P09.01 Cost-effectiveness of testing fortrichomonas vaginalisin genitourinary medicine clinics and primary care in england using aptima tv naat

ObjectivesMental health disorders contribute significantly to the global burden of disease and lead to extensive strain on health systems. The integration of mental health workers into primary care has been proposed as one possible solution, but evidence of clinical and cost effectiveness of this approach is unclear. We reviewed the clinical and cost effectiveness of mental health workers colocated within primary care practices.DesignSystematic literature review.Data sourcesWe searched the Medline, Embase, PsycINFO, Healthcare Management Information Consortium (HMIC) and Global Health databases.Eligibility criteriaAll quantitative studies published before July 2019 were eligible for the review; participants of any age and gender were included. Studies did not need to report a certain outcome measure or comparator in order to be eligible.Data extraction and synthesisData were extracted using a standardised table; however, pooled analysis proved unfeasible. Studies were assessed for risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool and the Cochrane collaboration’s tool for assessing risk of bias in randomised trials.ResultsFifteen studies from four countries were included. Mental health worker integration was associated with mental health benefits to varied populations, including minority groups and those with comorbid chronic diseases. Furthermore, the interventions were correlated with high patient satisfaction and increases in specialist mental health referrals among minority populations. However, there was insufficient evidence to suggest clinical outcomes were significantly different from usual general practitioner care.ConclusionsWhile there appear to be some benefits associated with mental health worker integration in primary care practices, we found insufficient evidence to conclude that an onsite primary care mental health worker is significantly more clinically or cost effective when compared with usual general practitioner care. There should therefore be an increased emphasis on generating new evidence from clinical trials to better understand the benefits and effectiveness of mental health workers colocated within primary care practices.

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A referral aid for smoking cessation interventions in primary care: study protocol for a randomized controlled trial

Primary Health Care Research & Development ◽

10.1017/s1463423621000244 ◽

2021 ◽

Vol 22 ◽

Author(s):

Daniëlle N. Zijlstra ◽

Jean W.M. Muris ◽

Catherine Bolman ◽

J. Mathis Elling ◽

Vera E.R.A. Knapen ◽

...

Keyword(s):

Primary Care ◽

Decision Making ◽

Smoking Cessation ◽

Cost Effectiveness ◽

Structural Equation ◽

Controlled Trial ◽

Linear Regression Analysis ◽

Informed Decision ◽

Equation Modeling ◽

Informed Decision Making

Abstract Background: To expedite the use of evidence-based smoking cessation interventions (EBSCIs) in primary care and to thereby increase the number of successful quit attempts, a referral aid was developed. This aid aims to optimize the referral to and use of EBSCIs in primary care and to increase adherence to Dutch guidelines for smoking cessation. Methods: Practice nurses (PNs) will be randomly allocated to an experimental condition or control condition, and will then recruit smoking patients who show a willingness to quit smoking within six months. PNs allocated to the experimental condition will provide smoking cessation guidance in accordance with the referral aid. Patients from both conditions will receive questionnaires at baseline and after six months. Cessation effectiveness will be tested via multilevel logistic regression analyses. Multiple imputations as well as intention to treat analysis will be performed. Intervention appreciation and level of informed decision-making will be compared using analysis of (co)variance. Predictors for appreciation and informed decision-making will be assessed using multiple linear regression analysis and/or structural equation modeling. Finally, a cost-effectiveness study will be conducted. Discussion: This paper describes the study design for the development and evaluation of an information and decision tool to support PNs in their guidance of smoking patients and their referral to EBSCIs. The study aims to provide insight into the (cost) effectiveness of an intervention aimed at expediting the use of EBSCIs in primary care.

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Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review

British Journal of General Practice ◽

10.3399/bjgp19x706745 ◽

2019 ◽

Vol 69 (689) ◽

pp. e809-e818 ◽

Cited By ~ 3

Author(s):

Sophie Chima ◽

Jeanette C Reece ◽

Kristi Milley ◽

Shakira Milton ◽

Jennifer G McIntosh ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Decision Making ◽

Decision Support ◽

Cost Effectiveness ◽

Cancer Diagnosis ◽

Decision Support Tools ◽

Diagnostic Decision ◽

Support Tools ◽

Diagnostic Decision Making

BackgroundThe diagnosis of cancer in primary care is complex and challenging. Electronic clinical decision support tools (eCDSTs) have been proposed as an approach to improve GP decision making, but no systematic review has examined their role in cancer diagnosis.AimTo investigate whether eCDSTs improve diagnostic decision making for cancer in primary care and to determine which elements influence successful implementation.Design and settingA systematic review of relevant studies conducted worldwide and published in English between 1 January 1998 and 31 December 2018.MethodPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, and a consultation of reference lists and citation tracking was carried out. Exclusion criteria included the absence of eCDSTs used in asymptomatic populations, and studies that did not involve support delivered to the GP. The most relevant Joanna Briggs Institute Critical Appraisal Checklists were applied according to study design of the included paper.ResultsOf the nine studies included, three showed improvements in decision making for cancer diagnosis, three demonstrated positive effects on secondary clinical or health service outcomes such as prescribing, quality of referrals, or cost-effectiveness, and one study found a reduction in time to cancer diagnosis. Barriers to implementation included trust, the compatibility of eCDST recommendations with the GP’s role as a gatekeeper, and impact on workflow.ConclusioneCDSTs have the capacity to improve decision making for a cancer diagnosis, but the optimal mode of delivery remains unclear. Although such tools could assist GPs in the future, further well-designed trials of all eCDSTs are needed to determine their cost-effectiveness and the most appropriate implementation methods.

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Cost-effectiveness of Treatments for Major Depression in Primary Care Practice

Archives of General Psychiatry ◽

10.1001/archpsyc.55.7.645 ◽

1998 ◽

Vol 55 (7) ◽

pp. 645 ◽

Cited By ~ 169

Author(s):

Judith R. Lave ◽

Richard G. Frank ◽

Herbert C. Schulberg ◽

Mark S. Kamlet

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Major Depression ◽

Primary Care Practice ◽

Care Practice

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PGI10 COST EFFECTIVENESS OF PROTON PUMP INHIBITOR TRIPLE THERAPY REGIMENS FOR HELICOBACTER PYLORI ERADICATION IN THE PRIMARY CARE SETTING IN IRELAND

Value in Health ◽

10.1016/s1098-3015(10)67517-1 ◽

2005 ◽

Vol 8 (6) ◽

pp. A121

Author(s):

V Nagle ◽

C O'Morain ◽

K Bennett ◽

P Keeling ◽

M Barry

Keyword(s):

Primary Care ◽

Helicobacter Pylori ◽

Cost Effectiveness ◽

Proton Pump Inhibitor ◽

Triple Therapy ◽

Proton Pump ◽

Care Setting ◽

Primary Care Setting ◽

Helicobacter Pylori Eradication

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A comparison of the cost-effectiveness of sertraline versus tricyclic antidepressants in primary care

Journal of Affective Disorders ◽

10.1016/0165-0327(95)00098-4 ◽

1996 ◽

Vol 38 (2-3) ◽

pp. 97-111 ◽

Cited By ~ 25

Author(s):

J Forder

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Tricyclic Antidepressants ◽

The Cost

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Effectiveness and cost-effectiveness of implementing HIV testing in primary care in East London: protocol for an interrupted time series analysis

BMJ Open ◽

10.1136/bmjopen-2017-018163 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018163 ◽

Cited By ~ 2

Author(s):

Werner Leber ◽

Lee Beresford ◽

Claire Nightingale ◽

Estela Capelas Barbosa ◽

Stephen Morris ◽

...

Keyword(s):

Primary Care ◽

Time Series ◽

General Practice ◽

Cost Effectiveness ◽

Hiv Testing ◽

Cost Effective ◽

Interrupted Time Series ◽

Rapid Hiv Testing ◽

Post Trial ◽

Implementation Programme

IntroductionHIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised controlled trial, we showed that providing training and rapid point-of-care HIV testing at general practice registration (RHIVA2 intervention) in Hackney led to cost-effective, increased and earlier diagnosis of HIV. However, interventions effective in a trial context may be less so when implemented in routine practice. We describe the protocol for an MRC phase IV implementation programme, evaluating the impact of rolling out the RHIVA2 intervention in a post-trial setting. We will use a longitudinal study to examine if the post-trial implementation in Hackney practices is effective and cost-effective, and a cross-sectional study to compare Hackney with two adjacent boroughs providing usual primary care (Newham) and an enhanced service promoting HIV testing in primary care (Tower Hamlets).Methods and analysisService evaluation using interrupted time series and cost-effectiveness analyses. We will include all general practices in three contiguous high HIV prevalence East London boroughs. All adults aged 16 and above registered with the practices will be included. The interventions to be examined are: a post-trial RHIVA2 implementation programme (including practice-based education and training, external quality assurance, incentive payments for rapid HIV testing and incorporation of rapid HIV testing in the sexual health Local Enhanced Service) in Hackney; the general practice sexual health Network Improved Service in Tower Hamlets and usual care in Newham. Coprimary outcomes are rates of HIV testing and new HIV diagnoses.Ethics and disseminationThe chair of the Camden and Islington NHS Research Ethics Committee, London, has endorsed this programme as an evaluation of routine care. Study results will be published in peer-reviewed journals and reported to commissioners.

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