Usual Care Procedures Research Articles

Effectiveness of Catch-Up Vaccination Interventions Versus Standard or Usual Care Procedures in Increasing Adherence to Recommended Vaccinations Among Different Age Groups: Systematic Review and Meta-Analysis of Randomized Controlled Trials and Before-After Studies.

To address the global challenge of vaccine hesitancy, the Strategic Advisory Group of Experts on Immunization strongly promotes vaccination reminder and recall interventions. Coupled with the new opportunities presented by scientific advancements, these measures are crucial for successfully immunizing target population groups. This systematic review and meta-analysis aims to assess the effectiveness of various interventions in increasing vaccination coverage compared with standard or usual care. The review will cover all vaccinations recommended for different age groups. In February 2022, 2 databases were consulted, retrieving 1850 studies. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 79 manuscripts were included after the assessment phase. These comprised 46 trials/randomized controlled trials (RCTs) and 33 before-after studies. A meta-analysis using a random-effects model was performed with STATA software (version 14.1.2). The selected outcome was the risk ratio (RR) of vaccination coverage improvement effectiveness. Additionally, meta-regression analyses were conducted for the included manuscripts. The analyses showed an overall efficacy of RR 1.22 (95% CI 1.19-1.26) for RCTs and RR 1.70 (95% CI 1.54-1.87) for before-after studies when considering all interventions cumulatively. Subgroup analyses identified multicomponent interventions (RR 1.58, 95% CI 1.36-1.85) and recall clinical interventions (RR 1.24, 95% CI 1.17-1.32) as the most effective in increasing vaccination coverage for RCTs. By contrast, educational interventions (RR 2.13, 95% CI 1.60-2.83) and multicomponent interventions (RR 1.61, 95% CI 1.43-1.82) achieved the highest increases for before-after studies. Meta-regression analyses indicated that the middle-aged adult population was associated with a higher increase in vaccination coverage (RCT: coefficient 0.54, 95% CI 0.12-0.95; before-after: coefficient 1.27, 95% CI 0.70-1.84). Community, family, and health care-based multidimensional interventions, as well as education-based catch-up strategies, effectively improve vaccination coverage. Therefore, their systematic implementation is highly relevant for targeting undervaccinated population groups. This approach aligns with national vaccination schedules and aims to eliminate or eradicate vaccine-preventable diseases.

CARE TO PLAN: TAILORING RESOURCES FOR DEMENTIA CAREGIVERS ACROSS A HEALTH SYSTEM

Abstract Each day, millions of persons with Alzheimer’s disease or related dementias (ADRD) rely on family members for necessary care and support. While there are many well-documented interventions to support ADRD caregivers, they lack individualization for specific caregiver needs and contexts. Care to Plan (CtP) was designed to address this gap in tailoring recommendations to support caregivers. After a Phase I pilot, CtP was refined and implemented within a moderately sized health system in the eastern US. A mixed-methods randomized controlled trial aimed to provide insights into the efficacy, acceptability, and utility of CtP. Twenty-two caregivers were randomly assigned to the treatment group (to review the CtP tool with a senior care navigator) and 21 were assigned to receive usual care. After completion of usual care procedures, 7 participants joined a waitlist control group, following treatment procedures. Three- and six-month outcomes included caregiver self-efficacy and distress, caregiver use of recommended support, and service utilization by the person with memory loss. Most caregivers were white (81%), female (74%), and cared for a parent (56%) or spouse (35%). The majority of caregivers agreed that the tool was helpful (70%) and would recommend it to other caregivers (83%). While 48% of caregivers felt that resources provided by the tool were not new to them, the checklist scores and interviews indicate that the senior care navigators were valuable in discussing the recommendations. Phase II findings will guide future evaluation and dissemination, and inform future models of CtP for health system usage.

A Telehealth-Enhanced Referral Process in Pediatric Primary Care: A Cluster Randomized Trial.

Our partners were a multisite federally qualified health center and 2 CMHCs in Los Angeles County. We randomly assigned 6 federally qualified health center clinics to the intervention or as a control and implemented a newly developed telehealth-enhanced referral process (video orientation to the CMHC and a live videoconference CMHC screening visit) for all MH referrals from the intervention clinics. Our primary outcome was CMHC access defined by completion of the initial access point for referral (CMHC screening visit). We used multivariate logistic and linear regression to examine intervention impact on our primary outcome. To accommodate the cluster design, we used mixed-effect regression models. A total of 342 children ages 5 to 12 were enrolled; 86.5% were Latino, 61.7% were boys, and the mean age at enrollment was 8.6 years. Children using the telehealth-enabled referral process had 3 times the odds of completing the initial CMHC screening visit compared with children who were referred by using usual care procedures (80.49% vs 64.04%; adjusted odds ratio 3.02 [95% confidence interval 1.47 to 6.22]). Among children who completed the CMHC screening visit, intervention participants took 6.6 days longer to achieve it but also reported greater satisfaction with the referral system compared with controls. Once this initial access point in referral was completed, >80% of eligible intervention and control participants (174 of 213) went on to an MH visit. A novel telehealth-enhanced referral process developed by using a community-partnered approach improved initial access to CMHCs for children referred from primary care.

Premature ejaculation in primary care: communication strategies versus usual care for male patients consulting for a sexual, urogenital or psychological reason \u2013 GET UP: study protocol for a cluster randomised controlled trial

BackgroundPremature ejaculation (PE) is the most common sexual dysfunction among men. According to patients, the general practitioner (GP) is the appropriate professional with whom to discuss this issue. However, few patients receive the medical help needed because GPs find it difficult to talk to their patients about sex. A previous qualitative study provided six strategies described by GPs who had tackled the topic during consultation. A pilot study showed that using one of these strategies after a training course led to an increase in the rate of consultations where the topic was raised: an increase from 6.6 to 30.8%. The aim of this study is to compare whether training in communication skills with these six strategies is more effective than usual care on the incidence of patients bringing up the topic of PE with their GP.MethodsA cluster randomised controlled trial, stratified over four areas comparing an intervention group, which will receive the six strategies training session, and a control group, which ensures routine medical care. The primary outcome is to investigate the efficacy of a training in communication skills directed towards this pathology, compared with usual care procedures, on the incidence of patients bringing up the topic of PE with their GP. The secondary objective relates to the variation in the quality of life of patients after having recently addressed the topic of PE. Quality of life will be evaluated using the SF-12 health scale, with scoring filled in by the patient immediately after the consultation and 4 weeks later. The patients suffering from PE will be identified if their score is higher than 9 on the Premature Ejaculation Diagnostic Tool filled in 4 weeks after the consultation. The number of patients necessary to highlight a significant difference between the two groups from 5 to 20% is 101. Therefore, a total of 600 patients is expected, 300 in each arm (40 GPs, 15 patients per GP; risk α = 5%; power = 90%; intra-cluster correlation coefficient ρ = 0.2; Hawthorne effect = 15%; lost-to-follow-up rates for GPs = 10% and for patients = 20%).DiscussionThe implication for practice is the improvement in the quality of patient-centred care within a topic area which encompasses almost 30% of male sex-related complaints.Trial registrationClinicalTrials.gov, ID: NCT02378779. Registered on 3 February 2015.

Option Grids to facilitate shared decision making for patients with Osteoarthritis of the knee: protocol for a single site, efficacy trial.

BackgroundDespite policy interest, an ethical imperative, and evidence of the benefits of patient decision support tools, the adoption of shared decision making (SDM) in day-to-day clinical practice remains slow and is inhibited by barriers that include culture and attitudes; resources and time pressures. Patient decision support tools often require high levels of health and computer literacy. Option Grids are one-page evidence-based summaries of the available condition-specific treatment options, listing patients’ frequently asked questions. They are designed to be sufficiently brief and accessible enough to support a better dialogue between patients and clinicians during routine consultations. This paper describes a study to assess whether an Option Grid for osteoarthritis of the knee (OA of the knee) facilitates SDM, and explores the use of Option Grids by patients disadvantaged by language or poor health literacy.Methods/DesignThis will be a stepped wedge exploratory trial involving 72 patients with OA of the knee referred from primary medical care to a specialist musculoskeletal service in Oldham. Six physiotherapists will sequentially join the trial and consult with six patients using usual care procedures. After a period of brief training in using the Option Grid, the same six physiotherapists will consult with six further patients using an Option Grid in the consultation. The primary outcome will be efficacy of the Option Grid in facilitating SDM as measured by observational scores using the OPTION scale. Comparisons will be made between patients who have received the Option Grid and those who received usual care. A Decision Quality Measure (DQM) will assess quality of decision making. The health literacy of patients will be measured using the REALM-R instrument. Consultations will be observed and audio-recorded. Interviews will be conducted with the physiotherapists, patients and any interpreters present to explore their views of using the Option Grid.DiscussionOption Grids offer a potential solution to the barriers to implementing traditional decision aids into routine clinical practice. The study will assess whether Option Grids can facilitate SDM in day-to-day clinical practice and explore their use with patients disadvantaged by language or poor health literacy.Trial registrationCurrent Controlled Trials ISRCTN94871417

Reducing inappropriate, anticholinergic and psychotropic drugs among older residents in assisted living facilities: study protocol for a randomized controlled trial.

BackgroundUse of inappropriate drugs is common among institutionalized older people. Rigorous trials investigating the effect of the education of staff in institutionalized settings on the harm related to older people’s drug treatment are still scarce. The aim of this trial is to investigate whether training professionals in assisted living facilities reduces the use of inappropriate drugs among residents and has an effect on residents’ quality of life and use of health services.Methods and designDuring years 2011 and 2012, a sample of residents in assisted living facilities in Helsinki (approximately 212) will be recruited, having offered to participate in a trial aiming to reduce their harmful drugs. Their wards will be randomized into two arms: one, those in which staff will be trained in two half-day sessions, including case studies to identify inappropriate, anticholinergic and psychotropic drugs among their residents, and two, a control group with usual care procedures and delayed training. The intervention wards will have an appointed nurse who will be responsible for taking care of the medication of the residents on her ward, and taking any problems to the consulting doctor, who will be responsible for the overall care of the patient. The trial will last for twelve months, the assessment time points will be zero, six and twelve months.The primary outcomes will be the proportion of persons using inappropriate, anticholinergic, or more than two psychotropic drugs, and the change in the mean number of inappropriate, anticholinergic and psychotropic drugs among residents. Secondary endpoints will be, for example, the change in the mean number of drugs, the proportion of residents having significant drug-drug interactions, residents' health-related quality of life (HRQOL) according to the 15D instrument, cognition according to verbal fluency and clock-drawing tests and the use and cost of health services, especially hospitalizations.DiscussionTo our knowledge, this is the first large-scale randomized trial exploring whether relatively light intervention, that is, staff training, will have an effect on reducing harmful drugs and improving QOL among institutionalized older people.Trial registrationACTRN12611001078943

Drug users’ adherence to a 6-month vaccination protocol: Effects of motivational incentives

Vaccines represent a new and promising avenue of treatment for drug abuse but pose new medication adherence challenges due to prolonged and widely spaced administration schedules. This study examined effects of prize-based incentives on retention and medication adherence among 26 cocaine users involved in a 6-month hepatitis B vaccination series. Participants could meet with research staff weekly for 24 weeks and receive 7 injections containing either the Hepatitis B vaccine or a placebo. All participants received $10 at each weekly visit (maximum of $240). Those randomly assigned to the incentive program received additional monetary payments on an escalating schedule for attendance at weekly monitoring and vaccination visits with maximum possible earnings of $751. Group attendance diverged after study week 8 with attendance better sustained in the incentive than control group (group by time interaction, p = .035). Overall percent of weekly sessions attended was 82% for incentive versus 64% for control ( p = .139). Receiving all scheduled injections were 77% of incentive versus 46% of control participants ( p = .107). A significantly larger percentage (74% versus 51%; p = .016) of injections were received by incentive versus control participants on the originally scheduled day. Results suggest that monetary incentives can successfully motivate drug users to attend sessions regularly and to receive injected medications in a more reliable and timely manner than may be seen under usual care procedures. Thus, incentives may be useful for addressing adherence and allowing participants to reap the full benefits of newly developed medications.

Institutional Review Board Training for Community Practices: Advice from the Agency for Health Care Research and Quality Practice-Based Research Network Listserv

Human subject protection training is required for all research personnel regardless of funding source. This article summarizes recommendations from a discussion about ethics training for community personnel from the practice-based research network (PBRN) listserv sponsored by the Agency for Health Care Research and Quality PBRN Resource Center. PBRN projects can involve community providers and their staff as subjects of the research project or as collaborators with recruitment and data collection. Distinguishing between usual care and research procedures is important for determining if training is required of community-based personnel. The use of research assistants or practice facilitators to collect research-related information is one way of limiting practice involvement to usual care procedures, thereby allowing PBRNs to limit training to dedicated research staff. Key methodologies for human subject protection training of community practice staff include on-site lectures, online modules, videotapes, and paper-based training. Ultimately, a discussion by the PBRN researcher with his or her governing Institutional Review Board is recommended for finding acceptable strategies within a PBRN.

Interview of patients by pharmacists contributes significantly to the identification of drug‐related problems (DRPs)

To investigate whether pharmacist interviews of hospitalised patients about their medication would result in identification of more drug-related problems (DRPs) than those found by usual care procedures and further to characterise the DRPs revealed at the interviews. Patients from five internal medicine and two rheumatology departments in four hospitals in Norway were prospectively included in the study. Clinical pharmacists assessed DRPs by reviewing medical records and by participating in multidisciplinary team discussions. Drugs used, medical history, laboratory data and clinical/pharmacological risk factors were recorded (usual care procedure). A proportion of patients were randomly selected for interview with pharmacists. A quality team assessed the clinical significance of the DRPs. Seven hundred and twenty seven patients were included. Significantly more DRPs were found in the interview group (96 patients), an average of 4.4 DRPs per patient as compared to 2.4 DRPs in the non-interview group (631 patients) (p < 0.01). Of a total of 431 DRPs recorded in the interview group, 168 DRPs (39.9%) were disclosed through interviews. 'Need for additional drug', 'medical chart error', 'patient adherence' and 'need for patient education' were significantly more often recorded in this group. The quality team assessed 63% of the DRPs revealed in the interviews to be of major clinical significance. Significantly more DRPs were identified among the patients who were interviewed compared to those patients having only usual care examination. A high proportion of the DRPs identified in the interviews were of major clinical significance. The clinical pharmacists, with their way of interviewing, seem to fill a gap, ensuring that significant DRPs do not escape detection.

Book Review: Psychotherapy: Psychotherapy for Children and Adolescents: Evidence-Based Treatment and Case Examples

Psychotherapy Psychotherapy for Children and Adolescents: Evidence-Based Treatment and Case Examples John R Weisz. Cambridge (UK): Cambridge University Press; 2004. 528 p. US$35.00. Reviewer rating: Excellent John Weisz is an experienced researcher and clinician in child and adolescent treatment. The purpose of his book is to evaluate research on treatments tested and shown to work in children and adolescents with emotional and behavioural problems. He aims to correct a preceived deficit in transmission of research findings to clinical practice community, owing to of language differences as well as differences between research and clinical conditions. The book is aimed at practitioners, researchers, training directors, parents, and administrators, offering a choice of treatment appropriate to their various roles. The book is arranged in 6 sections labelled A to F. Section A is a 23-page introduction that provides a comprehensive background on child and adolescent therapy from its historical roots to studies of effectiveness and outcome. The last section (F), discusses Strengths, Limitations, and Future Directions of Evidence-Based Youth Psychotherapy. The 4 intervening chapters deal with treatment studies of following 4 major categories of disorders: fears and anxiety, depression, ADHD, and conduct problems and conduct disorder. The introduction includes some important background information. For instance, findings from studies of clinically guided treatment in usual care tend to show it has no benefit, and studies of the effects of integrating of usual care procedures into systems of care show little evidence of benefit (p 15). Metaanalysis of controlled studies of structured therapies for children and youth show benefits comparable with adults in effect sizes and precision of effect as well as in duration of effect. There are, however, problems with metaanalyses, and hence, an increasing use of focused review by different professionals such as pediatricians and child psychiatrists. For this review, author uses guidelines of American Psychological Association's Task Force of Society of Clinical Psychology (1995), which rates therapies as well-established or probably efficacious according to number and quality of supportive studies, use of a manual, specification of sample, and support by 2 or more investigators or research teams. Therapies that were well established and probably efficacious were further identified for 4 broad symptom and diagnostic clusters: fears and anxieties, depression, ADHD, and conduct problems and disorders. The studies reviewed in this book were selected from 350 studies meeting methodological requirements for inclusion in above-mentioned metaanlysis, meeting criteria of Task Force as either well established or probably efficacious, and further meeting other criteria imposed by author, such as addressing existing, compared with anticipated, psychological dysfunctio; treating a specific problem, compared with general harm or trauma; and focusing on primary behavioural and mental problems, compared with medical or physical problems. …

Reaching Midlife and Older Smokers: Tailored Interventions for Routine Medical Care

Background.Although older adults can achieve significant health benefits from smoking cessation, few programs have specifically targeted this population. This study tested the effectiveness of an office-based smoking cessation program tailored to midlife and older smokers.Methods.This paper describes a randomized controlled trial comparing usual care with physician-delivered brief quit-smoking advice and counseling for midlife and older smokers (ages 50–74). Outpatient medical practices assigned to the Immediate Intervention (experimental) condition were trained to deliver brief quit-smoking advice and counseling. Delayed Intervention (control) practices followed usual care procedures. Thirty-nine practices accruing five or more patients per practice were included in the analyses.Results.Using a conservative measure of quitting, self-reported quit rates at 6-month follow-up were 15.41% for the Immediate Intervention group versus 8.16% of subjects in the Delayed Intervention group (P< 0.005). Baseline subject (N= 659) characteristics related to 6-month abstinence included number of previous quit attempts, quitting for 24 hr in the past year, desire to quit, confidence in quitting, perceived health benefits, and lower nicotine dependence.Conclusions.Smoking abstinence was significantly increased by training physicians and key office and clinical staff to intervene with older smokers. Brief interventions tailored to this age cohort can be successfully and efficaciously integrated into routine care.