scholarly journals Adaptations and patient responses to behavioral intervention components in a depression-focused chronic disease care model implemented in India

2020 ◽  
Vol 10 (1) ◽  
pp. 35-45
Author(s):  
Leslie C M Johnson ◽  
Lydia Chwastiak ◽  
Subramani Poongothai ◽  
Nikhil Tandon ◽  
Ranjit Mohan Anjana ◽  
...  
Keyword(s):  
Integrated Care ◽  
Behavioral Intervention ◽  
Behavioral Interventions ◽  
Secondary Analysis ◽  
Independent Study ◽  
Care Model ◽  
Care Coordinator ◽  
Individualized Care ◽  
Care Coordinators ◽  
Patient Responses

Abstract Integrated care models offer one approach to treat patients with chronic multimorbidity. However, because these models consist of multiple components designed to provide individualized care, they should be adapted to best meet the needs of patients in diverse settings. This paper presents qualitative and quantitative data from a realist process evaluation embedded in the INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) study to uncover what worked, for whom, how, and in what circumstances. We aimed to examine adaptations made to a care coordinator-led behavioral intervention, and how patients responded to adaptations, through a secondary analysis of these data. A purposive sample of 62 patients and 3 care coordinators were recruited based on their involvement with the INDEPENDENT care model across two clinics. Patients were interviewed and surveyed about their experiences in the care model and care coordinators were interviewed about their experiences implementing intervention components. Interview data were coded for reported modifications in intervention content, tools, and delivery; then, these adaptations were categorized by how they served to enhance implementation in the Indian context. Adaptations made in the delivery of this care model served two functions: (a) to improve health promotion communication between care coordinators and patients and (b) to improve patient engagement. Patients’ expressed needs were consistent with what care coordinators perceived. Patients were satisfied with adaptations designed to improve intervention fit for local contexts. Study findings demonstrate that adapting components of an integrated care model can enhance patient satisfaction and engagement with behavioral interventions.

VA Researchers Test Integrated Care Model for Substance-Abusing Patients

2001 ◽  
Author(s):  
Andrew J. Saxon ◽  
Daniel R. Kivlahan ◽  
Donelle Howell
Keyword(s):  
Integrated Care ◽  
Substance Abusing ◽  
Care Model

scholarly journals Identifying and measuring the common elements of naturalistic developmental behavioral interventions for autism spectrum disorder: Development of the NDBI-Fi

Autism ◽  
2020 ◽  
Vol 24 (8) ◽  
pp. 2285-2297
Author(s):  
Kyle M Frost ◽  
Jessica Brian ◽  
Grace W Gengoux ◽  
Antonio Hardan ◽  
Sarah R Rieth ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Behavioral Intervention ◽  
Behavioral Interventions ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Common Elements ◽  
Intervention Science ◽  
Intervention Models ◽  
The Common ◽  
Naturalistic Developmental Behavioral Intervention

Naturalistic developmental behavioral interventions for young children with autism spectrum disorder share key elements. However, the extent of similarity and overlap in techniques among naturalistic developmental behavioral intervention models has not been quantified, and there is no standardized measure for assessing the implementation of their common elements. This article presents a multi-stage process which began with the development of a taxonomy of elements of naturalistic developmental behavioral interventions. Next, intervention experts identified the common elements of naturalistic developmental behavioral interventions using quantitative methods. An observational rating scheme of those common elements, the eight-item NDBI-Fi, was developed. Finally, preliminary analyses of the reliability and the validity of the NDBI-Fi were conducted using archival data from randomized controlled trials of caregiver-implemented naturalistic developmental behavioral interventions, including 87 post-intervention caregiver–child interaction videos from five sites, as well as 29 pre–post video pairs from two sites. Evaluation of the eight-item NDBI-Fi measure revealed promising psychometric properties, including evidence supporting adequate reliability, sensitivity to change, as well as concurrent, convergent, and discriminant validity. Results lend support to the utility of the NDBI-Fi as a measure of caregiver implementation of common elements across naturalistic developmental behavioral intervention models. With additional validation, this unique measure has the potential to advance intervention science in autism spectrum disorder by providing a tool which cuts across a class of evidence-based interventions. Lay abstract Naturalistic developmental behavioral interventions for young children with autism spectrum disorder share key elements. However, the extent of similarity between programs within this class of evidence-based interventions is unknown. There is also currently no tool that can be used to measure the implementation of their common elements. This article presents a multi-stage process which began with defining all intervention elements of naturalistic developmental behavioral interventions. Next, intervention experts identified the common elements of naturalistic developmental behavioral interventions using a survey. An observational rating scheme of those common elements, the eight-item NDBI-Fi, was developed. We evaluated the quality of the NDBI-Fi using videos from completed trials of caregiver-implemented naturalistic developmental behavioral interventions. Results showed that the NDBI-Fi measure has promise; it was sensitive to change, related to other similar measures, and demonstrated adequate agreement between raters. This unique measure has the potential to advance intervention science in autism spectrum disorder by providing a tool to measure the implementation of common elements across naturalistic developmental behavioral intervention models. Given that naturalistic developmental behavioral interventions have numerous shared strategies, this may ease clinicians’ uncertainty about choosing the “right” intervention package. It also suggests that there may not be a need for extensive training in more than one naturalistic developmental behavioral intervention. Future research should determine whether these common elements are part of other treatment approaches to better understand the quality of services children and families receive as part of usual care.

scholarly journals Provider attitudes towards a brief behavioral intervention for sexual health in Moldova

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rob Stephenson ◽  
Galina Lesco ◽  
Viorel Babii ◽  
Andrei Luchian ◽  
Nataliia Bakunina ◽  
...  
Keyword(s):  
Sexual Health ◽  
Behavioral Intervention ◽  
Brief Intervention ◽  
Behavioral Interventions ◽  
Brief Interventions ◽  
Health Centers ◽  
Capital City ◽  
Vulnerable Groups ◽  
Provider Attitudes ◽  
Brief Behavioral Intervention

Abstract Background Brief behavioral interventions are seen as an efficient way to improve knowledge, change behavior, and reduce provider stigma regarding sexual health. When grounded in evidence-based behavioral change techniques and delivered using Brief Sexuality-related Communication (BSC) tools, brief behavioral interventions can address client-driven sexual health goals in a single session with their provider. Evidence for the efficacy of brief interventions for creating gains in sexual health comes largely from resource rich settings, and there is a lack of knowledge of how brief interventions can be implemented in the more resource constrained environments of low- and middle-income countries. As a first step in developing a brief intervention to address sexual health issues in Moldova, this paper reports on qualitative data collected from Moldovan providers to understand their attitudes, willingness and perceived barriers to the brief intervention and its implementation. Methods Thirty-nine in-depth interviews (IDI) were conducted between February and March 2020, with health providers recruited from three primary health care institutions, two Youth Friendly Health Centers and counselors from three NGOs who work with key populations in Moldova, including health centers selected from two cites - the capital city, Chisinau and from the Comrat Region. The IDI addressed four domains of provider attitudes: 1) attitudes towards the intervention; 2) willingness and motivation to implement the intervention; 3) logistics of providing the intervention and 4) ability to implement the intervention. A coding analysis approach was applied to all interview transcripts. Results Providers largely reported being willing to be trained in and implement the brief intervention. Willingness to implement the intervention stemmed from two perceptions: that it would improve the ability of providers to talk with their clients about sex, and that vulnerable groups would benefit from these conversations. However, while there were generally positive attitudes towards the intervention, providers consistently reported structural barriers to their perceived ability to implement the intervention. Conclusions While providers reported high levels of initial acceptance of a brief behavioral intervention, care is needed to ensure that brief interventions, and the training of providers on brief interventions, incorporate cultural attitudes and norms around sex, particularly in highly patriarchal settings, and provide opportunities for providers to practice the intervention in ways that address their assumptions and implicit biases.

scholarly journals Implementing an Interdisciplinary Committee to Reduce Psychotropic Drug and Increase Behavioral Intervention Use

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 306-306
Author(s):  
Lauren Hess Conrad ◽  
David Portman
Keyword(s):  
Psychotropic Drug ◽  
Behavioral Intervention ◽  
Psychotropic Medication ◽  
Behavioral Interventions ◽  
Psychotropic Medications ◽  
Interdisciplinary Treatment ◽  
Fiscal Year ◽  
Term Care ◽  
Care Plans ◽  
And Behavior

Abstract In Fiscal Year (FY) 2018, the Butler VA Health Care System’s Psychotropic Medication and Behavior Management Committee was identified as a Veterans Integrated Service Network 4 Best Practice. The goal of this committee is to reduce unnecessary psychotropic medication use and polypharmacy and to increase behavioral intervention implementation among Community Living Center (CLC) Veterans. This committee meets quarterly to review Psychotropic Drug Safety Initiative data, behaviors and behavior care plans, and all psychotropic medications prescribed to Veterans. Psychiatric diagnoses, changes to psychotropic medications, and appropriate behavioral interventions are discussed. Committee members take responsibility for action items in accordance with their discipline; documentation of recommendations are made in quarterly behavioral health assessments in CPRS; and follow-up on action items is completed at twice weekly interdisciplinary treatment team meetings, weekly behavior rounds, and/or as needed. From the first quarter (Q1) of FY16 to Q1 FY20, the Butler VA CLC has seen decreased prescriptions of 2 or more anticholinergics (6.6% to 0.80%), antihistamines (12.5% to 5.9%), benzodiazepines (24.7% to 11.0%), and benzodiazepines or sedative hypnotics (23.2% to 9.0%). While prescription of antipsychotic use has increased (Q1 FY20 = 23.8%), the committee will follow Long Term Care Institute guidelines for gradual dose reductions, behavioral interventions, and as needed psychotropic medication PRN use. This committee provides an interdisciplinary forum to discuss and implement beneficial changes to pharmacological and non-pharmacological interventions among all CLC Veterans. The committee is a valuable process for monitoring and reinforcing best practices that may be easily replicated across VA CLCs nationwide.

scholarly journals Adherence to Behavioral Interventions for Urge Incontinence When Combined With Drug Therapy: Adherence Rates, Barriers, and Predictors

2010 ◽  
Vol 90 (10) ◽  
pp. 1493-1505 ◽  
Author(s):  
Diane Borello-France ◽  
Kathryn L. Burgio ◽  
Patricia S. Goode ◽  
Alayne D. Markland ◽  
Kimberly Kenton ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Pelvic Floor ◽  
Behavioral Intervention ◽  
Behavioral Interventions ◽  
Pelvic Floor Muscle ◽  
Exercise Adherence ◽  
Secondary Data ◽  
Prevention Strategies ◽  
Exercise Barriers

Background Behavioral intervention outcomes for urinary incontinence (UI) depend on active patient participation. Objective The purpose of this study was to describe adherence to behavioral interventions (pelvic-floor muscle [PFM] exercises, UI prevention strategies, and delayed voiding), patient-perceived exercise barriers, and predictors of exercise adherence in women with urge-predominant UI. Design This was a prospectively planned secondary data analysis from a 2-stage, multicenter, randomized clinical trial. Patients and Intervention Three hundred seven women with urge-predominant UI were randomly assigned to receive either 10 weeks of drug therapy only or 10 weeks of drug therapy combined with a behavioral intervention for UI. One hundred fifty-four participants who received the combined intervention were included in this analysis. Measurements Pelvic-floor muscle exercise adherence and exercise barriers were assessed during the intervention phase and 1 year afterward. Adherence to UI prevention strategies and delayed voiding were assessed during the intervention only. Results During intervention, 81% of women exercised at least 5 to 6 days per week, and 87% performed at least 30 PFM contractions per day. Ninety-two percent of the women used the urge suppression strategy successfully. At the 12-month follow-up, only 32% of the women exercised at least 5 to 6 days per week, and 56% performed 15 or more PFM contractions on the days they exercised. The most persistent PFM exercise barriers were difficulty remembering to exercise and finding time to exercise. Similarly, difficulty finding time to exercise persisted as a predictor of PFM exercise adherence over time. Limitations Co-administration of medication for UI may have influenced adherence. Conclusions Most women adhered to exercise during supervised intervention; however, adherence declined over the long term. Interventions to help women remember to exercise and to integrate PFM exercises and UI prevention strategies into daily life may be useful to promote long-term adherence.

A randomized clinical trial of home telemonitoring in patients with advanced heart and lung diseases.

2021 ◽  
pp. 1357633X2110597
Author(s):  
Carlos Hernandez-Quiles ◽  
Máximo Bernabeu-Wittel ◽  
Bosco Barón-Franco ◽  
Alfonso Aguirre Palacios ◽  
M Rocio Garcia-Serrano ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Functional Status ◽  
Integrated Care ◽  
Lung Diseases ◽  
Care Model ◽  
Emergency Admissions ◽  
Perceived Satisfaction ◽  
Lung Failure ◽  
Functional Features

Brief Summary The addition of home monitoring to an integrated care model in patients with advanced chronic heart/lung diseases decreases mortality, hospital and emergency admissions, improves functional status, HRQoL, and is cost-effective. Background Telemonitoring is a promising implement for medicine, but its efficacy is unknown in patients with advanced heart and lung failure (AHLF). Objective To determine the efficacy of a telemonitoring system added to coordinated clinical care in patients with AHLF. Design Randomized phase 3 multicenter clinical trial with parallel groups in adult patients. Participants Five spanish centers including patients with AHLF at discharge or in out-patient clinics. Intervention Patients were randomly assigned to receive a remote bio-parameters telemonitoring system (TELECARE) or best usual care (UCARE). TELECARE patients were provided with devices that collected symptoms and bio-parameters, and transferred them synchronously to a call-center, with a real-time health-care response. Main Measures Primary end point was the need of admissions/emergency room visits at 45, 90, 180 days. Secondary end points included health care requirements, mortality, functional assessment, health related quality of life (HRQoL), perceived satisfaction, and cost-efficacy. Results 510 patients were included (54.5% women, median age 76.5 years; 63.1% suffered heart failure, 13.9% lung failure, and 22.9% both conditions). Clinical and functional features were comparable in both arms. TELECARE globally needed less admissions with respect UCARE after 45 days of inclusion (35.4% vs. 46.9%, p < 0.05). This tendency was maintained in the subgroups of patients with multimorbidity (34.2% vs. 46.9%, p < 0.05), intermediate risk of mortality (36.5% vs. 51.1%, p < 0.05), and those included after hospital discharge (34.9% vs. 50.5%, p < 0.01). HRQoL significantly improved (TELECARE/UCARE EuroQol baseline of 56.2 ± 18.2/55.1 ± 19.7, p = 0.054, and 64 ± 19.9/56.3 ± 21.6; p < 0.01 at the end), and perceived satisfaction was also higher (6.77 ± 0.52 vs. 6.62 ± 0.81, p < 0.001; highest possible score = 7). A trend to mortality decrease was also observed (12.9% vs. 19.3%, p = 0.13). TELECARE was cost-efficacious (TELECARE/UCARE QALY 3.94 Euros/0.81Euros). Conclusions The addition of a telemonitoring system to an integrated care model in patients with AHLF decreases hospital and emergency admissions, improves functional status as well as HRQoL, and is cost-efficacious.

When Outpatient Care Is Not Enough: Successful Use of an Inpatient Behavioral Intervention for a Child With ARFID

2018 ◽  
Vol 17 (6) ◽  
pp. 469-481 ◽  
Author(s):  
Katrina R. Lenz ◽  
Laurie A. Mitan ◽  
Susan R. Kleinhenz ◽  
Abigail Matthews
Keyword(s):  
Behavioral Intervention ◽  
Outpatient Care ◽  
Behavioral Interventions ◽  
Best Practice ◽  
Fluid Intake ◽  
Multidisciplinary Care ◽  
Body Image Disturbance ◽  
Drive For Thinness ◽  
Psychosocial Impairment ◽  
Food And Fluid Intake

Avoidant/restrictive food intake disorder (ARFID) is characterized by restrictive eating in the absence of body image disturbance or drive for thinness, resulting in the persistent failure to meet appropriate nutritional and/or energy needs and/or psychosocial impairment. ARFID is a heterogeneous diagnosis with diverse etiologies. Thus, identification of best practice guidelines and evidence-based treatments for ARFID is challenging and, to our knowledge, randomized treatment studies have not been published. Existing literature promotes a multidisciplinary care approach that integrates behavioral, cognitive behavioral, and family-based interventions. In this report, we present the case of an 8-year-old female with ARFID who began restricting her food and fluid intake following a viral illness. The patient also choked on a lozenge at school and peers laughed in response, resulting in heightened fears of eating, subsequent dehydration, and admission to a gastroenterology unit at a pediatric hospital. While hospitalized, she was diagnosed with ARFID, a nasogastric tube (NGT) was placed, and was referred to outpatient eating disorder specialists. Despite participating in 16-outpatient therapy sessions, progress was limited and the patient was medically admitted to safely remove the NGT in the context of behavioral interventions targeting food refusal. This case report describes the successful use of an intensive inpatient behavioral intervention used for the patient, which resulted in the rapid resumption of food and fluid intake, by mouth. This case study supports the use of such intervention for ARFID when sufficient progress is not achieved in outpatient care.

scholarly journals Homelessness and integrated care: an application of integrated care knowledge to understanding services for wicked issues

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Michael Clark ◽  
Michelle Cornes ◽  
Martin Whiteford ◽  
Robert Aldridge ◽  
Elizabeth Biswell ◽  
...  
Keyword(s):  
Integrated Care ◽  
Hospital Discharge ◽  
Secondary Analysis ◽  
Policy Issue ◽  
Content Type ◽  
Complex Needs ◽  
Integration Of Services ◽  
Key Issues ◽  
Discharge From Hospital ◽  
High Degree

PurposePeople experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wicked policy issue. The purpose of this paper is to examine the challenge of integrating care in this context using evidence from an evaluation of English hospital discharge services for people experiencing homelessness.Design/methodology/approachThe paper undertakes secondary analysis of qualitative data from a mixed methods evaluation of hospital discharge schemes and uses an established framework for understanding integrated care, the Rainbow Model of Integrated Care (RMIC), to help examine the complexities of integration in this area.FindingsSupporting people experiencing homelessness to have a good discharge from hospital was confirmed as a wicked policy issue. The RMIC provided a strong framework for exploring the concept of integration, demonstrating how intertwined the elements of the framework are and, hence, that solutions need to be holistically organised across the RMIC. Limitations to integration were also highlighted, such as shortages of suitable accommodation and the impacts of policies in aligned areas of the welfare state.Research limitations/implicationsThe data for this secondary analysis were not specifically focussed on integration which meant the themes in the RMIC could not be explored directly nor in as much depth. However, important issues raised in the data directly related to integration of support, and the RMIC emerged as a helpful organising framework for understanding integration in this wicked policy context.Practical implicationsIntegration is happening in services directly concerned with the discharge from hospital of people experiencing homelessness. Key challenges to this integration are reported in terms of the RMIC, which would be a helpful framework for planning better integrated care for this area of practice.Social implicationsAddressing homelessness not only requires careful planning of integration of services at specific pathway points, such as hospital discharge, but also integration across wider systems. A complex set of challenges are discussed to help with planning the better integration desired, and the RMIC was seen as a helpful framework for thinking about key issues and their interactions.Originality/valueThis paper examines an application of integrated care knowledge to a key complex, or wicked policy issue.

scholarly journals TESTING THE EFFECTIVENESS OF INTEGRATED ELDERLY CARE MODEL ON QUALITY OF CARE AND HEALTH OUTCOMES AMONG HOSPITALIZED ELDERLIES IN WEST BANK

2020 ◽  
Vol 20 (1) ◽  
pp. 82-89
Author(s):  
Atef H. Khatib ◽  
Ayman M. Hamdan- Mansour ◽  
Hamza F. Ratrout ◽  
Atallah Alenezi ◽  
Tala R. Chahien
Keyword(s):  
Time Series ◽  
Quality Of Care ◽  
Integrated Care ◽  
Older Patients ◽  
West Bank ◽  
Elderly Care ◽  
Multiple Time ◽  
Ageing Population ◽  
Care Model

The rapid increase in the ageing population and health conditions are imposing a higher challenge to the health care system that requires multidisciplinary teamwork utilizing coordinated care approach. This study examined the effects of integrated care model on quality of care received by older hospitalized patients in West Bank. A quantitative interrupted time series design (pretest and posttest multiple time series, quasi-experiment design) was used. The study examined the effects of integrated care model on admitted older patients (n=32) in the West Bank measuring ten dimensions of quality of care and four health indicators. There was a significant improvement in the dimensions of quality of care: dimensions: nurses’ communications with patients, physicians’ communications with patients, staff response to patients’ needs, pain management, explanations on medications, amount of information given on discharge plan, patients' area cleanliness, patients' area quietness, rating of the hospital, and willingness to recommend the hospital. Incidence of falls and incidence of pressure ulcer improved after implementing the model, while readmission rate and average length of stay did not improve. This study contributed to the limited body of knowledge related to the effect of integrated care model on hospitalized older patients’ quality of care in Palestine/ West Bank. Integrated care has the potential to improve care outcomes among hospitalized older patients.

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