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PubMed2004

[Nurse's confidence in addressing the discharge needs of disabled patient caregivers].

A challenge among nurses is giving appropriate counseling to the caregivers of disabled patients who are ready for discharge. This cross-sectional study was designed to determine levels of confidence among 413 nurses who perform this task in discharge planning units at one medical center and regional teaching hospitals in southern Taiwan. Participants were asked to fill out a questionnaire specifically designed for this study (Cronbach's alpha = .95). The data show: a) an average confidence score of 62.4 (S.D. = 15.04); b) a high-to-low order of scores regarding nursing confidence of providing medical care information (2.79) continuing care service (2.52) manpower services (2.07) and emotional support (2.02); c) according to the results a multiple regression analysis, the main predictors of confidence in this area are experience in dealing with disabled patients' discharge needs, nursing level, and administrative support (45.4% of total variance). It is hoped that this information will be of use to nurses and administrators involved in discharge planning, in-service education, and nursing education.

Adult↗
PubMed2004

A case study of telephone interpersonal counseling for women with breast cancer and their partners.

PURPOSE/OBJECTIVES: To present a case study of one woman with breast cancer and her partner to provide a firsthand account of an innovative telephone interpersonal counseling intervention. DATA SOURCES: Journal articles, book chapters, research data, and transcriptions of telephone counseling sessions. DATA SYNTHESIS: Substantial evidence exists that face-to-face psychosocial interventions improve psychological adjustment and health-related quality of life for patients with cancer. Yet psychosocial interventions are not offered routinely, and many patients with cancer do not use face-to-face counseling mechanisms. The telephone may be an innovative and effective method of delivering interventions, and telephone-delivered interpersonal counseling may be an especially effective intervention for women with breast cancer and their partners. CONCLUSIONS: Despite the fact that the telephone counseling occurred over a brief period of time, the woman and her partner in this case study reported substantial positive changes in their own distress (e.g., symptoms such as depression and anxiety) and the nature of their relationships with each other and their children. This is precisely the effect that would be predicted by interpersonal theories of psychological distress. These results were not atypical for other women and their partners who participated in the study. IMPLICATIONS FOR NURSING: Family members play a significant role in supporting women through the breast cancer experience; thus, nurses should assess the emotional distress of both partners during the course of treatment and, if needed, provide critical education and referral to psychosocial interventions. This woman and her partner clearly benefited from the intervention, resulting in improved symptom management and quality of life. Although this intervention requires additional training in the advanced practice nursing role, some techniques of the intervention can be used by all nurses, regardless of specialty training.

Absenteeism↗
PubMed2006

Effects of health counseling on behavioural risk factors in a high-risk cardiology outpatient population: a randomized clinical trial.

BACKGROUND: An evaluation study of an individual lifestyle advice intervention to reduce cardiovascular risk behaviours (high fat consumption, smoking, physical inactivity). METHODS: A randomized, controlled trial at the cardiology outpatient clinic of the University Hospital Maastricht. Participants were at high risk of incurring a cardiovascular event. Changes in risk behaviours and behavioural determinants were assessed with self-administered validated questionnaires. RESULTS: Questionnaires were completed by 1270 patients at baseline, 1169 after 4 months (92%), and 1032 after 18 months (81.3%). After 4 months, intention-to-treat analyses revealed a decrease in fat consumption (-5.6%, P = 0.000), a reduction in the percentage of smokers [odds ratio (OR) 0.57, 95% confidence intervals (CI) 0.33-0.97] and a trend towards a maintained physical activity level (OR 1.28, 95% CI 0.97-1.70). No long-term effects were found. CONCLUSION: The lifestyle advice intervention was potentially effective in changing cardiovascular risk behaviours, but should be further improved to be effective in secondary cardiovascular prevention. The main limitations of the study were related to the randomization procedure and the self-selection of patients and cardiologists.

Adult↗
PubMed2002

Basing pharmacy counselling on the perspective of the angina pectoris patient.

AIM OF THE STUDY: A participatory action research study design was developed and tested in 40 Danish internship pharmacies as part of a 3-year study supported by the Research Centre for Quality in Medicine Use. The aim of the study was to create a foundation for improving the quality of counselling practice in pharmacies by comparing the pharmacy staff's views on, knowledge of and behaviour towards a specific patient group with the knowledge, perceptions and medication use of the same patients. METHOD: Pharmacy students in their fourth year collected data for the study. In 1999, the students carried out 123 qualitative interviews with angina pectoris patients and collected 569 questionnaires from pharmacy staff in 40 internship pharmacies. RESULTS: The results indicate that discrepancies exist between the patients' and pharmacy staff's perspectives on important issues such as knowledge about medicines (patients)/provision of information about medicines (pharmacy staff), experienced side effects (patients)/information about side effects (pharmacy staff), knowledge on prevention and lifestyle (patients)/information on lifestyle and prevention (pharmacy staff) and expectations of pharmacies (patients)/initiatives started in pharmacies (pharmacy staff). CONCLUSION: The study gives reason to believe that angina pectoris patients might benefit if pharmacies provided more information on the relationship between lifestyle factors and angina pectoris, the possible side effects of medicines and the function of medicines.

Angina Pectoris↗
PubMed2005

Prompting primary providers to increase community exercise referrals for older adults: a randomized trial.

OBJECTIVES: To determine whether a clinic-based physical activity promotion intervention can lead to more community-based exercise referrals by providers and higher exercise motivation in patients. DESIGN: Cluster randomized, controlled trial. SETTING: Seattle Veterans Affairs General Internal Medicine Clinic. PARTICIPANTS: Thirty-one physicians and nurse practitioners were randomized to a physical activity counseling intervention or control condition (counseling about tobacco cessation). Three hundred thirty-six patients aged 50 and older and visiting a study provider were enrolled. INTERVENTION: Intervention providers were trained to offer referrals to community exercise programs for patients who reported before their clinic visit that they were "contemplative" about regular exercise. MEASUREMENTS: Process measures of health behavior assessment and provider advice, exercise stage-of-change, proportion of participants reporting regular physical activity. RESULTS: At baseline, 172 intervention patients and 164 controls were similar with respect to sex, age, comorbidity score, and exercise motivation level. Forty-five percent of all intervention patients and 35% of controls reported receiving exercise advice (P=.07). Intervention patients who were contemplative about exercise were even more likely to receive exercise advice than contemplative controls (59% vs 38%; P=.02). After 4 months, 35% of all intervention patients reported regular exercise, compared with 28% of controls (P=.06). CONCLUSION: Primary providers are more likely to offer exercise advice when informed whether patients are contemplative about exercise. Patients may be more likely to start regular exercise as a result of this advice.

Aged↗
PubMed2004

Voluntary HIV counseling and testing of pregnant women--an assessment of compliance with Michigan public health statutes.

OBJECTIVES: First, to evaluate compliance with Michigan's laws mandating universal, voluntary HIV counseling and testing (VCT) of all pregnant women who provide informed consent (ie, the "opt-out strategy"). Second, to assess the acceptability of and agreement to VCT. METHODS: Women who delivered a live infant at a large, urban academic medical center were interviewed before hospital discharge. Obstetric and prenatal medical records were abstracted to document that VCT was offered, accepted, or declined and that pre- and posttest counseling were provided and test results noted. RESULTS: Our survey of 491 postpartum women interviewed from February 1998 through January 1999 revealed that 83% reported that they were offered VCT; of those, 95% reported that they had agreed to testing. Uninsured women were least likely to undergo VCT; no other demographic, social, or behavioral characteristics were associated with VCT. Nor was VCT more likely to occur according to providers' different practice settings (ie, "private" vs publicly funded). Most women reported that they did not find VCT offensive or threatening, although only 49% reported that they felt "very comfortable," refusing testing. CONCLUSION: These results suggest the opt-out strategy for VCT, as currently practiced in Michigan, can effectively promote the US Public Health Service testing goals. Offering VCT with the understanding that it may be refused without risk is essential. Additional educational interventions about HIV infection during pregnancy and perinatal HIV-transmission interruption were requested by women in our study and should be widely promoted. Given that 95% of women agreed to VCT, mandatory testing without consent is not needed to achieve federal testing benchmarks and seems ethically problematic.

AIDS Serodiagnosis↗
PubMed2005

The cost of a rapid-test VCT clinic in South Africa.

CONTEXT: Demand for HIV voluntary counselling and testing (VCT) will increase as HIV prevention and treatment scale up in South Africa. Understanding the cost of delivering VCT will inform funding decisions. OBJECTIVE: To determine the cost per client completing VCT (pretest counselling, testing and post-test counselling) in a non-research- based programme using rapid-test technology. DESIGN: One year of expenditure and output data were collected retrospectively as part of the PANCEA (Prevent AIDS: Network for Cost-Effectiveness Analysis) study. Market prices were determined for donated resources. SETTING: An urban, church-based, non-profit organisation that offers rapid-test VCT services in KwaZulu-Natal, South Africa. RESULTS: Financial expenditure for the 2002/2003 fiscal year was 39,761 dollars (calculated using an average conversion rate for July 2003, which was 0.133). Using market prices for donated resources, the economic cost for the year was estimated at 67,248 dollars. Six hundred and sixty-two clients completed VCT, resulting in financial expenditure of 60.06 dollars per client and an economic cost of 101.58 dollars per client. Financial expenditures and economic costs per client decreased over the year by 66% because expenses remained stable as more clients were served. CONCLUSIONS: The cost of providing VCT services was higher than previously reported, but declined with expanding scale.

AIDS Serodiagnosis↗
PubMed2003

Effect of 7-year infancy-onset dietary intervention on serum lipoproteins and lipoprotein subclasses in healthy children in the prospective, randomized Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) study.

BACKGROUND: We previously showed that low-saturated-fat dietary intervention from infancy until 5 years of age safely and effectively reduced serum cholesterol concentration. We now report how such intervention influenced serum lipids, LDL particle size, and HDL subfractions in children when they reached the age of 7 years. METHODS AND RESULTS: Healthy 7-month-old infants (n=1062) were randomized to the intervention (n=540) and control (n=522) groups. Each year, two individualized counseling sessions were organized to the intervention families. Serum lipid values were measured annually. The intervention boys had 0.20 to 0.39 mmol/L lower serum cholesterol values than the control boys throughout the follow-up (always P<0.05), but the values of the intervention and control girls did not differ. The LDL particle sizes and HDL subfractions were determined in a random subgroup of 96 intervention and 101 control children at the age of 7 years. The mean particle diameter of major LDL peak was 262.6 A in the intervention boys and 258.5 A in the control boys (P=0.05), and 259.2 A in the intervention girls and 261.3 A in the control girls (P=0.30). HDL2 and HDL3 cholesterol concentrations did not differ between the intervention and control children or between the two genders. CONCLUSIONS: The 7-year intervention favorably influenced not only the serum total and LDL cholesterol concentrations but also the LDL particle size in boys. LDL particle size remained unchanged in girls, as did HDL2 and HDL3 concentrations in both genders.

Child↗
PubMed2005

[Views, practices, barriers, and the will to change, when counselling to give up smoking is being given].

OBJECTIVE: To get to know the opinions, current practices, perceived barriers and stage of change in respect to the smoking cessation advice (SCA) offered to patients by the different health professionals (HP) from primary care. DESIGN: Descriptive cross-sectional study. LOCATION: Area Sanitaria 9's Health Centers, in Madrid, Spain. PARTICIPANTS: 480 HPs, including primary care doctors, pediatricians, primary care residents, and nursery staff. MEASUREMENTS: Using a self-filled and anonymous questionnaire, we will gather sociodemographic variables and from the HP's office, regarding the attitudes towards tobacco, efficiency beliefs and use of strategies in the advice, and the perceived barriers to give it, as well as the state of change. RESULTS: 75.2% of the HPs filled the questionnaire (94.2%, 61.1%, 51.6%, and 88% by doctors, nurses, pediatricians, and residents respectively). 72% ask regularly, this rate increasing to 92.4% over tobacco-related diseases. No differences were made between sexes, professional types, tobacco habits, or previous attendance to courses. 85.8% offers tracing and 63.5% give written advices. Nearly 75% of non-smokers are considered social role models, that against only 40% of smokers. The main barriers found were lack of time and low motivation from the patients. 93.5% consider an specific education necessary to give efficient SCA. CONCLUSIONS: Inquiries are made and SCA is given, independently of the smoking habits of the SCA. Likewise, there is a good state of change by the HPs to optimize the treatment of tobacco dependency.

Cross-Sectional Studies↗
PubMed2006

A systematic review of motivational interviewing in physical health care settings.

PURPOSE: Motivational interviewing (MI), a method of augmenting an individual's motivation to change problematic behaviours, is a patient-centred counselling style that seeks to help patients resolve ambivalence about behaviour change. MI has successfully been used in the field of addictions and has recently received increased interest as a means of promoting treatment adherence in physical health care settings. This systematic review is aimed to evaluate the effectiveness of MI interventions in physical health care settings. METHODS: Electronic databases were searched for articles specifying the use of 'motivational interviewing' in physical health care settings between 1966 and April 2004. Fifty-one relevant abstracts were yielded and data was extracted from eight relevant selected studies. RESULTS: Eight studies were identified in the fields of diabetes, asthma, hypertension, hyperlipidaemia, and heart disease. The majority of studies found positive results for effects of MI on psychological, physiological, and life-style change outcomes. Problems with research in this area include: small sample sizes, lack of power, use of disparate multiple outcomes, inadequate validation of questionnaires, poorly-defined therapy and training. CONCLUSIONS: While MI has high face validity across a number of domains in physical health care settings, the general quality of trials in this area is inadequate and therefore recommendations for its dissemination in this area cannot yet be made. More research into MI applied to health behaviour change is urgently required.

Behavior Therapy↗
PubMed2005

Comparison of mothers' and counselors' perceptions of predelivery counseling for extremely premature infants.

OBJECTIVE: To understand mothers' and counselors' perceptions of their roles in decision-making about resuscitation of extremely premature infants at delivery and to assess mothers' and counselors' satisfaction with the counseling and decision-making process. METHODS: Mothers who delivered an infant between 22 and 27 completed weeks of gestation and their self-identified counselor were interviewed using a structured interview format. Mothers' and counselors' perceptions of the content, tone, and directiveness of predelivery counseling and their satisfaction with the decision-making process were compared. Demographic data were collected for the mothers, infants, and counselors. Simple descriptive statistics described demographic characteristics of mothers, counselors, and infants. Pearson's correlation coefficient was used to determine agreement within individual mother-counselor pairs about the content and directiveness of counseling. RESULTS: Thirty-three counselors and 15 mother-counselor pairs were interviewed. The majority (66.7%) of mothers stated that the counselor had made a treatment recommendation, and 60% stated that they had no choice in how their infant would be treated. Only 27.3% of counselors stated that they had made a recommendation, saying instead that they had described the treatment plan or offered options. Counselors believed that mothers were given a treatment choice in 57.6% of encounters. Specific mother-counselor pairs showed little correlation in their perceptions of whether a treatment recommendation had been made (R = 0.0) or a choice had been given about resuscitation (R = 0.07). Despite a lack of perceived choice, mothers generally believed that they were included in treatment decisions (66.7%) and were satisfied with the amount of influence that they had in the decision-making process (73.3%). CONCLUSIONS: The decision-making process in this study conforms most closely to a model of informed assent. Mothers may have been satisfied with this type of counseling because they felt informed and included in the decision-making process. Physicians and nurses need to elicit mothers' preferences to incorporate them into the treatment plan, as counseling about the resuscitation of extremely premature infants at delivery is considered directive by mothers even when it is not intended to be directive.

Adult↗
PubMed2004

Clinical practice characteristics and preconception counseling strategies of health care providers who recommend alcohol abstinence during pregnancy.

OBJECTIVE: National initiatives on fetal alcohol syndrome in Canada and the United States aimed at prevention, identification, and treatment of individuals who are affected by alcohol exposure in utero recommend that women abstain from consuming alcohol during pregnancy. Health care providers are key educators regarding appropriate alcohol use. The objective of this study was to describe characteristics of physicians who recommend alcohol abstinence during pregnancy with regard to knowledge of fetal alcohol syndrome and preconception counseling strategies. METHODS: A survey was mailed to Canadian physicians and midwives between 2001 and 2002. Participants consisted of a national random sample of 1090 Canadian obstetricians and gynecologists, midwives, and family physicians who were current members of provincial and national professional organizations. The main outcome measure was questionnaire responses to knowledge, prevention, and diagnosis of issues related to alcohol use during pregnancy. RESULTS: Response rates ranged from 31.1% among family physicians to 63.5% among midwives. Overall, 91.2% of providers recommended abstinence from alcohol during pregnancy. These providers were significantly more likely to believe that there is sufficient information about alcohol use and that clients were interested in discussing alcohol (p < 0.05). They were also significantly more likely to discuss depression, personal alcohol use, partner's use of alcohol, and family history of alcohol misuse with women of childbearing age (p < 0.05). Once a patient became pregnant, fewer practice differences were noted, although those who recommended alcohol abstinence were significantly more likely to take clinical action when pregnant patients were consuming moderate amounts of alcohol (p < 0.05). CONCLUSIONS: It is encouraging that almost 90% of Canadian health care providers recommend abstinence from alcohol during pregnancy. However, differences in clinical practice exist between providers who recommend alcohol abstinence during pregnancy as compared with those who recommend a "glass in moderation."

Alcohol Drinking↗
PubMed2004

Obesity among US immigrant subgroups by duration of residence.

CONTEXT: The prevalence of obesity has increased substantially since the 1980s. While immigrants are the fastest growing segment of the US population, little is known about obesity or clinician counseling about diet and exercise in this group. OBJECTIVES: To estimate the prevalence of obesity among immigrant subgroups and quantify the magnitude of the association with duration of US residence, and to describe reported diet and exercise counseling by birthplace, race, and ethnicity. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study using data from the 2000 National Health Interview Survey. MAIN OUTCOME MEASURES: Body mass index (BMI, measured as weight in kilograms divided by the square of height in meters) based on self-reported height and weight measurements, and self-reported rates of diet and exercise counseling. RESULTS: Of 32,374 respondents, 14% were immigrants. The prevalence of obesity was 16% among immigrants and 22% among US-born individuals. The age- and sex-adjusted prevalence of obesity was 8% among immigrants living in the United States for less than 1 year, but 19% among those living in the United States for at least 15 years. After adjusting for age, sociodemographic, and lifestyle factors, living in the United States for 10 to 15 and at least 15 years was associated with BMI increases of 0.88 and 1.39, respectively. The association for 15 years or more was significant for all immigrant subgroups except foreign-born blacks. Additionally, immigrants were less likely than US-born individuals to report discussing diet and exercise with clinicians (18% vs 24%, P<.001; 19% vs 23%, P<.001, respectively). These differences were not accounted for by sociodemographic characteristics, illness burden, BMI, or access to care among some subgroups of immigrants. CONCLUSIONS: Among different immigrant subgroups, number of years of residence in the United States is associated with higher BMI beginning after 10 years. The prevalence of obesity among immigrants living in the United States for at least 15 years approached that of US-born adults. Early intervention with diet and physical activity may represent an opportunity to prevent weight gain, obesity, and obesity-related chronic illnesses.

Adult↗
PubMed2006

"Tobacco Free With FDNY": the New York City Fire Department World Trade Center Tobacco Cessation Study.

CONTEXT: After the World Trade Center (WTC) collapse, 15% (1,767) of rescue workers from the Fire Department of the City of New York (FDNY) considered themselves to be current cigarette smokers. Post-WTC collapse, 98% reported acute respiratory symptoms, and 81% reported health concerns. Nonetheless, 29% of current smokers increased tobacco use, and 23% of ex-smokers resumed cigarette smoking. OBJECTIVE: To determine the effect of a comprehensive tobacco-cessation program using combination tobacco-dependency treatment medications adjusted to the individual's daily tobacco use. DESIGN: FDNY cigarette smokers enrolled in "Tobacco Free With FDNY," a no-cost quit-smoking program providing counseling, support, and medications. At the end of the 3-month treatment phase and at the 6-month and 12-month follow-up visits, abstinence rates were confirmed by expired carbon monoxide levels or by the verification of a household member. SETTING: FDNY Bureau of Health Services between August 1, 2002 and October 30, 2002. PARTICIPANTS: A total of 220 current cigarette smokers from the FDNY. RESULTS: At study enrollment, the mean (+/- SD) tobacco use was 20 +/- 7 cigarettes per day, and the mean tobacco dependency, as assessed by a modified Fagerstrom test score, was 6.7 +/- 2.5 (maximum score, 10). Based on tobacco use, 20% of enrollees used three types of nicotine medications, 64% used two types, 14% used one type, and 3% used no medications. Additionally, 14% of enrollees used bupropion sustained release. The confirmed continuous abstinence rates were 47%, 36%, and 37%, respectively, after 3 months of treatment and at the 6-month and 12-month follow-up. Abstinence rates did not correlate with the history of tobacco use but correlated inversely with tobacco dependency. Adverse events and maximal nicotine medication use were unrelated, and no one experienced a serious adverse event. CONCLUSION: Tobacco dependency treatment using combination nicotine medications is effective and safe. Future studies should consider the following: (1) both history of tobacco use and withdrawal symptoms to determine the number and dose of nicotine medications; and (2) continuing combination treatment for > 3 months.

Bupropion↗
PubMed2000

The net effects of the Project NetWork return-to-work case management experiment on participant earnings, benefit receipt, and other outcomes.

The Social Security Administration (SSA) initiated Project NetWork in 1991 to test case management as a means of promoting employment among persons with disabilities. The demonstration, which targeted Social Security Disability Insurance (DI) beneficiaries and Supplemental Security Income (SSI) applicants and recipients, offered intensive outreach, work-incentive waivers, and case management/referral services. Participation in Project NetWork was voluntary. Volunteers were randomly assigned to the "treatment" group or the "control" group. Those assigned to the treatment group met individually with a case or referral manager who arranged for rehabilitation and employment services, helped clients develop an individual employment plan, and provided direct employment counseling services. Volunteers assigned to the control group could not receive services from Project NetWork but remained eligible for any employment assistance already available in their communities. For both treatment and control groups, the demonstration waived specific DI and SSI program rules considered to be work disincentives. The experimental impact study thus measures the incremental effects of case and referral management services. The eight demonstration sites were successful in implementing the experimental design roughly as planned. Project NetWork staff were able to recruit large numbers of participants and to provide rehabilitation and employment services on a substantial scale. Most of the sites easily reached their enrollment targets and were able to attract volunteers with demographic characteristics similar to those of the entire SSI and DI caseload and a broad range of moderate and severe disabilities. However, by many measures, volunteers were generally more "work-ready" than project eligible in the demonstration areas who did not volunteer to receive NetWork services. Project NetWork case management increased average annual earnings by $220 per year over the first 2 years following random assignment. This statistically significant impact, an approximate 11-percent increase in earnings, is based on administrative data on earnings. For about 70 percent of sample members, a third year of followup data was available. For this limited sample, the estimated effect of Project NetWork on annual earnings declined to roughly zero in the third followup year. The findings suggest that the increase in earnings may have been short-lived and may have disappeared by the time Project NetWork services ended. Project NetWork did not reduce reliance on SSI or DI benefits by statistically significant amounts over the 30-42 month followup period. The services provided by Project NetWork thus did not reduce overall SSI and DI caseloads or benefits by substantial amounts, especially given that only about 5 percent of the eligible caseload volunteered to participate in Project NetWork. Project NetWork produced modest net benefits to persons with disabilities and net costs to taxpayers. Persons with disabilities gained mainly because the increases in their earnings easily outweighed the small (if any) reduction in average SSI and DI benefits. For SSA and the federal government as a whole, the costs of Project NetWork were not sufficiently offset by increases in tax receipts resulting from increased earnings or reductions in average SSI and DI benefits. The modest net benefits of Project NetWork to persons with disabilities are encouraging. How such benefits of an experimental intervention should be weighed against costs of taxpayers depends on value judgments of policymakers. Because different case management projects involve different kinds of services, these results cannot be directly generalized to other case management interventions. They are nevertheless instructive for planning new initiatives. Combining case and referral management services with various other interventions, such as longer term financial support for work or altered provider incentives, could produc

Adolescent↗
PubMed2006

Cost-effectiveness of a preventive counseling and support package for postnatal depression.

OBJECTIVES: This study reports the cost-effectiveness of a preventive intervention, consisting of counseling and specific support for the mother-infant relationship, targeted at women at high risk of developing postnatal depression. METHODS: A prospective economic evaluation was conducted alongside a pragmatic randomized controlled trial in which women considered at high risk of developing postnatal depression were allocated randomly to the preventive intervention (n = 74) or to routine primary care (n = 77). The primary outcome measure was the duration of postnatal depression experienced during the first 18 months postpartum. Data on health and social care use by women and their infants up to 18 months postpartum were collected, using a combination of prospective diaries and face-to-face interviews, and then were combined with unit costs ( pound, year 2000 prices) to obtain a net cost per mother-infant dyad. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics at alternative willingness to pay thresholds held by decision makers for preventing 1 month of postnatal depression. RESULTS: Women in the preventive intervention group were depressed for an average of 2.21 months (9.57 weeks) during the study period, whereas women in the routine primary care group were depressed for an average of 2.70 months (11.71 weeks). The mean health and social care costs were estimated at pounds sterling 2,396.9 per mother-infant dyad in the preventive intervention group and pounds sterling 2,277.5 per mother-infant dyad in the routine primary care group, providing a mean cost difference of pounds sterling 119.5 (bootstrap 95 percent confidence interval [CI], -535.4, 784.9). At a willingness to pay threshold of pounds sterling 1,000 per month of postnatal depression avoided, the probability that the preventive intervention is cost-effective is .71 and the mean net benefit is pounds sterling 383.4 (bootstrap 95 percent CI, - pounds sterling 863.3- pounds sterling 1,581.5). CONCLUSIONS: The preventive intervention is likely to be cost-effective even at relatively low willingness to pay thresholds for preventing 1 month of postnatal depression during the first 18 months postpartum. Given the negative impact of postnatal depression on later child development, further research is required that investigates the longer-term cost-effectiveness of the preventive intervention in high risk women.

Cost-Benefit Analysis↗
PubMed2003

The role of adherence on the effectiveness of nonpharmacologic interventions: evidence from the delirium prevention trial.

BACKGROUND: The impact of adherence on outcome for a nonpharmacologic intervention strategy has not been previously examined. OBJECTIVE: To examine the impact of level of adherence on effectiveness of the intervention strategy in a large clinical trial of nonpharmacologic interventions to prevent delirium. METHODS: The subjects included 422 consecutive patients 70 years or older admitted to the medicine service at a university hospital. The intervention protocols were targeted toward 6 delirium risk factors. The primary outcome was new-onset delirium during hospitalization. RESULTS: During 9882 patient-days, complete adherence rates for individual intervention protocols ranged from 10% for the sleep protocol to 86% for the orientation protocol. The rate of complete adherence with all protocols was 57%, and combined partial and complete adherence was 87%. Higher levels of adherence resulted in lower delirium rates, with a significant graded effect, for orientation, mobility, and therapeutic activities protocols, and for the composite adherence measure. After controlling for potential confounding variables, such as illness severity, comorbidity, baseline delirium risk, and functional status, adherence continued to demonstrate a consistently strong and significant protective effect against delirium (adjusted odds ratio, 0.69; 95% confidence interval, 0.56-0.87). Patients in the highest adherence group demonstrated an 89% reduction in delirium risk compared with patients in the lowest group. CONCLUSIONS: Adherence played an important independent role in the effectiveness of a nonpharmacologic multicomponent intervention strategy. Higher levels of adherence resulted in reduced rates of delirium in a directly graded fashion, with extremely low levels of delirium in the highest adherence group. Thus, adherence must be ensured in nonpharmacologic interventions to optimize effectiveness.

Aged↗