Digital intervention increases influenza vaccination rates for people with diabetes in a decentralized randomized trial

AbstractPeople with diabetes (PWD) have an increased risk of developing influenza-related complications, including pneumonia, abnormal glycemic events, and hospitalization. Annual influenza vaccination is recommended for PWD, but vaccination rates are suboptimal. The study aimed to increase influenza vaccination rate in people with self-reported diabetes. This study was a prospective, 1:1 randomized controlled trial of a 6-month Digital Diabetes Intervention in U.S. adults with diabetes. The intervention group received monthly messages through an online health platform. The control group received no intervention. Difference in self-reported vaccination rates was tested using multivariable logistic regression controlling for demographics and comorbidities. The study was registered at clinicaltrials.gov: NCT03870997. A total of 10,429 participants reported influenza vaccination status (5158 intervention, mean age (±SD) = 46.8 (11.1), 78.5% female; 5271 control, Mean age (±SD) = 46.7 (11.2), 79.4% female). After a 6-month intervention, 64.2% of the intervention arm reported influenza vaccination, vers us 61.1% in the control arm (diff = 3.1, RR = 1.05, 95% CI [1.02, 1.08], p = 0.0013, number needed to treat = 33 to obtain 1 additional vaccination). Completion of one or more intervention messages was associated with up to an 8% increase in vaccination rate (OR 1.27, 95% CI [1.17, 1.38], p < 0.0001). The intervention improved influenza vaccination rates in PWD, suggesting that leveraging new technology to deliver knowledge and information can improve influenza vaccination rates in high-risk populations to reduce public health burden of influenza. Rapid cycle innovation could maximize the effects of these digital interventions in the future with other populations and vaccines.

Download Full-text

Promotion of the influenza vaccination to hospital staff during pre-employment health check: a prospective, randomised, controlled trial

Journal of Occupational Medicine and Toxicology ◽

10.1186/s12995-020-00285-w ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Michael Currat ◽

Catherine Lazor-Blanchet ◽

Giorgio Zanetti

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Healthcare Workers ◽

Vaccination Campaign ◽

Intervention Group ◽

Vaccination Rate ◽

Health Check ◽

Control Group ◽

Vaccination Rates ◽

Newly Hired

Abstract Background Vaccination is the most effective prevention of seasonal influenza. Despite its recommendation and active promotion, vaccination coverage remains low among healthcare staff. The goal of the study was to test if a pre-employment health check is a good opportunity to promote future vaccination against influenza among healthcare workers newly hired by a university hospital. Methods All new hospital employees active at the bedside who underwent a pre-employment health check between the end of 2016’s influenza epidemic and the start of the next influenza vaccination campaign were randomly allocated to a control group or an intervention group. The intervention consisted of a semi-structured dialog and the release of an information leaflet about influenza and influenza vaccination during the check-up, and the shipment of a postcard reminder 2 weeks before the next vaccination campaign. Vaccination rates during the campaign were compared among the two groups. Results Three hundred fifty-seven employees were included. Vaccination rates were similar in both groups: 79/172 (46%) in the control and 92/185 (50%) in the intervention group. A significantly higher rate of vaccination was noted among physicians (70/117, 60%) than among other employees (101/240, 42%, p = 0.001). In a pre-defined exploratory analysis among physicians, the vaccination rate was higher in the intervention group (36/51, 71%) than in the control group (34/65, 52%, p = 0.046). Conclusions Promotion of the influenza vaccine during pre-employment health check did not improve the vaccination rate of newly hired hospital healthcare workers overall during the next influenza vaccination campaign. Results suggest a favourable impact on the vaccination rate of physicians. Thus, there may be an interest in using communication strategies tailored to the different categories of healthcare workers to promote the influenza vaccine during pre-employment health check. Trial registration ClinicalTrials, NCT02758145. Registered 26 April 2016.

Download Full-text

Effectiveness of a web-based medication adherence tool with patient centered communication: Results of a clustered randomized controlled trial (Preprint)

10.2196/preprints.16141 ◽

2019 ◽

Author(s):

Jan van Lieshout ◽

Joyca Lacroix ◽

Aart van Halteren ◽

Martina Teichert

Keyword(s):

Randomized Controlled Trial ◽

Medication Adherence ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Community Pharmacies ◽

Web Based ◽

Randomized Controlled ◽

Tailored Interventions ◽

Increased Risk

BACKGROUND Growing numbers of people use medication for chronic conditions; non-adherence is common, leading to poor disease control. A newly developed web-based tool to identify an increased risk for non-adherence with related potential individual barriers might facilitate tailored interventions and improve adherence. OBJECTIVE To assess the effectiveness of the newly developed tool to improve medication adherence. METHODS A cluster randomized controlled trial assessed the effectiveness of this adherence tool in patients initiating cardiovascular or oral blood glucose lowering medication. Participants were included in community pharmacies. They completed an online questionnaire comprising an assessments of their risk for medication non-adherence and subsequently of barriers to adherence. In pharmacies belonging to the intervention group, individual barriers displayed in a graphical profile on a tablet were discussed by pharmacists and patients at high non-adherence risk in face to face meetings and shared with their general practitioners and practice nurses. Tailored interventions were initiated by the healthcare providers. Barriers of control patients were not presented or discussed and these patients received usual care. The primary outcome was the difference in medication adherence at 8 months follow-up between patients with an increased non-adherence risk from intervention and control group, calculated from dispensing data. RESULTS Data from 492 participants in 15 community pharmacies were available for analyses (intervention 253, 7 pharmacies; control 239, 8 pharmacies). The intervention had no effect on medication adherence (-0.01; 95%CI -0.59 – 0.57; P= .96), neither in the post hoc per protocol analysis (0.19; 95%CI -0.50 – 0.89; P=.58). CONCLUSIONS This study showed no effectiveness of a risk stratification and tailored intervention addressing personal barriers for medication adherence. Various potential explanations for lack of effect were identified. These explanations relate for instance to high medication adherence in the control group, study power and fidelity. Process evaluation should elicit possible improvements and inform the redesign of intervention and implementation. CLINICALTRIAL The Netherlands National Trial Register: NTR5186. Date: May 18, 2015 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5186)

Download Full-text

Nutritional support for lactating women with or without Azithromycin for infants compared to breast-feeding counselling alone, to improve six-month growth outcomes among infants of peri-urban slums of Karachi, Pakistan – a protocol of multi-arm assessor blinded randomized controlled trial (Mumta LW trial)

10.21203/rs.3.rs-24814/v1 ◽

2020 ◽

Author(s):

Ameer Muhammad ◽

Yasir Shafiq ◽

M Imran Nisar ◽

Benazir Baloch ◽

Amna Tanweer Yazdani ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Low Income ◽

Controlled Trial ◽

Intervention Group ◽

Relative Length ◽

Trial Registration ◽

Control Group ◽

Lactating Women ◽

Randomized Controlled ◽

Increased Risk

Abstract BackgroundGlobally, 45% of under-five deaths are, directly or indirectly, attributable to malnutrition, most of these deaths are in low- and middle-income countries (LMICs). Children in the first 6 months of life are particularly vulnerable. An estimated 4.7 million infants under the age of 6 months are moderately wasted whereas 3.8 million are severely wasted. Despite the increased risk to a child of a mother with nutritional decompensation, there are discrepancies in guidance in this area. MethodsThis is a community-based, open-label factorial randomized controlled trial, using parallel assignment with 1:1:1 allocation ratio, in low-income squatter settlements of urban Karachi, Pakistan. In the control group (Arm A), women are randomized to standard counseling only; whereas in the first intervention group (Arm B), lactating women receive two sachets of balanced energy-protein (BEP) supplementation per day from enrollment till the infant reaches six months of age, in the second intervention group (Arm C), lactating women receive same BEP as in intervention Arm B while their babies also receive a single stat dose (20mg/kg orally) of azithromycin at 42 days. The primary outcome is relative length velocity from 0 to 6 months by the limb of allocation. The primary analysis will be Intention-to-treat analysisTrial registrationRegistration of the trial is done at ClinicalTrials.gov. NCT03564652, registered on June 21, 2018. Trial registration data is available through https://clinicaltrials.gov/ct2/show/NCT03564652

Download Full-text

Abstract P271: Influenza and Herpes Zoster Vaccination in United States Stroke Survivors: A Nationwide Analysis

Stroke ◽

10.1161/str.52.suppl_1.p271 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Mu Ji Hwang ◽

Setareh Salehi Omran ◽

Saad Mir ◽

Alexander E Merkler ◽

Hooman Kamel ◽

...

Keyword(s):

United States ◽

Herpes Zoster ◽

Influenza Vaccination ◽

Vaccination Rate ◽

Behavioral Risk ◽

Stroke Survivors ◽

Cross Sectional ◽

Vaccination Rates ◽

Increased Risk ◽

Prior Stroke

Introduction: Patients with stroke face an increased risk of contracting influenza and herpes zoster. We compared vaccination rates in stroke survivors versus the general United States population. Methods: We performed a cross-sectional analysis of data from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System, which is an annual, nationally representative, health survey. Respondents are asked about medical conditions and care. We used the most recent years with complete data for influenza (2018) and zoster (2017). We utilized survey procedures to estimate CDC-recommended vaccination rates for influenza (annual vaccination for all) and zoster (one-time vaccination for those at least 50 years old). Multiple logistic regression was used to compare the odds of vaccination in those with and without prior stroke, while adjusting for demographics (including income and health insurance) and comorbidities that may influence vaccination rates (obesity, diabetes, heart disease, cancer, pulmonary disease, and smoking). Results: In 2018, 8,254,136 (3.4%; 95% CI, 3.3-3.5) Americans were stroke survivors. The influenza vaccination rate was 44.4% (95% CI, 42.8-46.2) in stroke survivors and 32.8% (95% CI, 32.5-33.1) otherwise. In unadjusted models, stroke survivors were more likely to have had an influenza vaccination in the past year than those without stroke (OR, 1.6; 95% CI, 1.5-1.8). In 2017, 5,839,186 (5.7%; 95% CI, 5.5-5.9) Americans over 50 years old (i.e., eligible for zoster vaccination) were stroke survivors. The zoster vaccination rate was 30.3% (95% CI, 28.8-32.0) in stroke survivors and 27.6% (95% CI, 27.3-28.0) in those without prior stroke. Stroke survivors were more likely to have had zoster vaccination than those without stroke (OR, 1.14; 95% CI, 1.06-1.23). However, after accounting for demographics and comorbidities, stroke survivors were not more likely to be vaccinated for influenza (OR, 1.01; 95% CI, 0.93-1.10) or zoster (OR, 1.00; 95% CI, 0.90-1.12). Conclusion: Stroke survivors were not vaccinated at higher rates than expected based on demographics and comorbidities, and absolute vaccination rates were low, especially for zoster. Efforts to increase vaccination after stroke may be needed.

Download Full-text

The influence of a community intervention on influenza vaccination knowledge and behavior among diabetic patients

BMC Public Health ◽

10.1186/s12889-019-8101-6 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Lili Tao ◽

Ming Lu ◽

Xiaoning Wang ◽

Xiaoyan Han ◽

Shuming Li ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza Vaccination ◽

Community Intervention ◽

Vaccination Rate ◽

Control Group ◽

Diabetic Patients ◽

Vaccination Rates ◽

Significant Difference ◽

The Impact ◽

Experimental Group

Abstract Background This study was conducted to evaluate the impact of a comprehensive community intervention on cognition and inoculation behaviors of diabetic patients immunized with influenza vaccine. Methods A total of 1538 diabetic patients aged 35 years and above for outpatient visits and follow-up treatments were selected from six community health service centers (three for the experimental group, and the other three for the control group) in Chaoyang District, Beijing. Comprehensive interventions applied to the experimental group include patient intervention and community climate interventions. We compared the total awareness of influenza vaccine knowledge and influenza vaccination rates between the two groups before and after the intervention. Results Before the intervention, the total awareness rate of influenza vaccine in the experimental group and the control group was similar (50.6 and 50.2%, respectively. P = 0.171). After the intervention, the awareness rate of influenza vaccine in the experimental group and the control group increased. The amplitude of the increase was similar (70.3 and 70.1%, respectively. P = 0.822,). Before the intervention, there was no significant difference in the influenza vaccination rate between the experimental group and the control group (29.0 and 26.8%, respectively. P = 0.334). After the intervention, the vaccination rate of the experimental group was higher than that of the control group. The difference was statistically significant (The vaccination rate 45.8 and 27.4% for the experimental group and the control group, respectively. P < 0.001). Conclusion Comprehensive community interventions had a positive effect on vaccination in diabetic patients. Trial registration ChiCTR1900025194, registered in Aug,16th, 2019. Retrospectively registered.

Download Full-text

Effectiveness of online tailored advice to prevent running-related injuries and promote preventive behaviour in Dutch trail runners: a pragmatic randomised controlled trial

British Journal of Sports Medicine ◽

10.1136/bjsports-2016-097025 ◽

2017 ◽

Vol 52 (13) ◽

pp. 851-858 ◽

Cited By ~ 13

Author(s):

Luiz Carlos Hespanhol ◽

Willem van Mechelen ◽

Evert Verhagen

Keyword(s):

Randomised Controlled Trial ◽

Preventive Intervention ◽

Absolute Risk ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Number Needed To Treat ◽

Preventive Behaviour ◽

Randomised Controlled ◽

Tailored Advice

BackgroundTrail running is popular worldwide, but there is no preventive intervention for running-related injury (RRI).AimTo evaluate the effectiveness of adding online tailored advice (TrailS6) to general advice on (1) the prevention of RRIs and (2) the determinants and actual preventive behaviour in Dutch trail runners.MethodsTwo-arm randomised controlled trial over 6 months. 232 trail runners were randomly assigned to an intervention or control group. All participants received online general advice on RRI prevention 1 week after baseline. Every 2 weeks, participants in the intervention group received specific advice tailored to their RRI status. The control group received no further intervention. Bayesian mixed models were used to analyse the data.ResultsTrail runners in the intervention group sustained 13% fewer RRIs compared with those in the control group after 6 months of follow-up (absolute risk difference −13.1%, 95% Bayesian highest posterior credible interval (95% BCI) −23.3 to −3.1). A preventive benefit was observed in one out of eight trail runners who had received the online tailored advice for 6 months (number needed to treat 8, 95% BCI 3 to 22). No significant between-group difference was observed on the determinants and actual preventive behaviours.ConclusionsOnline tailored advice prevented RRIs among Dutch trail runners. Therefore, online tailored advice may be used as a preventive component in multicomponent RRI prevention programmes. No effect was observed on determinants and actual preventive behaviours.Trial registration numberThe Netherlands National Trial Register (NTR5431).

Download Full-text

A randomized controlled trial of a brief educational and psychological intervention for patients presenting to a cardiac clinic with palpitation

Psychological Medicine ◽

10.1017/s0033291702005536 ◽

2002 ◽

Vol 32 (4) ◽

pp. 699-706 ◽

Cited By ~ 11

Author(s):

R. MAYOU ◽

D. SPRIGINGS ◽

J. BIRKHEAD ◽

J. PRICE

Keyword(s):

Randomized Controlled Trial ◽

Usual Care ◽

Educational Intervention ◽

Psychological Intervention ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Number Needed To Treat ◽

Treatment Needs ◽

Randomized Controlled

Background. We sought to determine whether a brief psycho-educational intervention reduced disability in patients with benign palpitation.Method. In a pragmatic randomized controlled trial within a cardiology clinic at a district general hospital, 80 consecutive patients diagnosed as having benign palpitation – either palpitation due to awareness of extrasystoles or sinus rhythm – with associated distress or disability were randomized to an intervention group (usual care plus nurse-delivered intervention based on cognitive-behavioural principles) or to a control group (usual care). Principal outcome was difference in proportion of participants with good or excellent researcher-rated activity levels at 3 months. Subsidiary outcomes were self-rated symptoms, distress and disability, researcher-rated unmet treatment needs.Results. The principal outcome showed a statistically and clinically significant benefit for the intervention group, with a number needed to treat of 3 (95% CIs 2 to 7). All but one subsidiary outcomes also showed a difference in favour of the intervention group, and several differences reached statistical significance. Significantly more of the control group had unmet treatment needs at 3 months.Conclusions. A brief, nurse-delivered, psycho-educational intervention, was an effective treatment for benign palpitation. Further evaluation, including assessment of cost-effectiveness, is needed. The findings have application to the care of patients presenting with other types of ‘unexplained’ medical symptoms.

Download Full-text

Effectiveness of 3 per cent boric acid in 70 per cent alcohol versus 1 per cent clotrimazole solution in otomycosis patients: a randomised, controlled trial

The Journal of Laryngology & Otology ◽

10.1017/s0022215116008598 ◽

2016 ◽

Vol 130 (9) ◽

pp. 811-815 ◽

Cited By ~ 4

Author(s):

S Romsaithong ◽

K Tomanakan ◽

W Tangsawad ◽

S Thanaviratananich

Keyword(s):

Adverse Events ◽

Confidence Interval ◽

Boric Acid ◽

Treatment Effectiveness ◽

Controlled Trial ◽

Intervention Group ◽

Acid Group ◽

Absolute Difference ◽

Control Group ◽

Number Needed To Treat

AbstractObjectives:To compare the clinical effectiveness and adverse events for 3 per cent boric acid in 70 per cent alcohol versus 1 per cent clotrimazole solution in the treatment of otomycosis.Methods:A total of 120 otomycosis patients were randomly assigned to receive either 1 per cent clotrimazole solution (intervention group) or 3 per cent boric acid in 70 per cent alcohol (control group) at the Khon Kaen Hospital ENT out-patient department. Treatment effectiveness was determined based on the otomicroscopic absence of fungus one week after therapy, following a single application of treatment.Results:After 1 week of treatment, there were data for 109 participants, 54 in the clotrimazole group and 55 in the boric acid group. The absolute difference in cure rates between 1 per cent clotrimazole solution and 3 per cent boric acid in 70 per cent alcohol was 17.9 per cent (95 per cent confidence interval, 2.3 to 33.5; p = 0.028) and the number needed to treat was 6 (95 per cent confidence interval, 3.0 to 43.4). Adverse events for the two agents were comparable.Conclusion:One per cent clotrimazole solution is more effective than 3 per cent boric acid in 70 per cent alcohol for otomycosis treatment.

Download Full-text

Improving population health in resident clinics: increasing pneumonia vaccination rates in adults 65 years and older

BMJ Open Quality ◽

10.1136/bmjoq-2019-000830 ◽

2020 ◽

Vol 9 (4) ◽

pp. e000830

Author(s):

Sheila McGreevy ◽

Caylin McGowan ◽

Kristin Gillenwater ◽

Rebecca Opole ◽

Meena Veluri ◽

...

Keyword(s):

Intervention Group ◽

Bacterial Pathogen ◽

The Elderly ◽

Vaccination Rate ◽

Resident Physician ◽

Control Group ◽

Vaccination Rates ◽

Attending Physician ◽

And Control ◽

Verbal Encouragement

Streptococcus pneumoniae is a significant bacterial pathogen, especially in the elderly. There are two types of pneumococcal vaccines, one with polysaccharides from the capsule of 23 serotypes (PPSV23) and one with polysaccharides from 13 serotypes that have been conjugated to a protein (PCV13). Both vaccines decrease the incidence of invasive pneumococcal disease and are recommended for all people ≥65 years of age. We found the vaccination rate against S. pneumoniae in patients ≥65 years of age in our resident physician continuity clinics was 59.85%, which is considerably lower than the vaccination rate of 69.16% in our attending physician clinics. The aim of our study was to double the number of vaccinations given in the resident physician clinics over a 1-month period without compromising workflow or unduly burdening the rooming nurse or resident physicians. For our primary intervention, we assigned a designated nurse with expertise in vaccinations the task of reviewing charts ahead of clinic visits then pending the order for the appropriate pneumococcal vaccine. Our secondary intervention was the education of physicians through pocket cards, verbal encouragement and email reminders. χ² test was conducted to compare the proportion of patients 65 years or older who were vaccinated between the intervention and control groups. The results indicated that the intervention group patients were 2.61 times (95% CI 1.18 to 6.10) more likely to be vaccinated compared with the control group patients (20% vs 8.7%, χ2 (1)=5.16, p=0.02, Cramer’s V=0.16). The intervention resulted in more than doubling the number of vaccinations in the intervention group compared with the control group. Moreover, poststudy interviews and surveys indicated our workflow is sustainable and amendable to wider use within the resident physician clinics.

Download Full-text

Family psychoeducation for major depression: randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.110.078626 ◽

2011 ◽

Vol 198 (5) ◽

pp. 385-390 ◽

Cited By ~ 51

Author(s):

Kae Shimazu ◽

Shinji Shimodera ◽

Yoshio Mino ◽

Atsushi Nishida ◽

Naoto Kamimura ◽

...

Keyword(s):

Major Depression ◽

Expressed Emotion ◽

Hazard Analysis ◽

Controlled Trial ◽

Bipolar Affective Disorder ◽

Intervention Group ◽

Control Group ◽

Number Needed To Treat ◽

Family Psychoeducation ◽

Treatment As Usual

BackgroundThe value of family psychoeducation for schizophrenia has been well established, and indications for its use have recently expanded to include bipolar affective disorder. However, no study to date has adequately examined its use in depression.AimsTo examine family psychoeducation in the maintenance treatment of depression and to investigate the influence of the family's expressed emotion (EE) on its effectiveness.MethodOf 103 patients diagnosed with major depression and their primary family members, 57 pairs provided written informed consent. The pairs were randomly allocated to the intervention (n = 25) or control (n = 32). One family in the intervention group and two in the control group withdrew their consent after randomisation. The intervention group underwent four psychoeducation sessions consisting of didactic lectures about depression and group problem-solving focusing on how to cope in high-EE situations. Patients did not attend these sessions. Patients in both the intervention and control groups received treatment as usual. The families' EE levels were evaluated through Five-Minute Speech Samples. The primary outcome was relapse.ResultsTime to relapse was statistically significantly longer in the psychoeducation group than in the control group (Kaplan–Meier survival analysis, P = 0.002). The relapse rates up to the 9-month follow-up were 8% and 50% respectively (risk ratio 0.17, 95% CI 0.04–0.66; number needed to treat 2.4, 95% CI 1.6–4.9). In Cox proportional hazard analysis, baseline EE did not moderate the effectiveness of the intervention.ConclusionsFamily psychoeducation is effective in the prevention of relapse in adult patients with major depression.

Download Full-text