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Pfammatter AF, Champion KE, Finch LE, Siddique J, Hedeker D, Spring B. A mHealth intervention to preserve and promote ideal cardiovascular health in college students: Design and protocol of a cluster randomized controlled trial. Contemp Clin Trials 2020; 98:106162. [PMID: 33038506 PMCID: PMC7686283 DOI: 10.1016/j.cct.2020.106162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/26/2020] [Accepted: 09/27/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of death globally. Seven health factors are associated with ideal cardiovascular health: being a non-smoker; not overweight; physically active; having a healthy diet; and normal blood pressure; fasting plasma glucose and cholesterol. Whereas approximately half of U.S. youth have ideal levels in at least 5 of the 7 components of cardiovascular health, this proportion falls to 16% by adulthood. OBJECTIVE We will evaluate whether the NUYou cardiovascular mHealth intervention is more effective than an active comparator to promote cardiovascular health during the transition to young adulthood. METHODS 302 incoming freshmen at a midwest university will be cluster randomized by dormitory into one of two mHealth intervention groups: 1) Cardiovascular Health (CVH), addressing behaviors related to CVD risk; or 2) Whole Health (WH), addressing behaviors unrelated to CVD. Both groups will receive smartphone applications, co-designed with students to help them manage time, interact with other participants via social media, and report health behaviors weekly. The CVH group will also have self-monitoring features to track their risk behaviors. Cardiovascular health will be assessed at the beginning of freshman year and the end of freshman and sophomore years. Linear mixed models will be used to compare groups on a composite of the seven cardiovascular-related health factors. SIGNIFICANCE This is the first entirely technology-mediated multiple health behavior change intervention delivered to college students to promote cardiovascular health. Findings will inform the potential for primordial prevention in young adulthood. TRIAL REGISTRATION NUMBER clinicaltrials.gov #NCT02496728.
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Affiliation(s)
- Angela F Pfammatter
- Northwestern University Feinberg School of Medicine, United States of America.
| | | | - Laura E Finch
- NORC at the University of Chicago, United States of America.
| | - Juned Siddique
- Northwestern University Feinberg School of Medicine, United States of America.
| | | | - Bonnie Spring
- Northwestern University Feinberg School of Medicine, United States of America.
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McElroy JA, Day TM, Becevic M. The Influence of Telehealth for Better Health Across Communities. Prev Chronic Dis 2020; 17:E64. [PMID: 32678060 PMCID: PMC7380287 DOI: 10.5888/pcd17.200254] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Rapid spread of coronavirus disease 2019 (COVID-19) forced an abrupt shift in the traditional US health care delivery model to meet the needs of patients, staff, and communities. Through federal policy changes on telehealth, patient care shifted from in-person to telephone or video visits, and health care providers reached out to patients most at risk for exacerbation of chronic disease symptoms. ECHO (Extension for Community Healthcare Outcomes), a videoconferencing peer learning application, engaged health care providers across Missouri in the treatment and management of complex COVID-19-positive patients. Re-envisioning health care in the digital age includes robust utilization of telehealth to enhance care for all.
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Affiliation(s)
- Jane A McElroy
- Family and Community Medicine Department, University of Missouri, Columbia, Missouri.,Family and Community Medicine Department, DC032.00, University of Missouri, 1 Hospital Dr, MA306 Medical Science Bldg, Columbia MO 65212.
| | - Tamara M Day
- University of Missouri Health Care, University of Missouri, Columbia, Missouri
| | - Mirna Becevic
- Department of Dermatology, University of Missouri, Columbia, Missouri
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Rondinelli JL, Omery AK, Crawford CL, Johnson JA. Self-reported activities and outcomes of ambulatory care staff registered nurses: an exploration. Perm J 2014; 18:e108-15. [PMID: 24626081 DOI: 10.7812/tpp/13-135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Ambulatory care is a growing field of nursing practice. As ambulatory registered nurse (RN) practice grows, there has been an ongoing effort to identify the desired role of the staff RN in outpatient care and to provide linkages to preferred outcomes. OBJECTIVE This study sought to describe the perceived impact of components of the staff RN role on specific activities and outcomes, as guided by the structures, processes, and outcomes of the Nursing Role Effectiveness Model. DESIGN This exploratory research study used a descriptive, self-report survey design. RESULTS Survey respondents were ambulatory care staff RNs from various primary and specialty care clinics (n = 187) in an integrated health care organization in Southern California. The most frequently reported activities included patient assessment, nurse advice during message management, and completion of patient triage. Reported patient outcomes most frequently affected by RN activities were patient satisfaction, normalization of laboratory values, receiving the correct level of medical treatment, and prevention of complications. Respondents expressed that "emergency situations" periodically occur in the ambulatory setting. CONCLUSIONS This research study supports what ambulatory care RNs say they are doing: daily, diverse, and complex patient care activities that influence multiple relevant patient outcomes. Future research studies could reveal best practices related to message management, in addition to activities and outcomes unique to specialty care populations.
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Affiliation(s)
- June L Rondinelli
- Project Manager for Patient Care Services in the Regional Nursing Research Program for Kaiser Permanente Southern California in Pasadena.
| | - Anna K Omery
- Senior Director for Clinical Practice for Patient Care Services for Kaiser Permanente Southern California in Pasadena.
| | - Cecelia L Crawford
- Project Manager in Patient Care Services in the Regional Nursing Research Program for Kaiser Permanente Southern California in Pasadena.
| | - Joyce A Johnson
- Director of Regional Nursing Education and Research for the Southern California Permanente Medical Group in Pasadena.
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Halcomb EJ, Salamonson Y, Davidson PM, Kaur R, Young SAM. The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on. BMC FAMILY PRACTICE 2014; 15:52. [PMID: 24666420 PMCID: PMC3987204 DOI: 10.1186/1471-2296-15-52] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/19/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nursing in Australian general practice has grown rapidly over the last decade in response to government initiatives to strengthen primary care. There are limited data about how this expansion has impacted on the nursing role, scope of practice and workforce characteristics. This study aimed to describe the current demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time. METHODS In the nascence of the expansion of the role of nurses in Australian general practice (2003-2004) a national survey was undertaken to describe nurse demographics, clinical roles and competencies. This survey was repeated in 2009-2010 and comparative analysis of the datasets undertaken to explore workforce changes over time. RESULTS Two hundred eighty four nurses employed in general practice completed the first survey (2003/04) and 235 completed the second survey (2009/10). Significantly more participants in Study 2 were undertaking follow-up of pathology results, physical assessment and disease specific health education. There was also a statistically significant increase in the participants who felt that further education/training would augment their confidence in all clinical tasks (p < 0.001). Whilst the impact of legal implications as a barrier to the nurses' role in general practice decreased between the two time points, more participants perceived lack of space, job descriptions, confidence to negotiate with general practitioners and personal desire to enhance their role as barriers. Access to education and training as a facilitator to nursing role expansion increased between the two studies. The level of optimism of participants for the future of the nurses' role in general practice was slightly decreased over time. CONCLUSIONS This study has identified that some of the structural barriers to nursing in Australian general practice have been addressed over time. However, it also identifies continuing barriers that impact practice nurse role development. Understanding and addressing these issues is vital to optimise the effectiveness of the primary care nursing workforce.
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Affiliation(s)
| | - Yenna Salamonson
- School of Nursing & Midwifery, University of Western Sydney, Sydney, Australia
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Lau R, Cross W, Moss C, Campbell A, De Castro M, Oxley V. Leadership and management skills of general practice nurses: Experience or education? Int J Nurs Pract 2013; 20:655-61. [DOI: 10.1111/ijn.12228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Rosalind Lau
- School of Nursing and MidwiferyMonash University, Clayton Campus Clayton Victoria Australia
| | - Wendy Cross
- School of Nursing and MidwiferyMonash University Melbourne Victoria Australia
| | - Cheryle Moss
- School of Nursing and MidwiferyMonash University Melbourne Victoria Australia
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Sargent GM, Forrest LE, Parker RM. Nurse delivered lifestyle interventions in primary health care to treat chronic disease risk factors associated with obesity: a systematic review. Obes Rev 2012; 13:1148-71. [PMID: 22973970 PMCID: PMC3533768 DOI: 10.1111/j.1467-789x.2012.01029.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 07/30/2012] [Indexed: 11/29/2022]
Abstract
Nurses in primary health care (PHC) provide an increasing proportion of chronic disease management and preventive lifestyle advice. The databases MEDLINE, CINAHL, EMBASE and PsychINFO were searched and the articles were systematically reviewed for articles describing controlled adult lifestyle intervention studies delivered by a PHC nurse, in a PHC setting. Thirty-one articles describing 28 studies were analysed by comparison group which revealed: (i) no difference of effect when the same intervention was delivered by a PHC nurse compared to other health professionals in PHC (n = 2); (ii) the provision of counselling delivered by a PHC nurse was more effective than health screening (n = 10); (iii) counselling based on behaviour change theory was more effective than the same dose of non-behavioural counselling when at least three counselling sessions were delivered (n = 3). The evidence supports the effectiveness of lifestyle interventions delivered by nurses in PHC to affect positive changes on outcomes associated with the prevention of chronic disease including: weight, blood pressure, cholesterol, dietary and physical activity behaviours, patient satisfaction, readiness for change and quality of life. The strength of recommendations is limited by the small number of studies within each comparison group and the high risk of bias of the majority of studies.
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Affiliation(s)
- G M Sargent
- The Australian Primary Health Care Research Institute (APHCRI), The Australian National University (ANU), Australian Capital Territory, Canberra, Australia.
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Greaves CJ, Sheppard KE, Abraham C, Hardeman W, Roden M, Evans PH, Schwarz P. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health 2011; 11:119. [PMID: 21333011 PMCID: PMC3048531 DOI: 10.1186/1471-2458-11-119] [Citation(s) in RCA: 723] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 02/18/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To develop more efficient programmes for promoting dietary and/or physical activity change (in order to prevent type 2 diabetes) it is critical to ensure that the intervention components and characteristics most strongly associated with effectiveness are included. The aim of this systematic review of reviews was to identify intervention components that are associated with increased change in diet and/or physical activity in individuals at risk of type 2 diabetes. METHODS MEDLINE, EMBASE, CINAHL, PsycInfo, and the Cochrane Library were searched for systematic reviews of interventions targeting diet and/or physical activity in adults at risk of developing type 2 diabetes from 1998 to 2008. Two reviewers independently selected reviews and rated methodological quality. Individual analyses from reviews relating effectiveness to intervention components were extracted, graded for evidence quality and summarised. RESULTS Of 3856 identified articles, 30 met the inclusion criteria and 129 analyses related intervention components to effectiveness. These included causal analyses (based on randomisation of participants to different intervention conditions) and associative analyses (e.g. meta-regression). Overall, interventions produced clinically meaningful weight loss (3-5 kg at 12 months; 2-3 kg at 36 months) and increased physical activity (30-60 mins/week of moderate activity at 12-18 months). Based on causal analyses, intervention effectiveness was increased by engaging social support, targeting both diet and physical activity, and using well-defined/established behaviour change techniques. Increased effectiveness was also associated with increased contact frequency and using a specific cluster of "self-regulatory" behaviour change techniques (e.g. goal-setting, self-monitoring). No clear relationships were found between effectiveness and intervention setting, delivery mode, study population or delivery provider. Evidence on long-term effectiveness suggested the need for greater consideration of behaviour maintenance strategies. CONCLUSIONS This comprehensive review of reviews identifies specific components which are associated with increased effectiveness in interventions to promote change in diet and/or physical activity. To maximise the efficiency of programmes for diabetes prevention, practitioners and commissioning organisations should consider including these components.
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Affiliation(s)
- Colin J Greaves
- University of Exeter, Peninsula Medical School, Smeall Building, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, UK
| | - Kate E Sheppard
- University of Exeter, Peninsula Medical School, Smeall Building, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, UK
| | - Charles Abraham
- University of Sussex, School of Psychology, Pevensey Building, Falmer BN1 9QG, UK
| | - Wendy Hardeman
- University of Cambridge, General Practice and Primary Care Research Unit, 16 Colwyn Close, Cambridge CB4 3NU, UK
| | - Michael Roden
- Heinrich-Heine University, Institute for Clinical Diabetology, German Diabetes Centre and Department of Metabolic Diseases, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany
| | - Philip H Evans
- University of Plymouth, Peninsula Medical School, Smeall Building, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, UK
| | - Peter Schwarz
- Technical University of Dresden (Carl Gustav Carus Medical Faculty), Medizinische Klinik III, Fetscherstraße 74, Dresden D-01307, Germany
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Cossette S, Frasure-Smith N, Robert M, Chouinard MC, Juneau M, Guertin MC, Cournoyer A, Mailhot T. Évaluation préliminaire d'une intervention infirmière de soutien à la cessation tabagique chez des patients hospitalisés pour un problème cardiaque : étude pilote (So-Live). Rech Soins Infirm 2011. [DOI: 10.3917/rsi.105.0060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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ZWAR NICHOLASA, RICHMOND ROBYNL, FORLONGE GAIL, HASAN IQBAL. Feasibility and effectiveness of nurse-delivered smoking cessation counselling combined with nicotine replacement in Australian general practice. Drug Alcohol Rev 2010; 30:583-8. [DOI: 10.1111/j.1465-3362.2010.00243.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zwar N, Richmond R, Halcomb E, Furler J, Smith J, Hermiz O, Blackberry I, Borland R. Quit in general practice: a cluster randomised trial of enhanced in-practice support for smoking cessation. BMC FAMILY PRACTICE 2010; 11:59. [PMID: 20701812 PMCID: PMC2931485 DOI: 10.1186/1471-2296-11-59] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 08/12/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study will test the uptake and effectiveness of a flexible package of smoking cessation support provided primarily by the practice nurse (PN) and tailored to meet the needs of a diversity of patients. METHODS/DESIGN This study is a cluster randomised trial, with practices allocated to one of three groups 1) Quit with Practice Nurse 2) Quitline referral 3) GP usual care. PNs from practices randomised to the intervention group will receive a training course in smoking cessation followed by access to mentoring. GPs from practices randomised to the Quitline referral group will receive information about the study and the process of written referral and GPs in the usual care group will receive information about the study. Eligible patients are those aged 18 and over presenting to their GP who are daily or weekly smokers and who are able to give informed consent. Patients on low incomes in all three groups will be able to access free nicotine patches.Primary outcomes are sustained abstinence and point prevalence abstinence at the three month and 12 month follow-up points; and incremental cost effectiveness ratios at 12 months. Process evaluation on the reach and acceptability of the intervention approached will be collected through Computer Assisted Telephone Interviews (CATI) with patients and semi-structured interviews with PNs and GPs.The primary analysis will be by intention to treat. Cessation outcomes will be compared between the three arms at three months and 12 month follow-up using multiple logistic regression. The incremental cost effectiveness ratios will be estimated for the 12 month quit rate for the intervention groups compared to usual care and to each other. Analysis of qualitative data on process outcomes will be based on thematic analysis. DISCUSSION High quality evidence on effectiveness of practice nurse interventions is needed to inform health policy on development of practice nurse roles. If effective, flexible support from the PN in partnership with the GP and the Quitline could become the preferred model for providing smoking cessation advice in Australian general practice. TRIAL REGISTRATION ACTRN12609001040257.
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Affiliation(s)
- Nicholas Zwar
- School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2052 Australia
| | - Robyn Richmond
- School of Public Health and Community Medicine, University of New South Wales, Sydney NSW 2052 Australia
| | - Elizabeth Halcomb
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith South DC Sydney NSW 1797, Australia
| | - John Furler
- Primary Care Research Unit, Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, Melbourne Victoria 3053, Australia
| | - Julie Smith
- Australian Centre for Economic Research on Health, Australian National University Canberra, ACT 0200, Australia
| | - Oshana Hermiz
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia
| | - Irene Blackberry
- Primary Care Research Unit, Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, Melbourne Victoria 3053, Australia
| | - Ron Borland
- Cancer Council Victoria 1 Rathdowne St, Carlton, Melbourne Vic, 3053, Australia
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Halcomb EJ, Davidson PM, Brown N. Uptake of Medicare chronic disease items in Australia by general practice nurses and Aboriginal health workers. Collegian 2010; 17:57-61. [DOI: 10.1016/j.colegn.2010.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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