1
|
Schwenker R, Kroeber ES, Deutsch T, Frese T, Unverzagt S. Identifying patients with psychosocial problems in general practice: a scoping review protocol. BMJ Open 2021; 11:e051383. [PMID: 34930731 PMCID: PMC8689158 DOI: 10.1136/bmjopen-2021-051383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/05/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Psychosocial problems (PSPs) are common issues associated with negative health outcomes. Since general practitioners are the first point of contact for any health-related concern, understanding their options to recognise patients with PSPs plays an important role as it is essential for early intervention and can prevent serious conditions. The objective of our scoping review is to map published evidence on the usage of instruments to identify patients with PSPs in general practice. METHODS AND ANALYSIS We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual on scoping reviews. A systematic search of four electronic databases (Medline (Ovid), Web of Science Core Collection, PsycInfo, Cochrane Library) will be conducted for quantitative and qualitative studies published in English, Spanish, French and German. Main study characteristics as well as information on identification instruments will be extracted and visualised in structured tables to map the available evidence. The protocol has been registered with Open Science Framework, https://osfio/c2m6z. ETHICS AND DISSEMINATION This study does not require ethical approval as we will not collect personal data. Dissemination will consist of publications, presentations and other knowledge translation activities.
Collapse
Affiliation(s)
- Rosemarie Schwenker
- Faculty of Medicine, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg, Halle (Saale), Germany
| | - Eric Sven Kroeber
- Faculty of Medicine, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg, Halle (Saale), Germany
| | - Tobias Deutsch
- Department of General Practice, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Thomas Frese
- Faculty of Medicine, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg, Halle (Saale), Germany
| | - Susanne Unverzagt
- Faculty of Medicine, Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University of Halle Wittenberg, Halle (Saale), Germany
| |
Collapse
|
2
|
Asnani MR, Francis D, Knight-Madden J, Chang-Lopez S, King L, Walker S. Integrating a problem-solving intervention with routine care to improve psychosocial functioning among mothers of children with sickle cell disease: A randomized controlled trial. PLoS One 2021; 16:e0252513. [PMID: 34106974 PMCID: PMC8189456 DOI: 10.1371/journal.pone.0252513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/16/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the feasibility of a problem-solving skills training intervention in improving psychological outcomes in mothers of infants with sickle cell disease (SCD). DESIGN AND METHODS This parallel randomized controlled trial recruited 64 babies with SCD, 6 to 12 months of age, and their mothers. Baseline measurements assessed mothers' coping and problem-solving skills, depression, and parental stress before random assignment to intervention or control groups (n = 32 each). Problem-solving skills intervention was delivered through 6 monthly sessions, when babies attended for routine penicillin prophylaxis. All measurements were repeated for both groups at the end of the intervention period. Intention to treat analysis used repeated measures mixed models with the restricted estimation maximum likelihood approach. RESULTS The problem-solving intervention had no significant effect on mothers' problem-solving skills (adjusted treatment effect: -1.69 points (95% CI:-5.62 to 2.25)), coping behaviours (adjusted treatment effect: 0.65 points (95% CI:- -7.13 to 8.41)) or depressive symptoms (adjusted treatment effect: -0.41 (95% CI: -6.00 to 5.19)). It reduced mothers' level of difficulty in managing stressful events by 9.5 points (95% CI (-16.86 to -2.16); effect size: 0.21 SD). In the subgroup of mothers at risk of depression (n = 31 at baseline), the intervention reduced depression scores with treatment effect of 10.4 points (95%CI: -18.83 to -1.88; effect size: 0.67 SD). CONCLUSION This problem-solving skills intervention study suggests feasibility and possible efficacy in improving some maternal outcomes. Further refinement and culturally appropriate adaptations of the intervention could lead to stronger effects.
Collapse
Affiliation(s)
- Monika R. Asnani
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
- * E-mail:
| | - Damian Francis
- School of Health and Human Performance, Georgia College, Milledgeville, Georgia, United States of America
| | - Jennifer Knight-Madden
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Susan Chang-Lopez
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Lesley King
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Susan Walker
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| |
Collapse
|
3
|
AlHadi AN, AlGhofili HH, Almujaiwel NA, Alsweirky HM, Albeshr MF, Almogbel GT. Perception and barriers to the use of cognitive-behavioral therapy in the treatment of depression in primary healthcare centers and family medicine clinics in Saudi Arabia. J Family Community Med 2021; 28:77-84. [PMID: 34194271 PMCID: PMC8213094 DOI: 10.4103/jfcm.jfcm_494_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/13/2021] [Accepted: 01/31/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND General practitioners (GPs) and family medicine physicians (FMPs) have a vital role to play in co-ordinating the care for mental disorders. The objective of this study was to determine the perception of GPs and FMPs on the use of cognitive-behavioral therapy (CBT) for depression in Saudi Arabia, and the barriers against the implementation of CBT in such settings. MATERIALS AND METHODS All physicians working in Primary Healthcare Centers and Family Medicine Clinics in Saudi Arabia were targeted and invited to participate in this cross-sectional study. A self-administered online questionnaire was sent via E-mail through the Saudi Commission for Health Specialties and the Saudi Society of Family and Community Medicine. Data was collected using an existing validated questionnaire and was modified to fit the objectives of current study. RESULTS A total of 469 FMPs and GPs completed the survey; the mean age of respondents was 38 years. More than half of the FMPs' and GPs' (53%) showed a positive perception of the use of CBT in primary healthcare settings. Most participants (91.9%) were willing to use CBT if they had adequate education and training. More than half of the participants (59.5%) thought it was time-consuming, while 39% thought that CBT training was a very time-intensive process. CONCLUSION We conclude that more than half of the physicians clearly had a good perception of the effectiveness of CBT administration in primary healthcare settings. Younger physicians were more perceptive. The most agreed-on barrier to CBT implementation was the lack of training and education.
Collapse
Affiliation(s)
- Ahmad N. AlHadi
- Department of Psychiatry and SABIC Psychological Health Research and Applications Chair, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Hesham H. AlGhofili
- Department of Psychiatry and SABIC Psychological Health Research and Applications Chair, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Nasser A. Almujaiwel
- Department of Psychiatry and SABIC Psychological Health Research and Applications Chair, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Helmi M. Alsweirky
- Department of Psychiatry and SABIC Psychological Health Research and Applications Chair, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed F. Albeshr
- Department of Psychiatry and SABIC Psychological Health Research and Applications Chair, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Gassan T. Almogbel
- Department of Psychiatry and SABIC Psychological Health Research and Applications Chair, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Silverstein M, Cabral H, Hegel M, Diaz-Linhart Y, Beardslee W, Kistin CJ, Feinberg E. Problem-Solving Education to Prevent Depression Among Low-Income Mothers: A Path Mediation Analysis in a Randomized Clinical Trial. JAMA Netw Open 2018; 1:e180334. [PMID: 30646083 PMCID: PMC6324419 DOI: 10.1001/jamanetworkopen.2018.0334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Although problem solving has been an important component of successful depression prevention and treatment interventions, evidence to support problem solving's mechanism of action is sparse. OBJECTIVE To understand the mechanism of an efficacious depression prevention intervention, problem-solving education (PSE). DESIGN, SETTING, AND PARTICIPANTS A multivariate path analysis was embedded within a randomized efficacy trial (February 15, 2011, to May 9, 2016). Participants were mothers with depressed mood, anhedonia, or depression history (but not in current major depressive episode) at 1 of 6 Head Start agencies. Participants were followed up for 12 months with serial assessments of potential intervention mediators and depressive symptoms. INTERVENTIONS Problem-solving education (n = 111) and usual Head Start services (n = 119). MAIN OUTCOMES AND MEASURES Primary outcomes were depressive symptom elevations, which were measured bimonthly. Eight plausible intervention mediators were assessed: problem-solving ability; mastery; self-esteem; perceived stress; behavioral activation; and avoidant, problem-focused, and social coping. RESULTS Among 230 participants, 152 (66.1%) were Hispanic; mean (SD) age was 31.4 (7.3) years. Based on associations with either PSE participation or depressive symptom outcomes, problem-solving ability, perceived stress, behavioral activation, and problem-focused coping were included in a parsimonious, multivariate path model. In this model, only perceived stress was associated with both PSE participation and depressive symptoms. Participants in the PSE group had adjusted standardized perceived stress change scores that were 11% lower than controls (95% CI, -0.19 to -0.03), and improvement in perceived stress generated an adjusted rate ratio (aRR) of 0.42 (95% CI, 0.33-0.53) for depressive symptom elevations. Participants in the intervention group also had standardized behavioral activation change scores 15% greater than controls (95% CI, 0.01-0.30) and problem-focused coping change scores 17% greater than controls (95% CI, 0.03-0.31); however, changes in these constructs were not associated with a differential rate of depressive symptom elevations. The direct effect of PSE on depressive symptom elevations (aRR, 0.72; 95% CI, 0.52-0.97) was greater than the mediated effect explained by improvement in perceived stress (aRR, 0.91; 95% CI, 0.85-0.98). CONCLUSIONS AND RELEVANCE Problem-solving education is efficacious in preventing depressive symptoms and appears to work by decreasing perceived stress; however, the mechanism for much of PSE's impact on depression remains unexplained. These results can be used to simplify the intervention model in preparation for effectiveness testing. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01298804.
Collapse
Affiliation(s)
- Michael Silverstein
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Mark Hegel
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Yaminette Diaz-Linhart
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - William Beardslee
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Caroline J. Kistin
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Emily Feinberg
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
5
|
O'Donnell A, Wallace P, Kaner E. From efficacy to effectiveness and beyond: what next for brief interventions in primary care? Front Psychiatry 2014; 5:113. [PMID: 25221524 PMCID: PMC4147417 DOI: 10.3389/fpsyt.2014.00113] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 08/12/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Robust evidence supports the effectiveness of screening and brief alcohol interventions in primary healthcare. However, lack of understanding about their "active ingredients" and concerns over the extent to which current approaches remain faithful to their original theoretical roots has led some to demand a cautious approach to future roll-out pending further research. Against this background, this paper provides a timely overview of the development of the brief alcohol intervention evidence base to assess the extent to which it has achieved the four key levels of intervention research: efficacy, effectiveness, implementation, and demonstration. METHODS Narrative overview based on (1) the results of a review of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare and (2) synthesis of the findings of key additional primary studies on the improvement and evaluation of brief alcohol intervention implementation in routine primary healthcare. RESULTS The brief intervention field seems to constitute an almost perfect example of the evaluation of a complex intervention. Early evaluations of screening and brief intervention approaches included more tightly controlled efficacy trials and have been followed by more pragmatic trials of effectiveness in routine clinical practice. Most recently, attention has shifted to dissemination, implementation, and wider-scale roll-out. However, delivery in routine primary health remains inconsistent, with an identified knowledge gap around how to successfully embed brief alcohol intervention approaches in mainstream care, and as yet unanswered questions concerning what specific intervention component prompt the positive changes in alcohol consumption. CONCLUSION Both the efficacy and effectiveness of brief alcohol interventions have been comprehensively demonstrated, and intervention effects seem replicable and stable over time, and across different study contexts. Thus, while unanswered questions remain, given the positive evidence amassed to date, research efforts should maintain a continued focus on promoting sustained implementation of screening and brief alcohol intervention approaches in primary care to ensure that those who might benefit from screening and brief alcohol interventions actually receive such support.
Collapse
Affiliation(s)
- Amy O'Donnell
- Institute of Health and Society, Newcastle University , Newcastle upon Tyne , UK
| | - Paul Wallace
- Department of Primary Care and Population Health, University College London , London , UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University , Newcastle upon Tyne , UK
| |
Collapse
|
6
|
O'Donnell A, Anderson P, Newbury-Birch D, Schulte B, Schmidt C, Reimer J, Kaner E. The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews. Alcohol Alcohol 2013; 49:66-78. [PMID: 24232177 PMCID: PMC3865817 DOI: 10.1093/alcalc/agt170] [Citation(s) in RCA: 339] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aims: The aim of the study was to assess the cumulative evidence on the effectiveness of brief alcohol interventions in primary healthcare in order to highlight key knowledge gaps for further research. Methods: An overview of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare published between 2002 and 2012. Findings: Twenty-four systematic reviews met the eligibility criteria (covering a total of 56 randomized controlled trials reported across 80 papers). Across the included studies, it was consistently reported that brief intervention was effective for addressing hazardous and harmful drinking in primary healthcare, particularly in middle-aged, male drinkers. Evidence gaps included: brief intervention effectiveness in key groups (women, older and younger drinkers, minority ethnic groups, dependent/co-morbid drinkers and those living in transitional and developing countries); and the optimum brief intervention length and frequency to maintain longer-term effectiveness. Conclusion: This overview highlights the large volume of primarily positive evidence supporting brief alcohol intervention effects as well as some unanswered questions with regards to the effectiveness of brief alcohol intervention across different cultural settings and in specific population groups, and in respect of the optimum content of brief interventions that might benefit from further research.
Collapse
Affiliation(s)
- Amy O'Donnell
- Corresponding author: Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE2 4AX, UK.
| | | | | | | | | | | | | |
Collapse
|
7
|
Braun S, Kleynen M, van Heel T, Kruithof N, Wade D, Beurskens A. The effects of mental practice in neurological rehabilitation; a systematic review and meta-analysis. Front Hum Neurosci 2013; 7:390. [PMID: 23935572 PMCID: PMC3731552 DOI: 10.3389/fnhum.2013.00390] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 07/04/2013] [Indexed: 11/25/2022] Open
Abstract
Objective: To investigate the beneficial and adverse effects of a mental practice intervention on activities, cognition, and emotion in patients after stroke, patients with Parkinson's disease or multiple sclerosis. Methods: Electronic databases PubMed/Medline, PEDro, Science Direct, Cochrane Library, PsycINFO, Rehadat, Embase, and Picarta were searched until June 2012. Fourteen randomized controlled trials in stroke and two randomized controlled trials in Parkinson's disease were included, representing 491 patients (421 with stroke). No randomized controlled trials in multiple sclerosis were identified. The methodologic quality of the included trials was assessed with the Amsterdam-Maastricht-Consensus-List (AMCL). Information on study characteristics and outcomes was summarized and evidence for effects described. Data from individual studies in stroke with same outcome measures were pooled. Results: The included 16 randomized controlled trials were heterogeneous and methodologic quality varied. Ten trials reported significant effects in favor of mental practice in patients with stroke (n = 9) and Parkinson's disease (n = 1). In six studies mental practice had similar effects as therapy as usual (n = 5 in stroke and n = 1 in Parkinson's disease). Of six performed meta-analyses with identical measures in stroke studies only two showed significant effects of mental practice: short-term improvement of arm-hand-ability (ARAT: SMD 0.62; 95% CI: 0.05 to 1.19) and improvement of performance of activities (NRS: SMD 0.9; 95% CI: 0.04 to 1.77). Five studies found effects on cognition (e.g., effects on attention, plan actions in unfamiliar surroundings) and four reported observed side-effects, both positive (e.g., might increase motivation and arousal and reduce depression) and negative (e.g., diminished concentration, irritation). Conclusions: Mental practice might have positive effects on performance of activities in patients with neurological diseases, but this review reports less positive results than earlier published ones. Strengths and limitations of past studies are pointed out. Methodologic recommendations for future studies are given.
Collapse
Affiliation(s)
- Susy Braun
- Research Centre Autonomy and Participation of Patients with a Chronic Illness, Zuyd University of Applied Sciences Heerlen, Netherlands ; School for Public Health and Primary Care (CAPHRI), Maastricht University Maastricht, Netherlands
| | | | | | | | | | | |
Collapse
|
8
|
Pech M, O'Kearney R. A randomized controlled trial of problem-solving therapy compared to cognitive therapy for the treatment of insomnia in adults. Sleep 2013; 36:739-49. [PMID: 23633757 DOI: 10.5665/sleep.2640] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To compare the efficacy of problem-solving therapy (PST) combined with behavioral sleep strategies to standard cognitive therapy (CT) combined with behavioral sleep strategies in the treatment of insomnia. DESIGN A six-week randomized controlled trial with one month follow-up. SETTING The Australian National University Psychology Clinic, Canberra, Australia. PARTICIPANTS Forty-seven adults aged 18-60 years recruited from the community meeting the Research Diagnostic Criteria for insomnia. INTERVENTIONS Participants received 6 weeks of treatment including one group session (sleep education and hygiene, stimulus control instructions and progressive muscle relaxation) followed by 5 weeks of individual treatment of PST or CT. MEASUREMENTS AND RESULTS Primary outcomes included sleep efficiency (SE) from sleep diaries, the Insomnia Severity Index (ISI), and the Pittsburgh Sleep Quality Index (PSQI). Secondary measures assessed dysfunctional sleep beliefs, problem-solving skills and orientations, and worry. Both treatments produced significant post therapy improvements in sleep which were maintained at 1 month follow-up (on SE Cohen d = 1.42, 95% CI 1.02-1.87 for PST; d = 1.26, 95% CI 0.81-1.65 for CT; on ISI d = 1.46, 95% CI 1.03-1.88 for PST; d = 1.95, 95% CI 0.52-2.38 for CT; for PSQI d = 0.97, 95% CI 0.55-1.40 for PST and d = 1.34, 95% CI 0.90-1.79 for the CT). There were no differences in PST and CT in the size or rate of improvement in sleep although CT produced a significant faster rate of decline in negative beliefs about sleep than PST and there was a trend (P = 0.08) for PST to produce a faster rate of improvement in negative problem orientation than CT. CONCLUSIONS The results provide preliminary support for problem solving treatment as an equally efficacious alternative component to cognitive therapy in psychological interventions for insomnia.
Collapse
Affiliation(s)
- Melissa Pech
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | | |
Collapse
|
9
|
Bosmans JE, Schreuders B, van Marwijk HWJ, Smit JH, van Oppen P, van Tulder MW. Cost-effectiveness of problem-solving treatment in comparison with usual care for primary care patients with mental health problems: a randomized trial. BMC FAMILY PRACTICE 2012; 13:98. [PMID: 23052105 PMCID: PMC3515338 DOI: 10.1186/1471-2296-13-98] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 10/04/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Mental health problems are common and are associated with increased disability and health care costs. Problem-Solving Treatment (PST) delivered to these patients by nurses in primary care might be efficient. The aim of this study was to evaluate the cost-effectiveness of PST by mental health nurses compared with usual care (UC) by the general practitioner for primary care patients with mental health problems. METHODS An economic evaluation from a societal perspective was performed alongside a randomized clinical trial. Patients with a positive General Health Questionnaire score (score ≥ 4) and who visited their general practitioner at least three times during the past 6 months were eligible. Outcome measures were improvement on the Hospital Anxiety and Depression Scale and QALYs based on the EQ-5D. Resource use was measured using a validated questionnaire. Missing cost and effect data were imputed using multiple imputation techniques. Bootstrapping was used to analyze costs and cost-effectiveness of PST compared with UC. RESULTS There were no statistically significant differences in clinical outcomes at 9 months. Mean total costs were €4795 in the PST group and €6857 in the UC group. Costs were not statistically significantly different between the two groups (95% CI -4698;359). The cost-effectiveness analysis showed that PST was cost-effective in comparison with UC. Sensitivity analyses confirmed these findings. CONCLUSIONS PST delivered by nurses seems cost-effective in comparison with UC. However, these results should be interpreted with caution, since the difference in total costs was mainly caused by 3 outliers with extremely high indirect costs in the UC group. TRIAL REGISTRATION Nederlands Trial Register ISRCTN51021015.
Collapse
Affiliation(s)
- Judith E Bosmans
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
10
|
Problem-solving education to prevent depression among low-income mothers of preterm infants: a randomized controlled pilot trial. Arch Womens Ment Health 2011; 14:317-24. [PMID: 21667323 PMCID: PMC6013041 DOI: 10.1007/s00737-011-0222-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 05/25/2011] [Indexed: 01/19/2023]
Abstract
We sought to assess the feasibility and document key study processes of a problem-solving intervention to prevent depression among low-income mothers of preterm infants. A randomized controlled pilot trial (n = 50) of problem-solving education (PSE) was conducted. We assessed intervention provider training and fidelity; recruitment and retention of subjects; intervention acceptability; and investigators' ability to conduct monthly outcome assessments, from which we could obtain empirical estimates of depression symptoms, stress, and functioning over 6 months. Four of four bachelor-level providers were able to deliver PSE appropriately with standardized subjects within 4 weeks of training. Of 12 randomly audited PSE sessions with actual subjects, all met treatment fidelity criteria. Nineteen of 25 PSE subjects (76%) received full four-session courses; no subjects reported negative experiences with PSE. Eighty-eight percent of scheduled follow-up assessments were completed. Forty-four percent of control group mothers experienced an episode of moderately severe depression symptoms over the follow-up period, compared to 24% of PSE mothers. Control mothers experienced an average 1.19 symptomatic episodes over the 6 months of follow-up, compared to 0.52 among PSE mothers. PSE appears feasible and may be a promising strategy to prevent depression among mothers of preterm infants.
Collapse
|
11
|
Silverstein M, Feinberg E, Cabral H, Linhart YD, Sandler J, Hegel M, Appugliese DP, Beardslee W. Potential impact of trauma on the ability to prevent depression among low-income mothers. Depress Anxiety 2011; 28:478-84. [PMID: 21506207 PMCID: PMC3110557 DOI: 10.1002/da.20817] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/14/2011] [Accepted: 03/15/2011] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Violent trauma is common in urban communities. We explored the hypothesis that past trauma could moderate the effect of a cognitive behavioral intervention designed to prevent depression among urban, low-income mothers. METHODS Synthesis of two pilot randomized trials of problem solving education (PSE) among 93 mothers of children hospitalized in the neonatal intensive care unit or enrolled in community-based Early Intervention programs. Outcomes included depressive symptoms, perceived stress, and social functioning. Results were adjusted for baseline depressive symptoms, then stratified according to subjects' trauma history. RESULTS Fifteen of the 44 PSE subjects (34%) experienced a moderately severe depressive symptom episode during the 3-month follow-up period, as opposed to 21 of 45 control subjects (47%), for a nearly significant adjusted odds ratio (aOR) of 0.36 (95% CI: 0.13, 1.02). Among mothers without trauma histories, far fewer PSE mothers (5 of 24; 21%) experienced an episode of moderately severe depressive symptoms than control mothers (12 of 26; 46%) for a significant aOR of 0.15 (95% CI: 0.03, 0.79). Conversely, among mothers with trauma histories, a similar proportion of PSE mothers (10 of 19; 53%) experienced an episode of moderately severe depressive symptoms as control mothers (9 of 19; 47%). Similar trends held for perceived stress and social functioning. CONCLUSIONS PSE may be more effective at preventing depression among mothers without trauma histories. Our results are consistent with the depression treatment literature, but are novel because they support the principle of intervention moderation in risk prevention, as opposed to treatment, paradigm.
Collapse
Affiliation(s)
| | - Emily Feinberg
- Boston Medical Center, Boston MA; Boston University School of Medicine, Boston MA,Boston University School of Public Health, Boston
| | | | - Yaminette Diaz Linhart
- Boston Medical Center, Boston MA; Boston University School of Medicine, Boston MA,Boston University School of Public Health, Boston
| | - Jenna Sandler
- Boston Medical Center, Boston MA; Boston University School of Medicine, Boston MA
| | | | | | | |
Collapse
|
12
|
Hoedeman R, Blankenstein AH, van der Feltz-Cornelis CM, Krol B, Stewart R, Groothoff JW. Consultation letters for medically unexplained physical symptoms in primary care. Cochrane Database Syst Rev 2010:CD006524. [PMID: 21154369 DOI: 10.1002/14651858.cd006524.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In primary care between 10% and 35% of all visits concern patients with medically unexplained physical symptoms (MUPS). MUPS are associated with high medical consumption, significant disabilities and psychiatric morbidity. OBJECTIVES To assess the effectiveness of consultation letters (CLs) to assist primary care physicians or occupational health physicians in the treatment of patients with MUPS and diagnostic subgroups. SEARCH STRATEGY We searched for randomized controlled trials (RCTs) on the Cochrane Collaboration Depression, Anxiety and Neurosis Group Controlled Trials Registers, the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 2, 2009), MEDLINE (1966-2009), MEDLINE In Process (2009-08-17), EMBASE (1974-2009), PSYCINFO (1980-2009) and CINAHL (1982-2009). We screened the references lists of selected studies and consulted experts in the field to identify any additional, eligible RCTs. SELECTION CRITERIA RCTs of CLs for patients with MUPS being treated in primary care settings. DATA COLLECTION AND ANALYSIS Two authors independently screened the abstracts of the studies identified through the searches and independently assessed the risk of bias of the included studies. We resolved any disagreement by discussion with a third review author. We assessed heterogeneity and, where a number of studies reported the same outcomes, pooled results in a meta-analysis. MAIN RESULTS We included six RCTs, with a total of 449 patients. In four studies (267 patients) the CL intervention resulted in reduced medical costs (in two studies the outcomes could be pooled: MD -352.55 US Dollars (95% CI -522.32 to -182.78)) and improved physical functioning (three studies, MD 5.71 (95% CI 4.11 to 7.31)). In two studies (182 patients) the intervention was a joint consultation with a psychiatrist in presence of the physician, and resulted in reduced severity of somatization symptoms, reduced medical consumption and improved social functioning. AUTHORS' CONCLUSIONS There is limited evidence that a CL is effective in terms of medical costs and improvement of physical functioning for patients with MUPS in primary care. The results are even less pronounced in patients with clinically less severe, but more meaningful, forms of MUPS and the results vary for other patient-related outcomes. All studies, except one, were performed in the United States and therefore the results can not be generalized directly to countries with other healthcare systems. Furthermore all studies were small and of only moderate quality. There is very limited evidence that a joint consultation with the patient by a psychiatrist in the presence of the physician, together with the provision of a CL, reduces severity of somatization symptoms and medical consumption.
Collapse
Affiliation(s)
- Rob Hoedeman
- University Medical Center Groningen, Department of Health Sciences, University of Groningen, ArboNed, Postbus 85092, Utrecht, Netherlands, 3508 AB
| | | | | | | | | | | |
Collapse
|
13
|
Arnold IA, de Waal MW, Eekhof JA, Assendelft WJ, Spinhoven P, van Hemert AM. Medically Unexplained Physical Symptoms in Primary Care: A Controlled Study on the Effectiveness of Cognitive-Behavioral Treatment by the Family Physician. PSYCHOSOMATICS 2009. [DOI: 10.1016/s0033-3182(09)70845-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Functional interpretations of sadness, stress and demoralization among an urban population of low-income mothers. Matern Child Health J 2009; 14:245-53. [PMID: 19156506 DOI: 10.1007/s10995-009-0445-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 01/05/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We sought to understand how low-income urban mothers explain feelings of sadness, stress or demoralization in the context of their life experiences. METHODS 28 in-depth qualitative interviews, constituting part of a community-based participatory research (CBPR) project aimed at developing a culturally relevant, community-based intervention for maternal depression. Qualitative data validity was ensured through investigator and expert triangulation, and through member checking. RESULTS The following themes emerged: (1) Informants spoke of wanting reprieves from chaos, and discussed this desire relative to wanting to be alone. By contrast, informants expressed loneliness not only in interpersonal terms, but also related to having problems that precluded future relationships, or feeling unique in experiencing an adversity. (2) Informants spoke of demoralization associated with feeling that their problems were externally imposed and therefore beyond their control, but spoke of empowerment associated with owning one's problems. (3) Informants discussed degrees of sadness in relation to their own abilities to adjust or modify their mood, or their ability to contain their feelings. CONCLUSIONS Our data suggest that helping a mother find reprieves from chaos, increasing her perception of her own locus of control around externally imposed adversities, and empowering her to recognize and self-manage her own feelings may constitute important elements of a culturally relevant, community-based intervention for depression.
Collapse
|
15
|
Wolfenden L, Campbell E, Wiggers J, Walsh RA, Bailey LJ. Helping hospital patients quit: what the evidence supports and what guidelines recommend. Prev Med 2008; 46:346-57. [PMID: 18207229 DOI: 10.1016/j.ypmed.2007.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 05/06/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The study aimed to critically appraise the extent and strength of systematic review evidence for, and guideline recommendations regarding hospital smoking cessation interventions. METHODS Systematic reviews of smoking cessation interventions were identified via an electronic search of the Cochrane Library. Meta-analyses from Cochrane reviews were categorised as those that incorporated only studies of hospital based interventions, and those which incorporated interventions which were not hospital based. Smoking cessation guidelines for hospital health professionals were identified via a search of the World Wide Web. RESULTS The review found that evidence from meta-analyses restricted to hospital studies was insufficient to evaluate a number of specific intervention strategies and at times conflicted with the findings of meta-analyses without such restrictions. The majority of guidelines recommended the provision of brief advice, counseling, nicotine replacement therapy despite the absence of clear supporting evidence. CONCLUSIONS Further hospital-based research addressing specific cessation strategies is required. Furthermore, smoking cessation guidelines for hospital based health professionals should more specifically reflect evidence from this setting.
Collapse
Affiliation(s)
- Luke Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Locked Bag No. 10, Wallsend NSW 2287, Australia.
| | | | | | | | | |
Collapse
|
16
|
Primary care patients with mental health problems: outcome of a randomised clinical trial. Br J Gen Pract 2008; 57:886-91. [PMID: 17976289 DOI: 10.3399/096016407782317829] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The prevalence of patients with mental health problems in general practice is high, and at least one-third of these problems last for 6 months or longer. Patients with these problems take up more time during a consultation and attend more frequently. AIM This study investigated the effectiveness of problem-solving treatment for primary care patients with mental health problems. The hypothesis was that patients receiving problem-solving treatment from a nurse would have fewer symptoms after 3 months, or a lower attendance rate, compared with patients receiving the usual care from the GP. DESIGN OF THE STUDY Randomised clinical trial. SETTING Twelve general practices in Amsterdam and 12 nurses from a mental healthcare institution. METHOD A sample of patients aged >or=18 years were screened for mental health problems with the general health questionnaire (GHQ-12) in the waiting room of the general practices, and were randomised. Patients receiving the problem-solving treatment were required to complete four to six treatment sessions, while patients in the control group were treated as usual by the GP. RESULTS No significant difference was found between the groups in terms of improved psychopathology or a decrease in attendance rate. Post-hoc analyses showed a sub-group of patients with more severe pathology who may benefit from problem-solving treatment. CONCLUSION The main results show that problem-solving treatment provided by a nurse adds little to the usual care from the GP for frequent attenders with mental health problems. Post-hoc analyses show that there may be a sub-group of more severely depressed patients who could benefit from problem-solving treatment.
Collapse
|
17
|
Rose JH, Radziewicz R, Bowmans KF, O'Toole EE. A coping and communication support intervention tailored to older patients diagnosed with late-stage cancer. Clin Interv Aging 2008; 3:77-95. [PMID: 18488881 PMCID: PMC2544372 DOI: 10.2147/cia.s1262] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
As our society ages, increasing numbers of older Americans will be diagnosed and eventually will die of cancer. To date, psycho-oncology interventions for advanced cancer patients have been more successful in reaching younger adult age groups and generally have not been designed to respond to the unique needs and preferences of older patients. Theories and research on successful aging (Baltes and Baltes 1990; Baltes 1997), health information processing style (Miller 1995; Miller et al 2001) and non-directive client-centered therapy (Rogers 1951, 1967), have guided the development of a coping and communication support (CCS) intervention. Key components of this age-sensitive and tailored intervention are described, including problem domains addressed, intervention strategies used and the role of the CCS practitioner. Age group comparisons in frequency of contact, problems raised and intervention strategies used during the first six weeks of follow up indicate that older patients were similar to middle-aged patients in their level of engagement, problems faced and intervention strategies used. Middle-aged patients were more likely to have problems communicating with family members at intervention start up and practical problems as well in follow up contacts. This is the first intervention study specifically designed to be age sensitive and to examine age differences in engagement from the early treatment phase for late-stage cancer through end of life. This tailored intervention is expected to positively affect patients' quality of care and quality of life over time.
Collapse
Affiliation(s)
- Julia Hannum Rose
- Case Western Reserve University, School of Medicine, Cleveland, Ohio 44109, USA
| | | | | | | |
Collapse
|
18
|
May CR, Mair FS, Dowrick CF, Finch TL. Process evaluation for complex interventions in primary care: understanding trials using the normalization process model. BMC FAMILY PRACTICE 2007; 8:42. [PMID: 17650326 PMCID: PMC1950872 DOI: 10.1186/1471-2296-8-42] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 07/24/2007] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Normalization Process Model is a conceptual tool intended to assist in understanding the factors that affect implementation processes in clinical trials and other evaluations of complex interventions. It focuses on the ways that the implementation of complex interventions is shaped by problems of workability and integration. METHOD In this paper the model is applied to two different complex trials: (i) the delivery of problem solving therapies for psychosocial distress, and (ii) the delivery of nurse-led clinics for heart failure treatment in primary care. RESULTS Application of the model shows how process evaluations need to focus on more than the immediate contexts in which trial outcomes are generated. Problems relating to intervention workability and integration also need to be understood. The model may be used effectively to explain the implementation process in trials of complex interventions. CONCLUSION The model invites evaluators to attend equally to considering how a complex intervention interacts with existing patterns of service organization, professional practice, and professional-patient interaction. The justification for this may be found in the abundance of reports of clinical effectiveness for interventions that have little hope of being implemented in real healthcare settings.
Collapse
Affiliation(s)
- Carl R May
- Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK
| | - Frances S Mair
- Division of General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Christopher F Dowrick
- School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool UK
| | - Tracy L Finch
- Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK
| |
Collapse
|
19
|
Linden M, Dierkes W, Munz T. Non-pharmacological treatment of psychiatrists in addition to the prescribing of an antidepressant drug. Eur Psychiatry 2007; 22:419-26. [PMID: 17482798 DOI: 10.1016/j.eurpsy.2007.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Revised: 03/17/2007] [Accepted: 03/18/2007] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Guidelines for the treatment of depression regularly emphasize that pharmacotherapy of depression should be accompanied by supportive counseling and other psychotherapeutic interventions. It is unknown which role psychiatrists in routine care give to such verbal therapies. METHODS In a drug utilization study of venlafaxine, psychiatrists in private practice and in hospitals were asked to tell what non-pharmacological therapies they saw as an important part of the treatment of the present depressive episode. Additionally patient characteristics, treatment variables, setting characteristics and physician characteristics were assessed. RESULTS Psychiatrists reported some kind of verbal therapies in 19.0% of outpatients and 36.8% of inpatients. Verbal therapies were reported more often for younger patients, who got more double diagnoses and were more severely ill. Patients with verbal therapies got more psychotropic medication. In the inpatient setting verbal therapies were related to generally more treatment overall and a higher rate of treatment response. In both treatment settings verbal therapies were related to lower rates of discontinuation of the antidepressant. CONCLUSION Verbal interactions are part of any patient-physician encounter and should be theory guided as part of the therapeutic process in the treatment of depressive disorders. Under this assumption the rate of patients for which psychiatrists reported some kind of verbal therapy as explicit part of their treatment could be higher. More research is needed on patient guidance, counseling and supportive psychotherapy in psychiatry.
Collapse
Affiliation(s)
- M Linden
- Research Group Psychosomatic Rehabilitation at the Charité, University Medicine Berlin, Germany.
| | | | | |
Collapse
|
20
|
Abstract
Increasing numbers of patients are using complementary medicine for the treatment of depression, which complicates management. What is the evidence in support of one medication over another? What medications are safe to use in children and pregnant women? Is there any evidence supporting over-the-counter supplements? These are just a few of the questions that primary care physicians face on a daily basis. This article attempts to answer these questions and many others in an evidence-based approach to the management of depression, which focuses on diagnosis, medical management, and complementary treatments.
Collapse
Affiliation(s)
- Douglas Maurer
- Madigan Army Medical Center, Building 9040, Fitzsimmons Drive, Tacoma, WA 98431, USA.
| | | |
Collapse
|
21
|
Shearer S, Gordon L. The patient with excessive worry. S Afr Fam Pract (2004) 2006. [DOI: 10.1080/20786204.2006.10873462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
22
|
Rief W, Martin A, Rauh E, Zech T, Bender A. Evaluation of general practitioners' training: how to manage patients with unexplained physical symptoms. PSYCHOSOMATICS 2006; 47:304-11. [PMID: 16844888 DOI: 10.1176/appi.psy.47.4.304] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with unexplained physical symptoms ("somatoform disorders") tend to overuse the healthcare system. Therefore, the authors aimed to assess whether a training session for general practitioners (GPs) on managing patients with unexplained physical symptoms would be acceptable to GPs and lead to improvements in patient care. In a randomized clinical trial (GPs randomized), GPs got a 1-day training session and additional materials. Included were 26 GP offices in primary care and 295 patients with unexplained physical symptoms (minimum of two symptoms required). Outcome measures were healthcare utilization (number of doctor visits) 6 months before and 6 months after the index visit to the GP, somatization severity, depression, and hypochondriacal fears at the index visit to the GP's office and 6 months later. Training GPs to manage these patients led to significant reductions in healthcare utilization; patients of untrained GPs showed comparable attendance rates in the 6 months before and after the index visit. Differences in depression, somatization, and hypochondriacal fears, however, could not be attributed to the GP training. GPs rated the training as being highly relevant for their everyday practices, underlining the need for and acceptance of the training. Training GPs in managing patients with unexplained physical symptoms seems to be helpful for the reduction of excessive healthcare utilization. These 1-day workshops have high acceptability, so this approach could be a good model for empirically-validated continuing-education programs.
Collapse
Affiliation(s)
- Winfried Rief
- Dept. of Clinical Psychology and Psychotherapy, Philipps-Univ. of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany.
| | | | | | | | | |
Collapse
|
23
|
Nollen NL, Mayo MS, Sanderson Cox L, Okuyemi KS, Choi WS, Kaur H, Ahluwalia JS. Predictors of quitting among African American light smokers enrolled in a randomized, placebo-controlled trial. J Gen Intern Med 2006; 21:590-5. [PMID: 16808741 PMCID: PMC1924642 DOI: 10.1111/j.1525-1497.2006.00404.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 11/15/2005] [Accepted: 12/23/2005] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the predictors of quitting among African American (AA) light smokers (<10 cigarettes per day) enrolled in a smoking cessation trial. METHODS Baseline variables were analyzed as potential predictors from a 2 x 2 cessation trial in which participants were randomly assigned to 1 of 4 treatment groups: nicotine gum plus health education (HE) counseling, nicotine gum plus motivational interviewing (MI) counseling, placebo gum plus HE counseling, or placebo gum plus MI counseling. Chi-square tests, 2 sample t-tests, and multiple logistic regression analyses were used to identify predictors of cotinine (COT) verified abstinence at month 6. RESULTS In the final regression model, HE rather than MI counseling (odds ratio [OR]=2.26%, 95% confidence interval [CI]=1.36 to 3.74), older age (OR=1.03%, 95% CI=1.01 to 1.06), and higher body mass index (OR=1.04%, 95% CI=1.01 to 1.07) significantly increased the likelihood of quitting, while female gender (OR=0.46%, 95% CI=0.28 to 0.76),=$1,800/month income (OR=0.60%, 95% CI=0.37 to 0.97), higher baseline COT (OR=0.948%, 95% CI=0.946 to 0.950), and not completing all counseling sessions (OR=0.48%, 95% CI=0.27 to 0.84) reduced the odds of quitting. CONCLUSIONS Individual characteristics may decrease the likelihood of quitting; however, the provision of directive, advice-oriented counseling focused on the addictive nature of nicotine, health consequences of smoking, benefits of quitting, and development of a concrete quit plan may be an important and effective facilitator of quitting among AA light smokers.
Collapse
Affiliation(s)
- Nicole L Nollen
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | | | | | | | | | | | | |
Collapse
|
24
|
Bakker IM, Terluin B, van Marwijk HWJ, Gundy CM, Smit JH, van Mechelen W, Stalman WAB. Effectiveness of a Minimal Intervention for Stress-related mental disorders with Sick leave (MISS); study protocol of a cluster randomised controlled trial in general practice [ISRCTN43779641]. BMC Public Health 2006; 6:124. [PMID: 16674806 PMCID: PMC1475849 DOI: 10.1186/1471-2458-6-124] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Accepted: 05/04/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The main aims of this paper are to describe the setting and design of a Minimal Intervention in general practice for Stress-related mental disorders in patients on Sick leave (MISS), as well as to ascertain the study complies with the requirements for a cluster randomised controlled trial (RCT). The potential adverse consequences of sick leave due to Stress-related Mental Disorders (SMDs) are extensive, but often not recognised. Since most people having SMDs with sick leave consult their general practitioner (GP) at an early stage, a tailored intervention given by GPs is justified. We provide a detailed description of the MISS; that is more accurate assessment, education, advice and monitoring to treat SMDs in patients on sick leave. Our hypothesis is that the MISS will be more effective compared to the usual care, in reducing days of sick leave of these patients. METHODS The design is a pragmatic RCT. Randomisation is at the level of GPs. They received the MISS-training versus no training, in order to compare the MISS vs. usual care at patient level. Enrollment of patients took place after screening in the source population, that comprised 20-60 year old primary care attendees. Inclusion criteria were: moderately elevated distress levels, having a paid job and sick leave for no longer than three months. There is a one year follow up. The primary outcome measure is lasting full return to work. Reduction of SMD- symptoms is one of the secondary outcome measures. Forty-six GPs and 433 patients agreed to participate. DISCUSSION In our study design, attention is given to the practical application of the requirements for a pragmatic trial. The results of this cluster RCT will add to the evidence about treatment options in general practice for SMDs in patients on sick leave, and might contribute to a new and appropriate guideline. These results will be available at the end of 2006.
Collapse
Affiliation(s)
- Ingrid M Bakker
- EMGO Institute, VU University Medical Centre Amsterdam, The Netherlands
- Department of General Practice, VU University Medical Centre Amsterdam, The Netherlands
| | - Berend Terluin
- EMGO Institute, VU University Medical Centre Amsterdam, The Netherlands
- Department of General Practice, VU University Medical Centre Amsterdam, The Netherlands
| | - Harm WJ van Marwijk
- EMGO Institute, VU University Medical Centre Amsterdam, The Netherlands
- Department of General Practice, VU University Medical Centre Amsterdam, The Netherlands
| | - Chad M Gundy
- Clinical Epidemiology and Bio statistics, VU University Medical Centre Amsterdam, The Netherlands
| | - Johannes H Smit
- EMGO Institute, VU University Medical Centre Amsterdam, The Netherlands
- Department of Psychiatry, VU University Medical Centre Amsterdam, The Netherlands
| | - Willem van Mechelen
- EMGO Institute, VU University Medical Centre Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Centre Amsterdam, The Netherlands
| | - Wim AB Stalman
- EMGO Institute, VU University Medical Centre Amsterdam, The Netherlands
- Department of General Practice, VU University Medical Centre Amsterdam, The Netherlands
| |
Collapse
|
25
|
Abstract
Getting back to work is important for most patients but doctors are often unsure how best to help. The article reviews evidence for the effectiveness of the interventions now available.
Collapse
Affiliation(s)
- Jos H Verbeek
- Academic Medical Center Universiteit van Amsterdam, Amsterdam, Netherlands.
| |
Collapse
|