Opportunistic Interventions Research Articles

Chlamydia screening interventions from community pharmacies: a systematic review

Chlamydia (Chlamydia trachomatis) is the most commonly notified sexually transmissible infection in Australia. Increasing the number of people aged 16-25 years being tested for chlamydia has become a key objective. The strategy recommends that chlamydia screening sites should be easy to access. Community pharmacies are conveniently located and easily accessible. This review aimed to determine the different types of pharmacy-based chlamydia screening interventions, describe their uptake rates, and understand issues around the acceptability of and barriers to testing. Seven electronic databases were searched for peer-reviewed articles published up to 30 October 2011 for studies that reported chlamydia screening interventions from community pharmacies, or had qualitative evidence on acceptability or barriers linked with interventions. Of the 163 publications identified, 12 met the inclusion criteria. Nine reported chlamydia screening interventions in a pharmacy setting, whereas three focussed on perspectives on chlamydia screening. Pharmacists could offer a chlamydia test to consumers attending the pharmacy for a sexual health-related consultation, or consumers could request a chlamydia test as part of a population-based intervention. Participating consumers said pharmacies were accessible and convenient, and pharmacists were competent when offering a chlamydia test. Pharmacists reported selectively offering tests to women they thought would be most at risk, undermining the principles of opportunistic interventions. Chlamydia screening from community pharmacies is feasible, and can provide an accessible, convenient venue to get a test. Professional implementation support, alongside resources, education and training programs, and incentives may overcome the issue of pharmacists selectively offering the test.

Treatment Fidelity Instrument to Measure a Brief Opportunistic Intervention for Prenatal Substance Use

To develop and psychometrically evaluate an instrument designed to measure the treatment fidelity associated with implementation of the I Am Concerned (IAC) brief opportunistic intervention by frontline, prenatal, primary care staff. A methodologic approach framed development of the IAC Treatment Fidelity Instrument in a six-phase protocol. A simulated prenatal clinic with standardized patients portraying substance-using pregnant women. Prenatal, primary care, frontline staff (N=6), experienced in IAC implementation. Following development of the IAC treatment fidelity instrument, independent raters used the instrument to evaluate audio recordings (N=49) of frontline staff implementing the IAC brief opportunistic intervention with standardized patients representing substance-using pregnant women. Psychometric analysis provided evidence of content validity. Intraclass correlation coefficients calculated for inter-rater reliability were satisfactory for subscales (0.64) and (0.62) and ranged from -0.07 to 0.81 for individual items. Internal consistency alpha coefficients were satisfactory for the total scale (0.72) and lower than acceptable for adherence (0.54) and competence (0.56) subscales. Overall high rater percentage agreement and negatively skewed ratings distribution indicated reliability results were paradoxically low due to the base rate problem. Results support revision and ongoing testing of the IAC treatment fidelity instrument. The impact on reliability statistics exerted by this study's skewed data distribution has implications for nursing research as low variance can be anticipated when measuring care provided to homogenous patient populations. It is important to recognize the resulting influence on inter-rater agreement to avoid making inaccurate interpretations about the reliability of an instrument's measurements.

Alcohol screening, brief intervention, and stepped care with older alcohol users

The Alcohol Needs Assessment Project estimated that 20% of people aged ≥55 years consume alcohol at levels hazardous to their health, which is associated with a wide range of physical, psychological, and social problems, including coronary heart disease, hypertension, stroke, liver disease, and increased risk of a range of cancers. The Alcohol—Evaluating Stepped Care for Older Populations (AESOPS) research study is a randomized controlled trial looking at the effectiveness and cost-effectiveness of an opportunistic screening, brief intervention, and stepped care framework for older hazardous alcohol users in primary care compared with minimal intervention. Opportunistic screening of patients aged ≥55 years was conducted in 53 primary health care practices from eight areas across England. Patients who screened positive for an alcohol use disorder (AUD) were randomly allocated to one of two intervention conditions: brief structured advice (minimal intervention) or stepped care. Approximately 78,260 screening questionnaires were distributed, and 21,524 (27.5%) were returned. Seven-and-a-half percent of respondents screened positive for AUD. Of eligible patients, 51.3% were randomized to stepped care, most (99.6%) of whom received step one (brief lifestyle intervention); 55.1% received step two (brief motivational intervention), and 10.2% were referred to step three (specialist alcohol treatment). Results to date are discussed.

Brief opportunistic smoking cessation interventions: a systematic review and meta‐analysis to compare advice to quit and offer of assistance

This study aimed to assess the effects of opportunistic brief physician advice to stop smoking and offer of assistance on incidence of attempts to stop and quit success in smokers not selected by motivation to quit. We included relevant trials from the Cochrane Reviews of physician advice for smoking cessation, nicotine replacement therapy (NRT), varenicline and bupropion. We extracted data on quit attempts and quit success. Estimates were combined using the Mantel-Haentszel method and heterogeneity assessed with the I(2) statistic. Study quality was assessed by method of randomization, allocation concealment and follow-up blind to allocation. Thirteen studies were included. Compared to no intervention, advice to quit on medical grounds increased the frequency of quit attempts [risk ratio (RR) 1.24, 95% confidence interval (CI): 1.16-1.33], but not as much as behavioural support for cessation (RR 2.17, 95% CI 1.52-3.11) or offering NRT (RR 1.68, 95% CI: 1.48-1.89). In a direct comparison, offering assistance generated more quit attempts than giving advice to quit on medical grounds (RR 1.69, 95% CI: 1.24-2.31 for behavioural support and 1.39, 95% CI: 1.25-1.54 for offering medication). There was evidence that medical advice increased the success of quit attempts and inconclusive evidence that offering assistance increased their success. Physicians may be more effective in promoting attempts to stop smoking by offering assistance to all smokers than by advising smokers to quit and offering assistance only to those who express an interest in doing so.

Reconsidering the Case for Enhancing Accountability Via Regulation

This paper considers dangers and pitfalls associated with a range of oversight options and scenarios, including self-regulation, government regulation, donor monitoring and community participation. The paper outlines the blind spots and sources of potential bias associated with each of these oversight mechanisms. Examining the Ugandan case study we find that perceptions of corruption and ineffectiveness tarnished the reputation of the sector, but at this stage the proposed peer review mechanism and stricter government regulation are unlikely to improve NGO sector outcomes. Government regulation is anticipated to be ineffectual due to poor design and insufficient resource allocation, but both of these factors may be attributable to the underlying political motivations. Similarly, not much is expected from the peer review mechanism because participation is voluntary, offers few benefits and the list of guidelines is too long and contains too many vague and intangible quality standards. The paper argues for more empirical research to inform the design of oversight mechanisms and to monitor the impact of self-regulation and government regulation on the NGO sector. This may also help to expose and limit opportunistic interventions by government, often thinly concealed under the conceptual cloak of accountability and oversight.

Information technology-initiated interventions: a case study for the UK National Health Service Breast Screening Programme to improve screening attendance using a new intervention research framework

Population-based screening has been accepted as the best tool for preventing breast cancer. Many women cohorts are left out from screening sessions on a regular basis. Increasing screening attendance through well-coordinated interventions has been accepted as a norm for such screening programme. The need for more resources for making such interventions within the primary care domain has held back many such initiatives. A case study on increasing screening attendance through prediction techniques to identify women likely to miss screening and initiate opportunistic intervention, is discussed in this paper. A new intervention research framework and a questionnaire-based survey are also presented.

Challenges to alcohol and other drug discussions in the general practice consultation

Background. There is a widely held expectation that GPs will routinely use opportunities to provide opportunistic screening and brief intervention for alcohol and other drug (AOD) abuse, a major cause of preventable death and morbidity.Aim. To explore how opportunities arise for AOD discussion in GP consultations and how that advice is delivered.Design. Analysis of video-recorded primary care consultationsSetting. New Zealand General Practice.Methods. Interactional content analysis of AOD consultations between 15 GP’s and 56 patients identified by keyword search from a bank of digital video consultation recordings.Results. AOD-related words were found in almost one-third (56/171) of the GP consultation transcripts (22 female and 34 male patients). The AOD dialogue varied from brief mention to pertinent advice. Tobacco and alcohol discussion featured more often than misuse of anxiolytics, night sedation, analgesics and caffeine, with only one direct enquiry about other (unspecified) recreational drug use. Discussion was associated with interactional delicacy on the part of both doctor and patient, manifested by verbal and non-verbal discomfort, use of closed statements, understatement, wry humour and sudden topic change.Conclusions. Mindful prioritization of competing demands, time pressures, topic delicacy and the acuteness of the presenting complaint can impede use of AOD discussion opportunities. Guidelines and tools for routine screening and brief intervention in primary care do not accommodate this reality. Possible responses to enhance AOD conversations within general practice settings are discussed.

Supporting Weight Management in Primary Care - ABO Programme – Brief Opportunistic Intervention & Ongoing Management

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

The role of assisted self-help in services for alcohol-related disorders

Potentially harmful substance use is common, but many affected people do not receive treatment. Brief face-to-face treatments show impact, as do strategies to assist self-help remotely, by using bibliotherapies, computers or mobile phones. Remotely delivered treatments offer more sustained and multifaceted support than brief interventions, and they show a substantial cost advantage as users increase in number. They may also build skills, confidence and treatment fidelity in providers who use them in sessions. Engagement and retention remain challenges, but electronic treatments show promise in engaging younger populations. Recruitment may be assisted by integration with community campaigns or brief opportunistic interventions. However, routine use of assisted self-help by standard services faces significant challenges. Strategies to optimize adoption are discussed.

Brief Motivational Interviewing for DWI Recidivists Who Abuse Alcohol and Are Not Participating in DWI Intervention: A Randomized Controlled Trial

Driving while impaired (DWI) recidivists with unresolved alcohol use problems pose an ongoing risk for traffic safety. Following conviction, many do not participate in mandated alcohol evaluation and intervention programs, or continue to drink problematically after being relicensed. This study investigated if, in DWI recidivists with alcohol problems and not currently involved in DWI intervention, Brief Motivational Interviewing (BMI) produced greater reductions in risky drinking at 6- and 12-month follow-up compared to an information-advice control condition. Additional analyses explored whether BMI was associated with greater readiness to change, subsequent substance abuse treatment service utilization, and satisfaction compared to the control condition. Male and female recidivists with drinking problems and not currently engaged in DWI intervention were recruited, evaluated, and then randomly assigned to receive 1 of 2 manualized interventions: 30-minute BMI session or information-advice. Participants, interviewers, researchers, and statisticians were blind to assignment. Outcomes were changed in: percent of risky drinking days (i.e., > or =3 standard drinks/d for males; > or =2 for females) in the previous 6 months derived from the Timeline Followback, biomarkers of alcohol abuse (GGT, AST, ALT, MCV) by blood assay, and alcohol abuse-related behaviors using the MMPI-Mac scale. Data from the Readiness to Change Questionnaire, a substance abuse service utilization questionnaire, and the Client Satisfaction Scale were also collected. Analyses revealed significant declines in risky drinking with both interventions. BMI (n = 92) resulted in a 25% reduction in risky drinking days at 12-month follow-up, which compared to the control intervention (n = 92) represented a significant decline from 6-month levels. Exposure to BMI also produced significantly greater improvement at 6-month follow-up in a biomarker of alcohol abuse and a behavioral measure related to recidivism risk. Exploration of readiness to change, substance abuse service utilization, and satisfaction with intervention indicated a perception of BMI being more useful in coping with problems. Brief MI approaches warrant further implementation and effectiveness research as an opportunistic DWI intervention strategy to reduce risks associated with alcohol use outside of clinical and DWI relicensing settings.

Seeing patients first: creating an opportunity for practice nurse care?

Practice nurses see patients in both a planned (i.e., scheduled appointment) and an unplanned (i.e., opportunistic) manner. This study aimed to investigate how often and why New Zealand practice nurses see patients prior to the general practitioner and whether they organise their care to support unplanned, opportunistic activity. National postal survey from a random sample of 500 general practices, requesting a response from one nurse per practice. Semi-structured telephone interviews with a purposeful sample of respondents. Responses came from 225 nurses (51% of practices confirmed to be eligible). Nearly all (92%) said their work role was the same as that of others in their practice. Only 13% of nurses routinely saw patients prior to the doctor, while 24% would choose to do so it they could, and 65% thought it important. Positive and negative aspects of seeing patients first are presented. Constraints included time, their role assisting practice workflow and perceptions of patient expectations. Few organised their work to create opportunities for lifestyle interventions. The current working environment of practice nurses in New Zealand does not readily support them routinely seeing patients before the general practitioner. We suggest this is a lost opportunity for patient-centred preventive care.

Cost-Effectiveness of an Opportunistic Screening Programme and Brief Intervention for Excessive Alcohol Use in Primary Care

BackgroundEffective prevention of excessive alcohol use has the potential to reduce the public burden of disease considerably. We investigated the cost-effectiveness of Screening and Brief Intervention (SBI) for excessive alcohol use in primary care in the Netherlands, which is targeted at early detection and treatment of ‘at-risk’ drinkers.Methodology and ResultsWe compared a SBI scenario (opportunistic screening and brief intervention for ‘at-risk’ drinkers) in general practices with the current practice scenario (no SBI) in the Netherlands. We used the RIVM Chronic Disease Model (CDM) to extrapolate from decreased alcohol consumption to effects on health care costs and Quality Adjusted Life Years (QALYs) gained. Probabilistic sensitivity analysis was employed to study the effect of uncertainty in the model parameters. In total, 56,000 QALYs were gained at an additional cost of €298,000,000 due to providing alcohol SBI in the target population, resulting in a cost-effectiveness ratio of €5,400 per QALY gained.ConclusionPrevention of excessive alcohol use by implementing SBI for excessive alcohol use in primary care settings appears to be cost-effective.

Opportunistic maintenance based on fuzzy modelling of component proximity

Conventional maintenance strategies on a single component are being phased out in favor of more predictive maintenance actions. These new forms of maintenance are emerging today for better controlling the global performances of the whole system all along its life cycle. They are anticipative in nature allowing developing non-already-planned maintenance actions or to move earlier or later a planned maintenance action. It leads to investigate opportunistic interventions by considering, for example, the direct environment of a given component to be maintained in order to run additional maintenance actions on other components considered enough closed (proximity principle). Thus, this paper presents a new fuzzy methodology to assess component proximity in the design phase to impact design out maintenance. The methodology is applied on an industrial case study.

A Smoking Cessation Program in the Neonatal Intensive Care Unit

AbstractBackground: Parental smoking remains a significant risk to the preterm infant both pre and post delivery. Pharmacologically supported interventions have been previously contraindicated in this group during the perinatal period and during breastfeeding. We designed an evidence-based intervention for use in our high-risk population. This report assesses our outcomes after one year. Method: Questionnaire administered a median of 6 months after intervention. Results: There was no significant difference between those participants who returned the survey (n = 42) versus the group as a whole (n = 70). A total of 33% ceased smoking, p < .0001. If no nonresponders ceased smoking then this gives an overall success rate of 20%, p < .0001. Successful quitters had been smoking for a mean of 11 (SD = 7) years. Self-reported light smokers (< 10 cigarettes per day) were significantly more likely to quit (p < .01). Purchase of follow-on nicotine patches was a significant predictor of success in quitting (p = .02). If relapse occurred, it appeared to happen early and was mainly associated with current stressors. Conclusions: We have designed and applied a multidisciplinary intervention for parents and carers to be used in the perinatal period to decrease the postnatal risk for neonatal intensive care graduates. Our rates of successful smoking cessation are as good as, or better than, many published rates for opportunistic intervention. We suggest that randomised trials be focused on ways to further improve interventions at this time of opportunity for these infants and their families.

Brief alcohol interventions – everybody's business

Heavy drinking poses a significant risk to public health in the UK. Opportunistic screening and brief interventions offer a cost-effective method of reducing the harm related to excessive alcohol consumption at both an individual and a public health level. Given the high prevalence of alcohol misuse among patients attending mental health services and its impact on behaviour and health, professionals need to be skilled in identifying and treating these problems in all areas of mental health. There is also a need for effective joint working between mental health and specialist addiction services. This article describes the principles and evidence base for brief alcohol interventions, and methods of implementation in health settings.

A conceptual model of vegetation dynamics in the semiarid Highland savanna of Namibia, with particular reference to bush thickening by Acacia mellifera

Namibian rangelands are encroached with Acacia mellifera, partially resulting from a poor understanding of vegetation dynamics. A conceptual state-and-transition model of vegetation dynamics in the semiarid Highland savanna in central Namibia, emphasising bush thickening by A. mellifera, is described. Two main states, a grassy and a bushy state, are identified. These are further subdivided, and 11 transitions are identified. The key transition initiating a change from grassy to bushy state can be termed a “leap” (an occasional, infrequent mass recruitment event) following a long “sleep” (no or little change in A. mellifera density). It is rare because it requires three consecutive years of above-average rainfall for seedling establishment. Fire, coinciding with seedling establishment, can interrupt it, while a low biomass grass sward facilitates it. The phenology and physiology of the encroaching species, seed predation and sapling herbivory influence this transition. The model proposes opportunistic management interventions, particularly the use of fire, to minimise the risk of further landscape-scale transitions to a bushy state. It highlights areas where understanding of vegetation dynamics is lacking and recommends crucial research foci. Conceptual models of bush-thickening processes need to account for differences in climate and phenological details of encroaching species.

Opportunistic screening and clinician‐delivered brief intervention for high‐risk alcohol use among emergency department attendees: A randomized controlled trial

To evaluate the feasibility and efficacy of routine opportunistic screening and brief intervention (BI) by ED staff to reduce high-risk alcohol consumption. This was an open, randomized controlled trial with allocation blinding performed over 12 months. Using the Paddington Alcohol Test, adult patients were screened for high-risk alcohol use. Consenting patients who were screened positive were eligible for randomization to no counselling (standard care, SC), same-day BI by an emergency nurse or doctor or motivational intervention (MI) within 1 week by off-site drug and alcohol counsellors. Telephone follow up was performed at 1 and 3 months. The primary outcome was maximum self-reported daily standard drinks consumed. Analysis was by intention to treat. Of 32,965 eligible patients, 10,274 were screened, 1043 were positive, 468 consented to the study, and 161, 159 and 148 were allocated to SC, BI and MI, respectively. In the MI group, 133 declined intervention or failed to attend. At 3 months, 96, 81 and 74 participants in the SC, BI and MI groups, respectively, were contactable and consented to telephone interview. Overall, maximum daily alcohol consumption decreased from a median of 13.5 standard drinks at enrolment to 9.25 drinks at 3 months. At 3 months, SC participants reported fewer drinks than those randomized to MI. In the present study, neither BI nor MI was better than SC in reducing high-risk alcohol consumption. Uptake of opportunistic screening by ED staff was poor, as was patient compliance with off-site counselling.

OVERVIEW ON OPPORTUNISTIC MAINTENANCE

Conventional maintenance strategies on a single component are being phased out in favour of more predictive maintenance actions. These new forms of maintenance are emerging today to help controlling the global performances of the whole system. They are anticipative in nature, which allows considering non-already-planned maintenance actions. Thus they lead to investigate potential opportunistic interventions. Opportunistic maintenance, the way it is understood or practiced today, its tools and criteria are questioned in the present work. An overview and some illustrations of this concept are also provided.

Emergency clinician‐delivered screening and intervention for high‐risk alcohol use: A qualitative analysis

To evaluate qualitative feedback from patients who received opportunistic screening and brief intervention for harmful alcohol use during an ED attendance; to evaluate emergency staff attitudes to performing alcohol screening and delivering opportunistic brief intervention; and to document process issues associated with the introduction of routine clinician-initiated opportunistic screening and training and administration of brief intervention. Structured and semi-structured interviews with emergency staff and recipients of brief intervention. Sixty-nine patients were interviewed 3 months after an ED attendance where they received emergency clinician-delivered brief intervention for high-risk alcohol use. Twenty-two (32%; 95% CI 21-43%) reported a positive effect of brief intervention on thoughts or behaviour, but 29% (95% CI 18-40%) felt the intervention was not relevant for them or could not recall it. Four people (6%; 95% CI 1-12%) felt confronted or embarrassed, and 17 (25%; 95% CI 15-36%) felt timing or delivery could be improved. Staff had a positive attitude to delivering brief intervention, but nominated lack of time as the main barrier. Fourteen of 15 staff felt brief intervention should become routine in emergency care. Emergency clinicians can be trained to provide brief intervention for high-risk alcohol in an ED. The use of emergency clinician brief intervention is acceptable to most staff and patients.

Care and Treatment of HIV-Infected Children in Africa

More than 90% of pediatric HIV infection occurs in sub-Saharan Africa and 75% of these children currently die before their fifth birthday. Most HIV-infected children in Africa rely on district hospitals for HIV treatment, but insufficient attention has been paid to improving HIV/AIDS care at this level. Considerable confusion exists about optimal use of combination antiretroviral treatment, prophylaxis for opportunistic infections and other rational healthcare interventions that can greatly improve the quality of life for these children. A simple and inexpensive infant HIV diagnostic assay and alternative laboratory markers of pediatric HIV disease progression would be highly beneficial. Routine anthropometric and neurodevelopmental assessments could help guide initiation and monitoring of antiretroviral therapy. Even in the absence of antiretroviral therapy, interventions such as immunizations, provision of micronutrients and nutrition counseling, prevention and treatment of opportunistic as well as endemic infections (such as helminths and malaria) can substantially reduce pediatric HIV-related morbidity and mortality. The need for pain relief, palliative care, counseling and emotional support is often underestimated. Surmounting the sense of hopelessness by providing district healthcare workers with training in basic pediatric HIV/AIDS care is an urgent priority.