Effectiveness of participatory interventions in improving clinical coordination in Latin America

Abstract Background Evaluation of interventions to improve clinical coordination across care levels is scarce in Latin America. Aim to evaluate the effectiveness of interventions implemented through participatory action research in improving clinical coordination between care levels in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. Methods Quasi-experimental study (controlled before and after design). Comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys were conducted applying COORDENA® questionnaire to a sample of primary (PC) and secondary (SC) care doctors (174 doctors/network/year). Designed interventions promoted clinical agreement and communication across levels for patients’ follow-up. Outcome variables: a) intermediate: interactional and organizational factors; b) final: experience of clinical management coordination (care consistency and patients’ follow-up) and general perception of coordination between levels. Poisson regression models were estimated. Results Intermediate: interactional factors -personal knowledge and trust on the other care level-increased significantly in Brazil’ and Chile’ INs; and organizational factors -managers’ support- in the INs of Colombia and Mexico. Comparing to CN in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors. Final: care consistency items -agreement over the treatments- improved in the INs of Brazil, Colombia and Uruguay; and patients’ follow-up in the INs of Chile and Mexico. General perception of clinical coordination increased in the INs of Brazil, Colombia and Mexico. Compared to CN in 2017, only Brazil showed significant differences. Conclusions Improvements in intermediate and final care coordination results, consistent with expected results, were observed in all the INs. Reduced implementation time and some process and context factors may have limited their impact. Key messages First study assessing the effectiveness of participatory interventions in improving clinical coordination between care levels in public healthcare networks of Latin America. Results showed changes in the intermediate and final clinical coordination results in the intervention networks. Longer implementation and evaluation times are expected to achieve greater impact.

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Evaluating the effectiveness of care coordination interventions designed and implemented through a participatory action research process: Lessons learned from a quasi-experimental study in public healthcare networks in Latin America

PLoS ONE ◽

10.1371/journal.pone.0261604 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0261604

Author(s):

María-Luisa Vázquez ◽

Andrea Miranda-Mendizabal ◽

Pamela Eguiguren ◽

Amparo-Susana Mogollón-Pérez ◽

Marina Ferreira-de-Medeiros-Mendes ◽

...

Keyword(s):

Action Research ◽

Participatory Action Research ◽

Organizational Factors ◽

Lessons Learned ◽

Future Research ◽

Public Healthcare ◽

Participatory Action ◽

Intermediate Outcomes ◽

Quasi Experimental

Background Despite increasing recommendations for health professionals to participate in intervention design and implementation to effect changes in clinical practice, little is known about this strategy’s effectiveness. This study analyses the effectiveness of interventions designed and implemented through participatory action research (PAR) processes in healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay to improve clinical coordination across care levels, and offers recommendations for future research. Methods The study was quasi-experimental. Two comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys of a sample of primary and secondary care doctors (174 doctors/network/year) were conducted using the COORDENA® questionnaire. Most of the interventions chosen were based on joint meetings, promoting cross-level clinical agreement and communication for patient follow-up. Outcome variables were: a) intermediate: interactional and organizational factors; b) distal: experience of cross-level clinical information coordination, of clinical management coordination and general perception of coordination between levels. Poisson regression models were estimated. Results A statistically significant increase in some of the interactional factors (intermediate outcomes) -knowing each other personally and mutual trust- was observed in Brazil and Chile INs; and in some organizational factors -institutional support- in Colombia and Mexico. Compared to CNs in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors. In distal outcomes, care consistency items improved in Brazil, Colombia and Uruguay INs; and patient follow-up improved in Chile and Mexico. General perception of clinical coordination increased in Brazil, Colombia and Mexico INs. Compared to CNs in 2017, only Brazil showed significant differences. Conclusions Although more research is needed, results show that PAR-based interventions improved some outcomes regarding clinical coordination at network level, with differences between countries. However, a PAR process is, by definition, slow and gradual, and longer implementation periods are needed to achieve greater penetration and quantifiable changes. The participatory and flexible nature of interventions developed through PAR processes poses methodological challenges (such as defining outcomes or allocating individuals to different groups in advance), and requires a comprehensive mixed-methods approach that simultaneously evaluates effectiveness and the implementation process to better understand its outcomes.

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Effects of choral singing on salivary cortisol levels and self-reported stress in university students

Music and Medicine ◽

10.47513/mmd.v13i4.794 ◽

2021 ◽

Vol 13 (4) ◽

Author(s):

Gunnar Glauco De Cunto Carelli Taets ◽

Ramon Werner Heringer Gutierrez ◽

Leila Brito Bergold ◽

Luana Silva Monteiro

Keyword(s):

University Students ◽

Salivary Cortisol ◽

Health Issues ◽

Group Approach ◽

Choral Singing ◽

Before And After ◽

Quasi Experimental ◽

Potential Impact ◽

Cortisol Levels

Although mental disorders are common among university students, the majority of students with mental health issues do not seek out treatment during their academic life. The aim of this study was to evaluate the effects of a novel group approach- choir singing, and its potential impact on stress, via salivary cortisol levels and self-reported stress levels in university students during 4 sessions of choir singing. It was based on a quasi-experimental research conducted with 25 Brazilian university students. Each choir singing session lasted 60 minutes. A question was asked before and after the intervention: what is the level of your stress? Salivary cortisol was collected before and after the intervention. After the choir singing intervention, there was a statistically significant reduction in self-reported stress (p<0.0001) and salivary cortisol levels (p<0.0001). This research suggests that choir singing can reduce the self-reported stress of university students after 4 weeks of follow-up with ∆= 45.83% and salivary cortisol levels in the first week with ∆= 3.57%.

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Improving the Recording of Diagnoses in Primary Care with Team Incentives: A Controlled Longitudinal Follow-Up Study

BioMed Research International ◽

10.1155/2018/4606710 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Tuomo Lehtovuori ◽

Timo Kauppila ◽

Jouko Kallio ◽

Anna M. Heikkinen ◽

Marko Raina ◽

...

Keyword(s):

Primary Care ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Follow Up Study ◽

Primary Care Teams ◽

Before And After ◽

Quasi Experimental ◽

Clinically Significant ◽

Made In

Introduction. We studied whether primary care teams respond to financial group bonuses by improving the recording of diagnoses, whether this intervention leads to diagnoses reflecting the anticipated distribution of diseases, and how the recording of a significant chronic disease, diabetes, alters after the application of these bonuses. Methods. We performed an observational register-based retrospective quasi-experimental follow-up study with before-and-after setting and two control groups in primary healthcare of a Finnish town. We studied the rate of recorded diagnoses in visits to general practitioners with interrupted time series analysis. The distribution of these diagnoses was also recorded. Results. After group bonuses, the rate of recording diagnoses increased by 17.9% (95% CI: 13.6–22.3) but not in either of the controls (−2.0 to −0.3%). The increase in the rate of recorded diagnoses in the care teams varied between 14.9% (4.7–25.2) and 33.7% (26.6–41.3). The distribution of recorded diagnoses resembled the respective distribution of diagnoses in the former studies of diagnoses made in primary care. The rate of recorded diagnoses of diabetes did not increase just after the intervention. Conclusions. In primary care, the completeness of diagnosis recording can be, to varying degrees, influenced by group bonuses without guarantee that recording of clinically significant chronic diseases is improved.

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Outcomes of a 12-month patient-centred medical home model in improving patient activation and self-management behaviours among primary care patients presenting with chronic diseases in Sydney, Australia: A before-and-after study.

10.21203/rs.2.24539/v2 ◽

2020 ◽

Author(s):

James John ◽

Kathy Tannous ◽

Amanda Jones

Keyword(s):

Chronic Diseases ◽

Medical Home ◽

Multivariate Regression ◽

Regression Models ◽

Patient Activation ◽

Self Management ◽

Before And After ◽

General Practices ◽

Sydney Australia

Abstract Background: Studies report that increased patient activation is associated with increased patient engagement with the health care system, better adherence to treatment protocols, and improved health outcomes. This study aims to evaluate outcomes based on a 12-month Patient-Centred Medical Home (PCMH) model called ‘WellNet’ on activation levels of patients with one or more chronic diseases in general practices across Sydney, Australia.Methods: A total of 636 patients aged 40 years and above with one or more chronic conditions consented to participate in the WellNet program delivered across six general practices in Northern Sydney, Australia. The WellNet treatment includes a team-based care with general physicians and trained chronic disease management care coordinators collaborating with patients in designing a patient-tailored care plan with improved self-management support and care navigation according to the level of risk and health care needs. Level of patient activation was measured using the validated PAM 13-item scale at baseline and follow-up. A before and after case-series design was employed to determine adjusted differences between baseline and 12-months using repeated measures analysis of covariance (ANCOVA). Multiple imputation was used to compute missing follow-up scores using Markov Chain Monte Carlo (MCMC) algorithm known as fully conditional specification (FCS). Additionally, backward stepwise multivariate regression models were employed to identify significant predictors of activation at follow-up.Results: Of the 626 patients, 420 reported their PAM scores at follow-up. The mean (SD) baseline PAM score was 57.9 (13.0). The adjusted model showed significant mean difference in PAM scores of 6.5 (95% CI 5.0-8.1; p-value<0.001) after controlling for baseline covariates. Multivariate regression models showed that older age (B = -0.14; 95% CI -0.28, -0.01), baseline activation score (B = 0.48; 95% CI 0.37, 0.59), and private insurance (uninsured patients) (B = -3.41; 95% CI -6.50, -0.32) were significant predictors of patient activation at follow-up.Conclusion: The WellNet study is the first of its kind in Australia to report on changes in the patient activation levels among patients with one or more chronic diseases. PCMH has the potential to improve patient activation and engagement which can lead to long-term health benefits and sustained self-management behaviours.

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Are digital technology interventions effective to reduce loneliness in older adults? A systematic review and meta-analysis

10.1101/2020.08.27.20183012 ◽

2020 ◽

Cited By ~ 1

Author(s):

Syed Ghulam Sarwar Shah ◽

David Nogueras ◽

Hugo Cornelis van Woerden ◽

Vasiliki Kiparoglou

Keyword(s):

Systematic Review ◽

Older Adults ◽

Clinical Trials ◽

English Language ◽

Data Extraction ◽

Meta Analysis ◽

Future Research ◽

Before And After ◽

Quasi Experimental

Objective: To review the latest literature on the effectiveness of DTIs in reducing loneliness in (older) adults. Data Sources: Electronic searches in PubMed, Medline, CINAHL, EMBASE and Web of Science covering publication period from 1 January 2010 to 31 July 2019. Subjects: Adult men and women Design: Systematic review and meta-analysis Main Outcome Measure: Loneliness. Study Selection: Primary studies that used DTIs for tackling loneliness in adults (aged ≥18 years) with follow-up measurements at least three months or more and publication in the English language. Data Extraction and Synthesis: Two researchers independently screened articles and extracted data on several variables: participants, interventions, comparators and outcomes. Data was extracted on the primary outcome i.e. loneliness measured at the baseline and follow-up measurements at three, four, six and twelve months after the intervention. Results: Six studies were selected from 4939 articles screened. Selected studies included 5 clinical trials (4 RCTs and 1 quasi experimental study) and one before and after study, which enrolled 646 participants (men =154 (24%), women =427 (66%), no gender information =65 (10%) with average age between 73 and 78 years (SD 6-11). Five clinical trials were included in the meta-analysis and standardised mean differences (SMD) were calculated for each trial and pooled across studies using a random effects model. The overall effect estimates were not statistically significant in follow-up measurements at three months (SMD= 0.02, 95% CI= -0.36, 0.40; P=0.92), four months (SMDs= -1.11, 95% CI= -2.60, 0.38; P=0.14) and six months (SMD= -0.11, 95% CI= -0.54, 0.32; P=0.61). The quality of evidence was very low to moderate in these trials. Conclusions: There is insufficient evidence to make conclusions that DTIs are effective in reducing loneliness in older adults. Future research may consider RCTs with larger sample sizes and longer duration of interventions and follow-up.

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Assessments of Stress of Conscience, Perceptions of Conscience, Burnout, and Social Support Before and After Implementation of a Participatory Action-Research-Based Intervention

Clinical Nursing Research ◽

10.1177/1054773815618607 ◽

2016 ◽

Vol 26 (2) ◽

pp. 205-223 ◽

Cited By ~ 1

Author(s):

Eva Ericson-Lidman ◽

Johan Åhlin

Keyword(s):

Social Support ◽

Action Research ◽

Participatory Action Research ◽

Statistical Tests ◽

Participatory Action ◽

Before And After ◽

Stress Of Conscience ◽

Nonparametric Statistical ◽

Difficult Situations

Interventions aiming to constructively address stress of conscience are rare. The aim of the study was to compare assessments of stress of conscience, perceptions of conscience, burnout, and social support among health care personnel (HCP) working in municipal residential care of older adults, before and after participation in a participatory action research (PAR) intervention aiming to learn to constructively deal with troubled conscience. Questionnaire data were collected at baseline and at follow-up (1-year interval; n = 29). Descriptive statistics and nonparametric statistical tests were used to make comparisons between baseline and follow-up. HCP gave significantly higher scores to the question, “Are your work achievements appreciated by your immediate superior?” at follow-up compared with baseline. No significant differences in levels of stress of conscience and burnout at follow-up were found. The results suggested that a PAR intervention aiming to learn HCP to deal with their troubled conscience in difficult situations could be partially successful.

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MO470PATIROMER PHARMACOUTILIZATION IN REAL-WORLD GERMAN CKD PATIENTS WITH MODERATELY TO SEVERELY REDUCED EGFR

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab090.0032 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Roberto Pecoits-Filho ◽

Daniel Muenz ◽

K P McCullough ◽

Johannes Duttlinger ◽

Viviane Calice-Siva ◽

...

Keyword(s):

Logistic Regression ◽

Real World ◽

Regression Models ◽

High Serum ◽

High Morbidity ◽

Logistic Regression Models ◽

Ckd Stage ◽

Before And After ◽

Lower Egfr

Abstract Background and Aims Hyperkalemia (HK) (serum K>5.0 mEq/L) is a chronic condition in patients with chronic kidney disease (CKD) associated with high morbidity and mortality, and it is a frequent reasons for renin angiotensin aldosterone inhibition (RAASi) discontinuation. Patiromer is a non-absorbed, sodium-free, K+ binder that has been shown to reduce serum K+ in patients with HK, and thereby enable RAASi therapy, which is supported by randomized trial evidence. The description of patiromer utilization in patients with moderate to advanced CKD in the real-world setting in Europe is lacking. The objective of this analysis was to describe predictors of patiromer initiation and time to discontinuation among CKD patients using contemporary (April 2018-October 2020) data from German participants in CKD Outcomes and Practice Patterns Study (CKDopps). Method We identified 136 patiromer users (116 with matching K measurement) during the observation period. Patients with eGFR <60ml/min/1.73m2 and a serum potassium ≥4mEq/L who never initiated patiromer during the follow up were used as a comparison. We used the most recent lab and drug use information available within the 6-month period prior to baseline, which was defined as either first use of patiromer, April 1, 2018, or entry into the PDOPPS study. The median time between the most recent K+ measurement and baseline was 45 days for non-patiromer users and 4 days for patiromer users. Logistic regression models were used to test associations between patient factors and whether the patient was in the patiromer initiation group or the comparison group. Time on patiromer was estimated using a Kaplan-Meier curve, censoring for death, dialysis, transplantation, or loss of follow-up. Results Patiromer was prescribed to ≥2 patients in 11 clinics, one patient in 19 clinics, and zero patients in 57 clinics. Patients prescribed patiromer had lower eGFR (23.2 [15.8, 28.6] vs 36.9 [27.7, 46.3]ml/min) and higher serum K levels (5.6 [5.4, 6.1] vs 4.6 [4.3, 5.0]ml/min). There were no major differences according to patiromer use in other demographic, clinical, and biochemical characteristics. Despite the differences in serum K, use of RAAS inhibitors was similar in patiromer users (83%) versus non-users (80%). Thirty three percent of patiromer users were prescribed polystyrene sulfonate (SPS) before patiromer initiation. In a multiple logistic regression models (including serum K, CKD stage, gender, age, prescription of RAASi, diabetes, coronary artery disease, heart failure), patiromer use was strongly associated more advanced CKD stage (independently of high serum K), with odds ratios of initiation >3 for CKD stage 4 or 5 versus CKD stage 3. Among new users, 90% of patients had active prescription at 30 days and about one-half had active prescription at one year (Figure). Conclusion The main predictors of Patiromer initiation were advanced CKD stage and hyperkalemia. Treatment decisions did not appear to be based on other patient or clinical characteristics. Patiromer was often prescribed to patients already receiving alternative HK treatment (SPS), suggesting use for chronic hyperkalemia rather than response to acute event. Further analysis with a larger population and measurements of K+ before and after patiromer initiation may improve the understanding of its pharmacoutilization in moderate to advanced CKD.

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Analysis of brief Cognitive Behavioral Therapy for panic disorder

Revista Iberoamericana de Psicología ◽

10.33881/2027-1786.rip.11206 ◽

2018 ◽

Vol 11 (2) ◽

pp. 51-60

Author(s):

Nelson Arturo Chicaiza

Keyword(s):

Panic Disorder ◽

Cognitive Behavioral Therapy ◽

Experimental Model ◽

Clinical Symptoms ◽

Behavioral Therapy ◽

Cultural Characteristics ◽

Andean Region ◽

Before And After ◽

Quasi Experimental

The aim of this study was to determine if a modification made to the traditional treatments for panic disorder (PD) proved to be effective in adjusting to the cultural and economic characteristics of patients in the southern Andean Region of Colombia. A quasi-experimental model was used, measurements were taken before and after treatment and follow-ups took place after 1 and 2 years; the sample was made up of 82 people (47 women and 35 men, with an average age of 34 and 29 years respectively). Results showed a reduction of PD clinical symptoms after the treatment (d>0.8), the significance in all cases was p <0.001 and changes maintained throughout the follow up period. In conclusion, it is posible to draw the treatment closer to the socio-cultural characteristics of patients to whom it is directed and the number of sessions could be reduced maintaining the effectiveness of the treatment.

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Sleep quality deterioration in middle-aged and older adults living in a rural Ecuadorian village severely struck by the SARS-CoV-2 pandemic. A population-based longitudinal prospective study

SLEEP ◽

10.1093/sleep/zsab041 ◽

2021 ◽

Author(s):

Oscar H Del Brutto ◽

Robertino M Mera ◽

Aldo F Costa ◽

Bettsy Y Recalde ◽

Pablo R Castillo

Keyword(s):

Sleep Quality ◽

Mixed Models ◽

Regression Models ◽

Pittsburgh Sleep Quality Index ◽

Population Based ◽

Logistic Regression Models ◽

Before And After ◽

Atahualpa Project ◽

Relevant Covariates

Abstract Study Objectives This study assessed changes in sleep quality before and after the peak of the SARS-CoV-2 pandemic in community dwellers enrolled in the Atahualpa Project. Methods Atahualpa residents aged ≥40 years were eligible if they had a Pittsburgh Sleep Quality Index (PSQI) 9 months before the pandemic and a lateral flow-based test for identification of SARS-CoV-2 antibodies during the peak of the pandemic. Six months later, individuals completed a follow-up PSQI. The independent relationship between SARS-CoV-2 infection and deterioration in sleep quality was assessed by fitting logistic mixed models for longitudinal data. Results Of 639 participants (mean age at baseline: 59 ± 12.8 years), 325 (51%) had SARS-CoV-2 antibodies. A total of 185 (29%) individuals at baseline and 311 (49%) at follow-up were poor sleepers (p < 0.001). Mixed logistic regression models demonstrated a significant increase in poor sleepers at follow-up (odds ratio [OR]: 2.85; 95% CI: 2.16 to 3.75), which was more marked among SARS-CoV-2 seropositive subjects (OR: 3.8; 95% CI: 2.48 to 5.81). The adjusted proportion of poor sleepers increased from 29% to 56.2% (95% CI: 50.9% to 61.6%) among SARS-CoV-2 seropositive individuals, but only to 40.7% (95% CI: 35.3% to 46.1%) in their seronegative counterparts (p < 0.001). Likewise, progression from a good to a poor sleeper status was higher among seropositive individuals than in their seronegative counterparts (38.1% vs 22.3%; p < 0.001), after adjusting for relevant covariates. Conclusions This study shows a deleterious effect of SARS-CoV-2 in sleep quality. An effect of SARS-CoV-2 in disrupting sleep-related pathways cannot be ruled out. Trial registration The Atahualpa Project has been registered at ClinicalTrials.gov; the identifier number is NCT01627600, and the date was: 10/02/2012 (https://clinicaltrials.gov/ct2/show/NCT01627600?cond=Atahualpa&draw=2&rank=1). The Sleep Disorders substudy has been registered at ClinicalTrials.gov; the identifier number is NCT01877616, and the date was: 06/13/2013 (https://clinicaltrials.gov/ct2/show/NCT01877616?cond=Atahualpa&draw=2&rank=4).

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Outcomes of a 12-month patient-centred medical home model in improving patient activation and self-management behaviours among primary care patients presenting with chronic diseases in Sydney, Australia: A before-and-after study.

10.21203/rs.2.24539/v3 ◽

2020 ◽

Author(s):

James John ◽

Kathy Tannous ◽

Amanda Jones

Keyword(s):

Chronic Diseases ◽

Medical Home ◽

Multivariate Regression ◽

Regression Models ◽

Patient Activation ◽

Self Management ◽

Before And After ◽

General Practices ◽

Sydney Australia

Abstract Background: Studies report that increased levels of patient activation is associated with increased engagement with the health care system, better adherence to treatment protocols, and improved health outcomes. This study aims to evaluate outcomes based on a 12-month Patient-Centred Medical Home (PCMH) model called ‘WellNet’ on activation levels of patients with one or more chronic diseases in general practices across Sydney, Australia.Methods: A total of 636 patients aged 40 years and above with one or more chronic conditions consented to participate in the WellNet program delivered across six general practices in Northern Sydney, Australia. The WellNet intervention includes a team-based care with general physicians and trained chronic disease management care coordinators collaborating with patients in designing a patient-tailored care plan with improved self-management support and care navigation according to the level of risk and health care needs. Level of patient activation was measured using the validated PAM 13-item scale at baseline and follow-up. A before and after case-series design was employed to determine adjusted differences between baseline and 12-months using repeated measures analysis of covariance (ANCOVA). Additionally, backward stepwise multivariate regression models were employed to identify significant predictors of activation at follow-up.Results: Of the 626 patients, 420 reported their PAM scores at follow-up. The mean (SD) baseline PAM score was 57.9 (13.0). The adjusted model showed significant mean difference in PAM scores of 6.5 (95% CI 5.0-8.1; p-value<0.001) after controlling for baseline covariates. Multivariate regression models showed that older age (B = -0.14; 95% CI -0.28, -0.01) and private insurance (uninsured patients) (B = -3.41; 95% CI -6.50, -0.32) were significantly associated with lower PAM scores at 12 months whereas higher baseline PAM scores (B = 0.48; 95% CI 0.37, 0.59) was significantly associated with higher follow-up PAM scores.Conclusion: The WellNet study is the first of its kind in Australia to report on changes in the patient activation levels among patients with one or more chronic diseases. PCMH has the potential to improve patient activation and engagement which can lead to long-term health benefits and sustained self-management behaviours.

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