scholarly journals An electronic decision support‐based complex intervention to improve management of cardiovascular risk in primary health care: a cluster randomised trial (INTEGRATE)

2021 ◽  
Author(s):  
Ruth Webster ◽  
Tim Usherwood ◽  
Rohina Joshi ◽  
Bandana Saini ◽  
Carol Armour ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Decision Support ◽  
Cardiovascular Risk ◽  
Complex Intervention ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Electronic Decision Support ◽  
Primary Health ◽  
Cluster Randomised

scholarly journals Feasibility of alcohol screening and brief intervention in primary health care in Kazakhstan: study protocol of a pilot cluster randomised trial

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Bernd Schulte ◽  
Amy O’Donnell ◽  
Harald Lahusen ◽  
Christina Lindemann ◽  
Mariya Prilutskaya ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Brief Intervention ◽  
Randomised Trial ◽  
Alcohol Screening ◽  
Cluster Randomised Trial ◽  
Control Group ◽  
Screening And Brief Intervention ◽  
Primary Health ◽  
Cluster Randomised

Abstract Background Identifying and addressing heavy drinking represents a major public health priority worldwide. Whilst the majority of alcohol screening and brief intervention (ASBI) research has been conducted in western, high-income countries, evidence is growing that ASBI can also impact positively on heavy drinkers in low- and middle-income country populations. This mixed methods study aims to assess the feasibility of conducting a fully randomised controlled trial of the effectiveness of ASBI in primary care in Kazakhstan and explore the feasibility and acceptability of implementing ASBI in this setting from patients’ and physicians’ perspectives. Methods Six primary health care units in the region of Pavlodar will be cluster randomised to either an intervention (WHO manualised 5 min alcohol brief intervention plus alcohol leaflet) or control group (simple feedback plus alcohol leaflet). Primary feasibility measures will be rates of participation at baseline and retention of eligible patients at the 3-month follow-up point. Patient/physician questionnaires and physician focus groups will assess additional dimensions of feasibility, as well as acceptability, according to the RE-AIM framework: Reach (rates of eligible patients screened/received advice); Effectiveness (change in AUDIT-C score); Adoption (rate/representativeness of participating physicians); Implementation (quality of ASBI/barriers and facilitators to delivery); and Maintenance (potential sustainability of intervention). Discussion This is the first trial of the feasibility and acceptability of ASBI in Kazakhstan. As the planning and assessment of implementation determinants is based on the RE-AIM framework, the project outcomes will be relevant for the future development, tailoring and implementation of ASBI in Kazakhstan. Trial registration DRKS, DRKS00015882, Registered 17 December 2018.

Secondary prevention of stroke by a primary health care approach: An open-label cluster randomised trial

2021 ◽  
Vol 84 ◽  
pp. 53-59
Author(s):  
P.N. Sylaja ◽  
Gurpreet Singh ◽  
S. Sivasambath ◽  
K. Arun ◽  
Panniyammakal Jeemon ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Secondary Prevention ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Open Label ◽  
Primary Health ◽  
Cluster Randomised ◽  
Care Approach

scholarly journals A community-based service enhancement model of training and employing Ear Health Facilitators to address the crisis in ear and hearing health of Aboriginal children in the Northern Territory, the Hearing for Learning Initiative (the HfLI): study protocol for a stepped-wedge cluster randomised trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kelvin Kong ◽  
Alan Cass ◽  
Amanda Jane Leach ◽  
Peter Stanley Morris ◽  
Amy Kimber ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Service ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Primary Health ◽  
Cluster Randomised ◽  
Hearing Health ◽  
Aboriginal Children

Abstract Background Almost all Aboriginal children in remote communities have persistent bilateral otitis media affecting hearing and learning throughout early childhood and school years, with consequences for social and educational outcomes, and later employment opportunities. Current primary health care and specialist services do not have the resources to meet the complex needs of these children. Method/design This stepped-wedge cluster randomised trial will allocate 18 communities to one of five 6-monthly intervention start dates. Stratification will be by region and population size. The intervention (Hearing for Learning Initiative, HfLI) consists of six 20-h weeks of training (delivered over 3 months) that includes Certificate II in Aboriginal Primary Health Care (3 modules) and competencies in ear and hearing data collection (otoscopy, tympanometry and hearScreen), plus 3 weeks of assisted integration into the health service, then part-time employment as Ear Health Facilitators to the end of the trial. Unblinding will occur 6 months prior to each allocated start date, to allow Community Reference Groups to be involved in co-design of the HfLI implementation in their community. Relevant health service data will be extracted 6-monthly from all 18 communities. The primary outcome is the difference in proportion of children (0 to 16 years of age) who have at least one ear assessment (diagnosis) documented in their medical record within each 6-month period, compared to control periods (no HfLI). Secondary outcomes include data on sustainability, adherence to evidence-based clinical guidelines for otitis media, including follow-up and specialist referrals, and school attendance. Structured interviews with staff working in health and education services, Ear Health Trainees, Ear Health Facilitators and families will assess process outcomes and the HfLI broader impact. Discussion The impact of training and employment of Ear Health Facilitators on service enhancement will inform the health, education and employment sectors about effectiveness of skills and job creation that empowers community members to contribute to addressing issues of local importance, in this instance ear and hearing health of children. Trial registration ClinicalTrials.gov NCT03916029. Registered on 16 April 2019.

Do primary health care nurses address cardiovascular risk in diabetes patients?

2014 ◽  
Vol 106 (2) ◽  
pp. 212-220 ◽  
Author(s):  
Barbara Daly ◽  
Timothy Kenealy ◽  
Bruce Arroll ◽  
Nicolette Sheridan ◽  
Robert Scragg
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Cardiovascular Risk ◽  
Primary Health ◽  
Primary Health Care Nurses ◽  
Diabetes Patients

scholarly journals Improving quality of care during childbirth in primary health centres: a stepped-wedge cluster-randomised trial in India

2018 ◽  
Vol 3 (5) ◽  
pp. e000907 ◽  
Author(s):  
Ramesh Agarwal ◽  
Deepak Chawla ◽  
Minakshi Sharma ◽  
Shyama Nagaranjan ◽  
Suresh K Dalpath ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Management Strategy ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Primary Health ◽  
Cluster Randomised ◽  
Primary Health Centres ◽  
Health Centres

BackgroundLow/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models.MethodsWe conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3  months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for ‘months of intervention’.ResultsThe intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities.ConclusionA multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India.Trial registration numberCTRI/2016/05/006963.

scholarly journals District nurses’ experiences of using a clinical decision support system and an assessment tool at elderly care units in primary health care: a qualitative study

2021 ◽  
Vol 22 ◽  
Author(s):  
Annica Lagerin ◽  
Lena Törnkvist ◽  
Johan Fastbom ◽  
Lena Lundh
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Primary Health Care ◽  
Decision Support ◽  
Clinical Decision Support System ◽  
Elderly Care ◽  
Medication Use ◽  
Clinical Decision ◽  
Primary Health ◽  
District Nurses

Abstract Aim: The present study aimed to describe the experience of district nurses (DNs) in using a clinical decision support system (CDSS) and the safe medication assessment (SMA) tool during patient visits to elderly care units at primary health care centres. Background: In Swedish primary health care, general practitioners (GPs) prescribe and have the responsibility to regularly review older adults’ medications, while DN (nurses specialised in primary health care) play an important role in assessing older adults’ ability to manage their medications, detecting potential drug-related problems and communicating with patients and GPs about such problems. In a previous feasibility study, we found that DNs who use a combination of a CDSS and the SMA tool identified numerous potentially harmful or dangerous factors and took a number of nursing care actions to improve the safety and quality of patients’ medication use. In telephone interviews, patients indicated that they were positive towards the assessment and interventions. Methods: Individual interviews with seven DNs who worked at six different primary health care centres in Region Stockholm were carried out in 2018. In 2019, an additional group interview was conducted with two of the seven DNs so they could discuss and comment on preliminary findings. Qualitative content analysis was used to analyse the interview transcripts. Findings: Using the tools, the DNs could have a natural conversation about medication use with older adults. They could get a clear picture of the older adults’ medication use and thus obtain information that could facilitate collaboration with GPs about this important component of health care for older adults. However, for the tools to be used in clinical practice, some barriers would have to be overcome, such as the time-consuming nature of using the tools and the lack of established routines for interprofessional collaboration regarding medication discussions.

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