Pre-post Pilot Study Research Articles

Feasibility and Acceptability of an Intervention Providing Computer-Generated Tailored Feedback to Target Alcohol Consumption and Depressive Symptoms in Proactively Recruited Health Care Patients and Reactively Recruited Media Volunteers: Results of a Pilot Study

Background: A pre-post pilot study was conducted to test the feasibility, acceptability, and potential effectiveness of a fully automatized computer-based intervention targeting hazardous drinking and depressiveness in proactively recruited health care patients (HCPs). To address the importance of the sample selection when testing interventions, HCPs were compared to media recruited volunteers (MVs). Method: In a multicenter screening program 2,773 HCPs were screened for hazardous drinking and depressive symptoms. MVs were recruited via media solicitation. Over a period of 6 months, study participants received 6 individualized counseling letters and weekly short messages. Pre-post data were analyzed for 30 participants (15 HCPs, 15 MVs). Intervention acceptability was assessed in post-intervention interviews conducted with 32 study participants. Results: MVs showed higher problem severity and motivation to change than HCPs. Over the course of the intervention both subsamples reduced regular binge drinking (HCPs: p = 0.016; MVs: p = 0.031) and depressiveness (HCPs: p = 0.020; MVs: p < 0.001). MVs further reduced average daily alcohol consumption (p = 0.034). The intervention received positive ratings from both subsamples, the alcohol module was rated more favorably by MVs than by HCPs (p = 0.012). Subsamples further differed in terms of intervention usage (p = 0.013). Conclusion: The intervention was technically and logistically feasible, well accepted, and may have the potential to reduce hazardous drinking and depressive symptoms in different populations. Subsamples differed in terms of problem severity, motivation to change, intervention usage, pre-post changes, and attitudes toward the intervention, showing that intervention development should involve the intended target populations to avoid biased conclusions on intervention effectiveness and acceptability.

Effect of muscle energy techniques and facet joint mobilization on spinal curvature in patients with mechanical neck pain: A pilot study.

Neck is one of the most common site of musculoskeletal symptom manifestations. An impaired spinal curvature is a common finding in patients with mechanical neck pain. A pre-post quasi experimental pilot study was conducted at Fauji Foundation Hospital from January- March 2017,in which 12 patients with mechanical neck pain and straightening of the cervical spine were included and treated for 7 consecutive sessions consisting of muscle energy techniques (MET) in combination with facet joint mobilization. The objective of this study was to determine the effects of MET and facet joint mobilization on spinal curvature and functional outcomes in patients with neck pain. Outcome measurement tools that were included comprised of pain severity, neck disability index (NDI), cervical lordosis which was measured via x-ray based posterior tangential method, goniometry for cervical range of motion (ROM) and modified sphygmomanometer dynamometry (MSD) for isometric muscle strength. A significant difference was observed in pre and post treatment scores for all outcomes (p<0.05); demonstrating an effective combination therapy in terms of improved spinal curvature, pain, disability, ROM and isometric muscle strength.

Prevention of child mental health problems in Southeastern Europe: a multicentre sequential study to adapt, optimise and test the parenting programme ‘Parenting for Lifelong Health for Young Children’, protocol for stage 1, the feasibility study

IntroductionFamilies in low-income and middle-income countries (LMICs) face multiple challenges (eg, poverty and adverse childhood experiences) that increase the risk for child mental health problems, while the context may provide...

Corrigendum to 'A pre-post pilot study of electronic cigarettes to reduce smoking in people with severe mental illness' [Psychological Medicine

Corrigendum to 'A pre-post pilot study of electronic cigarettes to reduce smoking in people with severe mental illness' [Psychological Medicine

Prevent 2nd Stroke: a pilot study of an online secondary prevention program for stroke survivors

Objective:The prevalence of modifiable health risk factors and psychological distress following a stroke is high and markedly increase the chance of a second stroke. This study aimed to examine the usability and acceptability of an online secondary prevention program addressing modifiable psycho‐behavioural risk factors for stroke survivors. Methods:A pre–post pilot study was conducted in Australia between 2016 and 2017. Participants were recruited through the Australian Stroke Clinical Registry and completed measures of health‐related quality of life, physical activity, smoking status, depression and anxiety, alcohol status, nutrition and internet use. Participants also used an online secondary prevention program (Prevent 2nd Stroke) over a two‐week period. At follow‐up, acceptability and usability of the program were assessed. Results:A total of 18 out of 19 participants reported engaging in multiple health risk behaviours. Participants reported that they were interested in receiving an online program that provided health information (73.7%). Participants indicated Prevent 2nd Stroke was easy to use (63.1%) and that they would recommend the program to other stroke survivors (63.1%). Conclusions:The results indicated that online programs are an acceptable way to address these health outcomes. Implications to public health:Further research is needed to assess the effectiveness of these interventions using powered trials.

Effect of caffeine on sleep and behaviour in nursing home residents with dementia

Background and goalSleep problems and challenging behavioural symptoms are frequently reported among nursing home residents with dementia. Coffee with caffeine is consumed frequently by these residents and can have a negative effect on sleep and behaviour in older persons with dementia. In this interventional study, the effect of caffeine reduction on sleep and challenging behavioural symptoms in nursing home residents with dementia was investigated.MethodsIn 21 nursing home residents with dementia living in 1 dementia special care unit, caffeine was gradually eliminated in the afternoon and evening. During pre-intervention and post-intervention period the care workers daily scored sleep by a specially developed sleep questionnaire. Behavioural symptoms were scored in the afternoon and evening using four items of the NPI-NH: agitation/aggression, apathy, irritability and aberrant motor behaviour.ResultsA significant improvement in sleep scores (Wilcoxon signed-rank test, p = 0.015) and apathy (Wilcoxon signed-rank test, p = 0.020) was found after eliminating caffeine intake in the afternoon and evening. No significant changes occurred in agitation/aggression, irritability and aberrant motor behaviour.DiscussionThis pre-post pilot study found a significant positive effect of caffeine reduction on sleep and apathy and warrants further investigation in a larger controlled study.

IMPACT of nurses' solution-focused communication on the fluid adherence of adult patients on haemodialysis.

To test the hypothesis that fluid adherence in patients on haemodialysis can be improved through nurses' solution-focused communication with patients on issues of adherence. Adherence to fluid-intake restrictions is low in patients on haemodialysis, creating serious health risks. Psychosocial interventions to increase adherence have typically focused on patients and ignored patient/staff interactions. This is a single-group, pre-post pilot study registered in ClinicalTrials.gov (identifier: NCT03432988). A 1-month baseline of interdialytic weight gain was taken in April 2016 for a group of 36 adult patients in a hospital haemodialysis unit. Then, the nurses of the unit received a 4hr training in solution-focused communication on issues of fluid adherence and applied it with the patients of the sample. Interdialytic weight gains were measured during another month. Onemonth after the training, in October 2016, interdialytic weight gains were measured for another month. After introducing solution-focused communication on fluid adherence, patients' average interdialytic weight gains decreased significantly, below the level considered indicative of problematic adherence. These results were maintained at follow-up. Our results suggest that a novel approach to adherence, nurses' solution-focused communication with patients on haemodialysis, may improve patients' adherence to fluid restriction. More rigorous, controlled studies are required to confirm long-term benefits and to understand the causal mechanisms that may underlie the effectiveness of this intervention.

Short-term impact of the EuroPean Accredited Curriculum on Tobacco Treatment Training (EPACTT) program.

INTRODUCTIONThe aim of this pilot study was to assess the short-term effectiveness of the EuroPean Accredited Curriculum on Tobacco Treatment Training intervention in improving health care providers’ knowledge, attitudes and self-efficacy related to tobacco dependence treatment.METHODSA pre-post pilot study was conducted. The two-day training intervention took place in Brussels in April 2016. Health care professionals from six European countries (Russia, Ukraine, Georgia, Armenia, Romania and Greece) were purposively invited to participate in the study. Evaluation was performed before the intervention, immediately after, and at approximately two months following the intervention. Changes in outcomes of interest were examined before and after exposure to the intervention program.RESULTSIn all, 47 health care professionals participated in the training of which 40 completed the evaluation surveys. Significant increases in providers’ self-efficacy and perceived behavioral control related to tobacco treatment delivery were documented immediately following the training and at the 2 months follow-up. Significant improvement in provider knowledge and attitudes were observed in some items assessed.CONCLUSIONSThe results demonstrate that training is able to improve provider self-efficacy related to tobacco treatment delivery in this cross-national European sample of health care professionals. Additional research is required to examine the generalizability of our findings.

A New Online Mental Health Training Program for Workplace Managers: Pre-Post Pilot Study Assessing Feasibility, Usability, and Possible Effectiveness.

BackgroundMental health has become the leading cause of sickness absence in high-income countries. Managers can play an important role in establishing mentally healthy workplaces and coordinating their organization’s response to a mentally ill worker.ObjectiveThis pilot study aims to evaluate the feasibility, usability, and likely effectiveness of a newly developed online training program for managers called HeadCoach. HeadCoach aims to build managers’ confidence in supporting the mental health needs of staff and promote managerial behavior most likely to result in a more mentally healthy workplace.MethodsIn total, 66 managers from two organizations were invited to participate in this pre-post pilot study of HeadCoach, which was made available to managers to complete at their own pace over a 4-week period. Data were collected at baseline and post intervention via an online research platform. The difference in mean scores for each outcome between these two time points was calculated using paired samples t tests.ResultsOf all the invited managers, 59.1% (39/66) participated in the trial, with complete pre–post data available for 56.4% (22/39) of the participants. The majority of respondents reported positive engagement with the program. During the study period, managers’ knowledge regarding their role in managing mental health issues (P=.01) and their confidence in communicating with employees regarding mental illness (P<.001) significantly increased. In addition, a significant increase was observed from the baseline in managers’ self-reported actions to use strategies to prevent and decrease stress among their team members (P=.02).ConclusionsAlthough caution is needed due to the absence of a control group, preliminary results of this study suggest that HeadCoach could be a feasible, acceptable, and efficient method of training managers in best workplace practices to help support the mental health needs of their staff.

A mindfulness intervention to reduce maternal distress in neonatal intensive care: a mixed methods pilot study.

Mothers with an infant in the neonatal intensive care unit (NICU) are at risk for depression, anxiety, and trauma symptoms, with negative implications for maternal-infant bonding, maternal well-being, and infant development. Few interventions to promote NICU mothers' mental health, however, have been developed or tested. This pre-post pilot study assessed feasibility, acceptability, and preliminary outcomes of a mindfulness intervention for NICU mothers. Twenty-seven mothers were recruited from a university NICU and offered a mindfulness intervention via introductory video and audio-recorded practices. Participants completed a baseline self-report survey. After 2weeks of engaging with intervention materials, participants completed a second survey and in-depth interview. Quantitative data were analyzed using paired t tests; qualitative data were analyzed using thematic coding. Twenty-four women (89%) completed the study. Quantitative data indicated significant improvements in depressive, anxiety, and trauma symptoms, negative coping, NICU-related stress, and sleep (p < 0.05). Qualitative data identified themes of perceived improvements in psychological distress and stress symptoms, self-care, and relationships. Findings support the mindfulness intervention's feasibility, acceptability, and potential promise for reducing maternal distress and promoting well-being. Use of video and audio modalities may facilitate program sustainability and scale up. Further research on the program is merited.

Impact of the Tobacco Treatment Guidelines for High Risk Groups (TOB.g): A pilot study among physicians specializing in CVD, Diabetes and COPD.

INTRODUCTIONThe 2017 Tobacco Cessation Guidelines for High-risk Groups (TOB-G) is a comprehensive document on best practices for smoking cessation in clinical practice. The purpose of this pilot study was to assess physician satisfaction and changes in tobacco-related knowledge, self-efficacy and attitudes following exposure to training in the TOB-G guidelines for patients with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), or diabetes.METHODSA pre-post pilot study was conducted. All participating physicians received an electronic or printed copy of the TOB-G guidelines for patients with CVD, COPD or diabetes. Physicians were also exposed to a one-day training focused on the key clinical practice recommendations from the TOB.g guidelines. Outcome measurement occurred via survey before, immediately following and 6 months after exposure to the training.RESULTSFifty physicians participated in the TOB.g training session. High rates of participant satisfaction were documented (exceeded expectations 47.7%; met expectations to a great extent 52.3%). Significant increases in physician knowledge and self-efficacy were documented immediately following and 6 months after exposure to the guideline training session. Exposure to the training was associated with positive changes in some but not all tobacco-related treatment attitudes, however these were no longer significant at the 6-month follow-up. Lower knowledge, confidence and unfavourable attitudes were documented for aspects of treatment related to pharmacotherapy.CONCLUSIONSPositive changes in previously reported barriers to the delivery of tobacco treatment among physicians were documented following exposure to the TOB.g guidelines and training for patients with CVD, COPD or diabetes.

Development of a Web-based Family Intervention for BRCA Carriers and Their Biological Relatives: Acceptability, Feasibility, and Usability Study.

BackgroundCarriers of breast cancer gene (BRCA) mutations are asked to communicate genetic test results to their biological relatives to increase awareness of cancer risk and promote use of genetic services. This process is highly variable from family to family. Interventions that support communication of genetic test results, coping, and offer decision support in families harboring a pathogenic variant may contribute to effective management of hereditary cancer.ObjectiveThe aim of this paper was to describe the development of the Family Gene Toolkit, a Web-based intervention targeting BRCA carriers and untested blood relatives, designed to enhance coping, family communication, and decision making.MethodsWe present findings from focus groups regarding intervention acceptability and participant satisfaction and from a pre-post pilot study with random allocation to a wait-listed control group regarding intervention feasibility and usability.ResultsThe Family Gene Toolkit was developed by a multidisciplinary team as a psycho-educational and skills-building intervention. It includes two live webinar sessions and a follow-up phone call guided by a certified genetic counselor and a master’s prepared oncology nurse. Each live webinar includes two modules (total four modules) presenting information about BRCA mutations, a decision aid for genetic testing, and two skill-building modules for effective coping and family communication. Participants in focus groups (n=11) were highly satisfied with the intervention, reporting it to be useful and describing clearly the important issues. From the 12 dyads recruited in the pre-post pilot study (response rate 12/52, 23%), completion rate was 71% (10/14) for intervention and 40% (4/10) for wait-listed control groups.ConclusionsAcceptability and satisfaction with the Family Gene Toolkit is high. On the basis of the findings from usability and feasibility testing, modifications on timing, delivery mode, and recruitment methods have been implemented.Trial RegistrationClinicalTrials.gov NCT02154633; https://clinicaltrials.gov/ct2/show/NCT02154633 (Archived by WebCite at http://www.webcitation.org/6yYNvLPjv)

Total Lifestyle Coaching: A Pilot Study Evaluating the Effectiveness of a Mind-Body and Nutrition Telephone Coaching Program for Obese Adults at a Community Health Center.

BackgroundStress and obesity are interrelated and common among low-income adults. Mind–body interventions have been shown to reduce psychological distress and have been incorporated into many weight loss interventions. However, few of these programs have incorporated a telephone coaching component.ObjectiveWe designed and piloted a novel weight loss telephone coaching intervention for this population and examined its effectiveness on weight loss and improvements in health behaviors in obese community health center patients.MethodsThis was a 6-month, single-arm, prospective, pre–post pilot study. The study took place at a community health center near Boston, Massachusetts. Participants were 27 overweight and obese community health center patients. The intervention consisted of one in-person intake with the registered dietitian, trained in mind–body approaches, and approximately 1 phone coaching session every 2 weeks for 6 consecutive months. Anthropometric data consisted of weight, body mass index (BMI), and blood pressure. Questionnaires consisted of the Perceived Stress Scale-10 item, the CIGNA Healthy Eating Survey, Section H: Behavioral Eating, a physical activity questionnaire, and a nutritional habits questionnaire. We used paired samples t tests to assess pre–post changes in weight, BMI, blood pressure, perceived stress, behavioral eating, and physical activity. We also conducted semistructured exit interviews to learn about participants’ experiences in this program.ResultsThere was a trend toward weight reduction (P < .1, Cohen’s d = 0.33) and significant improvements in systolic blood pressure (P = .001, Cohen’s d = 0.72), perceived stress (P = .001, Cohen’s d = 0.75), and behavioral eating (P = .009, Cohen’s d = 0.54). Improvements in weight were sustained 6 months after completion of the intervention.ConclusionResults suggest that a telephone nutrition health coaching intervention is feasible and may facilitate weight loss in obese community health center patients. Future randomized-controlled studies are warranted to better understand these improvements.Clinicaltrials.gov registrationNCT03025217

Partnerships for active elementary schools: Physical education outcomes after 4 months of a 2-year pilot study

Objective: This study assessed the impact of Partnerships for Active Children in Elementary Schools (PACES) on children’s moderate-to-vigorous physical activity (MVPA) during physical education (PE) and teachers’ incorporation of physical activity promotion strategies after one academic semester (i.e. 4 months) of the intervention. Design: Single group pre–post pilot study. Setting: Three elementary schools in one southeastern metropolitan city in the USA. Methods: Using principles of community-based participatory-research, researchers worked with teachers to identify contextually appropriate physical activity promotion strategies aligned with prevailing recommendations, principles and theories. Outcome measures included accelerometer-derived percent of time children ( N = 150) engaged in MVPA. The System for Observing Fitness Instruction Time+ assessed changes in teachers’ incorporation of physical activity promotion strategies. Multi-level mixed-effects linear regression estimated differences over time. Results: MVPA increased for girls (22.7%–26.6%) and boys (33.2%–39.0%). Small-sided games (1.0%–9.0%) and teachers’ verbal promotion of physical activity (6.4%–13.5%) increased while student’s off-task behaviour (6.0%–2.0%) decreased. Lines (20.2%–8.4%) and elimination games (21.6%–13.3%) decreased, but these changes were not statistically significant. Conclusion: PACES shows promise for increasing the percent of time children spend in MVPA during PE but requires further evaluation.

Assessment of nutrition and physical activity practices using self-report and observation in early care and education across multiple US states.

The National Early Care and Education Learning Collaboratives (ECELC) Project aims to promote healthy physical activity and nutrition environments, policies and practices in early care and education (ECE) programmes across multiple states. The present pilot study sought to assess changes to the physical activity and nutrition practices in a sub-sample of ECE programmes participating in the ECELC using the Environment and Policy Assessment and Observation (EPAO). Additionally, it sought to compare results with the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC). Quasi-experimental pre-post pilot study where paired-sample t tests examined changes to physical activity and nutrition practices from pre-assessment to post-assessment (P<0·05). Pearson correlation coefficients examined change scores from EPAO compared with NAP SACC with statistical significance set at a two-sided α level of P<0·10 to account for sample size. The study occurred among ECE programmes. Pre-school classrooms in nineteen ECE programmes across four US states were observed. EPAO data demonstrated an increase in total score from pre-assessment to post-assessment (150 (sd 30) to 176 (sd 35)). NAP SACC change scores demonstrated little relationship with EPAO domain change scores, with exceptions in Nutrition Policy and Physical Activity Policy (r=-0·4 and -0·6, respectively). The overall improvements reported through the EPAO suggest participation in the ECELC resulted in changes in critical nutrition- and physical activity-related practices. However, considerable differences in data reported using the NAP SACC compared with the EPAO suggest subjective data should be interpreted with caution and objective measurement should be used when feasible.

Evaluation of an e-Learning Training in Brief Motivational Interviewing (MOTIV@Coeur) for Cardiovascular Care Nurses: A Single Group Pre-Post Pilot Study

Evaluation of an e-Learning Training in Brief Motivational Interviewing (MOTIV@Coeur) for Cardiovascular Care Nurses: A Single Group Pre-Post Pilot Study

Color Your Plate: A Pilot Nutrition Education Intervention to Increase Fruit and Vegetable Intake among Seniors Participating in the Congregate Meal Site Program in Kentucky Senior Centers

OF THESIS COLOR YOUR PLATE: A PILOT NUTRITION EDUCATION INTERVENTION TO INCREASE FRUIT AND VEGETABLE INTAKE AMONG OLDER ADULTS PARTICIPATING IN THE CONGREGATE MEAL SITE PROGRAM IN KENTUCKY SENIOR CENTERS The purpose of this study was to determine if the amount and variety of fruit and vegetable intake increased among community-dwelling older adults participating in Kentucky’s congregate meal site program following a series of educational nutrition lessons. A convenience sample (n=35) of community-dwelling older adults at two intervention (n=19) and two control (n=16) senior centers in central Kentucky participated in this quasi-experimental pre-post pilot study. Following the intervention there was a trend towards increased self-reported intake in the variety of fruit and vegetables among the intervention group (range:0.03+3.31 to 1.32+2.75 servings per week); a significant increase in the number of days participants incorporated at least 4.5 servings of fruits and vegetables per day intake; significant increases in the incorporation of fruits and vegetables in evening meal, and all meals (p<0.05); and phytochemical knowledge (p<0.05). Actual fruit and vegetable intake at the congregate meal increased post-intervention among the intervention group only (p<0.05) as measured by plate waste. The mean Phytochemical Index score was 25.4, with participants consuming 79% of the phytochemicalrich component to their meal. These results indicate that theory-based educational nutrition lessons among older adults is linked to favorable trends towards increased fruit and vegetable consumption and phytochemical knowledge.

Evaluation of a Web-Based E-Learning Platform for Brief Motivational Interviewing by Nurses in Cardiovascular Care: A Pilot Study.

BackgroundBrief motivational interviewing (MI) can contribute to reductions in morbidity and mortality related to coronary artery disease, through health behavior change. Brief MI, unlike more intensive interventions, was proposed to meet the needs of clinicians with little spare time. While the provision of face-to-face brief MI training on a large scale is complicated, Web-based e-learning is promising because of the flexibility it offers.ObjectiveThe primary objective of this pilot study was to examine the feasibility and acceptability of a Web-based e-learning platform for brief MI (MOTIV@CŒUR), which was evaluated by nurses in cardiovascular care. The secondary objective was to assess the preliminary effect of the training on nurses’ perceived brief MI skills and self-reported clinical use of brief MI.MethodsWe conducted a single-group, pre-post pilot study involving nurses working in a coronary care unit to evaluate MOTIV@CŒUR, which is a Web-based e-learning platform for brief MI, consisting of two sessions lasting 30 and 20 minutes. MOTIV@CŒUR covers 4 real-life clinical situations through role-modeling videos showing nurse-client interactions. A brief introduction to MI is followed by role playing, during which a nurse practitioner evaluates clients’ motivation to change and intervenes according to the principles of brief MI. The clinical situations target smoking, medication adherence, physical activity, and diet. Nurses were asked to complete both Web-based training sessions asynchronously within 20 days, which allowed assessment of the feasibility of the intervention. Data regarding acceptability and preliminary effects (perceived skills in brief MI, and self-reported clinical use of conviction and confidence interventions) were self-assessed through Web-based questionnaires 30 days (±5 days) after the first session.ResultsWe enrolled 27 women and 4 men (mean age 37, SD 9 years) in March 2016. Of the 31 participants, 24 (77%, 95% CI 63%–91%) completed both sessions in ≤20 days. At 30 days, 28 of the 31 participants (90%) had completed at least one session. The training was rated as highly acceptable, with the highest scores observed for information quality (mean 6.26, SD 0.60; scale 0–7), perceived ease of use (mean 6.16, SD 0.78; scale 0–7), and system quality (mean 6.15, SD 0.58; scale 0–7). Posttraining scores for self-reported clinical use of confidence interventions were higher than pretraining scores (mean 34.72, SD 6.29 vs mean 31.48, SD 6.75, respectively; P=.03; scale 10–50). Other results were nonsignificant.ConclusionsBrief MI training using a Web-based e-learning platform including role-modeling videos is both feasible and acceptable according to cardiovascular care nurses. Further research is required to evaluate the e-learning platform in a randomized controlled trial.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 16510888; http://www.isrctn.com/ISRCTN16510888 (Archived by WebCite at http://www.webcitation.org/6jf7dr7bx)

Evaluation of the Impact of a Pharmacist-Led Telehealth Clinic on Diabetes-Related Goals of Therapy in a Veteran Population.

Telemedicine has been offered as a way to ensure that all patients, including those who live in rural areas, have access to the same health care. This study was performed to evaluate the benefit of a real-time, clinic-based video telehealth (Clinical Video Telehealth [CVT]) program and the impact of a pharmacist-led CVT clinic for chronic disease state management. The primary objective was to evaluate changes from baseline values, in veterans referred by primary care providers to this clinic. This was a single-center, prospective, pre-post pilot study that also included a post-patient satisfaction survey. The study was conducted at the Tennessee Valley Healthcare System, which is composed of two medical centers and 12 community-based outpatient clinics (CBOCs) located away from the two main facilities. Fifteen clinical pharmacy specialists (CPSs)-seven at the two main facilities and eight at the CBOCs-provide disease state management clinical pharmacy services. One of the seven CPSs at the main facilities works via telemedicine and provides services to the CBOCs where on-site clinical pharmacy services did not exist. The primary outcomes were changes from baseline in A1C, LDL level, systolic blood pressure, and diastolic blood pressure after 6 months of CVT services by the CPS. Secondary outcomes were the percentages of patients meeting American Diabetes Association treatment goals for hemoglobin A1c (A1C), low-density lipoprotein level, and blood pressure, both individually and in combination after attending a pharmacist-led CVT program; the level of patient satisfaction with pharmacists' care and with CVT as a method of receiving chronic disease management, specifically for diabetes; and medication additions or changes made by the pharmacist. Twenty-six patients completed the 6-month evaluation. A significant decrease in A1C of 2% from baseline was observed (p=0.0002), and the percentage of patients meeting goal A1C significantly increased from 0% at baseline to 38% at 6 months (p=0.0007). Overall patient satisfaction scores were also high, with a median score 39.5 (interquartile range 36-40) of a maximum score of 40. Six months of CVT clinic attendance significantly improved A1C values and the overall percentage of patients meeting their goal A1C values in this veteran population. In addition, patient satisfaction scores also indicated a high level of satisfaction with the pharmacist-led CVT service.

Staff acceptability of contingency management to promote longer breastfeeding duration at WIC

Staff acceptability of contingency management to promote longer breastfeeding duration at WIC