scholarly journals A retrospective cohort study on a pharmaceutical consultation mode of multidisciplinary individualized medication recommendations

2021 ◽  
Author(s):  
Xiucong Fan ◽  
Danxia Chen ◽  
Siwei Bao ◽  
Rong Bai ◽  
Fang Fang ◽  
...  
Keyword(s):  
Intervention Group ◽  
Evaluation Criteria ◽  
Acceptance Rate ◽  
Post Intervention ◽  
Clinical Pharmacists ◽  
Effectiveness Rate ◽  
Rational Drug ◽  
Group A ◽  
Post Intervention Group

Aims: To develop a pharmaceutical consultation mode of multidisciplinary individualized medication recommendations, to improve the quantity and quality of clinical pharmacists’ consultations Methods: A retrospective study of 542 clinical pharmacists-led consultations was conducted. In the pre-intervention group, medication advice was given based on the purpose of the consultation. In the post-intervention group, a consultation mode of multidisciplinary individualized medication recommendation was implemented, in which clinical pharmacists with specialties of anticoagulation, gastroenterology and nutrition were asked to give individualized medication recommendations and a set of evaluation criteria for rational drug use was formulated. Outcomes, including the patterns and number of consultations, individualized medication recommendations, acceptance rate and effectiveness rate, were compared between the two periods. Results: A total of 651 cases were reviewed, and 542 cases of which meeting the predesigned inclusion and exclusion criteria were included, with 94 and 448 patients in the pre-intervention and post-intervention groups, respectively. The total number of consultations increased year by year, so did the number of general consultations, multidisciplinary difficult consultations, departments applying for general consultations, departments applying for multidisciplinary difficult consultations, anti-infection consultations and non-anti-infection consultations in details. The effectiveness rate of consultations in the post-intervention group was 81.7% vs 70.2% in the pre-intervention group (P < 0.05). No difference was shown between two groups in acceptance rate (96.9% vs 95.7%, p=0.578).

scholarly journals 87. Utilization of Methicillin-Sensitive/Resistant Staphylococcus aureus Nares Screen to Decrease Vancomycin and Linezolid Use in Hospitalized Patients with Respiratory Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S60-S60
Author(s):  
Noor F Zaidan ◽  
Rachel S Britt ◽  
David Reynoso ◽  
R Scott Ferren
Keyword(s):  
Staphylococcus Aureus ◽  
Respiratory Infections ◽  
Intervention Group ◽  
Kidney Injury ◽  
Post Intervention ◽  
Gram Positive ◽  
Stewardship Program ◽  
Screening Protocol ◽  
The Impact ◽  
Post Intervention Group

Abstract Background Pharmacist-driven protocols for utilization of methicillin-resistant Staphylococcus aureus (MRSA) nares screenings have shown to decrease duration of empiric gram-positive therapy and rates of acute kidney injury (AKI) in patients with respiratory infections. This study evaluated the impact of a pharmacist-driven MRSA nares screening protocol on duration of vancomycin or linezolid therapy (DT) in respiratory infections. Methods Patients aged 18 years and older with a medication order of vancomycin or linezolid for respiratory indication(s) were included. The MRSA nares screening protocol went into effect in October 2019. The protocol allowed pharmacists to order an MRSA nares polymerase chain reaction (PCR) for included patients, while the Antimicrobial Stewardship Program (ASP) made therapeutic recommendations for de-escalation of empiric gram-positive coverage based on negative MRSA nares screenings, if clinically appropriate. Data for the pre-intervention group was collected retrospectively for the months of October 2018 to March 2019. The post-intervention group data was collected prospectively for the months of October 2019 to March 2020. Results Ninety-seven patients were evaluated within both the pre-intervention group (n = 50) and post-intervention group (n = 57). Outcomes for DT (38.2 hours vs. 30.9 hours, P = 0.601) and AKI (20% vs. 14%, P = 0.4105) were not different before and after protocol implementation. A subgroup analysis revealed a significant reduction in DT within the pre- and post-MRSA PCR groups (38.2 hours vs. 24.8 hours, P = 0.0065) when pharmacist recommendations for de-escalation were accepted. Conclusion A pharmacist-driven MRSA nares screening protocol did not affect the duration of gram-positive therapy for respiratory indications. However, there was a reduction in DT when pharmacist-driven recommendations were accepted. Disclosures All Authors: No reported disclosures

scholarly journals 110. Impact of Diagnostic and Antimicrobial Stewardship on Time-to-Appropriate Therapy and Clinical Outcomes in Multi-Drug Resistant Pseudomonas Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S69-S70
Author(s):  
Katie A McCrink ◽  
Kailynn DeRonde ◽  
Adriana Jimenez ◽  
Gemma Rosello ◽  
Yoichiro Natori ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Patient Survival ◽  
Intervention Group ◽  
Culture Collection ◽  
Drug Resistant ◽  
Intervention Period ◽  
Post Intervention ◽  
Appropriate Therapy ◽  
Post Intervention Group

Abstract Background Timely effective therapy in multi-drug resistant (MDR) Pseudomonas (PsA) infections has a direct impact on patient survival. We aimed to determine the impact of diagnostic and antimicrobial stewardship (AMS) on time-to-appropriate therapy (TAP) and clinical outcomes of patients with MDR PsA infections utilizing novel beta-lactam/beta-lactamase inhibitors (BL/BLIs). Methods Retrospective cohort study of adult patients with MDR PsA infections at a 1,500-bed University-affiliated public hospital in Miami, Florida who received ≥72 hours of ceftazidime-avibactam (C/A) or ceftolozane-tazobactam (C/T). During the pre-intervention period (12/2017-12/2018), additional susceptibilities for C/A and C/T were performed upon providers’ request. In the post intervention period (01/2019 – 12/2019), we implemented automatic reflex algorithms (Figure 1) for faster identification and susceptibilities for MDR PsA, including carbapenemase producers. Results were communicated in real-time to the AMS team. Figure 1. Reflex Testing Algorithm for MDR Pseudomonas Isolates from Any Source Results Seventy-six patients were included; median age was 56 years (IQR 37.5–67.0), 40 (52.6%) were in an intensive care unit at time of culture collection; median APACHE II score was 20 (IQR 15.0 – 26.0). Three isolates were carbapenemase producers (VIM = 2; KPC = 1). The most common infections were pneumonia (56.6%) and bacteremia (18.4%). We found a significant decrease in median TAP (120.1 [IQR 82.5–164.6] vs 75.9 [IQR 51.3–101.7] hours, p = 0.003). Median time from culture collection to final susceptibility results was shorter in the post-intervention group (122.2 vs 90.5 hours; p &lt; 0.001). Median length-of-stay after culture collection was numerically lower in the post-intervention group (26.0 [11.6–59.4] vs 19.7 [12.9–37.8] days; p = 0.33). Controlling for ICU admission, our intervention was not associated with decreased 30-day inpatient mortality (OR = 1.62, 95% CI 0.45–5.79). Conclusion Our study identified an improvement in TAP in MDR PsA infections with implementation of diagnostic and AMS initiatives. In an adequately powered study, our intervention could potentially impact patient survival through timely initiation of effective therapy with novel BL/BLIs. Disclosures All Authors: No reported disclosures

scholarly journals Implementation of an Emergency Department Sepsis Bundle and System Redesign: A Process Improvement Initiative

CJEM ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 112-121 ◽  
Author(s):  
Tamara McColl ◽  
Mathieu Gatien ◽  
Lisa Calder ◽  
Krishan Yadav ◽  
Ryan Tam ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Intervention Group ◽  
Critical Conditions ◽  
Absolute Difference ◽  
Antibiotic Administration ◽  
Post Intervention ◽  
Sepsis Management ◽  
Sepsis Bundle ◽  
Post Intervention Group

AbstractBackgroundIn 2008–2009, the Canadian Institute for Health Information reported over 30,000 cases of sepsis hospitalizations in Canada, an increase of almost 4,000 from 2005. Mortality rates from severe sepsis and septic shock continue to remain greater than 30% in Canada and are significantly higher than other critical conditions treated in the emergency department (ED). Our group formed a multidisciplinary sepsis committee, conducted an ED process of care analysis, and developed a quality improvement protocol. The objective of this study was to evaluate the effects of this sepsis management bundle on patient mortality.MethodsThis before and after study was conducted in two large Canadian tertiary care EDs and included adult patients with suspected severe infection that met at least two systemic inflammatory response syndrome (SIRS) criteria. We studied the implementation of a sepsis bundle including triage flagging, RN medical directive, education campaign, and a modified sepsis protocol. The primary outcomes were 30-day all-cause mortality and sepsis protocol use.ResultsWe included a total of 167 and 185 patients in the pre- and post-intervention analysis, respectively. Compared to the pre-intervention group, mortality was significantly lower in the post-intervention group (30.7% versus 17.3%; absolute difference, 13.4%; 95% CI 9.8–17.0; p=0.006). There was also a higher rate of sepsis protocol use in the post-intervention group (20.3% versus 80.5%, absolute difference 60.2%; 95% CI 55.1–65.3; p<0.001). Additionally, we found shorter time-intervals from triage to MD assessment, fluid resuscitation, and antibiotic administration as well as lower rates of vasopressor requirements and ICU admission.InterpretationThe implementation of our multidisciplinary ED sepsis bundle, including improved early identification and protocolized medical care, was associated with improved time to achieve key therapeutic interventions and a reduction in 30-day mortality. Similar low-cost initiatives could be implemented in other EDs to potentially improve outcomes for this high-risk group of patients.

scholarly journals Group-based music intervention in Parkinson’s disease – findings from a mixed-methods study

2020 ◽  
Vol 34 (4) ◽  
pp. 533-544
Author(s):  
Petra Pohl ◽  
Ewa Wressle ◽  
Fredrik Lundin ◽  
Paul Enthoven ◽  
Nil Dizdar
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
Intervention Group ◽  
Group Differences ◽  
Control Group ◽  
Music Intervention ◽  
Post Intervention

Objective: To evaluate a group-based music intervention in patients with Parkinson’s disease. Design: Parallel group randomized controlled trial with qualitative triangulation. Setting: Neurorehabilitation in primary care. Subjects: Forty-six patients with Parkinson’s disease were randomized into intervention group ( n = 26), which received training with the music-based intervention, and control group ( n = 20) without training. Interventions: The intervention was delivered twice weekly for 12 weeks. Main measures: Primary outcome was Timed-Up-and-Go subtracting serial 7’s (dual-task ability). Secondary outcomes were cognition, balance, concerns about falling, freezing of gait, and quality of life. All outcomes were evaluated at baseline, post-intervention, and three months post-intervention. Focus groups and individual interviews were conducted with the intervention group and with the delivering physiotherapists. Results: No between-group differences were observed for dual-task ability. Between-group differences were observed for Falls Efficacy Scale (mean difference (MD) = 6.5 points; 95% confidence interval (CI) = 3.0 to 10.0, P = 0.001) and for Parkinson Disease Questionnaire-39 items (MD = 8.3; 95% CI = 2.7 to 13.8, P = 0.005) when compared to the control group post-intervention, but these were not maintained at three months post-intervention. Three themes were derived from the interviews: Expectations versus Results, Perspectives on Treatment Contents, and Key Factors for Success. Conclusion: Patient-reported outcomes and interviews suggest that the group-based music intervention adds value to mood, alertness, and quality of life in patients with Parkinson’s disease. The study does not support the efficacy in producing immediate or lasting gains in dual-tasking, cognition, balance, or freezing of gait.

scholarly journals 1774. Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S654-S654
Author(s):  
Matthew Moffa ◽  
Rawiya Elrufay ◽  
Thomas L Walsh ◽  
Dustin R Carr ◽  
Nathan Shively ◽  
...  
Keyword(s):  
Multiplex Polymerase Chain Reaction ◽  
Intervention Group ◽  
Turnaround Time ◽  
Cns Infection ◽  
Chain Reaction ◽  
Pcr Assay ◽  
Post Intervention ◽  
Multiplex Pcr Assay ◽  
Polymerase Chain ◽  
Post Intervention Group

Abstract Background Patients admitted from the community with a suspected central nervous system (CNS) infection require prompt antimicrobial treatment and diagnostic evaluation. Our health network recently implemented a multiplex polymerase chain reaction (PCR) assay in-house. Methods This was a pre-/post-intervention study evaluating the impact that a multiplex PCR assay had on the clinical management of patients ≥18 years of age admitted from the community with a lumbar puncture (LP) performed for a suspected CNS infection. The primary outcome was Herpes Simplex Virus (HSV) PCR turnaround time (TAT). Secondary outcomes included inpatient length of stay (LOS), total antimicrobial days of therapy (DOT), and antiviral DOT. Patients were excluded if an LP was performed after hospital day 3, if they were on a systemic antimicrobial for a non-CNS indication, if they were a neurosurgical patient, and if they had a fungal CNS infection. Results The pre- and post-intervention groups each had 57 patients. The average age was 51 and 52 years in the pre- and post-intervention groups, respectively. Four patients (7%) in the pre-intervention group were immunocompromised, compared with 9 (16%) in the post-intervention group. Four patients in the pre-intervention group had a positive PCR assay for either HSV or Varicella Zoster Virus (VZV), compared with 5 patients in the post-intervention group. Neither group had a positive cerebrospinal fluid culture, bacterial antigen assay, or bacterial PCR assay. The median (IQR) HSV PCR TAT was significantly longer in the pre-intervention group, 85 (78, 96) vs. 3.9 hours (2.9, 4.7), P < 0.001. The mean LOS was numerically greater in the pre-intervention arm (7 vs. 4.7 days, P = 0.069), as were the total antimicrobial DOT (9 vs. 7.4 days, P = 0.279) and antiviral DOT (3.9 vs. 2.7 days, P = 0.136). Pre-intervention antiviral DOT was significantly greater (3.1 vs. 1.6 days, P = 0.011) in patients without a positive HSV or VZV PCR. Conclusion Implementing a multiplex PCR assay for adults undergoing an LP for a suspected CNS infection significantly reduced the HSV PCR turnaround time. Antiviral DOT was significantly shorter in patients with a negative PCR result post-intervention. We also found a non-significant reduction in LOS, total antimicrobial DOT, and antiviral DOT. Disclosures All authors: No reported disclosures.

scholarly journals Assessment of Direct Oral Anticoagulant Prescribing and Monitoring Pre- and Post-Implementation of a Pharmacy Protocol at a Community Teaching Hospital

2017 ◽  
Vol 52 (3) ◽  
pp. 207-213 ◽  
Author(s):  
Christina Miele ◽  
Mary Taylor ◽  
Aditi Shah
Keyword(s):  
Teaching Hospital ◽  
Vitamin K Antagonists ◽  
Intervention Group ◽  
Adult Patients ◽  
Patient Specific ◽  
Post Intervention ◽  
Appropriate Prescribing ◽  
The Impact ◽  
Post Intervention Group ◽  
Community Teaching

Background Direct oral anticoagulants (DOACs) have become popular alternatives to vitamin K antagonists for the treatment and prevention of thromboembolic diseases; however, there are limited data regarding the appropriate use of DOACs in clinical practice. To ensure safety and efficacy of these medications, it is important that decisions regarding their use in patients rely on the available evidence. Objective The purpose of this study was to evaluate the appropriateness of DOAC prescribing in adult patients before and after the implementation of a pharmacist-driven DOAC protocol. Methods Data were collected on adult patients admitted to a community teaching hospital who received DOAC therapy for at least 2 days between January and March 2015 (pre-intervention group) and between January and March 2016 (post-intervention group). These data were analyzed to measure inappropriately prescribed DOACs, defined based on DOAC indication, renal function, drug interactions, and other pertinent patient-specific factors. Prior to the start of data collection for the post-intervention group, a pharmacist-driven protocol was developed and implemented. DOAC education was provided to pharmacists, including an evidence-based prescribing table to guide appropriate DOAC therapy. Comparisons were made between the pre-intervention and post-intervention groups to determine the impact of the pharmacist-driven service on appropriate DOAC prescribing. Results Fifty patients were analyzed in the pre-intervention group compared with 85 patients in the post-intervention group, with a total of 333 and 816 doses administered, respectively. Of the total doses administered, 32.4% were considered inappropriate in the pre-intervention group compared with 13.8% in the post-intervention group (adjusted odds ratio [OR], 0.42, 95% CI, 0.19-0.96; p = 0.039). Conclusions Implementing a pharmacist-driven DOAC service significantly improved appropriate prescribing of these agents. Provider education regarding DOAC use is essential to further increase appropriate prescribing of DOACs, optimize patients' therapy, and prevent adverse drug events.

scholarly journals Effects of Active Video Games on Children’s Psychosocial Beliefs and School Day Energy Expenditure

2019 ◽  
Vol 8 (9) ◽  
pp. 1268 ◽  
Author(s):  
Zan Gao ◽  
Zachary C. Pope ◽  
Jung Eun Lee ◽  
Minghui Quan
Keyword(s):  
Social Support ◽  
Self Efficacy ◽  
Intervention Group ◽  
Outcome Expectancy ◽  
Caloric Expenditure ◽  
Post Intervention ◽  
Active Video Games ◽  
Active Video ◽  
School Day ◽  
Post Intervention Group

Purpose: Examine the effects of active video games (AVGs) on children’s school-day energy expenditure (EE) and physical activity (PA)-related self-efficacy, social support, and outcome expectancy over 9 months. Method: Participants were 81 fourth grade students ( X ¯ age = 9.23 years, SD = 0.62; 39 girls) from two urban Minnesota elementary schools. A once-weekly 50 min AVG intervention was implemented in the intervention school for 9 months in 2014–2015 while the control school continued regular recess. Children’s school-day EE (daily caloric expenditure) and mean daily metabolic equivalent (MET) values were estimated via accelerometry whereas self-efficacy, social support, and outcome expectancy were assessed with psychometrically-validated questionnaires. All measures were completed at baseline and at the 4th and 9th months. Results: We observed significant interaction effects for daily caloric expenditure, F(1, 58) = 15.8, p < 0.01, mean daily MET values, F(1, 58) = 11.3, p < 0.01, and outcome expectancy, F(1, 58) = 4.5, p < 0.05. Specifically, intervention children had greater increases in daily caloric expenditure (91 kilocalorie/day post-intervention group difference), with control children decreasing daily caloric expenditure over time. We observed identical trends for mean daily MET values (0.35 METs/day post-intervention group difference). Interestingly, we observed outcome expectancy to increase in the control children, but decrease among intervention children, at post-intervention (1.35 group difference). Finally, we observed a marginally significant interaction effect for social support, F(1, 58) = 3.104, p = 0.08, with an increase and decrease seen in the intervention and control children, respectively. We observed no interaction or main effects for self-efficacy. Discussion: Observations suggested an AVG intervention contributed to longitudinal increases in school-day EE and social support compared to the control condition. Future research should examine how self-efficacy and outcome expectancy might be promoted during school-based AVG interventions.

scholarly journals An Electronic Alert for HIV Screening in the Emergency Department Increases Screening but not the Diagnosis of HIV

2014 ◽  
Vol 05 (01) ◽  
pp. 299-312 ◽  
Author(s):  
N. Liu ◽  
J. Sperling ◽  
R. Green ◽  
S. Clark ◽  
D. Vawdrey ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Hiv Testing ◽  
Intervention Group ◽  
Hiv Screening ◽  
Intervention Period ◽  
Post Intervention ◽  
Hiv Test ◽  
The Impact ◽  
Post Intervention Group

SummaryObjective: Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13–64. Three New York City adult emergency departments implemented an electronic alert that required clinicians to document whether an HIV test was offered before discharging a patient. The purpose of this study was to assess the impact of the electronic alert on HIV testing rates and diagnosis of HIV positive individuals.Methods: During the pre-intervention period (2.5–4 months), an electronic “HIV Testing” order set was available for clinicians to order a test or document a reason for not offering the test (e.g., patient is not conscious). An electronic alert was then added to enforce completion of the order set, effectively preventing ED discharge until an HIV test was offered to the patient. We analyzed data from 79,786 visits, measuring HIV testing and detection rates during the pre-intervention period and during the six months following the implementation of the alert.Results: The percentage of visits where an HIV test was performed increased from 5.4% in the pre-intervention period to 8.7% (p<0.001) after the electronic alert. After the implementation of the electronic alert, there was a 61% increase in HIV tests performed per visit. However, the percentage of patients testing positive per total patients-tested was slightly lower in the post-intervention group than the pre-intervention group (0.48% vs. 0.55%), but this was not significant. The number of patients-testing positive per total-patient visit was higher in the post-intervention group (0.04% vs. 0.03%).Conclusions: An electronic alert which enforced non-targeted screening was effective at increasing HIV testing rates but did not significantly increase the detection of persons living with HIV. The impact of this electronic alert on healthcare costs and quality of care merits further examination.Citation: Schnall R, Liu N, Sperling J, Green R, Clark S, Vawdrey D. An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV. Appl Clin Inf 2014; 5: 299–312 http://dx.doi.org/10.4338/ACI-2013-09-RA-0075

scholarly journals Efficacy of hand washing beeswax food wrap in household use

2019 ◽  
Author(s):  
Celine Hsin ◽  
BCIT School of Health Sciences, Environmental Health ◽  
Dale Chen
Keyword(s):  
Cold Water ◽  
Intervention Group ◽  
P Value ◽  
Cross Contamination ◽  
Post Intervention ◽  
Food Residue ◽  
Specific Category ◽  
Single Use ◽  
The Mean ◽  
Post Intervention Group

  Background: Over the years, many reusable products have been invented to replace single-use disposable items to reduce waste. One of such products is the reusable beeswax food wrap, which aims to replace plastic film wraps to store food. According to manufacturer instructions, the beeswax wrap can only be washed with cold water and detergent. This presents the question whether the beeswax wrap can be effectively cleaned, as continuous reuse may present cross contamination issues. This study examines if manufacturer instructions is effective in cleaning the beeswax wrap. Methods: ATP analysis was used to determine the level of cleanliness on the beeswax wrap between the pre-intervention and post-intervention treatments. Pre-intervention samples are the new beeswax wraps. Post- intervention samples are wraps that have been contaminated with avocado, washed, and dried. ATP counts (RLU) were measured with Hygiena SystemSURE Plus ATP monitoring system. Paired T-Test was done on NCSS to analyze the results. Results: The mean of the pre-intervention group was measured at 8 RLU, which is considered clean under the Hygiena standard. The mean for the post-intervention group was measured at 67 RLU, which is considered a fail on cleanliness under the Hygiena standard. This shows that the manufacturer instructions on washing the beeswax wrap does not effectively clean the beeswax wrap. Statistical analysis show p-value is 0.000, therefore one can conclude there is a statistically significance difference in the mean ATP count between pre-intervention and post-intervention beeswax wrap samples. Conclusion: Results show that some food residue remained on the wrap after washing. This means manufacturer instructions cannot effectively clean beeswax wrap. Therefore, it is recommended that manufactures should put a label on their packaging to let their customers know that the wrap can’t be thoroughly cleaned, and certain foods should be avoided for its use. During its use, the wraps should be labeled for the specific category of food it is used for. BCCDC can also use this result to add into the reusable container guideline.  

scholarly journals A physical activity coaching intervention can increase and maintain physical activity and health-related outcomes in adult ambulatory care patients in a regional hospital: the Healthy4U-2 randomised controlled trial

2020 ◽  
Author(s):  
Stephen Barrett ◽  
Steve Begg ◽  
Paul O'Halloran ◽  
Michael Kingsley
Keyword(s):  
Physical Activity ◽  
Body Mass ◽  
Intervention Group ◽  
Trial Registration ◽  
Post Intervention ◽  
Coaching Intervention ◽  
Health Related ◽  
Active Adults

Abstract Background: The Healthy 4U-2 study sought to evaluate the effect of a twelve-week, physical activity (PA) coaching intervention for changes and maintenance in PA, anthropometrics and health-related outcomes in adults presenting to an ambulatory hospital clinic. Methods: One hundred and twenty insufficiently active adults were recruited from an ambulatory hospital clinic and randomised to an intervention group that received an education session and five 20-minute telephone sessions of PA coaching, or to a control group that received the education session only. ActiGraph GT3X accelerometers were used to measure moderate-to-vigorous physical activity (MVPA) at baseline, post-intervention (3-months) and follow-up (9-months). Secondary outcome measures (anthropometrics, PA self-efficacy, health-related and quality of life) were also assessed at the three time points. Results: At baseline, the mean age and body mass index of participants were 53 ± 8 years and 31 ± 4 kg/m 2 , respectively. Relative to control, the intervention group increased objectively measured MVPA at post-intervention (p<0.001) and 9 months follow-up (p<0.001). At the 9-month follow-up the intervention group completed 22 min/day of MVPA (95% CI: 20 to 25 min/day), which is sufficient to meet the recommended PA guidelines. The intervention group exhibited beneficial changes in body mass (p<0.001), waist circumference (p<0.001), body mass index (p<0.001), PA self-efficacy (p<0.001), and health-related quality of life (p<0.001) at the 9-month follow-up. Conclusions: This study demonstrates that a low contact PA coaching intervention results in beneficial changes in PA, anthropometrics and health-related outcomes in insufficiently active adults presenting to an ambulatory care clinic. The significant beneficial changes were measured at post-intervention and the 9-month follow-up, demonstrating a maintenance effect of the intervention. Trial registration: Prospectively registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR). Trial registration number: ACTRN12619000036112. http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376318 Keywords Physical activity; Exercise motivation; Accelerometry; Public health

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