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PubMedDate not supplied

Review of computer-generated outpatient health behavior interventions: clinical encounters "in absentia".

OBJECTIVE: To evaluate evidence of the effectiveness of computer-generated health behavior interventions-clinical encounters "in absentia"-as extensions of face-to-face patient care in an ambulatory setting. DATA SOURCES: Systematic electronic database and manual searches of multiple sources (1996-1999) plus search for gray literature were conducted to identify clinical trials using computer-generated health behavior interventions to motivate individuals to adopt treatment regimens, focusing on patient-interactive interventions and use of health behavior models. STUDY SELECTION: Eligibility criteria included randomized controlled studies with some evidence of instrument reliability and validity; use of at least one patient-interactive targeted or tailored feedback, reminder, or educational intervention intended to influence or improve a stated health behavior; and an association between one intervention variable and a health behavior. DATA EXTRACTION: Studies were described by delivery device (print, automated telephone, computer, and mobile communication) and intervention type (personalized, targeted, and tailored). We employed qualitative methods to analyze the retrieval set and explore the issue of patient interactive computer-generated behavioral intervention systems. DATA SYNTHESIS: Studies varied widely in methodology, quality, subject number, and characteristics, measurement of effects and health behavior focus. Of 37 eligible trials, 34 (91.9 percent) reported either statistically significant or improved outcomes. Fourteen studies used targeted interventions; 23 used tailored. Of the 14 targeted intervention studies, 13 (92.9 percent) reported improved outcomes. Of the 23 tailored intervention studies, 21 (91.3 percent) reported improved outcomes. CONCLUSIONS: The literature indicates that computer-generated health behavior interventions are effective. While there is evidence that tailored interventions can more positively affect health behavior change than can targeted, personalized or generic interventions, there is little research comparing different tailoring protocols with one another. Only those studies using print and telephone devices reported a theoretic basis for their methodology. Future studies need to identify which models are best suited to which health behavior, whether certain delivery devices are more appropriate for different health behaviors, and how ambulatory care can benefit from patients' use of portable devices.

Ambulatory Care↗
PubMed2005

Prevention of work related eye injuries: long term assessment of the effectiveness of a multicomponent intervention among metal workers.

BACKGROUND: Systematic assessments of the effectiveness of interventions to prevent work related eye injuries are needed. AIM: To investigate the long term effectiveness of a multicomponent prevention campaign. METHODS: The campaign (conducted in collaboration with the local Employers' Association and Trade Unions) targeted all 237 metal-ware factories in the district of Imola, Italy. Based on preliminary inspections, the main intervention included distribution to all factories of specific educational brochures and broadcasting/publication of television/radio programmes and local newspaper articles containing expert advice on the subject. This was followed by a four year "post-intervention reinforcement" period of unannounced official inspections. Main outcome measures analysed were eye injury rates (versus non-eye injury rates) among metal workers during "pre-intervention" (1988-90), "peri-intervention" (1991-92), "post-intervention reinforcement" (1993-96), "late post-intervention" (1997-2000), and "very late post-intervention" (2001-03) periods with respect to two comparison sectors (construction and wood/ceramics). RESULTS: A Poisson regression in which the eye injury rates were modelled for each sector, period, and interaction, adjusting for non-eye injury rates, was chosen. The periods did not by themselves determine an overall reduction in eye injuries. The period/sector interaction terms were related to significant reductions for the metal sector when crossed with the "post-intervention reinforcement" (IRR = 0.77, 95% CI 0.61 to 0.97; % decline = 23.4), the "late post-intervention" (IRR = 0.63, 95% CI 0.50 to 0.79; % decline = 37.4), and the "very late post-intervention" (IRR = 0.58, 95% CI 0.43 to 0.77; % decline = 42.4) periods, suggesting a sustained reduction in eye injury risk following the main intervention. CONCLUSION: Results suggest that a carefully coordinated, extensive, multicomponent intervention can lead to lasting reductions in the burden of eye injuries.

Accidents, Occupational↗
PubMed2006

Impact of internal mammary artery conduit on long-term outcomes after percutaneous intervention of saphenous vein graft.

BACKGROUND: The influence of an internal mammary artery (IMA) graft on long-term outcomes after percutaneous saphenous vein graft (SVG) intervention is currently unknown. METHODS AND RESULTS: To examine the impact of IMA on outcomes in patients undergoing SVG interventions, we analyzed 2119 patients from the Duke Cardiovascular Disease Database (1986-2003) with prior coronary artery bypass surgery undergoing cardiac catheterization who had at least 1 SVG graft. Patients were categorized into 4 groups: group I, SVG intervention and patent IMA; group II, no SVG intervention and patent IMA; group III, SVG intervention without patent IMA; and group IV, no SVG intervention without patent IMA. At a median follow-up of 4.8 years (interquartile range, 2.1 to 8.8 years), adjusted survival rates in groups I, II, III, and IV were 72.8%, 72.3%, 64.5%, and 58.9%, respectively. Multivariate Cox proportional hazards modeling showed similar survival for groups I and II (P=0.63) and for groups III and IV (P=0.33). The presence of IMA graft was related to lower long-term mortality (adjusted hazard ratio [HR], 0.69; 95% CI, 0.58 to 0.82), whereas SVG intervention was not associated with long-term mortality (adjusted HR, 0.94; 95% CI, 0.81 to 1.10). In contrast, the adjusted event-free rates for nonfatal myocardial infarction were lower in the SVG intervention groups (groups I and III) than in the non-SVG intervention groups (groups II and IV) (HR for SVG intervention versus no SVG intervention, 3.19; 95% CI, 2.18 to 4.66), with the presence of patent IMA conferring no significant benefit on this outcome (HR, 1.37; 95% CI, 0.91 to 2.08). CONCLUSIONS: In patients undergoing SVG interventions, survival, but not nonfatal myocardial infarction, is favorably influenced by the presence of patent IMA. In contrast, SVG intervention had no measurable survival benefit but was associated with an increased risk of nonfatal myocardial infarction.

Aged↗
PubMed1991

A review of social interventions for students with learning disabilities.

Twenty-two studies are reviewed that report the effects of social skills training and intervention with 572 children identified as learning disabled between 5 and 19 years of age. These studies are reviewed to examine characteristics and components of intervention effectiveness. Age and sex of subjects, grade grouping, group size, intervention duration, intervention procedures, subject selection, and type of interventional model are examined to find patterns that reflect intervention success. Several intervention characteristics and components are associated with social intervention effectiveness: selecting subjects who had social skills difficulties or low peer acceptance, using cognitive-behavioral intervention procedures, providing individual or small group instruction, and applying long-term intervention and training. Discussion focuses on difficulties in comparing studies to determine intervention effectiveness through the examination of outcome measures, a call for revisions in future reporting of social interventions in the literature, and those intervention factors that relate to increases in peer acceptance.

Adolescent↗
PubMed2004

Meta-analysis of interventions for medication adherence to antihypertensives.

OBJECTIVE: To identify methods targeted at improving adherence to antihypertensives and determine their effect on adherence using meta-analytic techniques. METHODS: A literature search from 1970 to December 2000 using MEDLINE, International Pharmaceutical Abstracts, PsychLit, ERIC, and EMBASE was performed using the terms compliance, adherence, and medication. Randomized articles with an intervention directed at a patient/caregiver, a comparator group, and a minimum of 10 subjects in each intervention group were identified by 3 independent reviewers. Articles that did not report sample size data or adequate results of the intervention were excluded. Sixteen citations focusing on antihypertensive adherence were identified. Of the 16 citations, 6 studied either more than one intervention in the same population or different interventions in different patient populations, yielding 24 cohorts with 2446 patients. RESULTS: Fifty-eight percent of the methods focused on behavioral interventions (BIs), 29% studied the effect of a combination of behavioral and educational interventions (BEIs), and 13% utilized educational interventions (EIs) alone. Overall, the study groups were nonhomogenous (Q = 183.92; p < 0.001). However, when the groups were separated by the intervention type, the BIs were homogenous (Q = 1.19; p = 1.00) with an overall effect size (ES) of 0.04 (95% CI -0.01 to -0.09), indicating a trend toward improved adherence. Fifty percent of the BIs were performed in the physician's office; however, setting did not influence the intervention's impact (p = 0.13). Within the BIs, no single intervention improved adherence over others. CONCLUSIONS: Based on the interventions included in this meta-analysis, there is no single intervention that improves adherence to antihypertensives over others; therefore, a patient-specific approach should be modeled.

Antihypertensive Agents↗
PubMed2001

Persuading school-age cyclists to use safety helmets: Effectiveness of an intervention based on the Theory of Planned Behaviour.

OBJECTIVES: To design and evaluate a theory-based intervention to encourage the use of protective helmets in school-age cyclists. DESIGN: Two-by-three mixed design on 97 cyclists who did not initially use a helmet: Condition (intervention/control) x Time (pre-intervention/immediately post-intervention/5-month follow-up). METHOD: The intervention builds on a previous study using the Theory of Planned Behaviour in which we identified a small number of salient beliefs that predict intention to use a safety helmet and helmet use (Quine et al., 1998). Participants were randomly assigned to intervention or control conditions. The intervention group was presented with a booklet containing a series of persuasive messages based on the identified salient beliefs, and the control group was presented with a different series of messages concerning a cycling proficiency and bicycle maintenance course. Initial beliefs were measured just before the intervention at Time 1, by questionnaire. The immediate effects of the intervention were evaluated by questionnaire at Time 2. Five months later, at Time 3, the long-term effects of the intervention on beliefs, intentions, and behaviour were assessed. RESULTS: The behavioural, normative and control beliefs and intentions of intervention participants became more positive than those of control participants, and the effect was maintained over time. There was also a significant effect on behaviour: at 5-month follow-up, none of the 49 control children had taken up helmet wearing, while 12 (25%) of the 48 intervention children had. CONCLUSIONS: The results suggest that in order to promote lasting helmet use in young cyclists, we need to change their beliefs. The intervention reported here may present an inexpensive solution to the problem of persuading adolescents to use safety helmets. The results point to the value of social cognition theories such as the Theory of Planned Behaviour in the design of effective interventions to change health behaviours.

Journal Article↗
PubMed2006

Smoking prevention and cessation intervention delivery by pediatric providers, as assessed with patient exit interviews.

OBJECTIVE: The goal was to evaluate the degree to which a smoking prevention and cessation intervention was delivered by providers to adolescents in the pediatric office setting. METHODS: Eight pediatric clinics in central Massachusetts were assigned randomly to either a special intervention (brief pediatric provider-delivered intervention plus peer counseling) or the usual care condition. Subjects (n = 2710) were adolescents 13 to 17 years of age, both smokers (smoked in the past 30 days) and nonsmokers/former smokers. The degree to which smoking prevention and treatment interventions were delivered by providers was assessed through patient exit interviews with adolescents after their clinic visits; interviews assessed the occurrence of 10 possible intervention steps. RESULTS: The percentage of providers engaging in the smoking interventions differed significantly between the special intervention and usual care conditions, according to adolescent reports in the patient exit interviews. For nonsmokers/former smokers, overall patient exit interview scores were 7.24 for the special intervention condition and 4.95 for the usual care condition. For current smokers, overall patient exit interview scores were 8.40 and 6.24 for the special intervention and usual care conditions, respectively. Intervention fidelity of special intervention providers was 72.2% and 84.0% for nonsmokers/former smokers and current smokers, respectively. CONCLUSIONS: Pediatric providers who receive training and reminders to deliver a brief smoking prevention and cessation intervention to adolescents in the context of routine pediatric primary care practice can do so feasibly and with a high degree of fidelity to the intervention protocol.

Adolescent↗
PubMed2002

Return-to-work interventions for low back pain: a descriptive review of contents and concepts of working mechanisms.

Low back pain is a major medical and social problem associated with disability, work absenteeism and high costs. Given the impact of the problem, there is a need for effective treatment interventions in occupational healthcare that aim at the prevention of chronic disability and the realisation of return to work. These so-called return-to-work (RTW) interventions are becoming increasingly popular. As well as questions concerning the effectiveness of RTW interventions, there are also important questions on the actual content and underlying concepts of these multifactorial intervention strategies. The purpose of this review is to examine the literature on the content and underlying concepts of RTW interventions for low back pain. A systematic literature search identified 14 randomised controlled trials (RCTs) evaluating the effects of 19 RTW interventions. The content and concepts of these RTW interventions are described, compared and discussed in this review. Further, the contents of the RTW interventions are classified by the use of predefined components (physical exercises, education, behavioural treatments and ergonomic measures). The identified RTW interventions varied with respect to the disciplines involved, the target population and the number and duration of sessions. The classification showed that physical exercises were a component of most of the selected interventions, followed by education, behavioural treatments and ergonomic measures. The most prevalent combination of components was the combination of physical exercises, behavioural treatment and education. However, the types of physical exercises, behavioural treatment and education varied widely among the RTW interventions. The described concepts for the physical exercises were an increase of muscle strength, coordination, range of motion of the spine and cardiovascular fitness, and a decrease of muscle tension. Education as a part of RTW interventions is believed to increase the understanding of patients regarding their disorder and treatment. Behavioural treatments were mainly based on the gate control theory of pain (psychophysiological processes are involved in pain perception) and/or the operant conditioning hypothesis (pain behaviour is determined by its consequences). No concepts were described for ergonomic measures. Finally, the plausibility of the described concepts is discussed. Future RCTs on this topic should evaluate the underlying concepts of the RTW intervention in addition to its effectiveness.

Absenteeism↗
PubMed2006

Why are health care interventions delivered over the internet? A systematic review of the published literature.

BACKGROUND: As Internet use grows, health interventions are increasingly being delivered online. Pioneering researchers are using the networking potential of the Internet, and several of them have evaluated these interventions. OBJECTIVE: The objective was to review the reasons why health interventions have been delivered on the Internet and to reflect on the work of the pioneers in this field in order to inform future research. METHODS: We conducted a qualitative systematic review of peer-reviewed evaluations of health interventions delivered to a known client/patient group using networked features of the Internet. Papers were reviewed for the reasons given for using the Internet, and these reasons were categorized. RESULTS: We included studies evaluating 28 interventions plus 9 interventions that were evaluated in pilot studies. The interventions were aimed at a range of health conditions. Reasons for Internet delivery included low cost and resource implications due to the nature of the technology; reducing cost and increasing convenience for users; reduction of health service costs; overcoming isolation of users; the need for timely information; stigma reduction; and increased user and supplier control of the intervention. A small number of studies gave the existence of Internet interventions as the only reason for undertaking an evaluation of this mode of delivery. CONCLUSIONS: One must remain alert for the unintended effects of Internet delivery of health interventions due to the potential for reinforcing the problems that the intervention was designed to help. Internet delivery overcomes isolation of time, mobility, and geography, but it may not be a substitute for face-to-face contact. Future evaluations need to incorporate the evaluation of cost, not only to the health service but also to users and their social networks. When researchers report the outcomes of Internet-delivered health care interventions, it is important that they clearly state why they chose to use the Internet, preferably backing up their decision with theoretical models and exploratory work. Evaluation of the effectiveness of a health care intervention delivered by the Internet needs to include comparison with more traditional modes of delivery to answer the following question: What are the added benefits or disadvantages of Internet use that are particular to this mode of delivery?

Delivery of Health Care↗
PubMedDate not supplied

Evaluation of a community-based intervention to promote physical activity in youth: lessons from Active Winners.

PURPOSE: To test the effects of a community-based physical activity intervention designed to increase physical activity and to conduct an extensive process evaluation of the intervention. DESIGN: Quasi-experimental. SETTING: Two rural communities in South Carolina. One community received the intervention, and the other served as the comparison. SUBJECTS: Public school students who were in fifth grade at the start of the study (558 at baseline) were eligible to participate. A total of 436 students participated over the course of the study. INTERVENTION: The intervention included after-school and summer physical activity programs and home, school, and community components designed to increase physical activity in youth. The intervention took place over an 18-month period. MEASURES: Students reported after-school physical activity at three data collection points (prior to, during, and following the intervention) using the Previous Day Physical Activity Recall (PDPAR). They also completed a questionnaire designed to measure hypothesized psychosocial and environmental determinants of physical activity behavior. The process evaluation used meeting records, documentation of program activities, interviews, focus groups, and heart rate monitoring to evaluate the planning and implementation of the intervention. RESULTS: There were no significant differences in the physical activity variables and few significant differences in the psychosocial variables between the intervention and comparison groups. The process evaluation indicated that the after-school and summer physical activity component of the intervention was implemented as planned, but because of resource and time limitations, the home, school, and community components were not implemented as planned. CONCLUSIONS: The intervention did not have a significant effect on physical activity in the target population of children in the intervention community. This outcome is similar to that reported in other studies of community-based physical activity intervention.

Child↗
PubMedDate not supplied

A site-specific literature review of policy and environmental interventions that promote physical activity and nutrition for cardiovascular health: what works?

OBJECTIVE: To review the literature to determine whether policy and environmental interventions can increase people's physical activity or improve their nutrition. DATA SOURCES: The following databases were searched for relevant intervention studies: Medline, Chronic Disease Prevention File, PsychInfo, Health Star, Web of Science, ERIC, the U.S. Department of Transportation, and the U.S. Department of Agriculture. STUDY SELECTION: To be included in the review, studies must have (1) addressed policy or environmental interventions to promote physical activity and/or good nutrition; (2) been published from 1970 to October 2003; (3) provided a description of the intervention; and (4) reported behavioral, physiological, or organizational change outcomes. Studies that had inadequate intervention descriptions or that focused on determinants research, individual-level interventions only, the built environment, or media-only campaigns were excluded. DATA EXTRACTION: We extracted and summarized studies conducted before 1990 (n = 65) and during 1990-2003 (n = 64). DATA SYNTHESIS: Data were synthesized by topic (i.e., physical activity or nutrition), by type of intervention (i.e., point-of-purchase), and by setting (i.e., community, health care facility, school, worksite). Current studies published during 1990-2003 are described in more detail, including setting and location, sample size and characteristics, intervention, evaluation period, findings, and research design. Findings are also categorized by type of intervention to show the strength of the study designs and the associations of policy and environmental interventions with physical activity and nutrition. CONCLUSIONS: The results of our review suggest that policy and environmental strategies may promote physical activity and good nutrition. Based on the experimental and quasi-experimental studies in this review, the following interventions provide the strongest evidence for influencing these behaviors: prompts to increase stair use (N = 5); access to places and opportunities for physical activity (N = 6); school-based physical education (PE) with better-trained PE teachers, and increased length of time students are physically active (N = 7); comprehensive work-site approaches, including education, employee and peer support for physical activity, incentives, and access to exercise facilities (N = 5); the availability of nutritious foods (N = 33), point-of-purchase strategies (N = 29); and systematic officer reminders and training of health care providers to provide nutritional counseling (N = 4). Further research is needed to determine the long-term effectiveness of different policy and environmental interventions with various populations and to identify the steps necessary to successfully implement these types of interventions.

Adult↗
PubMed2000

[Application of cost-effectiveness analysis of health care interventions in developing countries. A case study in Mauritius].

OBJECTIVE: Cost-effectiveness analysis is a tool to help inform the decision maker of efficient allocation of scarce health care resources and its application has increased in developing countries during the past decade. There are, however, a variety of different approaches used to calculate cost-effectiveness ratios, given the range and the controversies surrounding the use of some components of total cost, depending on the constraints faced by various decision-making bodies. This study is an investigation of cost-effectiveness of both currently delivered and prospective health interventions in Mauritius to set priorities and assess allocative efficiency by taking into account such constraints. METHODS: Resource use and unit cost data were collected from the representative health facilities and the Ministry of Health to estimate costs of each health intervention per person. Effectiveness of each intervention was estimated from the results of the national burden of disease study and the efficacy database compiled for this exercise. Several types of cost-effectiveness were calculated for each intervention according to its characteristics and the constraints imposed by the existing infrastructures and other health interventions. RESULTS: Cost-effectiveness ratios with and without the decision maker's constraints differed significantly. Infrastructure-constrained average cost-effectiveness of thirteen currently delivered and twenty one prospective interventions ranged from $127 to $92,949 and from $77 to $66,302 per DALY averted, respectively. Incremental cost-effectiveness of the prospective interventions was from $83 to $70,553. Among the currently delivered interventions, those for perinatal disorders, mental illness, and ischemic heart disease were particularly less cost-effective than the prospective interventions. Sensitivity analysis of both effectiveness and discount rates did not change the cost-effectiveness ranking significantly. CONCLUSION: The present study showed that cost-effectiveness ratios differ significantly depending on the decision maker's constraints and that an interpretation of each cost-effectiveness study should be made with great caution when implementing its results in practice. Both average cost-effectiveness of the currently delivered interventions and incremental cost-effectiveness of the prospective interventions suggest that there is an allocative inefficiency among the currently delivered health interventions in Mauritius and a possibility of enhancing allocative efficiency through introducing alternative interventions.

Cost-Benefit Analysis↗
PubMedDate not supplied

Sudden rate drop intervention rate level in patients with new 'clarity' pacemakers and carotid sinus syndrome.

BACKGROUND: In patients in whom syncopal episodes are mainly caused by occasional drops in heart rate, Sudden Rate Drop intervention feature intends to provide high rate intervention pacing. New Vitatron Medical B.V. pacemaker system Clarity DDDR, provides AN option FOR recognizing Sudden Rate Drop and responding by intervention pacing until it detects the recovering. MATERIAL AND METHODS: In patients with carotid sinus syndrome it is possible to provoke this situation BY sinus carotidus massage. We have implanted 10 of these devices in our center, 2 of which in patients with hypersensitive carotid sinus syndrome. In both patients, we activated sudden rate drop intervention on DDD mode pacing and applied protocol for testing the necessary level of Sudden Rate Drop Intervention Rate. Both patients gave their informed consent to be submitted to this testing. Pacemaker software assumes rate intervention level of 110 bpm. We tested our patients for rate levels of 90 and 110 bpm. Massaging the carotid sinus during 5 seconds, we provoked Sudden Rate Drop Intervention 10 times, in each patient, 5 times at intervention rate of 90 and 5 times at 110 bpm. Patients were unaware of the programmed intervention rate and were merely expected to report any different sensations experienced during the testing. RESULTS: In all 20 tests, pacemaker responded to sudden rate drop elicited by carotid sinus massage (100%), which was verified by selected event recordings. After the massage, neither of the patients registered any sensations at sudden rate drop intervention rate level of 90 bpm in a total od 10 tests (100%), while 8 out of 10 massages at 110 bpm intervention rate provoked palpitations (80%). On the grounds of this testing, we concluded that lowering of Sudden Rate Drop Intervention Rate Level from 110 BPM to 90 BPM does not affect the reliability of system reaction, but changes patient's awareness of heart beats. CONCLUSION: As a final conclusion, it should be said that basic prerogatives of a pacing system: safety and efficacy with minimal energy consumption, and in this case, quality of life option that a patients practically does not feel intervention when it occurs, are all met.

Awareness↗
PubMed2002

[Interventions to improve the management of diabetes mellitus in primary health care and outpatient community settings].

UNLABELLED: This review should be cited as: Renders CM, Valk GD, Griffin S. Wagner EH, Eijk JThM van, Assendelft WJJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings (Cochrane Review). In: The Cochrane Library, Issue 2, 2001. Oxford: Update Software. A substantive amendment to this systematic review was last made on 29 June 2000. Cochrane reviews are regularly checked and updated if necessary. BACKGROUND: Diabetes is a common chronic disease that is increasingly managed in primary care. Different systems have been proposed to manage diabetes care. OBJECTIVES: To assess the effects of different interventions, targeted at health professionals or the structure in which they deliver care, on the management of patients with diabetes in primary care, outpatient and community settings. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, the Cochrane Controlled Trials Register (Issue 4 1999), MEDLINE (1966-1999), EMBASE (1980-1999), Cinahl (1982-1999), and reference lists of articles. SELECTION CRITERIA: Randomised trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) analyses of professional, financial and organisational strategies aimed at improving care for people with Type 1 or Type 2 diabetes. The participants were health care professionals, including physicians, nurses and pharmacists. The outcomes included objectively measured health professional performance or patient outcomes, and self-report measures with known validity and reliability. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Forty-one studies were included involving more than 200 practices and 48,000 patients. Twenty-seven studies were RCTs, 12 were CBAs, and two were ITS. The studies were heterogeneous in terms of interventions, participants, settings and outcomes. The methodological quality of the studies was often poor. In all studies the intervention strategy was multifaceted. In 12 studies the interventions were targeted at health professionals, in nine they were targeted at the organization of care, and 20 studies targeted both. In 15 studies patient education was added to the professional and organisational interventions. A combination of professional interventions improved process outcomes. The effect on patient outcomes remained less clear as these were rarely assessed. Arrangements for follow-up (organisational intervention) also showed a favourable effect on process outcomes. Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients' health outcomes. REVIEWERS' CONCLUSION: Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes. Organisational interventions that improve regular prompted recall and review of patients (central computerised tracking systems or nurses who regularly contact the patient) can also improve diabetes management. The addition of patient-oriented interventions can lead to improved patient health outcomes. Nurses can play an important role in patient-oriented interventions, through patient education or facilitating adherence to treatment.

Community Health Centers↗
PubMed2004

Impact of an educational intervention to improve prescribing by private physicians in Uganda.

INTRODUCTION: Private physicians in urban Uganda treat a large percentage of common adult illnesses. Improving their prescribing would not only encourage more rational drug use, but also reduce costs to patients. Interventions to improve drug use are generally more successful when face-to-face educational methods are included. OBJECTIVES: To determine the effectiveness of a face-to-face educational intervention on the treatment of acute respiratory infections (ARI), malaria, and non-dysenteric diarrhoea by private physicians in three urban areas of Uganda. METHODS: The study used an intervention with comparison group design to evaluate the impact of the educational intervention. A total of 108 private physicians was divided into intervention (n = 30) and control (n = 78) groups. Surrogate patients, trained to simulate presenting symptoms and signs of the target conditions, were used to collect data on the medical practices and prescribing behaviours of the physicians. Intervention physicians were invited to a one-day interactive educational seminar facilitated by local opinion leaders that covered principles of rational drug use and the National Standard Treatment Guidelines for treating the target conditions. Physicians were also provided with data about baseline practices. RESULTS: Baseline data indicated high rates of inappropriate treatment practices by both intervention and control groups. There was nearly universal antibiotic use for ARI (over 90%), high rates of injections recommended for malaria (over 30%), and high rates of polypharmacy (over thee drugs per patient). After the intervention, some significant improvements in key practices were observed in the intervention group. Compared to control physicians, antibiotic prescribing for ARI decreased by 23% in the intervention group, use of combination products for malaria declined by 28%, there were trends towards better adherence to guidelines for ARI and malaria, and marginal decreases in drug costs. However, the overall impacts of the intervention were limited, especially on quality indicators concerning history taking, adequate examination, and advice to patients. CONCLUSION: The face-to-face educational intervention resulted in some small improvements in key prescribing practices of private physicians. However, an intervention that involved repeated contacts with prescribers and which addressed economic considerations would be needed to obtain larger improvements. Private physicians need to be sensitized to and encouraged to use the National Standard Treatment Guidelines, and attempts to improve their prescribing should be supported by community education.

Acute Disease↗
PubMed2006

Development of a complex intervention for secondary prevention of coronary heart disease in primary care using the UK Medical Research Council framework.

OBJECTIVE: To apply the UK Medical Research Council (MRC) framework for development and evaluation of trials of complex interventions to a primary healthcare intervention to promote secondary prevention of coronary heart disease. STUDY DESIGN: Case report of intervention development. METHODS: First, literature relating to secondary prevention and lifestyle change was reviewed. Second, a preliminary intervention was modeled, based on literature findings and focus group interviews with patients (n = 23) and staff (n = 29) from 4 general practices. Participants' experiences of and attitudes toward key intervention components were explored. Third, the preliminary intervention was pilot-tested in 4 general practices. After delivery of the pilot intervention, practitioners evaluated the training sessions, and qualitative data relating to experiences of the intervention were collected using semistructured interviews with staff (n = 10) and patient focus groups (n = 17). RESULTS: Literature review identified 3 intervention components: a structured recall system, practitioner training, and patient information. Initial qualitative data identified variations in recall system design, training requirements (medication prescribing, facilitating behavior change), and information appropriate to the prospective study participants. Identifying detailed structures within intervention components clarified how the intervention could be tailored to individual practice, practitioner, and patient needs while preserving the theoretical functions of the components. Findings from the pilot phase informed further modeling of the intervention, reducing administrative time, increasing practical content of training, and omitting unhelpful patient information. CONCLUSION: Application of the MRC framework helped to determine the feasibility and development of a complex intervention for primary care research.

Clinical Trials as Topic↗
PubMed2001

Expert consensus on physical therapist intervention after botulinum toxin a injection for children with cerebral palsy.

PURPOSE: The purpose of this study was to gather expert consensus on physical therapist (PT) intervention after lower extremity botulinum toxin A (BtA) injection(s) for children with cerebral palsy (CP) and lower extremity spasticity. This study also examined differences in expert opinion on intervention for two groups of children with CP and differing levels of functional ability. METHODS: The Guide to Physical Therapist Practice was used to develop a questionnaire. Sixty-two therapists identified as experts in the field of pediatric physical therapy rated the importance of the three PT intervention components and the seven types of direct intervention from Neuromuscular Pattern 5A for both groups. The Wilcoxon signed rank test was used to identify differences in expert responses between the groups. Experts also ranked the importance of specific intervention strategies. Consensus criteria were used to determine the importance of interventions. RESULTS: All three intervention components and four direct interventions (Therapeutic Exercise; Functional Training-Self-Care; Functional Training-Community and Work; and Prescription of Devices/Equipment) met consensus criteria for both groups. Significant differences between groups were found for Patient/Client-Related Instruction and Direct Interventions and for Therapeutic Exercise, Functional Training in Self-Care, Functional Training-Community and Work, and Electrotherapeutic Modalities, suggesting that these items were more important for children with greater functional abilities. Twenty (35%) specific intervention strategies met consensus criteria for one or both groups. DISCUSSION AND CONCLUSIONS: All three intervention components and four direct interventions in Neuromuscular Pattern 5A are important in the PT plan of care after botulinum toxin A injection for children with CP and lower extremity spasticity. Functional ability influences therapists' intervention choices.

Journal Article↗
PubMed1994

Parenting and early development among children of drug-abusing women: effects of home intervention.

OBJECTIVE: To evaluate the efficacy of home intervention with drug-abusing women on parenting behavior and attitudes, and on children's development. DESIGN: A randomized, clinical trial of 60 drug-abusing women recruited prenatally and randomized into an intervention (n = 31) or comparison (n = 29) group. There were no group differences in gestational age, 1-minute Apgar scores, duration of hospital stay, or neonatal abstinence score. Intervention infants were slightly heavier (P = .098) and had slightly lower 5-minute Apgar scores (P = .089). Most mothers were single, African-American, multiparous, and non-high school graduates from low income families. Approximately 40% of the women were human immunodeficiency virus (HIV)-positive, all admitted to either cocaine and/or heroin use, and 62% had a history of incarceration. Intervention and comparison group women did not differ on any background variables. INTERVENTIONS: All children received primary care in a multidisciplinary clinic. Biweekly home visits were provided by a nurse beginning before delivery and extending through 18 months of life. The intervention was designed to provide maternal support and to promote parenting, child development, the utilization of informal and formal resources, and advocacy. MEASUREMENTS: Behavioral measures included self-reported ongoing drug abuse, compliance with primary care appointments, and an observation of the child-centered quality of the home (HOME Scale). Parenting attitudes were measured by the Child Abuse Potential Inventory (CAPI) and the Parenting Stress Index. The CAPI was administered before initiating the intervention and the Parenting Stress Index was administered when the children were 3 months of age. Both scales were repeated when the children were 18 months of age. Developmental status was measured with the Bayley Scales of Infant Development administered at 6, 12, and 18 months. ANALYSES: Repeated measures multivariate analyses of variance were used to examine changes in parenting attitudes and children's development. Analyses of covariance were used to examine compliance with primary care appointments and the quality of the home. Logistic regression was used to examine ongoing drug abuse. Birth weight and maternal education were used as covariates in all analyses. To control for social desirability, the faking-good index of the CAPI was included as a covariate in analyses involving self-report measures. MAIN RESULTS: Women in the intervention group were marginally more likely to report being drug-free (P = .059) and were compliant with primary care appointments for their children (P = .069). Based on the HOME Scale, women in the intervention group were more emotionally responsive (P = .033) and provided marginally more opportunities for stimulation (P = .065). At 18 months parents reported more normative attitudes regarding parenting and more child-related stress than they had initially, but the differences were not related to intervention status. At 6 months infants in the intervention group obtained marginally higher cognitive scores (P = .099); at 12 and 18 months there were no differences. CONCLUSIONS: The findings suggest a cautious optimism regarding the efficacy of early home intervention among drug-abusing women in promoting positive behaviors. Subsequent investigations of home intervention should include larger sample sizes and more intensive options.

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