Health Pilot Program Research Articles

Evaluation of the Ministry of Health's pilot program - A personal pregnancy follow-up service

Abstract Background The Israeli Ministry of Health has developed a unique pregnancy follow-up (PF) service in the Haifa District Infant-Parent Centers, including a fixed nurse attending the necessary examinations and services, supporting and guiding the woman throughout her pregnancy. Aim To examine the differences between the participants who received PF within the pilot program (research group) and those who received standard PF (control group) regarding health behaviors, receiving information and attitudes regarding health behaviors, professional support, and satisfaction with the service. Methods Questionnaires were filled in by 293 mothers to infants- 38% of which belonged to the research group and 62% to the control group. There were no significant differences between the two groups’ characteristics. Findings Significant differences were found between the groups regarding receiving information and support, and some of the attitudes and behaviors, as well as a difference in satisfaction, in favor of the research group; e.g., 95% of the participants in the research group were vaccinated against Pertussis, as compared to 85% of the control group (z = 2.47, p<.001). Process model for parallel mediation revealed that receiving PF in the research group was associated with (1) More positive attitudes (Effect=0.06, SE = 0.04 CI=0.01,0.15) and receiving information (Effect=0.18, SE = 0.08 CI=0.02,0.33), which in turn were associated with more reported health behaviors (Total indirect effect=0.30, SE = 0.09 CI=0.14,0.49); (2) Receiving more support (Effect=0.16, SE = 0.04 CI=0.09,0.26), as well as more information (Effect=0.10, SE = 0.05 CI=0.01, 0.19), which in turn were associated with higher satisfaction with the PF (Total indirect effect=0.25, SE = 0.05 CI=0.16,0.36). Conclusions The findings indicate the pilot program's success in promoting pregnant women's health, among other things, due to the guidance and support provided by a fixed dedicated nurse. Key messages • Personal pregnancy follow-up is efficient for supporting and guiding women during a sensitive period for their fetus’ and their own health, and encourages compliance with health behaviors. • It is recommended to implement the program in additional districts, and to examine the findings among a wider and more diverse sample.

The ACTIVATE Digital Health Pilot Program for Diabetes and Hypertension in an Underserved and Rural Community.

Community health centers and patients in rural and agricultural communities struggle to address diabetes and hypertension in the face of health disparities and technology barriers. The stark reality of these digital health disparities were highlighted during the coronavirus disease 2019 pandemic. The objective of the ACTIVATE (Accountability, Coordination, and Telehealth in the Valley to Achieve Transformation and Equity) project was to codesign a platform for remote patient monitoring and program for chronic illness management that would address these disparities and offer a solution that fit the needs and context of the community. ACTIVATE was a digital health intervention implemented in three phases: community codesign, feasibility assessment, and a pilot phase. Pre- and postintervention outcomes included regularly collected hemoglobin A1c (A1c) for participants with diabetes and blood pressure for those with hypertension. Participants were adult patients with uncontrolled diabetes and/or hypertension (n = 50). Most were White and Hispanic or Latino (84%) with Spanish as a primary language (69%), and the mean age was 55. There was substantial adoption and use of the technology: over 10,000 glucose and blood pressure measures were transmitted using connected remote monitoring devices over a 6-month period. Participants with diabetes achieved a mean reduction in A1c of 3.28 percentage points (standard deviation [SD]: 2.81) at 3 months and 4.19 percentage points (SD: 2.69) at 6 months. The vast majority of patients achieved an A1c in the target range for control (7.0-8.0%). Participants with hypertension achieved reductions in systolic blood pressure of 14.81 mm Hg (SD: 21.40) at 3 months and 13.55 mm Hg (SD: 23.31) at 6 months, with smaller reductions in diastolic blood pressure. The majority of participants also reached target blood pressure (less than 130/80). The ACTIVATE pilot demonstrated that a codesigned solution for remote patient monitoring and chronic illness management delivered by community health centers can overcome digital divide barriers and show positive health outcomes for rural and agricultural residents.

Campus‐based pilot seeks to lift barriers to care for young adults

Operators of a young adult mental health pilot program in Texas are planning to deliver services in a fashion that too many traditional mental health systems nationally have not: early, low‐barrier, and age‐specific.

Effectiveness of a whole health model of care emphasizing complementary and integrative health on reducing opioid use among patients with chronic pain

BackgroundThe opioid crisis has necessitated new approaches to managing chronic pain. The Veterans Health Administration (VHA) Whole Health model of care, with its focus on patient empowerment and emphasis on nonpharmacological approaches to pain management, is a promising strategy for reducing patients’ use of opioids. We aim to assess whether the VHA’s Whole Health pilot program impacted longitudinal patterns of opioid utilization among patients with chronic musculoskeletal pain.MethodsA cohort of 4,869 Veterans with chronic pain engaging in Whole Health services was compared with a cohort of 118,888 Veterans receiving conventional care. All patients were continuously enrolled in VHA care from 10/2017 through 3/2019 at the 18 VHA medical centers participating in the pilot program. Inverse probability of treatment weighting and multivariate analyses were used to adjust for observable differences in patient characteristics between exposures and conventional care. Patients exposed to Whole Health services were offered nine complementary and integrative health therapies alone or in combination with novel Whole Health services including goal-setting clinical encounters, Whole Health coaching, and personal health planning.Main measuresThe main measure was change over an 18-month period in prescribed opioid doses starting from the six-month period prior to qualifying exposure.ResultsPrescribed opioid doses decreased by -12.0% in one year among Veterans who began complementary and integrative health therapies compared to similar Veterans who used conventional care; -4.4% among Veterans who used only Whole Health services such as goal setting and coaching compared to conventional care, and -8.5% among Veterans who used both complementary and integrative health therapies combined with Whole Health services compared to conventional care.ConclusionsVHA’s Whole Health national pilot program was associated with greater reductions in prescribed opioid doses compared to secular trends associated with conventional care, especially when Veterans were connected with complementary and integrative health therapies.

"Something Fun to Look Forward to": Lessons From Implementing the Prescription for Health Farmers' Market Initiative in Rural Upper Michigan.

Fruit and vegetable (FV) prescription programs are an increasingly popular community-based approach to addressing food insecurity and improving nutrition by connecting local health care and food systems. The Prescription for Health farmers' market FV prescription program was piloted in a rural, low-access low-income Michigan community in 2017. The program enrolled 33 adult participants with chronic disease and provided weekly farmers' market FV vouchers, educational nutrition handouts, and seasonal healthy recipes over 10 weeks. Weight, blood pressure, and the following self-rated variables were assessed pre- and post program: dietary habits, food literacy, physical health, and mental health. While most metrics remained generally unchanged, one of the strongest findings from our data included significant improvement in quality of life. Increased social interaction as a result of the attending the farmers' market was a prominent theme from informal open-ended participant feedback. Given the ongoing public health crisis of loneliness and social isolation, this finding led us to consider the farmers' market as an avenue for creating opportunities for meaningful social connection among participants and farmers. To this end, we discuss health outcomes of the Prescription for Health pilot program, reflect on unique aspects of implementing this program in a rural area, and explore future opportunities for farmers' market prescription programs as an innovative form of nature-based social prescribing.

Implementing a Produce Prescription Program in Partnership With a Community Coalition.

Healthy eating reduces risk for chronic disease, but can be out of reach for many Americans experiencing food insecurity. Produce Prescription Programs (PPPs) have emerged as an intervention to address barriers related to fruit and vegetable consumption. Using a social prescribing model, PPPs connect patients with referrals to community resources to reduce barriers to healthy eating. There is evidence of success of PPPs at improving dietary intake, yet little discussion within the literature of practical aspects of implementation. As interest grows around establishing PPPs within communities, increased attention to strategic planning and implementation remains necessary to develop robust and effective programming. We describe implementing the Pontiac Prescription for Health pilot program, highlighting the participatory planning process with partners. Development and implementation included a program model, recruitment methods and materials, a voucher contract and tracking system with produce vendors, physical activity opportunities, culturally competent health education sessions, and evaluation tools. We offer insight into lessons learned and practical implications for future "on-the-ground" planning and implementation. Engaging in a rigorous participatory planning process with all community partners, allowing adequate time to establish service agreements and a voucher system with vendors, and engaging program participants in different ways and spaces throughout the community can enhance program success.

Removing Barriers: A Confidential Opt-Out Mental Health Pilot Program for Internal Medicine Interns.

There are significant barriers for resident physicians seeking mental health care, including lack of time, cost, and concerns about confidentiality. The authors sought to improve access to mental health resources by addressing these barriers through the development of a confidential opt-out mental health pilot program for interns and to assess the feasibility, acceptability, and resident satisfaction with the program. All internal medicine and internal medicine-pediatrics interns in the 2017-2018 residency class at the University of Colorado were enrolled in the confidential opt-out mental health program. Each intern was provided with an additional half-day off during their continuity clinic week, during which a mental health screening appointment at the campus health center with an in-network mental health provider was scheduled. All costs were covered by the residency program. An anonymous follow-up survey was sent to all interns to assess participation in the program and its perceived impact on their wellness. Appointments were made for 80 interns: 23 (29%) attended the appointment, 45 (56%) opted out in advance, and 12 (15%) were no-shows. The total cost of the program was $940 or $11.75 per intern. Of the 41 interns who responded to the survey, 35 (85%) agreed the program should continue next year. The majority of interns felt the program positively affected their wellness regardless of whether they attended the appointment. Of the 16 interns who attended the appointment and completed the survey, 4 (25%) reported receiving additional mental health referrals or follow-up appointments. This confidential opt-out mental health pilot program for interns was feasible, relatively low cost and simple to implement, and had positive impacts on self-reported wellness. Further study of interventions that remove barriers to accessing mental health care for residents is urgently needed.

Abstract WP469: The Art of Health: A Pilot Program for Stroke Survivors

Background and Purpose: Along with physical and cognitive effects, psychosocial well-being may be affected post-stroke, including depression, anxiety, and feelings of isolation. Incorporating holistic activities into stroke survivors’ recovery may be beneficial. An innovative pilot program was developed by a community hospital and a local university art therapy department to provide art classes to stroke survivors. The aim of this pilot program, The Art of Health , was to determine if stroke survivors and caregivers would participate in an art program for addressing overall well-being. Methods: Five art classes of 1.5 hours in length were scheduled for the program and advertised to hospital leaders and the rehab unit. Art therapy students volunteered to teach the art classes. Patients and caregivers were invited from the stroke support group and from the inpatient rehab unit to attend. The Stroke Coordinator prepared a small health topic to introduce to the art class attendees prior to the art activity. Art therapy students attempted to match their art class activity to the health topic, but were given freedom of choice for overall art project. Classes were held in the evening to accommodate caregivers’ potential schedules. Attendees were surveyed regarding the art classes to gain feedback on improving the program. Results: A total of 47 participants attended the five art classes (class median = 9). Of those surveyed, 100% (n = 47) stated that they would attend another type of art program at the hospital. Two students inquired if there was opportunity to complete their university clinical internship at the hospital. Due to The Art of Health pilot program success, the stroke coordinator collaborated with the art therapy department instructor to create a clinical rotation. With the support of the hospital CEO and CNO, an interprofessional team was formed to develop and support an Art Therapy Internship program at the hospital. Conclusions: In conclusion, innovative programs which include creative-arts based therapies and activities may be beneficial to both stroke survivors and caregivers. Future research on creative-arts and their impact on psychosocial well-being post-stroke would be of benefit.

Embracing Change In Dental Practice To Deliver Better Health Outcomes- A Type 2 Diabetes Screening and Oral Health Pilot Program

Disadvantaged communities carry the highest burden of disease with respect to oral and general health. Diabetes is a growing chronic-condition in Australia with those living in regional or lower socio-economic areas at a higher risk of developing diabetes and experiencing the associated complications. Oral and periodontal disease has been linked to diabetes. Within the community dental clinic we aimed to determine the feasibility of screening for diabetes and reduce the burden of both diseases. All patients presenting to the community dental clinic of the Colac Area Health Service were given the opportunity to participate in a Diabetes screening assessment. Adults who consented completed the Australian Type 2 Diabetes Risk Assessment (AUSDRISK) with those at high risk offered an HbA1c blood test. Six hundred and seventy patients were invited to participate. Seventy-five reported confirmed diabetes and 125 were currently being monitored by their general practitioner. Ninety-six of the remaining 470 eligible patients declined to participate (participation rate 80%). The AUSDRISK was completed by 371 patients (n=3 incomplete) and identified 56 (15%) as low risk, 123 (33%) at intermediate risk and 192 (52%) at high risk. Following HbA1c blood testing, 14 patients were in the high risk range (>6.0%). The high risk category according to the AUSDRISK included 31% emergency patients, an average of 25 (IQR 19-29) Decayed Missing or Filled Teeth, 49% with early signs of periodontal disease, 73% aged 55 years or older, 48% male, 36% had a direct relative with diabetes, 18% had hypertension, 29% currently smoked and 75% had waist measurements >90 cm for men and 80cm for women. The study demonstrated that 68% of patients willing to participate in the study presenting to the community dental clinic had either confirmed diabetes, were being tested by their general practitioner or were in a high risk category (AUSDRISK).

Sustainability of improvements in medication adherence through a mobile health intervention.

Context-Very few patient-centered, theory-guided programs for medication adherence and blood pressure control have been conducted in kidney transplant recipients. Objective-To evaluate preliminary indications of sustainability of improved blood pressure in kidney transplant recipients 12 months after completion of a 3-month randomized controlled trial of a mobile health pilot program to improve blood pressure and medication adherence. Participants and Design-A total of 18 of the 19 trial participants were contacted and all consented to inclusion in the retrospective analysis of their medical records showing their clinic-recorded systolic blood pressures at 3, 6, and 12 months following participation in the 3-month trial of a medical regimen self-management intervention. Results-A significant group difference in systolic blood pressure was observed longitudinally, indicating that the intervention group, as compared with the standard-care group, exhibited lower clinic-measured systolic blood pressures at the 12-month posttrial follow-up visit (P= .01). At 12-month follow-up, success in establishing and sustaining control of systolic blood pressure (<131 mm Hg) was greater in the intervention group (50%) than in the control group (11%). Conclusion-Patients in the intervention group continued to exhibit lower systolic blood pressure than did patients in the control group 12 months after the trial ended, suggesting that the intervention may have a durable impact on blood pressure control that most likely reflects sustained medication adherence. These findings will aid in the development of an adequately powered randomized controlled trial to address the sustainable impact of the intervention program on medication adherence and blood pressure control.

Process evaluation of European 'Healthy Stadia' program.

Healthy Stadia (HS) is a European public health pilot-program started in 2007 to support sports stadia in promoting the health of people who work and visit sports stadia, as well as inhabitants of the surrounding communities. The aim of this study is to describe the process evaluation of the program, from its beginning in July 2007 to December 2009, in order to assess the feasibility and sustainability of an HS network across Europe. The program involved nine associate partners involved in the coordination of activities at a local level, in the recruitment of stadia, in the development of specific program tasks and in the dissemination of the program at a national level. The activities of associate partners were evaluated through structured questionnaires administered every 6 months. The questionnaire response rate from associate partners was 77.8% for the first and third evaluations and 88.9% for the second and fourth evaluations. According to the evaluation's results, several good practices such as alcohol prevention policies and those supporting people with disabilities were implemented in stadia over the course of the program. Conversely, practices supporting mental health and green transport were generally not achieved. The implemented activities mainly involved staff and visitors. Lack of human and economic resources, especially toward the end of the program, was considered the principal challenge for program development. In conclusion, the process evaluation presented the feasibility of the HS program and the development of health promoting practices in sport stadia over time.

The continued development and practice of school psychology in Singapore: Using REACH as an Illustration

School psychology in Singapore gained greater prominence with the development of the National Mental Health Blueprint in 2007 that included a focus on children and adolescents. A partnership between the Ministry of Health and the Ministry of Education was formed to develop a community mental health pilot program called ‘Response, Early Intervention and Assessment in Community Mental Health for Students’ (REACH). Disruptive behavior disorders (DBD) are among the most common disorders seen in schools and child psychiatric clinics in Singapore. Children with disruptive behavior disorders (DBD) often exhibit deficits in social cognition and behavior, thereby influencing their cognitive appraisal processes and interpersonal problem-solving skills. This in turn affects their processing and interpretation of social cues in ambiguous situations, and mars subsequent production of socially competent behavior. This article describes a potential framework based on the cognitive-behavioral approach for working with children with disruptive behaviors and aggression in the school system. By combining REACH, a national collaborative framework, and evidence-based treatment programs, we provide a promising model of care to support children and their families in Singapore.

The development and evaluation of the intervention model for the Florida Infant Mental Health Pilot Program.

The focus of this paper is on the development and evaluation of an intervention model for Florida's Infant and Young Child Mental Health Pilot Program, designed to identify families with children at risk for abuse and neglect, and to provide clinical evaluation and treatment services. The evaluation model, intervention strategies, and results presented in this paper are all part of the Florida pilot project developed as a response to the recommendations of the state's Strategic Plan for Infant Mental Health. Funded by the Florida legislature, the 3-year, multisite pilot was designed to provide earlier identification, better evaluation, and more effective treatment services for high-risk children under the age of three. The target population was children either at risk for out-of-home placement due to abuse and neglect, or those already in the child welfare system or adjudicated dependent by the state. The goals of the pilot project were: 1) to reduce the occurrence and re-occurrence of abuse and neglect; 2) to enhance the child's developmental functioning; 3) to improve the parent-child relationship; 4) to increase expeditious permanency placements; 5) to develop a model for intervention and treatment that could potentially be replicated in different sites; and 6) to document the components of a quality infant mental health intervention model and evaluate its effectiveness.

HIV-1 pol Gene Polymorphism and Antiretroviral Resistance Mutations in Drug-Naive Pregnant Women in Yaoundé, Cameroon

A recent demographic and health survey was performed in Cameroon in 2004 that showed an HIV-1 seroprevalence rate of 5.5% in the general population. In Yaounde the capital city of Cameroon HIV-1 prevalence is as high as 10% among pregnant women attending antenatal centers. Since the year 2000 a public health pilot program for the prevention of mother-to-child transmission started providing a single dose of the nonnucleoside reverse transcriptase (RT) inhibitor nevirapine (NVP) to pregnant women who were diagnosed as HIV-1 positive in a maternity ward in Yaounde. This program is now scaled to at least 60% of health districts of the country. One of the main portals of antiretroviral (ARV) entry in Cameroon is via the HIV-1 prevention of mother-to-child transmission program. To date no information is available on ARV resistance in this sentinel population. The present study aimed to investigate whether genetic polymorphisms were present in RT and protease (PR) of HIV-1 genes at positions affecting the susceptibility to ARV and to evaluate baseline drug resistance among HIV-1-infected pregnant women naive to NVP in Yaounde Cameroon where HIV-1 non-B subtypes predominate. (excerpt)

Formative evaluation results from the Mariner Project: a coordinated school health pilot program.

This study determined the extent to which a coordinated school health program (CSHP) infrastructure was in place and functioning adequately within a two- to three-year developmental period in South Carolina. The Mariner Project's eight-component model was implemented in three middle schools and their four feeder elementary schools in three communities. Evaluation criteria for the Mariner Project reflect rigorous, minimum adequacy performance standards, and were based on national standards for school health practice and research and objective judgments of project performance. Eleven critical performance elements were developed, and a modified indexing procedure was utilized for project evaluation efforts. Results suggest that a combination of four critical performance elements, 1) Administrative Support/Buy-In, 2)Coordination of the Eight-Component Personnel School-Based Health Promotion Team, 3) Program Champion/Liaison/Facilitator, and 4) Staff Wellness Coordinator, served as the foundation for adequate or less-than-adequate performance for each school among the remaining critical elements, and subsequently for the overall Mariner Project.