Wales Inverse Care Law Programme - Design and Implementation of Routine Data Evaluation and Lessons Learned

IntroductionThe Inverse Care Law (ICL) programme in Wales was setup to tackle health inequalities. Eligible populations from deprived communities, at higher risk of cardiovascular disease (CVD) were invited to a health-check and offered appropriate lifestyle and clinical interventions. Objectives and ApproachEvaluation of this programme is vital to ensure that targeted interventions have been received by those most in need, including referrals to lifestyle services and support. The use of longitudinal population-scale routine-data required the development of an approach which was both efficient and cost effective. To achieve this, the Welsh Longitudinal General Practice (WLGP) data held in SAIL Databank was utilised. A programme-specific methodology was agreed by the programme-board and developed so that data collected from GP records prior, during and post health-check accurately identified the eligible population and allowed the effective assessment of lifestyle and clinical risk factors for CVD; poor diet, physical inactivity, smoking and high alcohol intake, so appropriate interventions could be offered. ResultsWe evaluated the programme from 2015 to 2019 in 70 GP’s across the participating Health-Boards, and identified 175,671 individuals eligible by the programme criteria. Substantial preliminary work has been carried out to ensure the specification of outcome measures are both clinically and epidemiologically accurate and relevant. The final report scheduled for release in August-2020, which will evaluate the impact of the programme. Conclusion / ImplicationsThis ambitious evaluation of a large-scale programme set in the community involving disparate systems and a range of stakeholders, has been both complex and challenging, requiring substantial effort to design and implement. We hope the outcomes and lessons learned from our experience will improve the design, implementation and evaluation of the programme and lead to improvements in services and the quality of life for people in Wales, and provide an exemplar for health care providers worldwide wishing to conduct similar programmes in the future.

Download Full-text

Rapid Project Management in a Time of COVID-19 Crisis: Lessons learned from a Global VIRUS: COVID-19 Registry (Preprint)

10.2196/preprints.27921 ◽

2021 ◽

Author(s):

Janice R. Turek ◽

Vikas Bansal ◽

Aysun Tekin ◽

Mayank Sharma ◽

Marija Bogojevic ◽

...

Keyword(s):

Health Care ◽

Critical Care ◽

Project Management ◽

Health Care Providers ◽

Large Scale ◽

Lessons Learned ◽

Care Providers ◽

Healthcare Organizations ◽

Collect Patient Data ◽

The Impact

UNSTRUCTURED The COVID-19 pandemic emerged globally in a rapid and precipitous manner devastating healthcare organizations worldwide. The progression of the illness, the impact to the vulnerable and best care for the hospitalized patient, is undefined. Incomplete knowledge of best practices by frontline health care providers may result in error-prone care. Data on symptoms and advancement of the SARS-CoV-2 virus leading to critical care admission has not been captured or communicated well between international organizations experiencing the same impact from the virus. As the SARS-CoV-2 virus quickly reached every country, it was recognized that global communication and data collection on the critical care patients admitted with COVID-19 needed to be rapidly put in place. Developing a global registry to collect patient data and treatment in the critical care setting was of utmost priority with the goal to minimize preventable death, disability, and costly complications for patients with COVID-19. Project management around the prompt implementation of the registry is crucial. Valuable information could be lost daily without a format to record data and the opportunity to share significant findings. Putting the VIRUS: COVID-19 Registry in place could change patient outcomes by gaining insight to progression of symptoms and treatments worldwide. This article addresses project management lessons in a time of crises outlining the methodology used and is meant to be a useful tool for other organizations for rapid project management for a large-scale health care data registry.

Download Full-text

The Impact of Relationship Stage on the Determinants of Trust in the Pharmacist–Client Relationship: Results from a Social Marketing Campaign

Social Marketing Quarterly ◽

10.1080/15245004.2010.522766 ◽

2010 ◽

Vol 16 (4) ◽

pp. 18-40 ◽

Cited By ~ 1

Author(s):

Chiara Maniscalco ◽

Kim Daniloski ◽

David Brinberg

Keyword(s):

Health Care ◽

Social Marketing ◽

Health Care Providers ◽

Large Scale ◽

Medical Advice ◽

Care Providers ◽

Marketing Campaign ◽

Social Marketing Campaign ◽

Client Relationship ◽

The Impact

The relationship between clients and their health care providers has an important impact on health promotion and disease prevention. Perhaps the most important element of patients' relationships with their health care providers is trust. Enhancing clients' trust in their health care provider has been shown to lead to greater adherence to medical advice, continuity of care, and better overall health outcomes. Pharmacists are beginning to take on the role of primary health care providers to meet the increasing need for affordable, quality medical care. As pharmacists begin to dispense medical advice as well as medicine, there is an increased need for research on the determinants of trust in the pharmacist-client relationship. In this article, we conduct in-depth interviews and a large-scale field survey to develop a social marketing campaign to increase clients' trust in their pharmacists. We implement the campaign through a randomized field experiment and find evidence that emphasizing relational benefits in the developing stages of the pharmacist–client relationship increases trust.

Download Full-text

Impact of Social Restriction Imposed by 2019-ncov Pandemic on the Mobility of Older People: A Scope Review Protocol

10.21203/rs.3.rs-88174/v1 ◽

2020 ◽

Author(s):

Sarah Bandeira ◽

Patricia Batista ◽

Cristina Cristóvão Ribeiro Silva ◽

Ruth Caldeira Melo ◽

Monica Rodrigues Perracini

Keyword(s):

Older People ◽

Latin American ◽

Health Care Providers ◽

Adverse Outcomes ◽

Care Providers ◽

Targeted Interventions ◽

Thomson Reuters ◽

Social Restriction ◽

The Impact ◽

At Home

Abstract Background The 2019‑nCoV pandemic represents a high risk for older people that sustain higher mortality rates compared to young adults. Limited social contact and restriction of mobility in the community (stay-at-home precautions) are recognised as measures to prevent SARS-CoV-2 infection among older people. The impact of these measures on health, physical function and emotional wellbeing are numerous, and might result in long-term adverse outcomes such as disability, falls and limited mobility. Thus, the objective of this scope review is to map the estimated impact of measures of social restrictions on the mobility of older people living in the community and to systematize the existing recommendations, anticipating possible intervention strategies gaps.Methods The search will be carried out using a standardized protocol in Latin American and Caribbean Literature on Health Sciences (LILACS), consulted by the Virtual Health Library (VHL), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), via PubMed; Web of Science, via Main Collection (Thomson Reuters Scientific) and SCOPUS. Documents and reports with recommendations from governmental and nongovernmental organizations will be consulted. Complete studies available in the English, Spanish or Portuguese languages included in the different methodological approaches (original articles, literature reviews, editorials and guidelines) that necessarily address the recommendations of social restriction measures for preventing Covid-19 disease and their impacts on mobility of older people will be included. Two reviewers will select the studies based on their titles and abstracts. The manuscripts and documents selected for full reading will be analysed by reviewers concerning the eligibility criteria. When disagreements occurred in any phase of the selection process, a third reviewer will be included for a consensus analysis. Data will be extracted using a template form and the PRISMA-ScR checklist will be used to guarantee quality and transparency. Results will be presented as a narrative summary, including tables and figures.Discussion Globally, recommendations to stay-at-home and social distancing are substantially affecting health and wellbeing of older people. Preserving mobility is crucial to active and healthy ageing. The evidence summarized in the selected studies will be analysed in order to answer the research questions. The results of this review will help clinical practitioners, health care providers and policy makers to estimate the impact of measures to protect older people from 2019‑nCoV and to identify gaps and anticipate needs for targeted interventions to prevent mobility decline. Systematic review registrationsubmitted on 10-09-2020 in https://osf.io/registries

Download Full-text

Enabling quality improvement in systemic cancer treatment through a collaborative approach.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.88 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 88-88

Author(s):

Vicky Simanovski ◽

Sherrie Hertz ◽

Esther Green ◽

Elaine Meertens ◽

Leonard Kaizer ◽

...

Keyword(s):

Quality Improvement ◽

Health Care Providers ◽

Large Scale ◽

Systemic Treatment ◽

Lessons Learned ◽

Average Score ◽

Quality And Safety ◽

Care Providers ◽

Safe Delivery ◽

Regional Engagement

88 Background: The Regional Systemic Treatment Program at Cancer Care Ontario (CCO) aims to ensure the highest quality of systemic treatment is available to Ontarians, as close to home as possible. CCO initiated a provincial collaborative with the aim of improving the safe delivery of parenteral chemotherapy from orders through preparation, to administration, for patients, and providers. Methods: From April 2011 to March 2012, interdisciplinary hospital teams across Ontario followed multiple Plan, Do, Study, Act cycles to perform QI projects focusing on safe delivery of systemic treatment. Over this period, three in-person sessions educating participants on improvement methodology were held. Monthly teleconferences and an electronic discussion forum encouraged a culture of knowledge sharing and collaboration. Results: 113 participants from 26 teams participated in a total of 81 improvement initiatives. 96% of participants surveyed indicated that the collaborative provided a valuable opportunity to network with peers, share ideas, and discuss lessons learned. During the collaborative, teams reported their progress on a scale of 1-5. At May 2011, teams averaged a self-assessment score of 1, indicating no progress had been made. By February 2012, this increased to an average score of 4, indicating significant progress and achievement of at least one improvement objective/goal. CCO has leveraged the foundations built by the collaborative to develop a Regional Quality and Safety Network. This network provides a regular forum for health care providers and administrators to share knowledge and collaborate on strategies for improving quality and safety in the delivery of systemic treatment. Conclusions: The collaborative demonstrated that the use of a formal quality improvement model is a successful mechanism for regional engagement; that provides the foundation necessary for building a provincial network with common goals and understanding regarding quality improvement. By educating participants, supporting local efforts and enabling knowledge transfer and exchange, the collaborative showed that shared ideas and even small changes can lead to large-scale improvements for patients and providers.

Download Full-text

Outcomes from the Medication Assisted Treatment Pilot Program for Adults With Opioid Use Disorders in Rural Colorado

10.21203/rs.3.rs-769124/v1 ◽

2021 ◽

Author(s):

Claudia R. Amura ◽

Tanya R. Sorrell ◽

Mary Weber ◽

Andrea Alvarez ◽

Nancy Beste ◽

...

Keyword(s):

Health Care Providers ◽

Rural Areas ◽

Addiction Severity Index ◽

Lessons Learned ◽

Opioid Overdose ◽

Pilot Program ◽

Care Providers ◽

Physical And Mental Health ◽

Opioid Use ◽

The Impact

Abstract Background. As Colorado ranked among the top nationally in non-medical use of opioids, a pilot medication for opioid use disorder (MOUD) program was developed to increase the number of NPs and PAs providing MOUD in order to bring this evidence based treatment 2 counties showing disproportionally high opioid overdose deaths. Over the first 18 months, the MOUD Pilot Program led to 15 new health care providers receiving MOUD waiver training and 1,005 patients receiving MOUD from the 3 participating organizations. Here we evaluate the impact of the pilot MOUD program implemented in 2 rural counties severely affected by the opioid crisis on patient centered clinical and functional outcomes. Methods. Under state-funded law, three rural agencies submitted patient-level data at baseline (N = 1005) and after 6 months of treatment (N = 190, 25%) between December 2017 and January 2020. The Addiction Severity Index with McNemar-Bowker and t tests were used to measure program impact. Results. Patients in treatment reported using less heroin (13.0 vs. 3.7 days), opioids (3.7 vs. 1.9 days), and alcohol (3.2 vs 0.7 days, all P < 0.01). Patients reported improved health (53.4% vs. 68.2%, P = 0.04), less days of disability (8.69 vs. 6.51, P = 0.02), symptoms (29.8% vs 21.3%), pain (67.5 % to 53.6), worry (45.3% vs 62.3%), anxiety (49.7% vs 23.2%), depression (54.1% vs 23.3%, all P < 0.02) after treatment. Conclusions. This study shows decreased substance use, improved physical and mental health, and reduced symptoms after 6 months of MOUD. Although more research on retention and long-term effects is needed, data shows improved health outcomes after 6 months of MOUD. Lessons learned from implementing this pilot program informed program expansion into other rural areas in need to address some of Colorado’ major public health crises.

Download Full-text

The Impact of Physical Activity (PA) on the Prevention of Type 2 Diabetes; Evidence and Lessons Learned from the Diabetes Prevention Program (DPP), a Long-Standing Clinical Trial Incorporating Subjective and Objective Activity Measures

10.2337/figshare.13103333.v1 ◽

2020 ◽

Author(s):

Andrea M. Kriska ◽

Bonny Rockette-Wagner ◽

Sharon L. Edelstein ◽

George A. Bray ◽

Linda M. Delahanty ◽

...

Keyword(s):

Health Care Providers ◽

Diabetes Prevention ◽

Cox Proportional Hazards ◽

Lessons Learned ◽

Diabetes Incidence ◽

Care Providers ◽

Cross Sectional ◽

Entire Cohort ◽

The Impact

Objective: Across the DPP follow-up, cumulative diabetes incidence remained lower in the lifestyle compared to placebo and metformin randomized groups and could not be explained by weight. Collection of self-reported PA (yearly) with cross-sectional objective PA (in follow-up) allowed for examination of PA and its long-term impact on diabetes prevention. Research Design and Methods: Yearly self-reported PA and diabetes assessment, OGTT, (fasting glucose semi-annually) was collected for 3232 participants with one accelerometry assessment 11-13 years after randomization (n=1,793). Mixed models determined PA differences across treatment groups. The association between PA and diabetes incidence was examined using Cox proportional hazards models. Results: There was a 6% decrease (Cox proportional HR 0.94 [0.92, 0.96]; P< 0.001) in diabetes incidence per 6 MET-hrs/week increase in time-dependent PA for the entire cohort over an average 12 years (controlled for age, sex, baseline PA and weight). The effect of PA was greater (12% decrease) among participants less active at baseline (<7.5 MET-hrs/week) (n=1338; HR 0.88 [0.83, 0.93] P<0.0001) with stronger findings for lifestyle participants. Lifestyle had higher cumulative PA compared with metformin or placebo (p<0.0001) and higher accelerometry total minutes/day measured in follow-up (P=0.001 and 0.047). All associations remained significant with weight in the models. Conclusions: PA was inversely related to incident diabetes in the entire cohort across the study with cross-sectional accelerometry results supporting these findings. This highlights the importance of PA within lifestyle intervention efforts designed to prevent diabetes and urge health-care providers to consider both PA and weight when counseling high-risk patients.

Download Full-text

The Impact of Physical Activity (PA) on the Prevention of Type 2 Diabetes; Evidence and Lessons Learned from the Diabetes Prevention Program (DPP), a Long-Standing Clinical Trial Incorporating Subjective and Objective Activity Measures

10.2337/figshare.13103333 ◽

2020 ◽

Author(s):

Andrea M. Kriska ◽

Bonny Rockette-Wagner ◽

Sharon L. Edelstein ◽

George A. Bray ◽

Linda M. Delahanty ◽

...

Keyword(s):

Health Care Providers ◽

Diabetes Prevention ◽

Cox Proportional Hazards ◽

Lessons Learned ◽

Diabetes Incidence ◽

Care Providers ◽

Cross Sectional ◽

Entire Cohort ◽

The Impact

Download Full-text

Recognizing the impact of COVID-19 on depression and its mitigation (Preprint)

10.2196/preprints.22455 ◽

2020 ◽

Author(s):

Harshil Bhatt ◽

Sandeep Singh ◽

Sijo Sunny

Keyword(s):

Mental Health ◽

Health Care Providers ◽

Large Scale ◽

Negative Impact ◽

Healthcare Access ◽

Care Providers ◽

Treatment And Prevention ◽

Increased Risk ◽

New Guidelines ◽

The Impact

UNSTRUCTURED Abstract Introduction: COVID-19 pandemic is a rapidly evolving threat to all of humanity and overall global stability. It is evident from history that events like pandemics or large-scale disasters lead to an increased risk of adverse mental health effects. The ongoing pandemic of COVID-19 is presenting unprecedented challenges to all walks of life and is also likely to spark a widespread negative impact on mental health all around the world. Objective: The primary purpose of this article is to review the effect of COVID- 19 pandemic on depression and discussion of possible methods to its recognition and mitigation. Discussion: The onset of the COVID-19 pandemic introduced a widespread panic into individuals from all parts of society. In many respects, it has had a negative domino effect on mental health. The pervasive stay-at-home orders targeted to contain the spread of the infection have led to isolation, which has further reduced outlet avenues for individuals from the difficult aspects of their lives and has planted the seeds for psychological issues. In some cases, preventative measures even have led to the surfacing of pre-existing mental health challenges. The economic hardship and the limitations of healthcare access during the pandemic have further escalated the situation. Cognizance, detection, treatment, and prevention methodologies are needed to combat the impact of COVID-19 pandemic on depression in the population. More research into this field would allow mental health care providers to formulate new guidelines and recommendations to limit the impact of this pandemic on behavioral health.

Download Full-text