1
|
Scharer JL, Gass JC, Shepardson RL, Maisto SA, Funderburk JS. Factors Influencing Patient Receptivity to Brief Alcohol Interventions in Primary Care: An Application of Conjoint Analysis. Subst Use Misuse 2023; 59:90-96. [PMID: 37791686 DOI: 10.1080/10826084.2023.2262008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background: Brief alcohol interventions (BAIs) are an evidence-based practice for addressing hazardous alcohol use in primary care settings. However, numerous barriers to implementation of BAIs in routine practice have been identified, including concerns about patient receptivity to BAIs. Despite this being a commonly identified barrier to BAI implementation, little BAI implementation research has focused on patient receptivity. Objectives: This study aimed to identify the treatment preferences of primary care patients who screened positive for hazardous alcohol use and to evaluate factors that may influence patients' receptivity to BAIs delivered in primary care. We conducted a mailed survey of primary care patients (N = 245) who screened positive for hazardous alcohol use on annual screening measures based on electronic medical record data. Patients completed measures assessing treatment preferences and a conjoint analysis questionnaire designed to evaluate the relative importance of three factors (focus of the BAI, tailoring of the BAI, and familiarity with the provider delivering the BAI) for patient receptivity. Results: Conjoint analysis results revealed that familiarity with provider (with patients preferring BAIs delivered by providers they have previously met) was the most important factor in predicting patients' receptivity to BAIs. Additionally, patients preferred to discuss alcohol use in the context of another concern (focus of the BAI) and preferred personalized information tailored based on their specific health concerns (tailoring of the BAI), although these factors were not statistically significant when accounting for familiarity with provider. Conclusions: Findings of the present study have potential to inform future research on implementation of BAIs.
Collapse
Affiliation(s)
- Jacob L Scharer
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
| | - Julie C Gass
- VA Center for Integrated Healthcare, VA Western New York Healthcare System (116N), Buffalo, New York, USA
- Department of Psychology, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Robyn L Shepardson
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Stephen A Maisto
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Jennifer S Funderburk
- Veterans Affairs Center for Integrated Healthcare, Syracuse VA Medical Center (116C), Syracuse, New York, USA
- Department of Psychology, Syracuse University, Syracuse, New York, USA
- Department of Psychiatry, University of Rochester, Rochester, New York, USA
| |
Collapse
|
2
|
Shepardson RL, Fletcher TL, Funderburk JS, Weisberg RB, Beehler GP, Maisto SA. Barriers to and facilitators of using evidence-based, cognitive-behavioral anxiety interventions in integrated primary care practice. Psychol Serv 2023; 20:709-722. [PMID: 35951391 PMCID: PMC10166237 DOI: 10.1037/ser0000696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cognitive-behavioral treatment for anxiety disorders and symptoms remains underutilized in integrated primary care (IPC), in part because the many treatments developed for specialty care are not readily translated to this unique setting. The objective of this study was to identify barriers and facilitators to behavioral health providers (BHPs) delivering evidence-based cognitive--behavioral anxiety interventions within IPC practice. We conducted semistructured interviews with a national sample of 18 BHPs (50% psychologists, 33% social workers, 17% registered nurses) working in IPC in the Veterans Health Administration. We assessed barriers to and facilitators of using psychoeducation, exposure, cognitive therapy, relaxation training, mindfulness/meditation, Acceptance and Commitment Therapy-based interventions, and problem-solving therapy. Qualitative coding and conventional content analysis revealed barriers and facilitators at three levels: IPC, provider, and patient. Themes suggested key barriers of poor fit with the IPC model, BHP training deficits, and lack of patient buy-in, and key facilitators of good perceived fit of the intervention (e.g., scope, duration) with the IPC model, BHPs feeling well equipped, and utility for patients. BHPs select interventions based on fit for the individual patient. Some results were consistent with prior work from specialty care, but the IPC model itself introduces significant implementation challenges. BHPs would benefit from flexible intervention options and training on IPC treatment goals and how to deliver the essence of evidence-based interventions in small doses. Our findings will help to inform adaptation of behavioral anxiety interventions to better fit IPC practice and development of beneficial training and resources for BHPs to reduce implementation challenges. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Robyn L. Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
| | - Terri L. Fletcher
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
- VA South Central Mental Illness Research, Education, and Clinical Center
| | - Jennifer S. Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
- Department of Psychiatry, University of Rochester
| | - Risa B. Weisberg
- VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
- Department of Family Medicine, Alpert Medical School, Brown University
| | - Gregory P. Beehler
- Center for Integrated Healthcare, VA Western New York Healthcare System
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Stephen A. Maisto
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
| |
Collapse
|
3
|
Spear SE, Garrow W, Fleischer FS, Mangat J, Risberg M. Development of a Health Behavior Screening Tool for Deaf College Students. JOURNAL OF DEAF STUDIES AND DEAF EDUCATION 2022; 27:434-442. [PMID: 35989623 DOI: 10.1093/deafed/enac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/13/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
Young adults who are Deaf or Hard-of-Hearing (D/HH) face behavioral health risks similar to hearing adults. Despite the emphasis on health behavior screening in health care settings, a brief screening tool in American Sign Language (ASL) does not exist. This manuscript describes the development and pilot testing of an online survey in ASL called the Deaf Health Behavior Report. The Deaf Health Behavior Report includes standardized questions for general health, health behaviors, and psychosocial topics. We invited all D/HH students at a university in Southern California to complete the Deaf Health Behavior Report. A total of 31 D/HH students completed the survey. The most prevalent health risks were related to nutrition, stress, and binge drinking. The Deaf Health Behavior Report is a useful tool for health promotion efforts on college campuses and in general health settings.
Collapse
Affiliation(s)
- Suzanne E Spear
- Health Sciences Department, California State University, Northridge, CA, USA
| | - William Garrow
- Department of Deaf Studies, California State University, Northridge, CA, USA
| | - Flavia S Fleischer
- Department of Deaf Studies, California State University, Northridge, CA, USA
| | | | - Mia Risberg
- Health Sciences Department, California State University, Northridge, CA, USA
| |
Collapse
|
4
|
Exploring the Relationship Between Community Program Location and Community Needs. J Am Board Fam Med 2022; 35:55-72. [PMID: 35039412 PMCID: PMC8902434 DOI: 10.3122/jabfm.2022.01.210310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/26/2021] [Accepted: 09/09/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Health behaviors, mental health, and social needs impact health, but addressing these needs is difficult. Clinicians can partner with community programs to provide patients support. The relationship between program location and community need is uncertain. METHODS We identified and geolocated community programs in Richmond, Virginia, that aid with 9 domains of needs (mental health, smoking, unhealthy alcohol use, nutrition, physical activity, transportation, financial, housing, food insecurity). For each census tract, we identified needs from public data sources. We used 2 methods to compare program location and need: (1) hotspot analysis and (2) a negative binomial regression model. RESULTS We identified 280 community programs that provide aid for the 9 domains. Programs most often provided financial assistance (n = 121) and housing support (n = 73). The regression analysis showed no relationship between the number of community programs and the level of need in census tracts, with 2 exceptions. There was a positive association between financial programs and financial need and a negative association between housing programs and housing need. CONCLUSIONS Community programs are generally not colocated with need. This poses a barrier for people who need help addressing these domains.
Collapse
|
5
|
Porter G, Michaud TL, Schwab RJ, Hill JL, Estabrooks PA. Reach Outcomes and Costs of Different Physician Referral Strategies for a Weight Management Program Among Rural Primary Care Patients: Type 3 Hybrid Effectiveness-Implementation Trial. JMIR Form Res 2021; 5:e28622. [PMID: 34668873 PMCID: PMC8567148 DOI: 10.2196/28622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rural residents are at high risk for obesity; however, little resources exist to address this disproportional burden of disease. Primary care may provide an opportunity to connect primary care patients with overweight and obesity to effective weight management programming. OBJECTIVE The purpose of this study is to examine the utility of different physician referral and engagement processes for improving the reach of an evidence-based and technology-delivered weight management program with counseling support for rural primary care patients. METHODS A total of 5 rural primary care physicians were randomly assigned a sequence of four referral strategies: point-of-care (POC) referral with active telephone follow-up (ATF); POC referral, no ATF; a population health registry-derived letter referral with ATF; and letter referral, no ATF. For registry-derived referrals, physicians screened a list of patients with BMI ≥25 and approved patients for participation to receive a personalized referral letter via mail. RESULTS Out of a potential 991 referrals, 573 (57.8%) referrals were made over 16 weeks, and 98 (9.9%) patients were enrolled in the program (58/98, 59.2% female). Differences based on letter (485/991, 48.9%) versus POC (506/991, 51.1%) referrals were identified for completion (100% vs 7%; P<.001) and for proportion screened (36% vs 12%; P<.001) but not for proportion enrolled (12% vs 8%; P=.10). Patients receiving ATF were more likely to be screened (47% vs 7%; P<.001) and enrolled (15% vs 7%; P<.001) than those not receiving ATF. On the basis of the number of referrals made in each condition, we found variations in the proportion and number of enrollees (POC with ATF: 27/190, 50%; POC no ATF: 14/316, 41%; letter ATF: 30/199; 15.1%; letter no ATF: 27/286, 9.4%). Across all conditions, participants were representative of the racial and ethnic characteristics of the region (60% female, P=.15; 94% White individuals, P=.60; 94% non-Hispanic, P=.19). Recruitment costs totaled US $6192, and the overall recruitment cost per enrolled participant was US $63. Cost per enrolled participant ranged from POC with ATF (US $47), registry-derived letter without ATF (US $52), and POC without ATF (US $56) to registry-derived letter with ATF (US $91). CONCLUSIONS Letter referral with ATF appears to be the best option for enrolling a large number of patients in a digitally delivered weight management program; however, POC with ATF and letters without ATF yielded similar numbers at a lower cost. The best referral option is likely dependent on the best fit with clinical resources. TRIAL REGISTRATION ClinicalTrials.gov NCT03690557; http://clinicaltrials.gov/ct2/show/NCT03690557.
Collapse
Affiliation(s)
- Gwenndolyn Porter
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States
| | - Tzeyu L Michaud
- Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, NE, United States
| | - Robert J Schwab
- University of Nebraska Medical Center, Omaha, NE, United States
| | - Jennie L Hill
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States
| |
Collapse
|
6
|
Wilson KE, Estabrooks PA. Does environmental message framing impact proportional reach and sample representativeness related to motivational characteristics? Transl Behav Med 2021; 12:585-594. [PMID: 34662412 DOI: 10.1093/tbm/ibab124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Physical activity (PA) promotion messages are commonly used to engage target populations in PA programs. However, little is known about how recruitment messages impact program reach. Evidence suggests that framing messages to be congruent with individuals' motivational orientation can maximize effectiveness. This congruency effect has not been tested in the context of brief PA promotion messages used in a recruitment environment. It is plausible that framed messages attract certain individuals, while deterring others. The purpose of this study was to determine whether message framing influences representativeness of a sample recruited for a PA program with regards to motivational factors. Three messaging conditions (gain-framed, neutral, loss-framed) were counterbalanced across days of data collection in a primary care waiting room. Patients were asked to complete a questionnaire including surveys on personality and PA, and basic demographic questions. Respondents were offered the chance to participate in a low-burden PA program. Interested respondents were instructed to provide contact information. The proportion and representativeness, with respect to motivational orientation, of individuals volunteering for program participation was assessed using chi-squared tests, and two-way (condition × group) ANOVAs, respectively. After controlling for demographic and behavioral covariates, there was no effect of message framing on the motivational orientation of the resultant samples. Results did not support a congruency effect of a covert message-framing manipulation. More work should aim to understand how recruitment materials and strategies influence motivational characteristics of the resulting sample to maximize intervention outcomes, and target individuals who are more likely to engage in risky health behaviors.
Collapse
Affiliation(s)
- Kathryn E Wilson
- Department of Kinesiology and Health, College of Education and Human Development, Georgia State University, Atlanta, GA, USA.,Center for the Study of Stress, Trauma, and Resilience, College of Education and Human Development, Georgia State University, Atlanta, GA, USA
| | - Paul A Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
7
|
Porter GC, Schwab R, Hill JL, Bartee T, Heelan KA, Michaud TL, Estabrooks PA. Examining the feasibility and characteristics of realistic weight management support for patients: Focus groups with rural, micropolitan, and metropolitan primary care providers. Prev Med Rep 2021; 23:101390. [PMID: 34026468 PMCID: PMC8134728 DOI: 10.1016/j.pmedr.2021.101390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
The purpose of this investigation was to understand perspectives of physicians, nurses, and staff regarding the feasibility of implementing an evidence-based weight management program to support primary care practice. An exploratory aim was to examine differences in responses based on the clinic location. Ten focus groups were conducted with primary care staff from rural, micropolitan, and metropolitan clinics. The Promoting Action on Research in Health Services (PARIHS) framework was used to inform the interview guide. Transcripts were reviewed to identify common themes among PARIHS constructs (evidence, context, and facilitation). Presence of comorbidities (e.g., diabetes, hypertension) were typical prompts for provider-led discussions about patient weight. Metropolitan clinics reported the availability of health coaching, diabetes education, or dietician consultation, but no clinic reported offering a comprehensive weight management program. Participants agreed it is possible to implement a weight management program through primary care, but cited potential facilitation challenges such as costs, clinic resources, and individual patient barriers. More enthusiasm arose for a referral program with patient tracking. Program characteristics such as proven efficacy, individual tailoring, program accessibility, and patient feedback to the providers were desired. Rural focus group participants reported unique barriers (lack of local resources) and facilitators (more flexibility in practice changes) to weight management when compared to metropolitan and micropolitan focus groups. Primary care staff are interested in weight management solutions for their patients and would prefer an evidence-based program to which they could refer patients, receive feedback on patient progress, and sustainably include as part of their regular services.
Collapse
Affiliation(s)
- Gwenndolyn C. Porter
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
- Corresponding author.
| | - Robert Schwab
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
| | - Jennie L. Hill
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
| | - Todd Bartee
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, United States
| | - Kate A. Heelan
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, United States
| | - Tzeyu L. Michaud
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, United States
| | - Paul A. Estabrooks
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
| |
Collapse
|
8
|
Krist AH, O'Loughlin K, Woolf SH, Sabo RT, Hinesley J, Kuzel AJ, Rybarczyk BD, Kashiri PL, Brooks EM, Glasgow RE, Huebschmann AG, Liaw WR. Enhanced care planning and clinical-community linkages versus usual care to address basic needs of patients with multiple chronic conditions: a clinician-level randomized controlled trial. Trials 2020; 21:517. [PMID: 32527322 PMCID: PMC7291479 DOI: 10.1186/s13063-020-04463-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 05/27/2020] [Indexed: 11/12/2022] Open
Abstract
Background Many patients with poorly controlled multiple chronic conditions (MCC) also have unhealthy behaviors, mental health challenges, and unmet social needs. Medical management of MCC may have limited benefit if patients are struggling to address their basic life needs. Health systems and communities increasingly recognize the need to address these issues and are experimenting with and investing in new models for connecting patients with needed services. Yet primary care clinicians, whose regular contact with patients makes them more familiar with patients’ needs, are often not included in these systems. Methods We are starting a clinician-level cluster-randomized controlled trial to evaluate how primary care clinicians can participate in these community and hospital solutions and whether doing so is effective in controlling MCC. Sixty clinicians in the Virginia Ambulatory Care Outcomes Research Network will be matched by age and sex and randomized to usual care (control condition) or enhanced care planning with clinical-community linkage support (intervention). From the electronic health record we will identify all patients with MCC, including cardiovascular disease or risks, diabetes, obesity, or depression. A baseline assessment will be mailed to up to 50 randomly selected patients for each clinician (3000 total). Ten respondents per clinician (600 patients total) with uncontrolled MCC will be randomly selected for study inclusion, with oversampling of minorities. The intervention includes two components. First, we will use an enhanced care planning tool, My Own Health Report (MOHR), to screen patients for health behavior, mental health, and social needs. Patients will be supported by a patient navigator, who will help patients prioritize needs, create care plans, and write a personal narrative to guide the care team. Patients will update care plans every 1 to 2 weeks. Second, we will create community-clinical linkage to help address patients’ needs. The linkage will include community resource registries, personnel to span settings (patient navigators and a community health worker), and care team coordination across team members through MOHR. Discussion This study will help inform efforts by primary care clinicians to help address unhealthy behaviors, mental health needs, and social risks as a strategy to better control MCC. Trial registration ClinicalTrials.gov: NCT03885401. Registered on 19 September 2019.
Collapse
Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA.
| | - Kristen O'Loughlin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Steven H Woolf
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA.,Center on Society and Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Roy T Sabo
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA.,Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer Hinesley
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA
| | - Anton J Kuzel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA
| | - Bruce D Rybarczyk
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Paulette Lail Kashiri
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA
| | - E Marshall Brooks
- Department of Family Medicine and Population Health, Virginia Commonwealth University, One Capital Square Room 631, 830 East Main St, Richmond, VA, 23219, USA
| | - Russel E Glasgow
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy G Huebschmann
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Winston R Liaw
- Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston, TX, USA
| |
Collapse
|
9
|
Skovlund SE, Lichtenberg TH, Hessler D, Ejskjaer N. Can the Routine Use of Patient-Reported Outcome Measures Improve the Delivery of Person-Centered Diabetes Care? A Review of Recent Developments and a Case Study. Curr Diab Rep 2019; 19:84. [PMID: 31420754 DOI: 10.1007/s11892-019-1190-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW In recent years, the recommendation for and use of patient-reported outcome measures (PROMs) in routine diabetes care has significantly increased. We review recent evidence and highlight key opportunities and challenges related to the active clinical use of PROMs to support person-centered diabetes care and focus areas for future research in the area. RECENT FINDINGS Recent pragmatic studies support that integration of multi-dimensional PROMs for diabetes in clinical care as part of a care improvement strategy can be acceptable for and valued by people with diabetes (PWD) and healthcare professionals (HCPs) and may improve multiple aspects of quality of care, including screening, medical care monitoring and decision support, individualization of self-management support and goal-setting, and broader benefits related to active patient participation and person-centred diabetes care. We identify multiple intervention, individual, and care setting characteristics, which influence acceptability, feasibility, implementation, and effectiveness of PROMs in routine care. Recent clinical PROM studies highlight the value of mixed methods research and systematic involvement of PWD, clinicians, and other stakeholders in the design and implementation of questionnaires for patient input in routine diabetes care. We identified a new significant trend towards participatory development of multi-dimensional PROMs with the aim of IT-enabled integration into routine diabetes care to facilitate multiple components of person-centered diabetes care and better clinical, quality of life, and cost outcomes. While results from large-scale randomized controlled studies are still limited, a growing number of pragmatic implementation studies support that user-centric PROM interventions have the potential to facilitate significant improvements in care for PWD.
Collapse
Affiliation(s)
- Soren E Skovlund
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000, Aalborg, Denmark.
| | | | - D Hessler
- Family & Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - N Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000, Aalborg, Denmark
| |
Collapse
|
10
|
Glenn BA, Hamilton AS, Nonzee NJ, Maxwell AE, Crespi CM, Ryerson AB, Chang LC, Deapen D, Bastani R. Obesity, physical activity, and dietary behaviors in an ethnically-diverse sample of cancer survivors with early onset disease. J Psychosoc Oncol 2018; 36:418-436. [PMID: 29764334 PMCID: PMC6209096 DOI: 10.1080/07347332.2018.1448031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess weight status, physical activity, and dietary behaviors in an ethnically-diverse sample of breast and colorectal cancer survivors with early onset disease (≤ 50 years). METHODS Breast and colorectal cancer survivors, diagnosed between 1999 and 2009 with early-stage cancer diagnosed by 50 years of age, were identified through a population-based cancer registry and surveyed. Descriptive and regression analyses were conducted to characterize the sample and identify correlates of lifestyle behaviors. FINDINGS The majority of participants (n = 156) were female (83%), insured (84%), and racial/ethnic minorities (29% Asian, 24% Latino, 15% African American). Participants' mean age at response was 50 years and mean time since diagnosis was 9 years. Over half of survivors were overweight or obese. Few participants reported engaging in regular physical activity (31%) and adhering to minimum guidelines for fruit and vegetable consumption (32%). A substantial proportion of survivors consumed fast food in the past week (75%) and nearly half (48%) reported daily consumption of sugar-sweetened beverages. Lower income was associated with inadequate fruit and vegetable intake. Fast food and sugar-sweetened beverage consumption was significantly higher among racial/ethnic minority survivors compared to non-Latino whites. CONCLUSIONS High prevalence of overweight and suboptimal adherence to recommended nutrition and physical activity behaviors were observed among cancer survivors with early onset disease. Cancer survivors diagnosed at a young age may benefit from targeted interventions to address overweight and suboptimal nutrition and physical activity.
Collapse
Affiliation(s)
- Beth A Glenn
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Ann S Hamilton
- b Department of Preventive Medicine, Los Angeles County Cancer Surveillance Program and Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Narissa J Nonzee
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Annette E Maxwell
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Catherine M Crespi
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - A Blythe Ryerson
- c Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta , Georgia , USA
| | - L Cindy Chang
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| | - Dennis Deapen
- b Department of Preventive Medicine, Los Angeles County Cancer Surveillance Program and Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Roshan Bastani
- a Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center , University of California , Los Angeles , California , USA
| |
Collapse
|
11
|
Glenn BA, Crespi CM, Rodriguez HP, Nonzee NJ, Phillips SM, Sheinfeld Gorin SN, Johnson SB, Fernandez ME, Estabrooks P, Kessler R, Roby DH, Heurtin-Roberts S, Rohweder CL, Ory MG, Krist AH. Behavioral and mental health risk factor profiles among diverse primary care patients. Prev Med 2018; 111:21-27. [PMID: 29277413 PMCID: PMC5930037 DOI: 10.1016/j.ypmed.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/02/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022]
Abstract
Behavioral and mental health risk factors are prevalent among primary care patients and contribute substantially to premature morbidity and mortality and increased health care utilization and costs. Although prior studies have found most adults screen positive for multiple risk factors, limited research has attempted to identify factors that most commonly co-occur, which may guide future interventions. The purpose of this study was to identify subgroups of primary care patients with co-occurring risk factors and to examine sociodemographic characteristics associated with these subgroups. We assessed 12 behavioral health risk factors in a sample of adults (n=1628) receiving care from nine primary care practices across six U.S. states in 2013. Using latent class analysis, we identified four distinct patient subgroups: a 'Mental Health Risk' class (prevalence=14%; low physical activity, high stress, depressive symptoms, anxiety, and sleepiness), a 'Substance Use Risk' class (29%; highest tobacco, drug, alcohol use), a 'Dietary Risk' class (29%; high BMI, poor diet), and a 'Lower Risk' class (27%). Compared to the Lower Risk class, patients in the Mental Health Risk class were younger and less likely to be Latino/Hispanic, married, college educated, or employed. Patients in the Substance Use class tended to be younger, male, African American, unmarried, and less educated. African Americans were over 7 times more likely to be in the Dietary Risk versus Lower Risk class (OR 7.7, 95% CI 4.0-14.8). Given the heavy burden of behavioral health issues in primary care, efficiently addressing co-occurring risk factors in this setting is critical.
Collapse
Affiliation(s)
- Beth A Glenn
- Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095, USA.
| | - Catherine M Crespi
- Center for Cancer Prevention and Control Research, Department of Biostatistics, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095, USA
| | - Hector P Rodriguez
- Division of Health Policy and Management, University of California, Berkeley School of Public Health, 50 University Hall, Berkeley, CA 94720, USA
| | - Narissa J Nonzee
- Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Chicago, IL 60611, USA
| | - Sherri N Sheinfeld Gorin
- New York Physicians against Cancer (NYPAC), Herbert Irving Comprehensive Cancer Center, New York, NY 10032, USA; Division of Cancer Control and Population Sciences (Leidos Biomedical Research, Inc.), National Cancer Institute, 6130 Executive Plaza, Bethesda, MD 20892, USA
| | - Sallie Beth Johnson
- Department of Health Sciences Administration, Jefferson College of Health Sciences at Carilion Clinic, 101 Elm Avenue, Roanoke, VA 24016, USA; Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA
| | - Maria E Fernandez
- University of Texas Health Science Center at Houston, School of Public Health, 7000 Fannin Street, Houston, TX 77030, USA
| | - Paul Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Rodger Kessler
- Doctor of Behavorial Health Program, College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ 85004, USA
| | - Dylan H Roby
- Department of Health Services Administration, University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD 20742, USA
| | - Suzanne Heurtin-Roberts
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, Rockville, MD 20852, USA
| | - Catherine L Rohweder
- UNC Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, NC 27599, USA
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M Health Sciences Center, College Station, TX 77843, USA
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, PO Box 980251, Richmond, VA 23298, USA
| |
Collapse
|
12
|
Krist AH, Glasgow RE, Heurtin-Roberts S, Sabo RT, Roby DH, Gorin SNS, Balasubramanian BA, Estabrooks PA, Ory MG, Glenn BA, Phillips SM, Kessler R, Johnson SB, Rohweder CL, Fernandez ME. The impact of behavioral and mental health risk assessments on goal setting in primary care. Transl Behav Med 2017; 6:212-9. [PMID: 27356991 DOI: 10.1007/s13142-015-0384-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patient-centered health risk assessments (HRAs) that screen for unhealthy behaviors, prioritize concerns, and provide feedback may improve counseling, goal setting, and health. To evaluate the effectiveness of routinely administering a patient-centered HRA, My Own Health Report, for diet, exercise, smoking, alcohol, drug use, stress, depression, anxiety, and sleep, 18 primary care practices were randomized to ask patients to complete My Own Health Report (MOHR) before an office visit (intervention) or continue usual care (control). Intervention practice patients were more likely than control practice patients to be asked about each of eight risks (range of differences 5.3-15.8 %, p < 0.001), set goals for six risks (range of differences 3.8-16.6 %, p < 0.01), and improve five risks (range of differences 5.4-13.6 %, p < 0.01). Compared to controls, intervention patients felt clinicians cared more for them and showed more interest in their concerns. Patient-centered health risk assessments improve screening and goal setting.Trial RegistrationClinicaltrials.gov identifier: NCT01825746.
Collapse
Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, PO Box 980101, Richmond, VA, 23298, USA.
| | - Russell E Glasgow
- Department of Family Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Suzanne Heurtin-Roberts
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Dylan H Roby
- School of Public Health, University of Maryland, College Park, MD, USA
| | - Sherri N Sheinfeld Gorin
- Division of Cancer Control and Population Sciences (Leidos Biomedical Research, Inc.), National Cancer Institute, Rockville, MD, USA
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Science, University of Texas Health Science Center at Houston School of Public Health, Dallas, TX, USA
| | - Paul A Estabrooks
- Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA, USA
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Sciences Center School of Public Health, College Station, TX, USA
| | - Beth A Glenn
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Rodger Kessler
- Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Sallie Beth Johnson
- Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA, USA
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Catherine L Rohweder
- Consortium for Implementation Science, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Maria E Fernandez
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
13
|
Factors Related to Implementation and Reach of a Pragmatic Multisite Trial: The My Own Health Report (MOHR) Study. J Am Board Fam Med 2017; 30:337-349. [PMID: 28484066 PMCID: PMC5878922 DOI: 10.3122/jabfm.2017.03.160151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/17/2016] [Accepted: 01/23/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Contextual factors relevant to translating healthcare improvement interventions to different settings are rarely collected systematically. This study articulates a prospective method for assessing and describing contextual factors related to implementation and patient reach of a pragmatic trial in primary care. METHODS In a qualitative case-series, contextual factors were assessed from the My Own Health Report (MOHR) study, focused on systematic health risk assessments and goal setting for unhealthy behaviors and behavioral health in nine primary care practices. Practice staff interviews and observations, guided by a context template were conducted prospectively at three time points. Patient reach was calculated as percentage of patients completing MOHR of those who were offered MOHR and themes describing contextual factors were summarized through an iterative, data immersion process.These included practice members' motivations towards MOHR, practice staff capacity for implementation, practice information system capacity, external resources to support quality improvement, community linkages, and implementation strategy fit with patient populations. CONCLUSIONS Systematically assessing contextual factors prospectively throughout implementation of quality improvement initiatives helps translation to other health care settings. Knowledge of contextual factors is essential for scaling up of effective interventions.
Collapse
|
14
|
A Quasi-Experiment to Assess the Impact of a Scalable, Community-Based Weight Loss Program: Combining Reach, Effectiveness, and Cost. J Gen Intern Med 2017; 32:24-31. [PMID: 28271423 PMCID: PMC5359160 DOI: 10.1007/s11606-016-3971-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Primary care addresses obesity through physician oversight of intensive lifestyle interventions or referral to external programs with demonstrated efficacy. However, limited information exists on community program reach, effectiveness, and costs across different groups of participants. OBJECTIVE To evaluate a scalable, community weight loss program using reach, effectiveness, and cost metrics. DESIGN Longitudinal pre-post quasi-experiment without control. PARTICIPANTS Enrolled participants in Weigh and Win (WAW), a community-based weight loss program. INTERVENTION A 12-month program with daily social cognitive theory-based email and/or text support, online access to health coaches, objective weight assessment through 83 community-based kiosks, and modest financial incentives to increase program reach. MAIN MEASURES Number of participants, representativeness, weight loss achievement (3%, 5% of initial weight lost), and cost of implementation. KEY RESULTS A total of 40,308 adults (79% women; 73% white; BMI = 32.3 ± 7.44, age = 43.9 ± 13.1 years) enrolled in WAW. Women were more likely than men to enroll in the program and continue engagement beyond an initial weigh-in (57% vs. 53%). Based on census data, African Americans were over-represented in the sample. Among participants who engaged in the program beyond an initial weigh-in (n = 19,029), 47% and 34% of participants lost 3% and 5% of their initial body weight, respectively. The average duration for those who achieved 5% weight loss was 1.7 ± 1.3 years. African American participants were more likely to achieve 5% weight loss and remain enrolled in the program longer compared to non-African American participants (2.0 ± 1.3 vs. 1.6 ± 1.2 years). Implementation costs were $2,822,698. Cost per clinically meaningful weight loss for African Americans ($257.97/3% loss; $335.96/5% loss) was lower than that for Hispanics ($318.62; $431.10) and Caucasians ($313.65; $441.87), due to the higher success rate of that subgroup of participants. CONCLUSIONS Weigh and Win is a scalable technology-supported and community-based weight loss program that reaches a large number of participants and may contribute to reducing health disparities.
Collapse
|
15
|
Abstract
Provision of dietary counseling in the office setting is enhanced by using team-based care and electronic tools. Effective provider-patient communication is essential for fostering behavior change: the key component of lifestyle medicine. The principles of communication and behavior change are skill-based and grounded in scientific theories and models. Motivational interviewing and shared decision making, a collaboration process between patients and their providers to reach agreement about a health decision, is an important process in counseling. The stages of change, self-determination, health belief model, social cognitive model, theory of planned behavior, and cognitive behavioral therapy are used in the counseling process.
Collapse
Affiliation(s)
- Robert F Kushner
- Northwestern Comprehensive Center on Obesity, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, Rubloff 9-976, Chicago, IL 60611, USA.
| |
Collapse
|
16
|
Simpson V, Pedigo L. Nurse and Physician Involvement in Health Risk Appraisals: An Integrative Review. West J Nurs Res 2016; 39:803-824. [PMID: 27445043 DOI: 10.1177/0193945916660341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Unhealthy lifestyle behaviors continue to be a strong contributor to chronic illness and death in the United States. Despite the health care system's efforts to refocus on prevention, primary care visits remain acute care focused. Health risk appraisals are tools that can be used by primary care providers to enhance lifestyle behavior change and prevention efforts. The purpose of this integrative review is to examine nurse and physician use of health risk appraisals in primary care. A total of 26 national and international papers, selected through an electronic database and ancestry search, were reviewed. Identified nurse and physician interventions in addition to other programming included helping participants understand and interpret feedback, behavioral counseling, and development of plans to address unhealthy lifestyle behaviors. The most common intervention was provision of telephonic nurse advice lines. Overall outcomes were positive. The use of these tools could be key to enhancing primary care prevention.
Collapse
|
17
|
Ferrer RL, Burge SK, Palmer RF, Cruz I. Practical Opportunities for Healthy Diet and Physical Activity: Relationship to Intentions, Behaviors, and Body Mass Index. Ann Fam Med 2016; 14:109-16. [PMID: 26951585 PMCID: PMC4781513 DOI: 10.1370/afm.1886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Current strategies for improving diet and activity patterns focus on encouraging patients to make better choices, but they meet with limited success. Because the choices people make depend on the choices they have, we examined how practical opportunities for diet and physical activity shape behavioral intentions and achieved behaviors. METHODS Participants included 746 adults who visited 8 large primary care practices in the Residency Research Network of Texas in 2012. We used structural equation models to confirm factor structures for a previously validated measure of practical opportunities, and then modeled achieved diet (Starting the Conversation - Diet questionnaire), physical activity (International Physical Activity Questionnaire), and BMI as a function of opportunities (classified as either resources or conversion factors that influence use of resources), behavioral intentions, and demographic covariates. RESULTS In path models, resources (P <.001) and conversion factors (P = .005) predicted behavioral intentions for activity. Conversion factors (P <.001), but not resources, predicted diet intentions. Both activity resources (P = .01) and conversion factors (P <.001) were positively associated with weekly activity minutes. Diet conversion factors (P <.001), but not diet resources (P = .08), were positively associated with diet quality. The same patterns were observed for body mass index (BMI). Socioeconomic gradients in resources and conversion factors were evident. CONCLUSIONS Individuals' feasible opportunities for healthy diet and activity have clinically meaningful associations with intentions, achieved behaviors, and BMI. Assessing opportunities as part of health behavior management could lead to more effective, efficient, and compassionate interventions.
Collapse
Affiliation(s)
- Robert L Ferrer
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Sandra K Burge
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Raymond F Palmer
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Inez Cruz
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | |
Collapse
|
18
|
Irvin VL, Kaplan RM. Effect Sizes and Primary Outcomes in Large-Budget, Cardiovascular-Related Behavioral Randomized Controlled Trials Funded by NIH Since 1980. Ann Behav Med 2016; 50:130-46. [PMID: 26507906 PMCID: PMC4744141 DOI: 10.1007/s12160-015-9739-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
PURPOSE We reviewed large-budget, National Institutes of Health (NIH)-supported randomized controlled trials (RCTs) with behavioral interventions to assess (1) publication rates, (2) trial registration, (3) use of objective measures, (4) significant behavior and physiological change, and (5) effect sizes. METHODS We identified large-budget grants (>$500,000/year) funded by NIH (National Heart Lung and Blood Institute (NHLBI) or National Institute of Diabetes & Digestive and Kidney Diseases (NIDDK)) for cardiovascular disease (dates January 1, 1980 to December 31, 2012). Among 106 grants that potentially met inclusion criteria, 20 studies were not published and 48 publications were excluded, leaving 38 publications for analysis. ClinicalTrials.gov abstracts were used to determine whether outcome measures had been pre-specified. RESULTS Three fourths of trials were registered in ClinicalTrials.gov and all published pre-specified outcomes. Twenty-six trials reported a behavioral outcome with 81 % reporting significant improvements for the target behavior. Thirty-two trials reported a physiological outcome. All were objectively measured, and 81 % reported significant benefit. Seventeen trials reported morbidity outcomes, and seven reported a significant benefit. Nine trials assessed mortality, and all were null for this outcome. CONCLUSIONS Behavioral trials complied with trial registration standards. Most reported a physiological benefit, but few documented morbidity or mortality benefits.
Collapse
Affiliation(s)
- Veronica L Irvin
- College of Public Health and Human Sciences, School of Social & Behavioral Health Sciences, Oregon State University, 457 Waldo Hall, Corvallis, OR, 97331, USA.
| | - Robert M Kaplan
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD, USA
| |
Collapse
|
19
|
Krist AH, Baumann LJ, Holtrop JS, Wasserman MR, Stange KC, Woo M. Evaluating Feasible and Referable Behavioral Counseling Interventions. Am J Prev Med 2015; 49:S138-49. [PMID: 26296548 DOI: 10.1016/j.amepre.2015.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 04/23/2015] [Accepted: 05/08/2015] [Indexed: 11/25/2022]
Abstract
The U.S. Preventive Services Task Force (USPTF) recognizes that behaviors have a major impact on health and well-being. Currently, the USPSTF has 11 behavioral counseling intervention (BCI) recommendations. These BCIs can be delivered in a primary care setting or patients can be referred to other clinical or community programs. Unfortunately, many recommended BCIs are infrequently and ineffectually delivered, suggesting that more evidence is needed to understand which BCIs are feasible and referable. In response, the USPSTF convened an expert forum in 2013 to inform the evaluation of BCI feasibility. This manuscript reports on findings from the forum and proposes that researchers use several frameworks to help clinicians and the USPSTF evaluate which BCIs work under usual conditions. A key recommendation for BCI researchers is to use frameworks whose components can support dissemination and implementation efforts. These frameworks include the Template for Intervention Description and Replication (TIDieR), which helps describe the essential components of an intervention, and pragmatic frameworks like Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) or Pragmatic-Explanatory Continuum Indicator Summary (PRECIS), which help to report study design elements and outcomes. These frameworks can both guide the design of more-feasible BCIs and produce clearer feasibility evidence. Critical evidence gaps include a better understanding of which patients will benefit from a BCI, how flexible interventions can be without compromising effectiveness, required clinician expertise, necessary intervention intensity and follow-up, impact of patient and clinician intervention adherence, optimal conditions for BCI delivery, and how new care models will influence BCI feasibility.
Collapse
Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
| | - Linda J Baumann
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin
| | | | | | - Kurt C Stange
- Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Meghan Woo
- Abt Associates, Cambridge, Massachusetts
| |
Collapse
|