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PubMedDate not supplied

Use of time studies for determining intervention costs.

BACKGROUND: Cost-effectiveness analyses are increasingly recommended to evaluate the effectiveness of health interventions. Determining the costs associated with delivery of a particular intervention is essential in conducting a cost-effectiveness analysis. Yet, there are few guidelines available to assist investigators in how to assess intervention costs associated with the personnel portion of an intervention. OBJECTIVES: To describe the use of time studies in calculating the program costs of personnel for use in future cost-effectiveness analysis of health interventions. METHODS: The literature on calculating intervention costs for use in cost-effectiveness analyses is reviewed. The process for conducting a time study for determining personnel costs in delivering an intervention and a step-by-step example from a time study are used to illustrate how personnel costs associated with delivery of the intervention can be separated from those costs associated with implementation of research procedures in the determination of research costs. CONCLUSIONS: Time studies provide a good estimate of part of the cost of implementing an intervention that is often difficult to determine-personnel time. The design of the time study should consider intervention components, staff involvement, and the time period for data collection.

Accidental Falls↗

PubMedDate not supplied

Tailored interventions to enhance osteoporosis prevention in women.

PURPOSE: The purpose of this pilot study was to determine if tailored nursing interventions based on personal knowledge of bone mineral density from a dual-energy x-ray absorptiometry cause increases in knowledge of osteoporosis, health beliefs, or osteoporosis-prevention behaviors in postmenopausal women 50-65 years of age, 6 months after the intervention. METHOD: The design for this pilot study was a two group quasi-experimental design. The treatment group received a tailored intervention; the control group did not. Outcome data were gathered at 6 months after dual-energy x-ray absorptiometry. The tailored intervention was designed and given to each woman via telephone using her dual-energy x-ray absorptiometry results and osteoporosis questionnaire data that addressed her knowledge of osteoporosis and osteoporosis-prevention behaviors of calcium intake, exercise, smoking, and alcohol use. A written mailed copy of the intervention followed the telephone interview. Six months after the intervention, the women were mailed another osteoporosis questionnaire to determine if the tailored intervention made a difference in the outcome variables. SAMPLE: A total 124 women between the ages of 50 and 65 (101 control, 23 treatment) comprised the sample. RESULTS: There was no difference in knowledge between groups. On the average, there were significantly more perceived barriers to calcium in the tailored group (mean = 13.48) than in the nontailored group (mean = 11.55) (t = 2.147; df = 122; p = .034). There were significantly more perceived barriers to exercise in the tailored group (mean = 14.39) than in the nontailored group (mean = 12.21) (t = .144; df = 122; p = .034). Daily calcium intake increased in both the tailored and the nontailored groups. The tailored intervention increased women's daily calcium intake from 614.28 to 1039.10 mg (t = -2.896; df = 22; p = .008). The nontailored group daily calcium intake increased from 587.91 to 916.30 mg (t = -3.541; df = 100; p = .001); there was no significant difference between the groups. Weight-bearing exercise behaviors decreased from 96.04 minutes to 59.2 minutes in the tailored group but increased slightly in the nontailored group from 81.47 to 87.26 minutes of exercise. CONCLUSION: Tailored interventions increased women's perceived barriers to calcium and exercise. Both groups increased calcium intake. The mixed findings of increased perception of barriers to calcium and exercise and decreased exercise behaviors indicate the need for further study. This important intervention has implications for orthopaedic nurses and healthcare professionals involved in health promotion and prevention of osteoporosis.

Aged↗

PubMedDate not supplied

A randomized trial of geriatric liaison intervention in elderly medical inpatients.

OBJECTIVE: The aim of this study was to examine the effect of psychogeriatric intervention in a group of elderly medical inpatients over 75 years of age. In addition to usual care, intervention consisted of multidisciplinary joint treatment by a psychogeriatric team. The main purpose of intervention was to obtain the optimal level of physical functioning. METHOD: In a prospective randomized trial the effect of the intervention (N = 140) compared with usual care (N = 97) was estimated for physical functioning, length of stay, and nursing home placement within 12 months of discharge. RESULTS: Substantially more patients assigned to the intervention group improved in their physical functioning, and fewer became worse. The mean length of stay was 5 days shorter for the intervention group. There were more readmissions to hospital in the usual care group (29.9%) compared with the intervention group (17.4%). Of the patients assigned to the intervention treatment, 18% were admitted to a nursing home. In the usual care group this was 27%. The effects of intervention remained statistically significant for all the outcome variables after controlling for possible confounding baseline characteristics. CONCLUSIONS: The intervention we studied had clinically relevant effects on important outcome variables. Psychiatric co-morbidity was an important risk factor for the outcome of the patients in our study. By combining elements from a psychiatric and geriatric consultation service with elements from a unit-driven service, we were able to improve health care for the elderly in our hospital in a feasible and cost-effective way.

Activities of Daily Living↗

PubMed2002

Effects of training on female trapezius Myalgia: An intervention study with a 3-year follow-up period.

STUDY DESIGN: A prospective randomized clinical trial was conducted. OBJECTIVE: To evaluate the long-term effects of three training interventions on women with work-related trapezius myalgia. SUMMARY OF BACKGROUND DATA: Studies with long-term follow-up evaluation of interventions for neck pain are scarce and usually cover fewer than 12 months. METHODS: For this study, 126 women with work-related trapezius myalgia were randomized into strength, muscular endurance, or coordination training or into a nontraining reference group. Intervention training occurred three times a week for 10 weeks. Assessment of pain intensity, pressure pain thresholds, symptom frequency, perceived health, and work and exercise habits was performed before and immediately after interventions, then at clinical examinations 8 months and 17 months after the interventions. Participation rates at these follow-up assessments were 84% and 81%. At 3 years after the interventions, a questionnaire was answered by 94% of the participants, 17 of whom were dropouts that never participated in any of the four intervention groups. RESULTS: All the training programs showed similar pain reducing effects immediately after the interventions. Pain reductions were maintained at follow-up evaluations, but at the 8-month follow-up assessment, there were no differences between the training groups and the reference group on any variable. At 3 years after the interventions, the intervention groups did not differ from the dropout group. Almost half (49%) of the women had persistent symptoms at the 3-year follow-up assessment. CONCLUSIONS: The long-term effect of all the training programs was low. Pain in neck and shoulder muscles was persistent in a large proportion of the women over the 3 years.

Adult↗

PubMed2004

Mini-intervention for subacute low back pain: two-year follow-up and modifiers of effectiveness.

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To Investigate the long-term effectiveness, costs, and effect modifiers of a mini-intervention, provided in addition to the usual care, and the incremental effect of a worksite visit for patients with subacute disabling low back pain (LBP). SUMMARY OF BACKGROUND DATA: A mini-intervention was earlier proved to be an effective treatment for subacute LBP. Whether the beneficial effect is sustained is not known. Furthermore, modifiers of a treatment effect are largely unknown. METHODS: A total of 164 patients with subacute LBP randomized into a mini-intervention (A, n = 56), a mini-intervention plus a worksite visit (B, n = 51), or the usual care (C, n = 57). Mini-intervention consisted of a detailed assessment of the patients' history, beliefs, and physical findings by a physician and a physiotherapist, followed by recommendations and advice. The usual care patients received the conventional care. Pain, disability, health-related quality of life, satisfaction with care, days on sick leave, and health care consumption and costs were measured during a 24-month follow-up. Thirteen candidate modifiers were tested for each outcome. RESULTS: There were no differences between the three treatment arms regarding the intensity of pain, the perceived disability, or the health-related quality of life. However, mini-intervention decreased occurrence of daily (A vs., C, P = 0.01) and bothersome (A vs. C, P < 0.05) pain and increased treatment satisfaction. Costs resulting from LBP were lower in the intervention groups (A 4670 Euros, B 5990 Euros) than in C (C 9510 Euros) (A vs. C, P = 0.04; and B vs. C, not significant). The average number of days on sick leave was 30 in A, 45 in B, and 62 in C (A vs. C, P = 0.03; B vs. C, not significant). The perceived risk for not recovering was the strongest modifier of treatment effect. Mental and mental-physical workers in A and B were less often on sick leave than those in C. CONCLUSIONS: Mini-intervention is an effective treatment for subacute LBP. Despite lack of a significant effect on intensity of low back pain and perceived disability, mini-intervention, including proper recommendations and advice, according to the "active approach," is able to reduce LBP-related costs. The perceived risk of not recovering was the strongest modifier of treatment effect. In alleviating pain, the intervention was most effective among the patients with a high perceived risk of not recovering.

Absenteeism↗

PubMed2006

Effectiveness of a low-intensity smoking cessation intervention for hospitalized patients.

Debate exists about how intense smoking cessation interventions for hospitalized patients should be. In this study we assessed the effectiveness of a low-intensity smoking cessation intervention for hospitalized patients, without follow-up phone calls. We designed a cohort study with a historical control group, in the Department of Medicine of an 850-bed teaching hospital. One hundred and seventeen consecutive eligible smokers received the intervention, and 113 smokers hospitalized before the implementation of the intervention constituted the historical control group. The 30-min smoking cessation intervention was performed by a trained resident without any follow-up contact. Counseling was matched to smokers' motivation to quit, and accompanied by a self-help booklet. Nicotine replacement therapy was prescribed when indicated. All patients received a questionnaire to evaluate their smoking habits 6 months after they left hospital. We counted patients lost to follow-up as continuous smokers and smoking abstinence was validated by patients' physicians. Validated smoking cessation rates were 23.9% in the intervention group and 9.7% in the control group (odds ratio 2.9, 95% confidence interval: 1.4-6.2). After adjusting for potential confounders, intervention was still effective with an adjusted odds ratio of 2.26 (95% confidence interval: 1.04-4.95). Among those who continued to smoke 6 months after hospitalization, the likelihood of reporting any decrease of cigarette consumption was higher in the intervention cohort (70.8 vs. 42.7%, P=0.001). A low-intensity smoking cessation intervention, based on two visits without any follow-up contact, is associated with a higher quit rate at 6 months than that for historical control patients. Our findings show that a low-intensity smoking cessation intervention, based on two visits without any follow-up contact, is associated with a higher quit rate at 6 months than that for historical control patients.

Adolescent↗

PubMed2003

Designing effective HIV/AIDS social and behavioral interventions for the population of those age 50 and older.

Social and behavioral HIV/AIDS prevention interventions designed to test their effects on older cohorts are sorely lacking in the scientific literature even though middle-aged and older people represent a significant minority of both existing and new AIDS cases. This article raises key issues relevant in developing and evaluating HIV/AIDS social and behavioral interventions for older cohorts. These interventions must build on our current understanding of behavior change and HIV prevention successes with younger populations while considering important intervention principles gathered from work with older populations in other health arenas. In addition, the authors expand on recent national panels and published reviews relevant to the topic and provide a set of intervention recommendations for use in tandem with these intervention principles. The article also calls for additional research into the sociocultural contexts that influence risk-taking among older cohorts and for the development of interventions at multiple levels. Pragmatic considerations such as identifying and dismantling ageism in interventions, delineating intervention outcomes, and planning for intervention transferability, dissemination, and sustainability also are raised.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Effects of a peer-led behavioral intervention to reduce HIV transmission and promote serostatus disclosure among HIV-seropositive gay and bisexual men.

OBJECTIVES: To evaluate the effects of an enhanced peer-led intervention on transmission risk behavior and serostatus disclosure of HIV-seropositive gay and bisexual men. DESIGN: A randomized intervention trial. METHODS: HIV-seropositive gay and bisexual men were recruited from New York City and San Francisco and were randomly assigned to either a standard or an enhanced intervention. The standard intervention consisted of one session that provided safer sex information. The enhanced intervention consisted of six sessions and included safer sex information, interactive learning activities, and discussion groups that were facilitated by HIV-seropositive peers. Participants completed audio computer-assisted self interview (A-CASI) assessments at baseline and 3 and 6-month follow-ups. Optional testing for sexually transmitted infections was offered at baseline and the 6-month follow-up. RESULTS: A total of 811 participants met the inclusion criteria for outcome analyses. Of these, 85 and 90% were retained for the 3 and 6-month follow-ups, respectively. Compared with the standard intervention, fewer men assigned to the enhanced intervention reported unprotected receptive anal intercourse with a negative or unknown-serostatus partner at 3 months (21 versus 26%, P < 0.05). However, there were no other significant differences in transmission risk or serostatus disclosure at 3 or 6 months. CONCLUSION: The enhanced intervention was associated with only a limited reduction in transmission risk at 3 months relative to the standard intervention. The characteristics of the intervention that may have reduced its efficacy are identified and directions for future research are suggested.

Adult↗

PubMed2004

The effect of cleaning on dust and the health of office workers: an intervention study.

BACKGROUND: Office employees often experience symptoms that could be related to indoor air exposures. METHODS: In an office building, 114 nonsmokers who had reported mucosal irritation complaints in a survey were selected to participate in a double-blind intervention study. The intervention was carried out in Oslo, Norway, during 1998. The offices of the intervention group were given a comprehensive cleaning, whereas the offices of the control group got a superficial cleaning as a placebo treatment. Dust concentration, health complaints, and nasal congestion were recorded before and after intervention or placebo. In the intervention group, the mean dust concentration was 67 microg/m3 before intervention and 50 microg/m3 after cleaning. RESULTS: The intervention group reported a reduction in mucosal irritation complaints (a median reduction of 1.0 irritation index points on a scale 0-8) compared with no change in the control group. The odds ratio for reporting a 2-point reduction of the mucosal irritation symptom index was 3.5 (95% confidence interval [CI] = 1.2-9.1) in the intervention group compared with the control group. Nasal congestion, measured by acoustic rhinometry, was also reduced in the intervention group. The odds ratio for reduction in nasal congestion above the 70th percentile was 4.2 (CI = 1.3-11) in the intervention group versus the control group. CONCLUSIONS: This experimental field trial shows that comprehensive cleaning reduces the airborne dust in offices, and also can reduce mucosal symptoms and nasal congestion.

Adult↗

PubMed2006

Reduction of global cardiovascular risk with nutritional versus nutritional plus physical activity intervention in Colombian adults.

BACKGROUND: Cardiovascular disease is a major cause of morbidity/mortality in non-developed countries. Reports of the effects of non-pharmacological interventions on global cardiovascular risk in Latin American adults, however, are scarce. OBJECTIVE: To compare the change in global cardiovascular risk induced by a tailored, Adult Treatment Panel-III compliant nutrition program versus the same program with addition of supervised, regular physical activity in Colombian adults. DESIGN: The study was a randomized, controlled trial. METHODS: Seventy-five Colombian patients aged 40-70 years and with Framingham-estimated global cardiovascular risk of 1% or higher were randomly assigned to a nutritional intervention program or a combined nutritional intervention-physical exercise program for 16 weeks. Patients underwent medical and anthropometric evaluation, bioelectrical impedance, lipid profile and Framingham global cardiovascular risk determination at baseline and at the end of follow-up. RESULTS: The groups were comparable at baseline; 21 persons in the nutritional intervention program group and 27 in the nutritional intervention-physical exercise program group completed the follow-up. Global cardiovascular risk modification (mean+/-SE) was -2.04+/-1.1 absolute percentage points (relative reduction 19.6%) in the nutritional intervention-physical exercise program group, compared with 0.23+/-0.9 (relative increase 2.8%) in the nutritional intervention program group. Mean difference in global cardiovascular risk modification between groups reached borderline statistical significance in ANCOVA (P=0.054). Reductions in systolic and diastolic blood pressure, waist circumference and low-density lipoprotein cholesterol were similar, but the nutritional intervention-physical exercise program group achieved significantly greater improvements in body weight, body mass index, percentage body fat and high-density lipoprotein cholesterol. CONCLUSIONS: Our data suggest that a structured nutritional intervention-physical exercise program is more efficacious than a nutritional intervention program in the reduction of global cardiovascular risk and cardiovascular risk factors, in only 16 weeks.

Adult↗

PubMed2003

Interventions to improve antipsychotic medication adherence: review of recent literature.

Antipsychotic nonadherence is an important barrier to the successful treatment of schizophrenia and can lead to clinical and economic burdens. Interventions capable of significantly improving medication adherence in patients with schizophrenia would be beneficial in maximizing treatment outcomes with antipsychotics. This article reviews recent literature reporting interventions designed to improve antipsychotic adherence in patients with schizophrenia. We searched the Medline, Healthstar, and PsycInfo electronic databases for articles published since 1980 on interventions to improve medication adherence in schizophrenia. Twenty-one studies met our selection criteria. In this review, educational, behavioral, affective, or a combination of these approaches to improve adherence were examined. A total of 23 interventions were tested, as 2 studies investigated more than 1 intervention. While study design and adherence measures varied across the trials reviewed, medication adherence was noted to moderately improve with 15 of the 23 interventions tested. Interventions of a purely educational nature were the least successful at improving antipsychotic adherence. The greatest improvement in adherence was seen with interventions employing combinations of educational, behavioral, and affective strategies with which improvements in adherence were noted in 8 out of 12 studies, with additional secondary gains such as: reduced relapse, decreased hospitalization, decreased psychopathology, improved social function, gains in medication knowledge, and improved insight into the need for treatment. Longer interventions and an alliance with therapists also appeared important for successful outcomes. The continuing development and study of successful interventions to improve medication adherence are necessary to maximize the usefulness of pharmacologic treatment of schizophrenia.

Adult↗

PubMed2006

Changes of cardiovascular risk factors in obese children effects of inpatient and outpatient interventions.

OBJECTIVE: The aim of the study was to compare the benefits of 2 different therapeutic approaches on cardiovascular risk factors (CVRF) in obese children and adolescents. METHODS: We analyzed the changes of weight status (as standard deviation score-body mass index [SDS-BMI]), blood pressure, lipids, and insulin levels in obese children (age range, 10-14 years) during a 1-year outpatient intervention based on lifestyle changes (group A, n = 124) and during a 6-week inpatient intervention program with dietary restriction and exercise therapy (group B, n = 119). In addition, we studied these parameters in 65 obese children without intervention for 1 year (control group). RESULTS: Age, degree of overweight, sex, and CVRF did not differ significantly between the control group and the intervention groups at baseline. During the observation period, CVRF did not change in the control group, whereas SDS-BMI slightly increased (+0.1 SDS-BMI). The SDS-BMI decreased significantly (P < 0.001) in group A (SDS-BMI, -0.40) and comparably in group B (SDS-BMI, -0.43). The decreases of total (P < 0.001) and low-density lipoprotein-cholesterol levels (P = 0.049) were significantly greater in group B, whereas triglyceride (P = 0.040) and insulin (P = 0.006) levels decreased significantly and were more pronounced in group A. High-density lipoprotein-cholesterol level increased significantly (P < 0.001) only in group A. Blood pressure decreased significantly (P < 0.01) and comparably in both intervention groups (A and B). CONCLUSIONS: In contrast to obese children without intervention, CVRF improved in obese children with intervention. The 6-week inpatient intervention led to a significant greater decrease of total and low-density lipoprotein-cholesterol levels as compared with the 1-year outpatient intervention, although the outpatient intervention yielded a significantly greater improvement in insulin, triglycerides, and high-density lipoprotein-cholesterol levels.

Adolescent↗

PubMedDate not supplied

Effects of treating exhaustion in angioplasty patients on new coronary events: results of the randomized Exhaustion Intervention Trial (EXIT).

BACKGROUND: Extreme fatigue is a common complaint in percutaneous coronary intervention (PCI) patients, and is associated with an increased risk for new cardiac events. The objective of the Exhaustion Intervention Trial (EXIT) was to determine whether a behavioral intervention on exhaustion reduces the risk of a new coronary event after PCI. METHODS AND RESULTS: Seven hundred ten consecutive patients, ages 35 to 68 years, who felt exhausted after PCI were randomized into an intervention group and a usual-care group. The intervention was based on group therapy focusing on stressors leading to exhaustion, and on support for recovery by promoting rest and making rest more efficient. One month after PCI, 50% of the patients felt exhausted. The intervention reduced the odds of remaining exhausted at 18 months by 56% in those without a previous history of coronary artery disease (CAD) (OR = 0.44; 95% CI 0.29-0.66), but had no effect on exhaustion in those with a history of CAD (OR = 0.93; 95% CI 0.56-1.55; p = .78). The intervention did not reduce the risk of a new coronary event within 2 years (RR = 1.14; 95%CI 0.82-1.57). Post-hoc analyses suggest that the effect of the intervention was limited by a positive history of CAD, the presence of a chronic, painful condition (especially rheumatism), and by opposite effects on early and late cardiac events. CONCLUSION: A behavioral intervention in PCI patients has a beneficial effect on feelings of exhaustion. It could not be demonstrated that the intervention reduces the risk of a new coronary event within 2 years.

Adult↗

PubMed2006

Sexual risk reduction interventions do not inadvertently increase the overall frequency of sexual behavior: a meta-analysis of 174 studies with 116,735 participants.

A meta-analytic review of the influence of HIV risk reduction interventions on sexual occasions, number of partners, and abstinence was conducted to assess whether condom-related interventions inadvertently undermine sexual risk reduction efforts by increasing the frequency of sexual behavior. Included studies examined sexual risk reduction strategies and used a controlled design. Data from 174 studies (206 interventions, N = 116,735 participants) were included. In general, HIV risk reduction interventions neither increased nor decreased sexual occasions or number of partners reported. Participants in intervention conditions were less likely to be sexually active than those in control conditions. When samples included more black participants, interventions reduced the number of sexual occasions; interventions were more successful at reducing the number of partners in samples that included more men who have sex with men (MSM) or individuals engaged in sex trading. Samples that included more MSM were more likely to adopt abstinence as a risk reduction strategy. Interventions that included more information, motivational enhancement, and skills training also led to greater risk reduction. HIV risk reduction interventions do not increase the overall frequency of sexual activity. To the contrary, for some subgroups, interventions that include components recommended by behavioral science theory reduce the frequency of sexual events and partners.

Adult↗

PubMed2005

Percutaneous management of chronic mesenteric ischemia: outcomes after intervention.

PURPOSE: To assess the efficacy and durability of percutaneous transluminal angioplasty (PTA)/stent placement for treatment of chronic mesenteric ischemia (CMI). MATERIALS AND METHODS: A retrospective review of patients treated from January 1986 to August 2003 was conducted. Twenty-nine patients (mean age, 62 years) were treated for clinical symptoms consistent with CMI. Clinical diagnosis was verified with angiographic assessment and PTA with or without stent placement was performed based on angiographic and/or pressure gradient findings. Outcomes were estimated with the Kaplan-Meier method. RESULTS: A total of 63 interventions were performed in 29 patients during the study period. Of these 63 interventions, 46 PTA and 17 stent implantation procedures were performed. Thirty-four interventions were performed for SMA stenosis/occlusion, 17 interventions for celiac artery stenosis/occlusion, and four interventions were performed on aorto-mesenteric graft stenoses. Technical success was 97%, and clinical success (defined as clinical resolution of symptoms) was 90% (26 of 29 patients). Mean duration of follow-up was 28.3 months. Primary patency for all interventions at 3, 6, and 12 months was 82.7% (95% CI: 68.7-96.7), 78.9% (66.7-91.1), and 70.1% (55.1-85.6), respectively. Primary assisted patency for all interventions at 3, 6, and 12 months was 87.9% (79.0-95.3), 87.9% (79.2-95.1), and 87.9% (77.3-98.3), respectively. An average of 1.9 interventions per patient was required. One major complication occurred (3.4%). There were three minor complications (10.3%). CONCLUSIONS: Percutaneous intervention for CMI is safe with durable early and midterm clinical success. However, repeated intervention is often required for improved primary assisted patency.

Adult↗

PubMed2003

National survey of trauma surgeons' use of alcohol screening and brief intervention.

BACKGROUND: A variety of policy groups have recommended that screening and brief interventions (BIs) for alcohol disorders be widely implemented in health care settings. This study was conducted to determine the current status of screening and intervention programs in trauma centers and to evaluate specific barriers to implementation of screening and BIs. The hypotheses tested were that surgeons who support screening and brief interventions would be less likely to endorse the purported barriers to screening and intervention and would have a better understanding of the concept of brief interventions. METHODS: A postal survey of 711 members of the American Association for the Surgery of Trauma and the Western Trauma Association was performed to assess current screening and treatment practices, along with barriers to screening and intervention. Two logistic regression models were constructed to determine which factors result in support for screening and which factors predict support of BIs to help determine potentially modifiable issues to facilitate implementation. RESULTS: Three hundred eighty-three surgeons responded, 315 of whom are currently practicing trauma. The majority of surgeons (267 [83%]) agreed that a trauma center is an appropriate setting for addressing harmful alcohol consumption. Over two thirds frequently check a blood alcohol concentration, with one third of the group reporting that they always do. The use of formal screening questionnaires was much less frequent (25%). Nearly one half (49%) understood the concept of BIs. However, the majority report that less than one half of patients with a suspected alcohol problem at their center have their alcohol problem addressed while they are hospitalized. Several barriers to screening and BIs were identified. Although only 2% thought screening and counseling would significantly increase health care costs, 7% thought screening was too time consuming and 13.6% thought it would compromise patient confidentiality. Screening was perceived to threaten reimbursement by 27%. Over half (55%) stated their facility is currently performing screening. One third (36%) stated their facility is currently performing BIs. Logistic regression revealed that surgeons who support screening were those who thought patients with alcohol problems should be referred for professional alcohol treatment (odds ratio [OR], 6.5; 95% confidence interval [CI], 2.3-18.2) and that a trauma center is an appropriate setting for addressing alcohol disorders (OR, 6.2; 95% CI, 2.7-14.2). In the model of support for BIs, understanding the concept of BIs (OR, 5.7; 95% CI, 3.1-10.5) and lack of the belief that screening and intervention would increase cost too much (OR, 0.14; 95% CI, 0.02-0.96) were the most potent predictors of support for BIs. CONCLUSION: Trauma surgeons are screening for alcohol disorders more frequently than they were 5 years ago. Barriers to screening are not as prevalent as previously reported. Support for implementing screening and intervention programs depends on whether surgeons believe trauma centers are appropriate sites for addressing alcohol disorders, whether surgeons believe patients with alcohol problems should be referred for professional treatment, whether surgeons understand the concept of brief interventions, and whether they believe the cost constraints are not prohibitive. Widespread education in the effectiveness and methods of BIs would facilitate implementation of alcohol screening and intervention programs to help reduce recurrent alcohol-related injury.

Alcoholism↗

PubMedDate not supplied

Population-based public health interventions: practice-based and evidence-supported. Part I.

The Intervention Wheel is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. The Intervention Wheel, previously known as the Public Health Intervention Model, was originally introduced in 1998 by the Minnesota Department of Health, Section of Public Health Nursing. The model has been widely disseminated and used throughout the United States since that time. The evidence supporting the Intervention Wheel was recently subjected to a rigorous critique by regional and national experts. This critical process, which involved hundreds of public health nurses, resulted in a more robust Intervention Wheel and established the validity of the model. The critique also produced basic steps and best practices for each of the 17 interventions. Part I describes the Intervention Wheel, defines population-based practice, and details the recommended modifications and validation process. Part II provides examples of the innovative ways that the Intervention Wheel is being used in public health/public health nursing practice, education, and administration. The two articles provide a foundation and vision for population-based public health nursing practice and direction for improving population health.

Attitude of Health Personnel↗

PubMedDate not supplied

Population-based public health interventions: innovations in practice, teaching, and management. Part II.

The Intervention Wheel is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. The Intervention Wheel, previously known as the Public Health Intervention Model, was originally introduced in 1998 by the Minnesota Department of Health, Section of Public Health Nursing (PHN). The model has been widely disseminated and used throughout the United States since that time. The evidence supporting the Intervention Wheel was recently subjected to a rigorous critique by regional and national experts. This critical process, which involved hundreds of public health nurses, resulted in a more robust Intervention Wheel and established the validity of the model. The critique also produced basic steps and best practices for each of the 17 interventions. Part I describes the Intervention Wheel, defines population-based practice, and details the recommended modifications and validation process. Part II provides examples of the innovative ways that the Intervention Wheel is being used in public health/PHN practice, education, and administration. The two articles provide a foundation and vision for population-based PHN practice and direction for improving population health.

Benchmarking↗