scholarly journals Effectiveness and cost effectiveness of syndromic sexually transmitted infection packages in South African primary care: cluster randomised trial

2006 ◽  
Vol 82 (4) ◽  
pp. 290-294 ◽  
Author(s):  
M Colvin
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
South African ◽  
Sexually Transmitted Infection ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Cluster Randomised

scholarly journals Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e030110 ◽  
Author(s):  
Joanna Thorn ◽  
Mei-See Man ◽  
Katherine Chaplin ◽  
Peter Bower ◽  
Sara Brookes ◽  
...  
Keyword(s):  
Primary Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Randomised Trial ◽  
Mean Difference ◽  
Secondary Outcome ◽  
Cluster Randomised Trial ◽  
Cluster Randomised ◽  
The Cost

ObjectivePatients with multiple chronic health conditions are often managed in a disjointed fashion in primary care, with annual review clinic appointments offered separately for each condition. This study aimed to determine the cost-effectiveness of the 3D intervention, which was developed to improve the system of care.DesignEconomic evaluation conducted alongside a pragmatic cluster-randomised trial.SettingGeneral practices in three centres in England and Scotland.Participants797 adults with three or more chronic conditions were randomised to the 3D intervention, while 749 participants were randomised to receive usual care.InterventionThe 3D approach: comprehensive 6-monthly general practitioner consultations, supported by medication reviews and nurse appointments.Primary and secondary outcome measuresThe primary economic evaluation assessed the cost per quality-adjusted life year (QALY) gained from the perspective of the National Health Service (NHS) and personal social services (PSS). Costs were related to changes in a range of secondary outcomes (QALYs accrued by both participants and carers, and deaths) in a cost–consequences analysis from the perspectives of the NHS/PSS, patients/carers and productivity losses.ResultsVery small increases were found in both QALYs (adjusted mean difference 0.007 (−0.009 to 0.023)) and costs (adjusted mean difference £126 (£−739 to £991)) in the intervention arm compared with usual care after 15 months. The incremental cost-effectiveness ratio was £18 499, with a 50.8% chance of being cost-effective at a willingness-to-pay threshold of £20 000 per QALY (55.8% at £30 000 per QALY).ConclusionsThe small differences in costs and outcomes were consistent with chance, and the uncertainty was substantial; therefore, the evidence for the cost-effectiveness of the 3D approach from the NHS/PSS perspective should be considered equivocal.Trial registration numberISCRTN06180958

scholarly journals Integrated management of atrial fibrillation including tailoring of anticoagulation in primary care: study design of the ALL-IN cluster randomised trial

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e015510 ◽  
Author(s):  
Carline J van den Dries ◽  
Ruud Oudega ◽  
Arif Elvan ◽  
Frans H Rutten ◽  
Sjef J C M van de Leur ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Cost Effectiveness ◽  
The Netherlands ◽  
Major Bleeding ◽  
Dominant Role ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Ageing Society ◽  
Cluster Randomised

IntroductionIn our ageing society, we are at the merge of an expected epidemic of atrial fibrillation (AF). AF management requires an integrated approach, including rate or rhythm control, stroke prevention with anticoagulation and treatment of comorbidities such as heart failure or type 2 diabetes. As such, primary care seems to be the logical healthcare setting for the chronic management of patients with AF. However, primary care has not yet played a dominant role in AF management, which has been in fact more fragmented between different healthcare providers. This fragmentation might have contributed to high healthcare costs. To demonstrate the feasibility of managing AF in primary care, studies are needed that evaluate the safety and (cost-)effectiveness of integrated AF management in primary care.Methods and analysisThe ALL-IN trial is a multicentre, pragmatic, cluster randomised, non-inferiority trial performed in primary care practices in a suburban region in the Netherlands. We aim to include a minimum of 1000 patients with AF aged 65 years or more from around 18 to 30 practices. Duration of the study is 2 years. Practices will be randomised to either the intervention arm (providing integrated AF management, involving a trained practice nurse and collaboration with secondary care) or the control arm (care as usual). The primary endpoint is all-cause mortality. Secondary endpoints are cardiovascular mortality, (non)-cardiovascular hospitalisation, major adverse cardiac events, stroke, major bleeding, clinically relevant non-major bleeding, quality of life and cost-effectiveness.Ethics and disseminationThe protocol was approved by the Medical Ethical Committee of the Isala Hospital Zwolle, the Netherlands. Patients in the intervention arm will be asked informed consent for participating in the intervention. Results are expected in 2019 and will be disseminated through both national and international journals and conferences.Trial registration numberThis trial is registered at the Netherlands Trial Register (NTR5532).

scholarly journals P3.380 Baseline Results of a Cluster-Randomised Trial Assessing the Effectiveness of Sport-Based HIV Prevention in South African Schools

2013 ◽  
Vol 89 (Suppl 1) ◽  
pp. A268.1-A268
Author(s):  
Z A Kaufman ◽  
E B Kaufman ◽  
S Dringus ◽  
H A Weiss ◽  
S Delany-Moretlwe ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
South African ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

scholarly journals Impact of patient education on chronic heart failure in primary care (ETIC): a cluster randomised trial

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Hélène Vaillant-Roussel ◽  
Catherine Laporte ◽  
Bruno Pereira ◽  
Marion De Rosa ◽  
Bénédicte Eschalier ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Chronic Heart Failure ◽  
Patient Education ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

scholarly journals Association between eye diagnosis and positive syphilis test results in a large, urban sexually transmitted infection/primary care clinic population

2017 ◽  
Vol 29 (4) ◽  
pp. 357-361 ◽  
Author(s):  
Ann-Marie Lobo ◽  
Yan Gao ◽  
Laura Rusie ◽  
Magda Houlberg ◽  
Supriya D Mehta
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Sexually Transmitted Infection ◽  
Laboratory Data ◽  
Primary Care Clinic ◽  
Eye Disease ◽  
Hiv Status ◽  
Transmitted Infection ◽  
Care Clinic ◽  
Sexually Transmitted

In 2015, the Centers for Disease Control and Prevention (CDC) and the American Academy of Ophthalmology (AAO) released clinical advisories on rising cases of ocular syphilis. We examined the association between eye disease and syphilis infection among primary care and sexually transmitted infection (STI) clinic patients attending an urban lesbian, gay, bisexual, transgender (LGBT) health center. We conducted a retrospective medical record review of all patients who underwent syphilis testing at Howard Brown Health between 1 January 2010 and 31 December 2015. Confirmed eye diagnosis was based on International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes for conjunctivitis, uveitis, keratitis, retinitis, and red eye. Demographic information, syphilis treatment, HIV status, and high-risk behaviors were abstracted. Syphilis diagnosis was defined by available laboratory data (enzyme immunoassay [EIA], rapid plasma reagin [RPR] titer, fluorescent treponemal antibody absorption [FTA-Abs], Treponema pallidum Ab). Multivariable logistic regression with robust variance was used to identify independent associations. During the study period, 71,299 syphilis tests were performed on 30,422 patients. There were 2288 (3.2%) positive syphilis tests. Seventy-seven patients had a confirmed eye diagnosis (0.25%). Patients with eye disease had higher probability of at least one positive syphilis test (33%) compared to those without eye disease (8%) ( p < 0.01). Of patients with eye disease, 77% were men who had sex with men (MSM) and 65% were HIV-positive. Patients with eye disease had 5.97 (95% CI: 3.70, 9.63) higher odds of having syphilis compared to patients without eye disease. When adjusted for age, race, gender/sexual orientation, insurance status, and HIV status, this association between positive syphilis test and eye disease decreased but was still significant (OR 2.00, 95% CI 1.17, 3.41). Patients who present with an eye diagnosis to STI/primary care clinic have a higher probability of positive syphilis tests even after adjusting for other risk factors for syphilis. High-risk patients with eye symptoms should have routine STI testing and in keeping with CDC and AAO recommendations, full ophthalmologic examination.

Using mHealth tools to improve access, coverage and treatment of uninsured people with high cardiovascular disease risk in Argentina: a study protocol for a pragmatic cluster randomised trial

2018 ◽  
Vol 4 (3) ◽  
pp. 135-141 ◽  
Author(s):  
Shafika Abrahams-Gessel ◽  
Andrea Beratarrechea ◽  
Vilma Irazola ◽  
Laura Gutierrez ◽  
Daniela Moyano ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
High Risk ◽  
Randomised Trial ◽  
Text Messages ◽  
Cluster Randomised Trial ◽  
Cvd Risk ◽  
High Risk Patients ◽  
Cluster Randomised ◽  
Risk Patients

IntroductionCardiovascular disease (CVD) accounts for approximately one-third of Argentina’s deaths. Despite government provision of free primary care health services to the uninsured population, with a focus on non-communicable diseases, screening and management of those with high CVD risk at primary care clinics (PCCs) remain low.Methods and analysisThis pragmatic cluster randomised trial will take place in two provinces of Argentina and will recruit 740 participants. Eight PCCs will be randomised to either the intervention or current practice arm. Community health workers (CHWs) in the intervention arm will be trained to use a set of integrated mHealth tools (a validated risk screening tool mobile application; electronic scheduling system using wireless access to PCCs; and educational text messages) to screen for CVD and to schedule appointments with primary care providers for persons with high CVD risk (≥10%). The primary aims of this study are to determine if the use of mHealth tools will (1) increase attendance of first appointments scheduled by CHWs for persons determined to have high risk for CVD during screening and, (2) lead to an increase in follow-up visits at PCCs by high risk patients. Secondary outcomes include assessing the proportion of high-risk patients receiving appropriate medications and a cost-effective analysis of the intervention.Ethics and disseminationThis study has been approved by the Institutional Review Boards at Partners/Brigham and Women’s Hospital (USA) and the Hospital Italiano de Buenos Aires (Argentina). The open-source software for the mHealth tools will be made publicly available at the end of the study.Trial registration numberNCT02913339.

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