions. According to an efficacy study conducted after the pilot study, the program produced successful outcomes in terms of caregiver competence in dealing with the health care staff and of perceived challenge of the caregiver situation. Recommendations are made aimed at giving caregivers recognition, that is their due.

  4. Health-system-based interventions to improve care in pediatric and adolescent type 1 diabetes.

    PubMed

    Corathers, Sarah D; Schoettker, Pamela J; Clements, Mark A; List, Betsy A; Mullen, Deborah; Ohmer, Amy; Shah, Avni; Lee, Joyce

    2015-11-01

    Despite significant advances in pharmacology and technology, glycemic targets are difficult to achieve for patients with type 1 diabetes (T1D) and management remains burdensome for patients and their families. Quality improvement (QI) science offers a methodology to identify an aim, evaluate complex contributors to the goal, and test potential interventions to achieve outcomes of interest. Day-to-day management of diabetes is often an iterative process but interventions exist at all care levels: individual patient and family, clinic, and larger population and health system. This article reviews current literature and proposes novel QI interventions for enhancing health outcomes, with attention to essential determinants or drivers of improved glycemic control and patient experience for pediatric T1D in the context of the Chronic Care Model. In-depth consideration of key drivers of successful T1D care, including self-management and integration of technology, are explored, and examples of larger health systems with improved outcomes, including Learning Health Systems are highlighted. PMID:26374568

  5. Perceptions of health, health care and community-oriented health interventions in poor urban communities of Kinshasa, Democratic Republic of Congo.

    PubMed

    Maketa, Vivi; Vuna, Mimy; Baloji, Sylvain; Lubanza, Symphorien; Hendrickx, David; Inocêncio da Luz, Raquel Andrea; Boelaert, Marleen; Lutumba, Pascal

    2013-01-01

    In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city's major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and

  6. Perceptions of Health, Health Care and Community-Oriented Health Interventions in Poor Urban Communities of Kinshasa, Democratic Republic of Congo

    PubMed Central

    Maketa, Vivi; Vuna, Mimy; Baloji, Sylvain; Lubanza, Symphorien; Hendrickx, David; Inocêncio da Luz, Raquel Andrea; Boelaert, Marleen; Lutumba, Pascal

    2013-01-01

    In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city’s major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and

  7. Effectiveness of a brief intervention based on the ‘5A’ model for smoking cessation at the primary care level in Santiago, Chile

    PubMed Central

    Puschel, Klaus; Thompson, Beti; Coronado, Gloria; Huang, Ying; Gonzalez, Loreto; Rivera, Solange

    2008-01-01

    Chilean women have the highest smoking rates in Latin America. Prevalence in this population is about 40%. There are no national programs for smoking cessation at the primary care level. This study explores the feasibility and effectiveness of a brief counseling intervention targeted to women smokers of childbearing age who seek primary care in Santiago, Chile. A quasi-experimental design was used to compare the effect of an intervention based on the ‘5A’ model developed by the National Cancer Institute in the United States and the standard care provided in two control clinics. Women smokers seeking care at the three primary care clinics were contacted during a 2 months period and offer to participate in the study. Sampling was stratified according to the age groups to ensure comparability between cohorts. Quotas were calculated for each age group. Participants were asked about their willingness to quit, self-efficacy, smoking behavior, addiction level as well as support received for smoking cessation. After 18 months of intervention all women were re-evaluated. A total of 773 women were recruited for the study; 76% of them completed the trial. Women smokers are characterized by a large percentage of light smokers with a low self-efficacy for quitting and with very low information on where and how to get assistance to quit. At study end, 15.2% of women reported quitting smoking at least for 1 month in the intervention clinic versus 7.8% in one of the control clinics (p < 0.05) and 14.6% in the second control clinic (p = NS). Over 70% of women in the intervention clinic were asked, assessed and received advice for quitting in comparison with <15% in the control clinics (p < 0.01). To conclude, a primary care intervention based on the ‘5A’ model for smoking cessation is feasible and can have a significant effect in reducing smoking prevalence in this population. PMID:18397953

  8. Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisation

    PubMed Central

    Baker, Adrian; Leak, Paul; Ritchie, Lewis D; Lee, Amanda J; Fielding, Shona

    2012-01-01

    Background Anticipatory care for older patients who are frail involves both case identification and proactive intervention to reduce hospitalisation. Aim To identify a population who were at risk of admission to hospital and to provide an anticipatory care plan (ACP) for them and to ascertain whether using primary and secondary care data to identify this population and then applying an ACP can help to reduce hospital admission rates. Design and setting Cohort study of a service intervention in a general practice and a primary care team in Scotland. Method The ACP sets out patients’ wishes in the event of a sudden deterioration in health. If admitted, a proactive approach was taken to transfer and discharge patients into the community. Cohorts were selected using the Nairn Case Finder, which matched patients in two practices for age, sex, multiple morbidity indexes, and secondary care outpatient and inpatient activity; 96 patients in each practice were studied for admission rate, occupied bed days and survival. Results Survivors from the ACP cohort (n = 80) had 510 fewer days in hospital than in the 12 months pre-intervention: a significant reduction of 52.0% (P = 0.020). There were 37 fewer admissions of the survivors from that cohort post-intervention than in the preceding 12 months, with a significant reduction of 42.5% (P = 0.002). Mortality rates in the two cohorts were similar, but the number of patients who died in hospital and the hospital bed days used in the last 3 months of life were significantly lower for the decedents with an ACP than for the controls who had died (P = 0.007 and P = 0.045 respectively). Conclusion This approach produced statistically significant reductions in unplanned hospitalisation for a cohort of patients with multiple morbidities. It demonstrates the potential for providing better care for patients as well as better value for health and social care services. It is of particular benefit in managing end-of-life care. PMID:22520788

  9. Commentary: The Challenge of Nonexperimental Interventions Studies in Social Work

    ERIC Educational Resources Information Center

    Schilling, Robert

    2010-01-01

    The challenging context of social work interventions require that most intervention studies will be derived from nonexperimental research designs. Two evaluation studies in this special issue employed nonrandomized designs to examine the efficacy of two programs--a police crisis intervention team designed to enhance officers' responses to mental…

  10. Effectiveness of intensive group and individual interventions for smoking cessation in primary health care settings: a randomized trial

    PubMed Central

    2010-01-01

    Objectives Primary: To compare the effectiveness of intensive group and individual interventions for smoking cessation in a primary health care setting; secondary: to identify the variables associated with smoking cessation. Methods Three-pronged clinical trial with randomisation at the individual level. We performed the following: an intensive individual intervention (III), an intensive group intervention (IGI) and a minimal intervention (MI). Included in the study were smokers who were prepared to quit smoking. Excluded from the study were individuals aged less than 18 years or with severe mental conditions or terminal illnesses. The outcome measure was continued abstinence at 12 months confirmed through CO-oximetry (CO). The analysis was based on intention to treat. Results In total, 287 smokers were recruited: 81 in the III, 111 in the IGI, and 95 in the MI. Continued abstinence at 12 months confirmed through CO was 7.4% in the III, 5.4% in the IGI, and 1% in the MI. No significant differences were noted between III and MI on the one hand, and between IGI and MI on the other [RR 7.04 (0.9-7.2) and RR 5.1 (0.6-41.9), respectively]. No differences were noted between IGI and III [RR 0.7 (0.2-2.2)]. In multivariate analysis, only overall visit length showed a statistically significant association with smoking cessation. Conclusions The effectiveness of intensive smoking interventions in this study was lower than expected. No statistically significant differences were found between the results of individual and group interventions. Trial registration number ISRCTN32323770 PMID:20178617

  11. A meta-analysis of hypnosis for chronic pain problems: a comparison between hypnosis, standard care, and other psychological interventions.

    PubMed

    Adachi, Tomonori; Fujino, Haruo; Nakae, Aya; Mashimo, Takashi; Sasaki, Jun

    2014-01-01

    Hypnosis is regarded as an effective treatment for psychological and physical ailments. However, its efficacy as a strategy for managing chronic pain has not been assessed through meta-analytical methods. The objective of the current study was to conduct a meta-analysis to assess the efficacy of hypnosis for managing chronic pain. When compared with standard care, hypnosis provided moderate treatment benefit. Hypnosis also showed a moderate superior effect as compared to other psychological interventions for a nonheadache group. The results suggest that hypnosis is efficacious for managing chronic pain. Given that large heterogeneity among the included studies was identified, the nature of hypnosis treatment is further discussed.

  12. A meta-analysis of hypnosis for chronic pain problems: a comparison between hypnosis, standard care, and other psychological interventions.

    PubMed

    Adachi, Tomonori; Fujino, Haruo; Nakae, Aya; Mashimo, Takashi; Sasaki, Jun

    2014-01-01

    Hypnosis is regarded as an effective treatment for psychological and physical ailments. However, its efficacy as a strategy for managing chronic pain has not been assessed through meta-analytical methods. The objective of the current study was to conduct a meta-analysis to assess the efficacy of hypnosis for managing chronic pain. When compared with standard care, hypnosis provided moderate treatment benefit. Hypnosis also showed a moderate superior effect as compared to other psychological interventions for a nonheadache group. The results suggest that hypnosis is efficacious for managing chronic pain. Given that large heterogeneity among the included studies was identified, the nature of hypnosis treatment is further discussed. PMID:24256477

  13. Primary care-based educational interventions to decrease risk factors for metabolic syndrome for adults with major psychotic and/or affective disorders: a systematic review

    PubMed Central

    2013-01-01

    Background Individuals with major psychotic and/or affective disorders are at increased risk for developing metabolic syndrome due to lifestyle- and treatment-related factors. Numerous pharmacological and non-pharmacological interventions have been tested in inpatient and outpatient mental health settings to decrease these risk factors. This review focuses on primary care-based non-pharmacological (educational or behavioral) interventions to decrease metabolic syndrome risk factors in adults with major psychotic and/or affective disorders. Methods The authors conducted database searches of PsychINFO, MEDLINE and the Cochrane Database of Systematic Reviews, as well as manual searches and gray literature searches to identify included studies. Results The authors were unable to identify any studies meeting a priori inclusion criteria because there were no primary care-based studies. Conclusions This review was unable to demonstrate effectiveness of educational interventions in primary care. Interventions to decrease metabolic syndrome risk have been demonstrated to be effective in mental health and other outpatient settings. The prevalence of mental illness in primary care settings warrants similar interventions to improve health outcomes for this population. PMID:24369749

  14. 5As Team obesity intervention in primary care: development and evaluation of shared decision-making weight management tools.

    PubMed

    Osunlana, A M; Asselin, J; Anderson, R; Ogunleye, A A; Cave, A; Sharma, A M; Campbell-Scherer, D L

    2015-08-01

    Despite several clinical practice guidelines, there remains a considerable gap in prevention and management of obesity in primary care. To address the need for changing provider behaviour, a randomized controlled trial with convergent mixed method evaluation, the 5As Team (5AsT) study, was conducted. As part of the 5AsT intervention, the 5AsT tool kit was developed. This paper describes the development process and evaluation of these tools. Tools were co-developed by the multidisciplinary research team and the 5AsT, which included registered nurses/nurse practitioners (n = 15), mental health workers (n = 7) and registered dieticians (n = 7), who were previously randomized to the 5AsT intervention group at a primary care network in Edmonton, Alberta, Canada. The 5AsT tool development occurred through a practice/implementation-oriented, need-based, iterative process during learning collaborative sessions of the 5AsT intervention. Feedback during tool development was received through field notes and final provider evaluation was carried out through anonymous questionnaires. Twelve tools were co-developed with 5AsT. All tools were evaluated as either 'most useful' or 'moderately useful' in primary care practice by the 5AsT. Four key findings during 5AsT tool development were the need for: tools that were adaptive, tools to facilitate interdisciplinary practice, tools to help patients understand realistic expectations for weight loss and shared decision-making tools for goal setting and relapse prevention. The 5AsT tools are primary care tools which extend the utility of the 5As of obesity management framework in clinical practice.

  15. 5As Team obesity intervention in primary care: development and evaluation of shared decision‐making weight management tools

    PubMed Central

    Asselin, J.; Anderson, R.; Ogunleye, A. A.; Cave, A.; Sharma, A. M.; Campbell‐Scherer, D. L.

    2015-01-01

    Summary Despite several clinical practice guidelines, there remains a considerable gap in prevention and management of obesity in primary care. To address the need for changing provider behaviour, a randomized controlled trial with convergent mixed method evaluation, the 5As Team (5AsT) study, was conducted. As part of the 5AsT intervention, the 5AsT tool kit was developed. This paper describes the development process and evaluation of these tools. Tools were co‐developed by the multidisciplinary research team and the 5AsT, which included registered nurses/nurse practitioners (n = 15), mental health workers (n = 7) and registered dieticians (n = 7), who were previously randomized to the 5AsT intervention group at a primary care network in Edmonton, Alberta, Canada. The 5AsT tool development occurred through a practice/implementation‐oriented, need‐based, iterative process during learning collaborative sessions of the 5AsT intervention. Feedback during tool development was received through field notes and final provider evaluation was carried out through anonymous questionnaires. Twelve tools were co‐developed with 5AsT. All tools were evaluated as either ‘most useful’ or ‘moderately useful’ in primary care practice by the 5AsT. Four key findings during 5AsT tool development were the need for: tools that were adaptive, tools to facilitate interdisciplinary practice, tools to help patients understand realistic expectations for weight loss and shared decision‐making tools for goal setting and relapse prevention. The 5AsT tools are primary care tools which extend the utility of the 5As of obesity management framework in clinical practice. PMID:26129630

  16. An Internet-Based Intervention for Depression in Primary Care in Spain: A Randomized Controlled Trial

    PubMed Central

    Montero-Marín, Jesús; Araya, Ricardo; Mayoral, Fermín; Gili, Margalida; Botella, Cristina; Baños, Rosa; Castro, Adoración; Romero-Sanchiz, Pablo; López-Del-Hoyo, Yolanda; Nogueira-Arjona, Raquel; Vives, Margarita; Riera, Antoni; García-Campayo, Javier

    2016-01-01

    Background Depression is the most prevalent cause of illness-induced disability worldwide. Face-to-face psychotherapeutic interventions for depression can be challenging, so there is a need for other alternatives that allow these interventions to be offered. One feasible alternative is Internet-based psychological interventions. This is the first randomized controlled trial (RCT) on the effectiveness of an Internet-based intervention on depression in primary health care in Spain. Objective Our aim was to compare the effectiveness of a low-intensity therapist-guided (LITG) Internet-based program and a completely self-guided (CSG) Internet-based program with improved treatment as usual (iTAU) care for depression. Methods Multicenter, three-arm, parallel, RCT design, carried out between November 2012 and January 2014, with a follow-up of 15 months. In total, 296 adults from primary care settings in four Spanish regions, with mild or moderate major depression, were randomized to LITG (n=96), CSG (n=98), or iTAU (n=102). Research completers at follow-up were 63.5%. The intervention was Smiling is Fun, an Internet program based on cognitive behavioral therapy. All patients received iTAU by their general practitioners. Moreover, LITG received Smiling is Fun and the possibility of psychotherapeutic support on request by email, whereas CSG received only Smiling is Fun. The main outcome was the Beck Depression Inventory-II at 3 months from baseline. Mixed-effects multilevel analysis for repeated measures were undertaken. Results There was no benefit for either CSG [(B coefficient=-1.15; P=.444)] or LITG [(B=-0.71; P=.634)] compared to iTAU, at 3 months. There were differences at 6 months [iTAU vs CSG (B=-4.22; P=.007); iTAU vs LITG (B=-4.34; P=.005)] and 15 months [iTAU vs CSG (B=-5.10; P=.001); iTAU vs LITG (B=-4.62; P=.002)]. There were no differences between CSG and LITG at any time. Adjusted and intention-to-treat models confirmed these findings. Conclusions An Internet

  17. [Epidemiological interventional study on controlling endemic arsenism].

    PubMed

    Li, Y

    1991-03-01

    Residents exposed to high arsenical water in Kuitum area of Xinjiang Autonomous Region were studied by on the spot interventional trial experiment. After ridding arsenic from drinking water, 82.43% of chronic arsenism were either cured or showed improvements of health conditions and no new' cases of arsenism developed during the experiment. The values of arsenic in patiens hair and urine decreased by drinking water free of arsenic, but remained higher than those of normal residents. Our results showed that drinking normal water could help to progressively eliminate arsenic storage from the chronic arsenism. By means of electromyograph (EMG), we found that the nerve conduction velocities of patients increased significantly (P less than 0.01) and that -SH reactivities of peripheral blood corpuscles of patients recovered to the normal level.

  18. Outcomes of Group Care for Youth: A Review of Comparative Studies

    ERIC Educational Resources Information Center

    Lee, Bethany R.; Bright, Charlotte L.; Svoboda, Deborah V.; Fakunmoju, Sunday; Barth, Richard P.

    2011-01-01

    Objective: The purpose of this study was to review empirical evidence of the effects of placement in group care compared to other interventions. Method: Two-group empirical studies were identified and effect sizes for all reported outcomes were calculated. Results: Nineteen two-group studies were found that compared group care with family foster…

  19. Impact of an Asha intervention on depressive symptoms among rural women living with AIDS in India: comparison of the Asha-Life and Usual Care program.

    PubMed

    Nyamathi, Adeline; Salem, Benissa E; Meyer, Visha; Ganguly, Kalyan K; Sinha, Sanjeev; Ramakrishnan, Padma

    2012-06-01

    The purpose of this randomized pilot study is to conduct an intervention with 68 rural women living with AIDS to compare the effectiveness of two different programs on depressive symptoms. The trial was designed to assess the impact of the Asha-Life intervention engaging with an HIV-trained village woman, Asha (Accredited Social Health Activist), to participate in the care of women living with AIDS (WLA), along with other health care providers compared to a Usual Care group. Two high prevalence HIV/AIDS villages in rural Andhra Pradesh, which were demographically alike and served by distinct Public Health Centers, were selected randomly from a total of 16 villages. The findings of this study demonstrated that the Asha-Life participants significantly reduced their depressive symptom scores compared to the Usual Care participants. Moreover, women living with AIDS who demonstrated higher depressive symptom scores at baseline had greater reduction in their depressive symptoms than women with lower scores.

  20. Development and implementation of a participative intervention to improve the psychosocial work environment and mental health in an acute care hospital

    PubMed Central

    Bourbonnais, R; Brisson, C; Vinet, A; Vézina, M; Lower, A

    2006-01-01

    Objectives To describe the development and implementation phases of a participative intervention aimed at reducing four theory grounded and empirically supported adverse psychosocial work factors (high psychological demands, low decision latitude, low social support, and low reward), and their mental health effects. Methods The intervention was realised among 500 care providers in an acute care hospital. A prior risk evaluation was performed, using a quantitative approach, to determine the prevalence of adverse psychosocial work factors and of psychological distress in the hospital compared to an appropriate reference population. In addition, a qualitative approach included observation in the care units, interviews with key informants, and collaborative work with an intervention team (IT) including all stakeholders. Results The prior risk evaluation showed a high prevalence of adverse psychosocial factors and psychological distress among care providers compared to a representative sample of workers from the general population. Psychosocial variables at work associated with psychological distress in the prior risk evaluation were high psychological demands (prevalence ratio (PR) = 2.27), low social support from supervisors and co‐workers (PR = 1.35), low reward (PR = 2.92), and effort‐reward imbalance (PR = 2.65). These results showed the empirical relevance of an intervention on the four selected adverse psychosocial factors among care providers. Qualitative methods permitted the identification of 56 adverse conditions and of their solutions. Targets of intervention were related to team work and team spirit, staffing processes, work organisation, training, communication, and ergonomy. Conclusion This study adds to the scarce literature describing the development and implementation of preventive intervention aimed at reducing psychosocial factors at work and their health effects. Even if adverse conditions in the psychosocial environment and

  1. A review of primary care interventions to improve health outcomes in adult survivors of adverse childhood experiences.

    PubMed

    Korotana, Laurel M; Dobson, Keith S; Pusch, Dennis; Josephson, Trevor

    2016-06-01

    Research has consistently demonstrated a link between the experience of adverse childhood experiences (ACEs) and adult health conditions, including mental and physical health problems. While a focus on the prevention or mitigation of adversity in childhood is an important direction of many programs, many individuals do not access support services until adulthood, when health problems may be fairly engrained. It is not clear which interventions have the strongest evidence base to support the many adults who present to services with a history of ACEs. The current review examines the evidence base for psychosocial interventions for adults with a history of ACEs. The review focuses on interventions that may be provided in primary care, as that is the setting where most patients will first present and are most likely to receive treatment. A systematic review of the literature was completed using PsycInfo and PubMed databases, with 99 studies identified that met inclusion and exclusion criteria. These studies evaluated a range of interventions with varying levels of supportive evidence. Overall, cognitive-behavioral therapies (CBT) have the most evidence for improving health problems - in particular, improving mental health and reducing health-risk behaviors - in adults with a history of ACEs. Expressive writing and mindfulness-based therapies also show promise, whereas other treatments have less supportive evidence. Limitations of the current literature base are discussed and research directions for the field are provided. PMID:27179348

  2. A review of primary care interventions to improve health outcomes in adult survivors of adverse childhood experiences.

    PubMed

    Korotana, Laurel M; Dobson, Keith S; Pusch, Dennis; Josephson, Trevor

    2016-06-01

    Research has consistently demonstrated a link between the experience of adverse childhood experiences (ACEs) and adult health conditions, including mental and physical health problems. While a focus on the prevention or mitigation of adversity in childhood is an important direction of many programs, many individuals do not access support services until adulthood, when health problems may be fairly engrained. It is not clear which interventions have the strongest evidence base to support the many adults who present to services with a history of ACEs. The current review examines the evidence base for psychosocial interventions for adults with a history of ACEs. The review focuses on interventions that may be provided in primary care, as that is the setting where most patients will first present and are most likely to receive treatment. A systematic review of the literature was completed using PsycInfo and PubMed databases, with 99 studies identified that met inclusion and exclusion criteria. These studies evaluated a range of interventions with varying levels of supportive evidence. Overall, cognitive-behavioral therapies (CBT) have the most evidence for improving health problems - in particular, improving mental health and reducing health-risk behaviors - in adults with a history of ACEs. Expressive writing and mindfulness-based therapies also show promise, whereas other treatments have less supportive evidence. Limitations of the current literature base are discussed and research directions for the field are provided.

  3. Effects of aromatherapy on the anxiety, vital signs, and sleep quality of percutaneous coronary intervention patients in intensive care units.

    PubMed

    Cho, Mi-Yeon; Min, Eun Sil; Hur, Myung-Haeng; Lee, Myeong Soo

    2013-01-01

    The purpose of this study was to investigate the effects of aromatherapy on the anxiety, sleep, and blood pressure (BP) of percutaneous coronary intervention (PCI) patients in an intensive care unit (ICU). Fifty-six patients with PCI in ICU were evenly allocated to either the aromatherapy or conventional nursing care. Aromatherapy essential oils were blended with lavender, roman chamomile, and neroli with a 6 : 2 : 0.5 ratio. Participants received 10 times treatment before PCI, and the same essential oils were inhaled another 10 times after PCI. Outcome measures patients' state anxiety, sleeping quality, and BP. An aromatherapy group showed significantly low anxiety (t = 5.99, P < .001) and improving sleep quality (t = -3.65, P = .001) compared with conventional nursing intervention. The systolic BP of both groups did not show a significant difference by time or in a group-by-time interaction; however, a significant difference was observed between groups (F = 4.63, P = .036). The diastolic BP did not show any significant difference by time or by a group-by-time interaction; however, a significant difference was observed between groups (F = 6.93, P = .011). In conclusion, the aromatherapy effectively reduced the anxiety levels and increased the sleep quality of PCI patients admitted to the ICU. Aromatherapy may be used as an independent nursing intervention for reducing the anxiety levels and improving the sleep quality of PCI patients.

  4. Caring School Leadership: A South African Study

    ERIC Educational Resources Information Center

    van der Vyver, Cornelius P.; van der Westhuizen, Philip C.; Meyer, L. W.

    2014-01-01

    The research pivoted on the question whether South African school principals fulfilled their caring role towards teachers. The aims of the study were threefold. First, to determine how principals rated their care-giving, secondly to determine whether significant discrepancies existed between principals' rating of their care-giving and…

  5. Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach

    PubMed Central

    Amador, Sarah; Mathie, Elspeth; Nicholson, Caroline

    2016-01-01

    In the United Kingdom, approximately a third of people with dementia live in long-term care facilities for adults, the majority of whom are in the last years of life. Working arrangements between health services and care homes in England are largely ad hoc and often inequitable, yet quality end-of-life care for people with dementia in these settings requires a partnership approach to care that builds on existing practice. This paper reports on the qualitative component of a mixed method study aimed at evaluating an organisational intervention shaped by Appreciative Inquiry to promote integrated working between visiting health care practitioners (i.e. General Practitioners and District Nurses) and care home staff. The evaluation uses a social identity approach to elucidate the mechanisms of action that underlie the intervention, and understand how organisational change can be achieved. We uncovered evidence of both (i) identity mobilisation and (ii) context change, defined in theory as mechanisms to overcome divisions in healthcare. Specifically, the intervention supported integrated working across health and social care settings by (i) the development of a common group identity built on shared views and goals, but also recognition of knowledge and expertise specific to each service group which served common goals in the delivery of end-of-life care, and (ii) development of context specific practice innovations and the introduction of existing end-of-life care tools and frameworks, which could consequently be implemented as part of a meaningful bottom-up rather than top-down process. Interventions structured around a Social Identity Approach can be used to gauge the congruence of values and goals between service groups without which efforts to achieve greater integration between different health services may prove ineffectual. The strength of the approach is its ability to accommodate the diversity of service groups involved in a given area of care, by valuing their

  6. Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach.

    PubMed

    Amador, Sarah; Goodman, Claire; Mathie, Elspeth; Nicholson, Caroline

    2016-01-01

    In the United Kingdom, approximately a third of people with dementia live in long-term care facilities for adults, the majority of whom are in the last years of life. Working arrangements between health services and care homes in England are largely ad hoc and often inequitable, yet quality end-of-life care for people with dementia in these settings requires a partnership approach to care that builds on existing practice. This paper reports on the qualitative component of a mixed method study aimed at evaluating an organisational intervention shaped by Appreciative Inquiry to promote integrated working between visiting health care practitioners (i.e. General Practitioners and District Nurses) and care home staff. The evaluation uses a social identity approach to elucidate the mechanisms of action that underlie the intervention, and understand how organisational change can be achieved. We uncovered evidence of both (i) identity mobilisation and (ii) context change, defined in theory as mechanisms to overcome divisions in healthcare. Specifically, the intervention supported integrated working across health and social care settings by (i) the development of a common group identity built on shared views and goals, but also recognition of knowledge and expertise specific to each service group which served common goals in the delivery of end-of-life care, and (ii) development of context specific practice innovations and the introduction of existing end-of-life care tools and frameworks, which could consequently be implemented as part of a meaningful bottom-up rather than top-down process. Interventions structured around a Social Identity Approach can be used to gauge the congruence of values and goals between service groups without which efforts to achieve greater integration between different health services may prove ineffectual. The strength of the approach is its ability to accommodate the diversity of service groups involved in a given area of care, by valuing their

  7. Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach.

    PubMed

    Amador, Sarah; Goodman, Claire; Mathie, Elspeth; Nicholson, Caroline

    2016-06-03

    In the United Kingdom, approximately a third of people with dementia live in long-term care facilities for adults, the majority of whom are in the last years of life. Working arrangements between health services and care homes in England are largely ad hoc and often inequitable, yet quality end-of-life care for people with dementia in these settings requires a partnership approach to care that builds on existing practice. This paper reports on the qualitative component of a mixed method study aimed at evaluating an organisational intervention shaped by Appreciative Inquiry to promote integrated working between visiting health care practitioners (i.e. General Practitioners and District Nurses) and care home staff. The evaluation uses a social identity approach to elucidate the mechanisms of action that underlie the intervention, and understand how organisational change can be achieved. We uncovered evidence of both (i) identity mobilisation and (ii) context change, defined in theory as mechanisms to overcome divisions in healthcare. Specifically, the intervention supported integrated working across health and social care settings by (i) the development of a common group identity built on shared views and goals, but also recognition of knowledge and expertise specific to each service group which served common goals in the delivery of end-of-life care, and (ii) development of context specific practice innovations and the introduction of existing end-of-life care tools and frameworks, which could consequently be implemented as part of a meaningful bottom-up rather than top-down process. Interventions structured around a Social Identity Approach can be used to gauge the congruence of values and goals between service groups without which efforts to achieve greater integration between different health services may prove ineffectual. The strength of the approach is its ability to accommodate the diversity of service groups involved in a given area of care, by valuing their

  8. A Primary Care-Based Early Childhood Nutrition Intervention: Evaluation of a Pilot Program Serving Low-Income Hispanic Women.

    PubMed

    Watt, Toni Terling; Appel, Louis; Lopez, Veronica; Flores, Bianca; Lawhon, Brittany

    2015-12-01

    Nutrition in early childhood can significantly impact physical and mental health outcomes for children. However, research on broadly defined pre/postnatal nutrition interventions is sparse. The present study is a process and outcome evaluation of a primary care-based nutrition intervention targeting low-income Hispanic women. Pregnant women enrolled in the program were in their first trimester and received services through their 6-month well child check. The program provided vouchers for fruits and vegetables from the local farmers' market, nutrition classes, cooking classes, and lactation counseling. We conducted a prospective study of program participants (n = 32) and a comparable group of women for whom the program was not available (n = 29). Panel survey data measured maternal diet, exercise, stress, depression, social support, infant feeding practices, and demographics. Outcome measures obtained from medical records included pregnancy weight gain, infant weight at 6 and 12 months, and infant development at 9 months. Findings reveal that the program was not associated with infant weights. However, despite similar profiles at baseline, women in the intervention group were more likely than women in the comparison group to have significant improvements in diet, exercise, and depression (p ≤ .05). In addition, participants were more likely to breastfeed (p = .07) and their infants were more likely to pass the ages and stages developmental screen (p = .06) than women in the comparison group. The study was limited by a lack of random assignment and small samples. However, the breadth and size of the effects suggest pre/postnatal nutrition interventions integrated into primary care warrant additional investigation. PMID:26863560

  9. A Primary Care-Based Early Childhood Nutrition Intervention: Evaluation of a Pilot Program Serving Low-Income Hispanic Women.

    PubMed

    Watt, Toni Terling; Appel, Louis; Lopez, Veronica; Flores, Bianca; Lawhon, Brittany

    2015-12-01

    Nutrition in early childhood can significantly impact physical and mental health outcomes for children. However, research on broadly defined pre/postnatal nutrition interventions is sparse. The present study is a process and outcome evaluation of a primary care-based nutrition intervention targeting low-income Hispanic women. Pregnant women enrolled in the program were in their first trimester and received services through their 6-month well child check. The program provided vouchers for fruits and vegetables from the local farmers' market, nutrition classes, cooking classes, and lactation counseling. We conducted a prospective study of program participants (n = 32) and a comparable group of women for whom the program was not available (n = 29). Panel survey data measured maternal diet, exercise, stress, depression, social support, infant feeding practices, and demographics. Outcome measures obtained from medical records included pregnancy weight gain, infant weight at 6 and 12 months, and infant development at 9 months. Findings reveal that the program was not associated with infant weights. However, despite similar profiles at baseline, women in the intervention group were more likely than women in the comparison group to have significant improvements in diet, exercise, and depression (p ≤ .05). In addition, participants were more likely to breastfeed (p = .07) and their infants were more likely to pass the ages and stages developmental screen (p = .06) than women in the comparison group. The study was limited by a lack of random assignment and small samples. However, the breadth and size of the effects suggest pre/postnatal nutrition interventions integrated into primary care warrant additional investigation.

  10. Workplace interventions to reduce HIV and TB stigma among health care workers - Where do we go from here?

    PubMed

    Siegel, Jacob; Yassi, Annalee; Rau, Asta; Buxton, Jane A; Wouters, Edwin; Engelbrecht, Michelle C; Uebel, Kerry E; Nophale, Letshego E

    2015-01-01

    Fear of stigma and discrimination among health care workers (HCWs) in South African hospitals is thought to be a major factor in the high rates of HIV and tuberculosis infection experienced in the health care workforce. The aim of the current study is to inform the development of a stigma reduction intervention in the context of a large multicomponent trial. We analysed relevant results of four feasibility studies conducted in the lead up to the trial. Our findings suggest that a stigma reduction campaign must address community and structural level drivers of stigma, in addition to individual level concerns, through a participatory and iterative approach. Importantly, stigma reduction must not only be embedded in the institutional management of HCWs but also be attentive to the localised needs of HCWs themselves. PMID:25769042

  11. Methodological Issues in Studies of the Effectiveness of Pressure Ulcer Prevention Interventions

    PubMed Central

    Baumgarten, Mona; Shardell, Michelle; Rich, Shayna

    2010-01-01

    PURPOSE To enhance the wound care practitioner's understanding of the research methods used to obtain information about the effectiveness of pressure ulcer prevention interventions. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After reading this article and taking this test, the reader should be able to: 1. Differentiate between randomized, historical, and nonrandomized comparison studies. 2. Explain terminology and concepts associated with pressure ulcer prevention research. PMID:19325278

  12. Case Studies in Neurocritical Care.

    PubMed

    Sakusic, Amra; Rabinstein, Alejandro A

    2016-08-01

    The practice of neurocritical care encompasses multiple acute neurologic and neurosurgical diseases and requires detailed knowledge of neurology and critical care. This article presents 5 cases that illustrate ju