scholarly journals Evaluation of a community paramedicine health promotion and lifestyle risk assessment program for older adults who live in social housing: a cluster randomized trial

2018 ◽  
Vol 190 (21) ◽  
pp. E638-E647 ◽  
Author(s):  
Gina Agarwal ◽  
Ricardo Angeles ◽  
Melissa Pirrie ◽  
Brent McLeod ◽  
Francine Marzanek ◽  
...  
Keyword(s):  
Older Adults ◽  
Risk Assessment ◽  
Health Promotion ◽  
Randomized Trial ◽  
Social Housing ◽  
Cluster Randomized Trial ◽  
Assessment Program ◽  
Community Paramedicine ◽  
Lifestyle Risk ◽  
Cluster Randomized

scholarly journals Spread and scale of an electronic deprescribing software to improve health outcomes of older adults living in nursing homes: study protocol for a stepped wedge cluster randomized trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marc-Eric Nadeau ◽  
Justine L. Henry ◽  
Todd C. Lee ◽  
Émilie Bortolussi-Courval ◽  
Carole Goodine ◽  
...  
Keyword(s):  
Older Adults ◽  
Randomized Trial ◽  
Study Design ◽  
Long Term Care ◽  
Cluster Randomized Trial ◽  
Stepped Wedge ◽  
Term Care ◽  
Medication Reviews ◽  
Cluster Randomized

Abstract Background Medication overload or problematic polypharmacy is a major problem causing widespread harm, particularly to older adults. Taking multiple medications increases the risk of potentially inappropriate medications (PIMs), and residents in long-term care (LTC) are frequently prescribed 10 or more medications at once. One strategy to address this problem is for the physician and/or pharmacist to perform regular medication reviews; however, this process can be complicated and time-consuming. With a prescription review, medications may be decreased, changed, or stopped altogether. MedReviewRx is a software that runs an analysis using deprescribing rules to produce a report to guide medication reviews addressing medication overload for residents in LTC. Methods This study will employ a mixed methods effectiveness-implementation hybrid type 2 study design. To measure effectiveness, a stepped wedge cluster randomized trial design is planned, which allows us to approximate a randomized clinical trial. Approximately 1000 residents living in LTC will be recruited from five facilities in New Brunswick. The study will begin with 3 months of baseline data on rates of deprescribing. Thereafter, every 3 months a new cluster will enter the intervention mode. The intervention consists of medication reviews augmented with the MedReviewRx software, which will be used by staff and clinicians in the facilities. The estimated study duration is 18 months and the main outcome will be the proportion of patients with one or more PIMs deprescribed (reduced/stopped or changed to a safer alternative) in the 90 days following a prescription review. The goal is to study the impact of MedReviewRx on medication overload among older adults living in LTC. In typical fashion of a stepped wedge cluster randomized trial, each cluster acts as an internal control (before and after) as well as a control for the other clusters (external control). Qualitative data collected will include resident/caregiver attitudes towards deprescribing and semi-structured interviews with staff working in the long-term care homes. Discussion This study design addresses issues with seasonality and allows all clusters to participate in the intervention, which is an advantage when the intervention is related to quality improvement. This study will provide valuable information on PIM use, cost savings, and facilitators and challenges associated with medication reviews and deprescribing. This study represents an important step towards understanding and promoting tools to guide safe and rational reduction of PIM use among older adults. Trial registration NCT04762303, Registered February 21, 2021.

scholarly journals Using the 4 Pillars Practice Transformation Program to Increase Pneumococcal Immunizations for Older Adults: A Cluster‐Randomized Trial

2016 ◽  
Vol 65 (1) ◽  
pp. 114-122 ◽  
Author(s):  
Richard K. Zimmerman ◽  
Anthony E. Brown ◽  
Valory N. Pavlik ◽  
Krissy K. Moehling ◽  
Jonathan M. Raviotta ◽  
...  
Keyword(s):  
Older Adults ◽  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Cluster Randomized

scholarly journals A cluster-randomized trial of workplace ergonomics and neck-specific exercise versus ergonomics and health promotion for office workers to manage neck pain—a secondary outcome analysis

2020 ◽  
Author(s):  
Venerina Johnston ◽  
Xiaoqi Chen ◽  
Alyssa Welch ◽  
Gisela Sjøgaard ◽  
Tracy A Comans ◽  
...  
Keyword(s):  
Health Promotion ◽  
Exercise Training ◽  
Neck Pain ◽  
Randomized Trial ◽  
Pain Intensity ◽  
Cluster Randomized Trial ◽  
Office Workers ◽  
Group Differences ◽  
Specific Exercise ◽  
Cluster Randomized

Abstract Background: Neck pain is prevalent among office workers. This study evaluated the impact of an ergonomic and exercise training (EET) intervention and an ergonomic and health promotion (EHP) intervention on neck pain intensity among the general office workers and a subgroup of office workers with neck pain at baseline. Methods: A prospective 12-month cluster-randomized trial was conducted in 14 public and private organisations. Participants were office workers, aged ≥18 years working ≥30 hours per week (n=740). All participants received an individualised workstation ergonomic intervention, followed by 1:1 allocation to the EET group (neck-specific exercise training), or the EHP group (health promotion) for 12 weeks. Neck pain intensity (scale: 0-9) was recorded at baseline, 12 weeks, and 12 months. Participants with data at these three time points were included for analysis (n=367). Intervention group differences were analysed using generalized estimating equation models on an intention-to-treat basis and adjusted for potential confounders (demographic, health or work-related). Subgroup analysis was performed on participants symptomatic at baseline (neck cases) (n=96).Results: The EET group demonstrated significantly greater reductions in neck pain intensity at 12 weeks compared to the EHP group for both the general office workers (EET: b=-0.53 points 95%CI: -0.84– -0.22 [36%] and EHP: b=-0.17 points 95%CI: -0.47–0.13 [10.5%], p-value=0.02) and neck cases subgroup (EET: b=-2.32 points 95%CI: -3.09– -1.56 [53%] and EHP: b=-1.75 points 95%CI: -2.35– -1.16 [36%], p=0.04). Reductions in pain intensity were not maintained at 12 months with no between-group differences observed in either the general office workers (EET: b=-0.18, 95%CI: -0.53–0.16 and EHP: b=-0.14 points 95%CI: -0.49–0.21, p=0.53) or neck cases subgroup, although in both groups an overall reduction was found (EET: b= -1.61 points 95%CI: -2.36– -0.89 and EHP: b=-1.9 points 95%CI: -2.59– -1.20, p=0.26). Conclusion: EET was more effective and clinically meaningful than EHP in reducing neck pain intensity in both general office workers and those with neck pain immediately following the intervention period (12 weeks) but not at 12 months follow-up. Findings suggest the need for continuation of exercise to maintain benefits in the longer term.Clinical trial registration: ACTRN12612001154897 Date of Registration: 31/10/2012

scholarly journals A Cluster Randomized Trial of a Personalized Multi-Condition Risk Assessment in Primary Care

2017 ◽  
Vol 52 (1) ◽  
pp. 100-105 ◽  
Author(s):  
Jennifer S. Haas ◽  
Heather J. Baer ◽  
Katyuska Eibensteiner ◽  
Elissa V. Klinger ◽  
Stella St. Hubert ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Cluster Randomized

scholarly journals Engaging Caregivers in Health-Related Housing Decisions for Older Adults With Cognitive Impairment: A Cluster Randomized Trial

2019 ◽  
Vol 60 (5) ◽  
pp. 947-957 ◽  
Author(s):  
Rhéda Adekpedjou ◽  
Dawn Stacey ◽  
Nathalie Brière ◽  
Adriana Freitas ◽  
Mirjam M Garvelink ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Home Care ◽  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Active Role ◽  
Health Centers ◽  
Cognitively Impaired ◽  
Health Related ◽  
Cluster Randomized

Abstract Background and Objectives Informal caregivers are rarely as involved as they want to be in the housing decisions of cognitively impaired older adults. Lack of awareness of available options and their benefits and risks may lead to decisions that do not reflect older adults’ preferences, and to guilt and regret. We assessed the effect of training home care teams in interprofessional shared decision-making (SDM) on the proportion of caregivers who report being active in this decision. Research Design and Methods In a two-arm pragmatic cluster randomized trial with home care teams working in health centers in the Province of Quebec, we randomized health centers to receive training in interprofessional SDM (intervention) or not (control). Eligible caregivers had made a housing decision for a cognitively impaired adult aged 65 years or older who was receiving services from a home care team. The primary outcome was the proportion of caregivers reporting an active role in decision making. We performed intention-to-treat multilevel analysis. Results We consecutively enrolled a random group of 16 health centers and recruited 309 caregivers, among whom 296 were included in the analysis. In the intervention arm, the proportion of caregivers reporting an active role in decision making increased by 12% (95% CI −2% to 27%; p = .10). After removal of an influential cluster outlier, the proportion increased to 18% (95% CI: 7%–29%; p < .01). Discussion and Implications Training home care teams in interprofessional SDM increased caregiver involvement in health-related housing decisions for cognitively impaired older adults.

Sign in / Sign up

Export Citation Format

Share Document