Preventive measures for falls and fractures in the community.

Optimizing telehealth pain care after COVID-19.

Background: Obesity and mental health issues are major public health concerns with a complex relationship. They share interconnections that significantly impair individuals’ physical, social, and mental well-being. Digital technology has emerged as a promising tool to facilitate communication between health professionals (HPs) and individuals living with obesity and mental health issues, but its role remains unclear. Aim: To critique the literature on the role of digital technology in supporting HP communication with individuals dealing with obesity and mental health issues. Methods: A comprehensive scoping review, guided by Arksey & O’Malley’s (2005) methodology, analysed literature from 2013-2023 across eight databases. Eight studies met the inclusion criteria, and data extraction focused on HPs' communication technologies, their roles, technology types, biopsychosocial considerations, and perceptions of technology use. Results: HPs, including psychologists, dietitians, and social workers, use digital technologies for virtual appointments, monitoring diet and mental health, and providing motivation and educational content. Digital technologies were inclusive of web-based platforms, social media groups, synchronous videos, telephone, automated SMS, and email. The findings indicate that digital technology does have a role in supporting HP communication with individuals dealing with obesity and mental health issues. This role includes enhancing the capacity of HPs to provide effective and accessible care to individuals dealing with obesity and mental health issues. Key findings highlight issues of miscommunication and conflicting messages, a need for an empathetic approach, a lack of personalisation to unique needs, and confusion regarding HP's roles in obesity and mental health care. Digital technologies have improved access to services and reduced stigma experienced with in-person evaluations, yet challenges persist in implementation, particularly in digitally underserved areas. Most notably, despite improvements in weight management in seven of the eight studies, none of the interventions showed any significant progress in mental health outcomes. Conclusion: This review demonstrates the diverse application of digital technologies by HPs in communicating education, counselling and motivation to those with obesity and mental health issues. The digital technologies facilitate improved communication between HPs and clients, allowing for consistent monitoring and support in a stigma-reduced, private setting. While effective in obesity management, the review reveals a shortfall in addressing mental health needs, emphasising the necessity for digital tools to be more than just information channels, but also a means of understanding and meeting the service user needs. Future Directions: The scoping review advocates for future research to focus on creating tailored digital interventions that cater to the complex biopsychosocial needs of individuals with obesity and mental health issues. This approach should incorporate a multidisciplinary perspective, aligning with the need to enhance workforce capacity and capability in the digital era. The findings emphasise the importance of digital technology in healthcare and the necessity for ongoing adaptation and innovation in HP communication strategies.

Objective Multidisciplinary care is recommended for pediatric inflammatory bowel disease (IBD). This study aims to describe provider attitudes, barriers, and facilitators regarding multidisciplinary care in pediatric IBD, and explore associations between multidisciplinary care access and center‐level factors. Methods This is a cross‐sectional survey of pediatric gastrointestinal (GI) providers at centers registered with the ImproveCareNow (ICN) Learning Health System in the United States. Participants completed the survey via REDCap. Respondents provided demographic information and answered questions regarding their center's access and approach to multidisciplinary IBD care. Data were analyzed using descriptive statistics, chi‐squared, and Fisher's exact tests. Results Sixty‐nine providers across 55 ICN centers were included. All participants felt multidisciplinary care was beneficial and 80% felt patients/families desired this care. Participants endorsed barriers including lack of support from institutional leadership (39%), limited access to providers (39%), and inadequate numbers of providers (35%). The most common team members were nurses (94%), dietitians (92%), social workers (67%), and nurse practitioners/physician assistants (67%). Multidisciplinary teams commonly provided care via telehealth (94%), standardized educational materials (84%), multidisciplinary visits (69%), new diagnosis education (65%), and transition programs (61%). Access to nurse practitioners/physician assistants, quality improvement specialists, multidisciplinary visits, and support groups were associated with increasing center size ( p < 0.05). Conclusion Pediatric GI providers have positive attitudes regarding IBD multidisciplinary care and perceive this care as important and desired. Access and barriers are variable among US ICN centers. Future work should seek to further understand and address barriers and evaluate the benefits of multidisciplinary care in pediatric IBD.

Patient-Centered Outcomes With a Multidisciplinary CKD Care Team Approach: An Observational Study

Intimate partner violence (IPV) in India remains an entrenched and prevalent public health issue. Despite ample evidence of the widespread problem of IPV in India and associated mental and physical morbidities, far less is known about intervention models to reduce IPV in India. The aims of this meta-analysis and systematic review are to assess the effectiveness of community-based interventions to reduce IPV in India and to provide a narrative synthesis of these intervention approaches. A total of 9 databases were searched to identify peer-reviewed, English-language articles published between January 2000 and September 2022. The search identified 10 studies that met study inclusion criteria, including 3 randomized control trials, 4 quasi-experimental, 2 pre/post, and 1 time-series evaluation. Eight studies were included in the meta-analysis. There was notable variation in the interventions and approaches employed to reduce IPV and varying measurement of IPV outcomes. The results of the meta-analysis show that participating in community-based IPV interventions produced a significant reduction in IPV among women. When considering different types of IPV, study participants were less likely to report physical and psychological IPV victimization. In addition, participants were also less likely to report approving of IPV after participating in community-based IPV interventions. Community-based interventions and research addressing IPV are still evolving in India. Missing descriptions of theoretical frameworks, sampling, intervention design, and inadequately reported effectiveness of intervention (both quantitative and qualitative reporting) need to be addressed. Moreover, long-term evaluations of the pilot interventions are needed to provide a clear picture of the long-term effectiveness, sustainability, and replicability of the community-based IPV interventions. The findings have implications for researchers, practitioners (community health workers, clinicians, and social workers), and policymakers keen on IPV reduction in India and globally.

The chronic disease management program, a community-based intervention including patient education, recall and remind service, and reduction of out-of-pocket payment, was implemented in 2005 in Korea to improve patients’ adherence for antihypertensive medications. This study aimed to assess the effect of a community-based hypertension intervention intended to enhance patient adherence to prescribed medications. This study applied a non-equivalent control group design using the Korean National Health Insurance Big Data. Hongcheon County has been continuously implementing the intervention program since 2012. This study involved a cohort of patients with hypertension aged >65 and <85 years, among residents who lived in the study area for five years (between 2010 and 2014). The final number of subjects was 2685 in both the intervention and control region. The indirect indicators were analyzed as patients’ adherence and level of continuous treatment using the difference-in-difference regression. The proportion of hypertensive patients who continuously received insurance benefits for >240 days in 2014 was 81.0% in the intervention region and 79.7% in the control region. The number of dispensations per prescription and the dispensation days per hypertensive patient in the intervention region increased by approximately 10.88% and 2.2 days on average by month, respectively, compared to those in the control region. The intervention program encouraged elderly patients with hypertension to receive continuous care. Another research is needed to determine whether further improvement in the continuity of comprehensive care will prevent the progression of cardiovascular diseases.

Purpose: To evaluate the effects of progressive resistance and balance (PRB) exercises on physical and psychological functions of post-stroke individuals.Materials and methods: In a randomized controlled trial with follow-up at 3, 6 and 15 months, 67 community-living individuals (76% male; 65–85 years) with a stroke 1–3 years previously were allocated to an intervention group (IG, n = 34; PRB exercises combined with motivational group discussions twice weekly for 3 months) or a control group (CG, n = 33). The primary outcomes were balance (Berg Balance Scale, 0–56 points) and mobility (Short Physical Performance Battery, 0–12 points) at 3 months. The secondary outcomes were 10 m comfortable walking speed, physical activity levels, health-related quality of life, depression and fall-related self-efficacy.Results: At 3 months, the IG exhibited significant improvements in balance (MD 2.5 versus 0 points; effect size [ES], 0.72; p < 0.01) and comfortable walking speed (MD 0.04 versus -0.05 m/s; ES, 0.68; p = 0.01) relative to the CG. A faster walking speed persisted at 6 months. No differences were found for the other outcomes.Conclusions: In chronic stroke patients, 3 months of PRB exercises and motivational discussions induced improvements in balance at 3 months and in walking speed at 3 and 6 months.Implications for RehabilitationA progressive resistance and balance exercise program supported by motivational group discussions and one home-based exercise appears to be an effective means of improving the short-term balance and the walking speed in individuals with chronic stroke.People with poor balance and motor function discontinued the study more often and may require additional support.There is a need for powerful and cost-effective strategies that target changes in behavior to obtain long-term changes in physical function after exercising.

Background: A team-based approach facilitates comprehensive assessment and individualized care plan for diabetes patients. The ADA recommends diabetes patients see a Certified Diabetes Educator (CDE), Registered Dietician (RD) and Social Worker (SW) at least once yearly. Prior to this QI project there was no structured process in our pediatric diabetes clinic for these visits, leading to low rates of multidisciplinary patient care. Objectives: Our goal was to improve the proportion of diabetes patients receiving evidenced-based multidisciplinary care for enhanced education and social support. Specifically, we aimed to improve the percentage of diabetes patients (&amp;lt;21yo) with CDE visits from baseline of 59% in FY2014 to ≥75% in FY2017, RD visits from baseline of 33% in FY2014 to ≥75% in FY2017, and SW visits from baseline of 24% in FY2014 to ≥75% in FY2017. Methods: Fish bone and key driver diagrams were deployed to identify strategies for improvement. Our intervention established a policy of Annual Visits for multidisciplinary care with a model to ensure optimal communication. PDSA1: Use birthdays as a mechanism to trigger Annual Visit with CDE, RD, SW; PDSA2: Develop and utilize sustainable pre-visit planning document; PDSA3: Staff call patients scheduled for Annual Visit the day prior; PDSA4: Multidisciplinary pre-clinic huddle to discuss daily clinic procedure; PDSA5: Utilization of EMR diabetes patient registry to identify gaps in care; PDSA6: Utilize a Nurse Coordinator to ensure patients receive required services Results: The rates of patients seen by multidisciplinary staff increased from baseline for all 3 groups in FY2017: CDE-79.4%, RD-64.3% and SW-83.9%. Thus, the goal of ≥75% was achieved for CDE and SW, but not RD visits (primarily due to staffing). Conclusions: This QI project resulted in improved transparency, organization and accountability within the clinic. Increasing CDE, RD, and SW support for diabetes patients could impact quality of care delivery, value to the patient, and clinical outcomes. Disclosure D.J. DeSalvo: Consultant; Self; Dexcom, Inc.. Speaker's Bureau; Self; Insulet Corporation. S.K. Bartz: None. C. Yee: None. R. Sonabend: None.

The measures undertaken to control COVID-19 have disrupted many platforms including tuberculosis (TB) healthcare services. Consequently, declines in TB notifications have been observed in various countries. We visualized changes over time in TB and SARS-CoV-2 infection notifications and reported on country-specific strategies to retain TB care and prevention services in Kyrgyzstan, Nigeria, Tanzania, and Vietnam. We collected and visualized quarterly, retrospective, and country-specific data (Quarter (Q) 1 2018- Q1 2021) on SARS-CoV-2 infection and TB notifications. Additionally, we conducted a country-specific landscape assessment on COVID-19 measures, including lockdowns, operational level strategy of TB care and prevention services, and strategies employed to recover and retain those services. We used negative binomial regression models to assess the association between the installation of COVID-19 measures and changes in TB notifications. TB notifications declined in Kyrgyzstan and Vietnam, and (slightly) increased in Nigeria and Tanzania. The changes in TB notifications were associated with the installation of various COVID-19 prevention measures for Kyrgyzstan and Vietnam (declines) and Nigeria (increases). All countries reported reduced TB screening and testing activities. Countries reported the following strategies to retain TB prevention and care services: digital solutions for treatment adherence support, capacity building, and monitor & evaluation activities; adjustment in medication supply/delivery & quantity, including home delivery, pick up points, and month supply; integrated TB/COVID-19 screening & diagnostic platform; and the use of community health care workers. Following the COVID-19 pandemic, we did not observe consistent changes in TB notifications across countries. However, all countries reported lower operating levels of TB prevention and care services. Digital health solutions, community-based interventions, and the integration of COVID-19 and TB testing services were employed to recover and retain those services.

BackgroundAir pollution remains a significant public health risk, particularly in urban areas. Effective communication strategies remain integral to overall protection by encouraging the adoption of personal air pollution exposure reduction behaviours. This study aims to explore how community health professionals can be empowered to communicate air pollution information and advice to the wider community, to encourage the uptake of desired behaviours in the population.MethodsThe study adopted a qualitative methodology, where four homogenous Focus Group Discussions (FGDs) were held with a range of community health professionals, including Health Care Professionals, Community Health and Wellbeing Workers (CHWWs) and Social Prescribing Link Workers (SPLW). A classical content analysis was conducted with the Structural Empowerment Theory (SET) and Psychological Empowerment Theory (PET) as guiding concepts.ResultsFive key themes were identified: from a structural empowerment perspective: [1] resources and support, [2] knowledge. From a psychological empowerment perspective: [3] confidence as advisor, [4] responsibility as advisor, and [5] residents’ receptiveness to advice. It was concluded that advice should be risk stratified, clear, easy to follow and provide alternatives.ConclusionThis study identified ways for community health professionals to be empowered by local councils or other organisations in providing advice on air pollution, through the provision of essential structural support and opportunities to enhance their knowledge and confidence in the subject. Implementing recommendations from this study would not only empower community health professionals to advise on air pollution to the wider community but also increase adherence to health advice.

Falls among older adults are a crucial problem that affects the quality of life of the elderly population significantly and increases the health care burden and cost of states. As people get older, they may fall more often for a variety of reasons including problems with balance, poor vision, and dementia. About a third of community-dwelling people over 65 years old fall each year, and the incidence of falls, and fall- related injuries, increases with age. Among older adults, falls are the leading cause of injury deaths. They are also the most common cause of nonfatal injuries and hospital admissions for trauma. However, many falls are predictable and preventable. Family physicians caring for older patients should integrate fall assessment into the annual history and physical examination. They should question the history of a fall if older patients don’t explain it. The risk of falling should be assessed for all elderly patients and precautions taken if necessary. Although falls may not result in injuries, they can nevertheless result in fear of falling and loss of confidence. This fear and loss of a sense of self-sufficiency may cause the elderly to restrict their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling. There are many risk factors for falls among older seniors. Risk factors for falls can be classified into two categories: intrinsic factors and extrinsic factors. Most falls result from a complex interplay of predisposing and precipitating factors in a person's environment. Environmental hazards are preventable by relevant measures. Muscle weakness and poor balance have been well established as intrinsic risk factors for falling in elderly. The other risk factors include the use of an assistive device, visual deficit, arthritis, impaired activities of daily living, depression, cognitive impairment, and age older than 80 years. Dizziness, vertigo, drop attacks, postural hypotension, visual impairment are also known to cause falls. There is good evidence for the benefit of exercise in preventing falls. Physical activity appears to be associated with a reduced risk or slower progression of several age-related conditions which increase the risk of falls among elderly. Regular participation in physical activity is not only integral to the maintenance of good health and functional independence in older adulthood but will also lower the risk for falls and fall-related injuries. Depending on the level of fall risk identified, physical activity may serve a primary, secondary, or tertiary role in the prevention of falls. Its primary role is to prevent the onset of pathology and system impairments that may lead to disability and heightened risk for falls. Its secondary role is in slowing the progression of disease and system impairments. Its tertiary role lies in the restoration of function to a level that allows for more autonomy in the performance of daily activities. Regular participation in moderate physical activity is integral to good health and maintaining independence. It prevents the onset of multiple pathologies and functional capacity decline. Moderate physical activities and exercise also lowers the risk of falls and fall-related injuries in older age through controlling weight as well as contributing to healthy bones and muscles. Exercise programs should be tailored according to fall risk and the condition of older persons and should consist of four main types of exercise for preventing falls: endurance activities, strengthening exercises, stretching exercises and balance exercises. Individually tailored programs that included muscle strength development, balance improvement, and walking significantly reduced falls in older persons. Promoting appropriate physical activities or exercises to improve strength, balance, and flexibility is one of the most feasible and cost-effective strategies to prevent falls among older adults in the community. Key words: Aged, Accidental Falls, Exercise, Postural Balance, Resistance Training, Fear

Chronic pelvic pain syndrome (CPPS) is prevalent and a complex multifactorial condition. The incidence is rising. CPPS patients may benefit from multidisciplinary care in a structured care pathway. The aim of this explorative study is to give an overview of patient and healthcare provider perspectives on the current patient journey to implement these perspectives in a CPPS care pathway. A Qualitative study was performed using nominal group technique. The participants were nine female patients CPPS and fourteen healthcare providers involved in CPPS care. The perspectives of the stakeholder groups on the individual components of the CPPS patient journey were collected. Five overarching key topics were identified: structured start of the patient journey, execution of the patient journey, follow-up after the patient journey, administration during the patient journey, and communication and education. The following recommendations were formulated based on the prioritised points: implementation of a multidisciplinary approach from the start of the journey, adding a case manager and expanding the multidisciplinary team, providing a collaborative triage, updating the questionnaires, improving communication, developing a rehabilitation programme, and reducing waiting times. Stakeholder focus groups using the nominal group technique was a pivotal step in the development of our CPPS care pathway. This step led to fundamental recommendations, of which a personalised treatment plan at an earlier stage in the patient journey might be the most impactful. This is now implemented, and we monitor the effects on outcomes, quality of life and patient's satisfaction.

Introduction: Demand for healthcare services is increasing due to the ageing population and events such as the COVID-19 pandemic. Healthcare workers and managers can respond by shifting from multidisciplinary to transdisciplinary teams, where multiple services are integrated and designed around the healthcare needs of individuals and patient groups. Background: Transdisciplinary teams provide the formal structures for healthcare professionals to blur professional boundaries, share and acquire new skills and knowledge, support each other, and provide high quality patient care. Instead of organising healthcare services in silos of professional groupings, transdisciplinary teams place the patient at the centre of care. Reorganising teams around the patient can reduce duplication of healthcare services, the number of healthcare professionals delivering services, and occasions of service. Healthcare professionals gain skills, time, and the ability to support each other, which are qualities of a flexible and capable workforce. Aims: In this submission, we show healthcare workers and managers how co-designed transdisciplinary teams can be translated into clinical practice. We aim to explain why and how to shift from multidisciplinary to transdisciplinary teams by 1) providing clinical evidence demonstrating how transdisciplinary teams can improve person-centred care and the healthcare workforce; and 2) sharing practical learnings when planning a transdisciplinary team. Methods/engagement: At the Mater Hospital Brisbane, assessment processes were reorganised around patients experiencing stroke symptoms. A transdisciplinary assessment was co-designed by allied health professionals, nurses, and managers where tasks and questions were integrated from occupational therapy, physiotherapy, speech pathology, social work, and nursing. A clinical mixed methods study evaluated the transdisciplinary assessment compared to usual multidisciplinary assessment. Patients and staff were also consulted during the clinical study via surveys and fortnightly meetings. Results/impact: All occupational therapists and physiotherapists completed transdisciplinary competency training, which improved staff availability and flexibility to comprehensively assess patients. Use of a transdisciplinary assessment resulted in a time saving of approximately 53 minutes per assessment, which indicated improved workforce productivity and capacity. The time saved could be reallocated to increasing rehabilitation time, or to an extra occasion of service to the same or other patients. Additionally, staff reported that the transdisciplinary assessment “saves time and helps staff manage clinical workloads by reallocating resources across teams” and resulted in an “agile workforce”. Learnings/next steps: To co-design and shift from a multidisciplinary to transdisciplinary team, stakeholder consultation was imperative to ensure comprehensive planning and barrier identification. Addressing barriers when shifting to a transdisciplinary team involved behaviour change from staff. For example, a lack of confidence in the skills of another professional, or a lack of willingness to share skills could impede transdisciplinary efforts. To negotiate these barriers, it was essential to establish clear competency training requirements and educate staff on the purpose of transdisciplinary teams for improving patient care and workforce capacity. To translate transdisciplinary teams into other healthcare settings internationally, we propose the practice guidelines: 1) key stakeholders should be consulted to co-design the transdisciplinary team, identify and address implementation barriers; 2) competency training is required; and 3) staff education on transdisciplinary teams is required.

To assess the effectiveness of a community-based falls-and-fracture nurse coordinator and multifactorial intervention in reducing falls in older people. Randomized, controlled trial. Screening for previous falls in family practice followed by community-based intervention. Three hundred twelve community-living people aged 75 and older who had fallen in the previous year. Home-based nurse assessment of falls-and-fracture risk factors and home hazards, referral to appropriate community interventions, and strength and balance exercise program. Control group received usual care and social visits. Primary outcome was rate of falls over 12 months. Secondary outcomes were muscle strength and balance, falls efficacy, activities of daily living, self-reported physical activity level, and quality of life (Medical Outcomes Study 36-item Short Form Questionnaire). Of the 3,434 older adults screened for falls, 312 (9%) from 19 family practices were enrolled and randomized. The average age was 81+/-5, and 69% (215/312) were women. The incidence rate ratio for falls for the intervention group compared with the control group was 0.96 (95% confidence interval=0.70-1.34). There were no significant differences in secondary outcomes between the two groups. This nurse-led intervention was not effective in reducing falls in older people who had fallen previously. Implementation and adherence to the fall-prevention measures was dependent on referral to other health professionals working in their usual clinical practice. This may have limited the effectiveness of the interventions.

PurposeOral endocrine therapy (OET) is recommended in prevention and treatment of hormone receptor-positive breast cancer (HR+ BC). Despite the reduced incidence, recurrence, and mortality, OET adherence is poor in this patient population. The aim of this study was to review the latest literature to identify effective interventions to improve medication adherence in patients taking OET for prevention or treatment of HR+ BC.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework was used to perform this review. We utilized PubMed, SCOPUS, EMBASE, Cochrane, and Web of Science to acquire articles using search terms including breast cancer, adherence, persistence, and acceptability. Inclusion criteria included publication in peer-reviewed journal, primary data source, longitudinal, patients on OET such as aromatase inhibitors (AIs) or selective estrogen receptor modulators (SERMs), measuring adherence, persistence, or acceptability.ResultsOut of 895 articles identified, 10 articles were included. Majority of patients had early-stage HR+ BC. Two out of two studies incorporating technological intervention, two out of three studies with text communication-based intervention, and three out of five studies with verbal communication-based intervention reported significant improvement in OET adherence and/or persistence.ConclusionsWhile the interventions tested so far have shown to improve OET adherence in HR+ BC patients in some studies, there is a need to design combination interventions addressing multiple barriers in this population.Implications for Cancer SurvivorsThis study showcases effectiveness of novel interventions to improve OET adherence and the need to further develop patient-centered strategies to benefit all patients with HR+ BC.