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Results for “Adherence Interventions”

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At least 1,063 records · Page 59Linked to original sources

PubMed2003

The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines.

BACKGROUND: This study tested the effects of two organizational support processes, the provision of financial incentives for superior clinical performance and the availability of a patient (smoker) registry and proactive telephone support system for smoking cessation, on provider adherence to accepted practice guidelines and associated patient outcomes. METHODS: Forty clinics of a large multispecialty medical group practice providing primary care services were randomly allocated to study conditions. Fifteen clinics each were assigned to the experimental conditions "control" (distribution of printed versions of smoking cessation guidelines) and "incentive" (financial incentive pay-out for reaching preset clinical performance targets). Ten clinics were randomized to receive financial incentives combined with access to a centralized patient registry and intervention system ("registry"). Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients' smoking cessation behaviors. RESULTS: Patients' tobacco use status was statistically significant (P < 0.01) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition. Patients visiting registry clinics accessed counseling programs statistically significantly more often (P < 0.001) than patients receiving care in the control condition. Other endpoints did not statistically significantly differ between the experimental conditions. CONCLUSIONS: The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practices and patient behaviors was mixed. Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment.

Ambulatory Care Facilities↗

PubMed2005

Children's adaptations to a fat-reduced diet: the Dietary Intervention Study in Children (DISC).

BACKGROUND: Prevention of cardiovascular disease through diet and lifestyle change is strongly advocated in adults and is initiated preferably during childhood. The Dietary Intervention Study in Children (DISC) was a multicenter, collaborative, randomized trial in 663 preadolescent children (363 boys and 301 girls) with elevated low-density lipoprotein cholesterol, designed to test the efficacy and safety of a dietary intervention to lower saturated-fat and cholesterol intake while also advocating a healthy eating pattern. DISC results have been published extensively. This ancillary study reports new data regarding changes in eating patterns among this cohort. OBJECTIVE: We set out to compare children's self-selected eating patterns and approaches to achieving adherence to the DISC fat-reduced diet intervention with children in the usual-care group. METHODS: An ancillary study was conducted to develop a detailed food-grouping system and report new analyses on dietary adherence to the recommended eating pattern. Every food in the nutrient database was ranked by its saturated-fat and cholesterol content and classified within its relevant food group as a "go" (less atherogenic) or "whoa" (more atherogenic) food. RESULTS: At baseline, go foods contributed approximately 57% of total energy intake and 12.4% to 13.1% total fat energy intake in both groups. At 3 years, go foods contributed 67.4% and 13.7% of total and fat energy intake, respectively, in the intervention group versus 56.8% and 12.8% in the usual-care group. Differences between the 2 treatment groups were significant for changes in consumption of dairy foods, desserts, and fats/oils, with the intervention group reporting a 0.2- to 0.3-serving-per-day greater increase in go foods than the usual-care group. The intervention group also reported a 0.2- to 0.8-serving-per-day greater decrease in whoa foods than the usual-care group for breads/grains, dairy, fats/oils, meat/fish/poultry, snacks, and vegetables. Overall, snack foods, desserts, and pizza contributed approximately one third of total daily energy intake in both groups at 3 years. CONCLUSIONS: Children in the intervention group reported consuming more servings per day of go grains, dairy, meats, and vegetable foods compared with children in the usual-care group, but intake of fruits and vegetables was low in both groups. Discovering that snacks, desserts, and pizza actively contribute so heavily to the diets of this age group, even among children who were part of this intervention, offers valuable insights regarding the need for more aggressive, innovative, and realistic approaches for additional dietary counseling.

Behavior Therapy↗

PubMed1991

Substantial improvement in compliance with universal precautions in an emergency department following institution of policy.

Seven months following the introduction of an institutional policy mandating compliance with universal precautions (UPs), we observed 127 health care workers performing 1421 interventions on 155 critically ill and injured patients in an emergency department setting in July 1989. Results were compared with a similar study undertaken exactly 1 year previously when UPs were considered as guidelines only. Overall adherence to UPs improved from 44.0% to 72.7% from 1 year to the next. Adherence to UPs improved from 19.5% to 55.7% during interventions on patients with profuse bleeding and from 16.7% to 54.5% during performance of major procedures. Compliance improved from 47.9% to 81.0% for emergency department-based health care workers (residents, attending physicians, nurses, x-ray film technicians). Prehospital care providers, a group not accountable to the institution, remained particularly noncompliant with only 13% adherence. We conclude that mandating UPs as policy with a monitoring component is effective in ensuring a reasonable level of adherence. However, given current barrier technology, achieving appropriate levels of compliance during unscheduled visits by patients requiring immediate attention and rapid intervention remains a challenge.

Acquired Immunodeficiency Syndrome↗

PubMed1986

The effectiveness of CO2 laser and electromicrosurgery in adhesiolysis: a comparative study.

This study was undertaken to assess the relative effectiveness of the CO2 laser and electromicrosurgery in adhesiolysis. Intraperitoneal adhesions were produced in 44 female white rats by inflicting a standard and reproducible injury to the serosa of a specific area of the right uterine horn. At a second intervention, 2 weeks later, the adhesions formed by the initial injury were assessed and division of adhesions effected in a random manner, either with the use of the CO2 laser or with electromicrosurgery, adhering to accepted microsurgical techniques. At a third intervention, results were assessed. The results demonstrate that electromicrosurgery and the CO2 laser are equally effective for adhesiolysis in the rat model.

Animals↗

PubMed1995

Adherence to worksite exercise programs: an integrative review of recent research.

1. Improving worker physical fitness through worksite exercise programs offers many benefits to the employee and the employer. Unfortunately, a small percentage of workers who begin an exercise program adhere to it. 2. It is essential to design program strategies to promote exercise adherence among persons who do not currently exercise at levels that achieve health benefits. 3. The results of this review of worksite research suggest a number of strategies that were successful in increasing at least short term exercise adherence. 4. Carefully controlled studies are needed to identify specific worksite exercise interventions or combination of interventions that maximize the initiation of exercise as well as short and long term adherence. A combination of strategies improves exercise adherence for at least 6 months, but more research is needed to determine long term maintenance of an exercise program.

Exercise Therapy↗

PubMed2003

Home monitoring for lung transplant candidates.

Home monitoring by lung transplant recipients has been effective for early detection of clinical problems. This study used an electronic diary for home monitoring by lung transplant candidates to improve communication between candidates and the transplant team. Candidates were randomized into control (52 subjects following standard telephone reporting procedures) and intervention (67 subjects using an electronic diary to record and transmit a range of health-related measures) groups. Outcome measures were monitoring adherence and level of communication (for monitor acceptability and utilization), hospital length of stay after transplantation and survival at 4 months (for clinical effectiveness). Subjects used the diary without difficulty and with good adherence. Subjects and coordinator contacts were similar between groups; intervention group subjects were positive regarding contact based on diary use. There were no significant differences in clinical outcomes between groups. Changing diary questions might improve the effectiveness of electronic monitoring for lung transplant candidates.

Adult↗

PubMed2004

Treatment adherence among Native Hawaiians living with HIV.

Cultural competence is essential in helping people living with HIV cope with the biopsychosocial and spiritual challenges associated with this illness. Efforts to understand the relationship of cultural values and social support practices to health-related behavior have rarely been more critical than in the emerging issue of treatment adherence to highly active antiretroviral therapy (HAART), a multidrug regime that potentially extends the longevity of those living with HIV but may be complex to manage. This article highlights findings from a study on health beliefs, perceived social support, and HAART adherence among Native Hawaiians, a group with historic difficulty in using Western health care services because of cultural conflict. Implications are suggested for social workers and other health care providers in the development of interventions that use cultural preferences to support HAART adherence.

Adult↗

PubMed2006

Long term oxygen therapy adherence and COPD: what we don't know.

Persons utilizing long term oxygen therapy (LTOT) at home suffer from chronic obstructive pulmonary disease (COPD). Adherence to LTOT ranges from 45% to 70% and utilization of 15 hours per day is widely accepted as efficacious. Although studies have reviewed the level of patient adherence with LTOT, few have introduced or evaluated interventions. The paucity of information regarding patients following oxygen prescription is an enormous void that must be tackled to augment clinical effectiveness and cost containment for the long term. A research agenda for LTOT adherence is postulated to help connect treatment adherence variables and concepts with clinical outcomes and quality of life.

Guideline Adherence↗

PubMed1993

Plasma lipid response and nutritional adequacy in hypercholesterolemic subjects on the American Heart Association Step-One Diet.

OBJECTIVES: To determine the efficacy of the American Heart Association Step-One Diet for lowering blood lipid levels and to assess its nutritional adequacy in younger (< 50 years old) and older (> or = 50 years old) subgroups. STUDY DESIGN: A prospective cohort study; 383 subjects were instructed in the American Heart Association Step-One Diet. Adherence to the diet was assessed at 6 weeks. Eighty-seven subjects continued the diet for an additional 12 weeks. SETTING: General community participants: volunteers from community cholesterol screening programs and chart reviews at family practice clinics. STUDY PARTICIPANTS: Men and women, aged 20 to 70 years, with baseline low-density lipoprotein cholesterol levels between the 50th and 95th percentile, and excluded if receiving any medications that affect blood lipid levels or if there was a history of diabetes, gout, peptic ulcer, or liver disease. INTERVENTION: Instruction by a registered dietitian and adherence to the American Heart Association Step-One Diet for 6 (n = 383) and 18 weeks (n = 87). This diet involves an intake of total fat not to exceed 30% of calories, saturated fatty acids not to exceed 10% of calories, and dietary cholesterol limited to 300 mg/d. RESULTS: Subjects aged 50 to 70 years averaged a reduction in total cholesterol level and low-density lipoprotein cholesterol level of 4% after 6 weeks. At the end of 18 weeks, mean total cholesterol and low-density lipoprotein cholesterol levels in subjects younger than 50 years exceeded their baseline levels, and in those older than 50 years returned to baseline lipid levels. Inadequate intake of several micronutrients were reported, notably, zinc, calcium, and vitamins A, D, and E. CONCLUSIONS: When recommending the American Heart Association Step-One Diet to persons with hyperlipidemia, baseline dietary behavior should be assessed to determine whether that diet offers therapeutic advantage over the persons's self-selected diet. Follow-up should include monitoring of lipid response and nutritional adequacy. Special emphasis should be placed on selection of foods with appropriate micronutrient content.

Adult↗

PubMed2003

[Experience of an adherence support for HIV-1 seropositive patients with failure under treatment].

CONTEXT: To be successful highly active antiretroviral therapies need very high levels of adherence to be successful. In need to help patients in dealing with adverse effects, complexity and multiple constraints of these drugs, adherence support programs have been developed. Therefore, the efficacy on viral load of these interventions has not been established in the HIV-1 positive population. The aim of our study was to assess the virological efficacy of this type of program in our institution. METHODS: Non randomized intervention study with a control group. The intervention group was constituted of patients presenting with virological failure who where admitted in the adherence program. The control group (2:1) has been selected in our data base. Factors known to influence viral load have been analyzed by multiple logistic regression. RESULTS: The probability of obtaining a significant decrease of viral load was better at 6 months for patients using the adherence program (OR: 4,48 [2,72-11,8]). This benefit was not sustained at 12 months. The program efficacy varied with the kind of treatment (with or without protease inhibitors), the therapeutic history and the initial viral load. The absence of protease inhibitor, a high initial viral load, small number of previous drugs were linked to viral load decrease. CONCLUSION: The good virological results observed at 6 months in the intervention group are incentive. Long term virological gain and the profile of patients who could make the best of an adherence support program have to be determined.

Adult↗

PubMed1999

Collaborative care models for the treatment of depression. Based on a presentation by Wayne Katon, MD.

The quality of treatment of depression in the primary care setting is limited by inadequate patient education, lack of adherence to treatment regimens, poor patient follow-up, and the absence of close collaboration between medical and mental health systems. Integrated models of care may help overcome some of these barriers and improve adherence, satisfaction with care, and outcomes. The health and economic outcomes of randomized controlled trials in which 2 models of collaborative care--psychiatrist and psychiatrist/psychologist plus primary care--were compared with usual primary care. Interventions were delivered at multiple levels and included enhanced patient education and monitoring, physician training, patient-physician interaction, and integration of a psychiatrist or psychologist into the primary care setting. After the interventions, patients with major depression showed significant improvements in adherence, satisfaction with care, and depressive outcomes, whereas, in patients with minor depression, outcomes were not significantly affected by the intervention. An analysis revealed that the cost of the interventions was higher than usual care, and that there was little evidence of any cost offset. However, in terms of cost effectiveness, the cost of successfully treating one patient with major depression was lower with the interventions, and the incremental costs of collaborative intervention were substantially lower than the usual primary care costs.

Continuity of Patient Care↗

PubMed2002

Project Family prevention trials based in community-university partnerships: toward scaled-up preventive interventions.

Findings from Project Family are presented to illustrate how a partnership-based program of research on universal family- and youth-focused interventions is addressing a public health challenge. One aspect of this public health challenge is the high prevalence of youth problem behaviors and a second aspect concerns barriers to scaling-up empirically-supported preventive interventions designed to ameliorate those problem behaviors. Illustrative findings are presented within a conceptual framework for scaling-up preventive interventions to achieve greater public health impact. Three interrelated sets of research requirements and findings are addressed within this framework: (a) rigorously demonstrating intervention effectiveness; (b) attaining sufficient levels of intervention utilization in diverse general populations, requiring study of recruitment/retention strategies, cultural sensitivity, and economic viability; and (c) achieving implementation quality, involving investigation of adherence and dosage effects, along with theory-driven, intervention quality improvement. The paper concludes with discussion of the need for careful investigation of community-university partnership models as a key mechanism for large-scale implementation.

Adolescent↗

PubMedDate not supplied

The effect of video interventions on improving knowledge and treatment compliance in the sexually transmitted disease clinic setting. Lesson for HIV health education.

Eight intervention studies investigating patient education and treatment adherence in the sexually transmitted disease (STD) clinic setting are reviewed. Across the eight studies selected for analysis, meta-analytic procedures were applied to compare the impact of educational and prevention approaches. The effect of video was compared with that of other modes of health education on: 1) knowledge and attitudes about STDs and condoms and 2) treatment compliance, as measured by return for test of cure, drug compliance, premature resumption of sexual activity, and condom coupon redemption rates. The largest effects were those for video on knowledge and attitudes about STDs and condoms, followed by the effects of other non-video interventions on STD knowledge. Lower effects were found among video and non-video interventions targeting treatment compliance outcomes. These results are consistent with prior prevention studies that have demonstrated difficulty in achieving behavior change.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Complete diagnostic evaluation in colorectal cancer screening: research design and baseline findings.

BACKGROUND: While indicated by guidelines, complete diagnostic evaluation, or CDE (i.e., colonoscopy or combined flexible sigmoidoscopy plus barium enema X ray), is often not recommended and performed for persons with an abnormal screening fecal occult blood test (FOBT) result. We initiated a randomized trial to assess the impact of a physician-oriented intervention on CDE rates in primary care practices. METHODS: In 1998, we identified 1,184 primary care physicians (PCPs) in 584 practices whose patients received FOBTs that are mailed annually by a managed care organization screening program. A total of 470 PCPs in 318 practices completed a baseline survey. Practices were randomly assigned either to a Control Group (N = 198) or to an Intervention Group (N = 120). Control Group practices received the screening program. Intervention Group practices received the screening program and the intervention (i.e., CDE reminder-feedback plus educational outreach). Practice CDE recommendation and performance rates are the primary outcomes to be measured in the study. RESULTS: Baseline CDE recommendation and performance rates were low and were comparable in Control and Intervention Group practices (54 to 57% and 39 to 40%, respectively). PCPs in the practices tended to view FOBT screening and CDE favorably, but had concerns about screening efficacy, time involved in CDE, and patient discomfort and adherence. Control Group physicians were more likely than Intervention Group physicians to believe that a mail-out FOBT screening program helps in the practice of medicine. CONCLUSIONS: We were able to enroll a high proportion of targeted primary care practices, measure practice characteristics and CDE rates at baseline, and develop and implement the intervention. Study outcome analyses will take into account baseline differences in practice characteristics.

Analysis of Variance↗

PubMed2002

Comparisons of tailored mammography interventions at two months postintervention.

The recent decrease in breast cancer mortality has been linked in part to increased breast cancer screening. Although the percentage of women screened once is rising, rate of continued adherence is poor. The purpose of this article is to assess the effects of tailored mammography interventions implemented prospectively in a factorial design contrasting groups receiving either (a) usual care (no intervention), (b) tailored telephone counseling for mammography, (c) tailored mailed materials promoting mammography, or (d) a combination of tailored mail and telephone counseling. This prospective, randomized study with a 2 x 2 factorial design included women 51 years and older (N = 1,367) who were not adherent with mammography at baseline. The intervention is based on integration of the Transtheoretical and Health Belief Models. Participants were enrolled in one of two health maintenance organizations or seen in a university-related primary care clinic. Baseline data were collected on mammography history and beliefs and knowledge related to mammography. Data were collected via telephone interviews using previously developed scales. The follow-up interviewers were conducted with 976 women. The sample was 41% White, 56% African American, and 3% other. Mean age at baseline was 66.5. Logistic regression indicates that postintervention mammography status in all three intervention groups was significantly better than usual care, with odds ratios ranging from 1.66 (telephone only) to 2.16 (telephone plus mail).

Aged↗

PubMed2003

Adherence to diabetes control recommendations: impact of nurse telephone calls.

BACKGROUND: Type 2 diabetes mellitus is increasing in incidence and research has shown that normalization of blood glucose levels can moderate the risk of microvascular and neurological complications. AIM: The purpose of this study was to investigate the effect of nurse telephone calls on glycosylated haemoglobin (HbA1c) levels and adherence to diabetes control recommendations. METHODS: A randomized design with control and experimental groups being assessed pre- and post intervention was used to assess the effectiveness of nurse telephone calls. Twenty patients were randomly assigned to an intervention group and 16 to a control group. The goal of the intervention was to keep blood glucose concentrations close to the normal range (HbA1c < 7%). The intervention was applied to the intervention group for 12 weeks, and consisted of continued education and reinforcement of diet, exercise, medication adjustment recommendations, as well as frequent self-monitoring of blood glucose levels. Telephone intervention was performed twice per week for the first month and then weekly for the second and third month. Participants were requested to write self-management logs including blood glucose levels, diet and an exercise diary. A dietitian analysed the diet diaries and participants were informed about their results by telephone or mail. All medication adjustments were communicated to participants' doctors. The HbA1c and diabetes adherence were measured before and after the intervention. RESULTS: Patients in the intervention group had a mean decrease of 1.2% in HbA1c levels and those in the control group had a mean increase of 0.6% in HbA1c levels. The intervention group had greater diet and blood glucose testing adherence than the control group. CONCLUSION: These findings indicate that a nurse telephone intervention can improve HbA1c, and diet and blood glucose testing adherence.

Blood Glucose↗

PubMed2006

Reduction of urinary tract infection and antibiotic use after surgery: a controlled, prospective, before-after intervention study.

BACKGROUND: Urinary tract infection is the most frequent health care-associated complication. We hypothesized that the implementation of a multifaceted prevention strategy could decrease its incidence after surgery. METHODS: In a controlled, prospective, before-after intervention trial with 1328 adult patients scheduled for orthopedic or abdominal surgery, nosocomial infection surveillance was conducted until hospital discharge. A multifaceted intervention including specifically tailored, locally developed guidelines for the prevention of urinary tract infection was implemented for orthopedic surgery patients, and abdominal surgery patients served as control subjects. Infectious and noninfectious complications, adherence to guidelines, and antibiotic use were monitored before and after the intervention and again 2 years later. RESULTS: The incidence of urinary tract infection decreased from 10.4 to 3.9 episodes per 100 patients in the intervention group (incidence-density ratio, 0.41; 95% CI, 0.20-0.79; P=.004). Adherence to guidelines was 82.2%. Both the frequency and the duration of urinary catheterization decreased following the intervention. Recourse to antibiotic therapy after surgery dropped in the intervention group from 17.9 to 15.6 defined daily doses per 100 patient-days (P<.005) because of a reduced need for the treatment of urinary tract infection (P<.001). Follow-up after 2 years revealed a sustained impact of the strategy and a subsequent low use of antibiotics, consistent with stable adherence to guidelines (80.8%). CONCLUSIONS: A multifaceted prevention strategy can dramatically decrease postoperative urinary tract infection and contribute to the reduction of the overall use of antibiotics after surgery.

Adolescent↗

PubMed2003

A prehabilitation program for physically frail community-living older persons.

OBJECTIVES: To describe the development and implementation of a preventive, home-based physical therapy program (PREHAB) and to provide evidence for the safety and interrater reliability of the PREHAB protocol. DESIGN: Demonstration study. SETTING: General community. PARTICIPANTS: Ninety-four physically frail, community-living persons, aged 75 years or older, who were randomized to the PREHAB program in a clinical trial. INTERVENTIONS: The PREHAB program built on the physical therapy component of 2 previous home-based protocols. A total of 223 assessment items were linked to 28 possible interventions, including progressive balance and conditioning exercises, by using detailed algorithms and decisions rules that were automated on notebook computers. MAIN OUTCOMES MEASURES: The percentages of participants who were eligible for and who completed each intervention, the extent of progress noted in the balance and conditioning exercises, adherence to the training program, and adverse events. RESULTS: Participants who completed the PREHAB program and those who ended it prematurely received an average of 9.7 and 7.2 interventions during an average of 14.9 and 9.5 home visits, respectively. With few exceptions, the completion rate and interrater reliability for the specific interventions were high. Despite high self-reported adherence to the training program, the majority of participants did not advance beyond the initial Thera-Band level for the upper- and lower-extremity conditioning exercises, and only about a third advanced to the highest 2 levels of the balance exercises. Adverse events were no more common in the PREHAB group than in the educational control group. CONCLUSION: Our results support the feasibility and safety of the PREHAB program, but also show the special challenges and pitfalls of such a strategy when it is implemented among persons of advanced age and physical frailty.

Aged↗