scholarly journals Can an epilepsy nurse specialist-led self-management intervention reduce attendance at emergency departments and promote well-being for people with severe epilepsy? A non-randomised trial with a nested qualitative phase

2013 ◽  
Vol 1 (9) ◽  
pp. 1-128 ◽  
Author(s):  
L Ridsdale ◽  
P McCrone ◽  
M Morgan ◽  
L Goldstein ◽  
P Seed ◽  
...  
Keyword(s):  
Health Services ◽  
Service Use ◽  
Randomised Trial ◽  
Well Being ◽  
Self Management ◽  
Nurse Specialist ◽  
Service Cost ◽  
Management Intervention ◽  
Ed Visits

ObjectivesTo (1) describe the characteristics and service use of people with established epilepsy (PWE) who attend the emergency department (ED); (2) evaluate the economic impact of PWE who attend the ED; (3) determine the effectiveness and cost-effectiveness of an epilepsy nurse specialist (ENS)-led self-management intervention plus treatment as usual (TAU) compared with TAU alone in reducing ED use and promoting well-being; (4) describe patients' views of the intervention; and (5) explore their reasons for attending the ED.DesignNon-randomised trial with nested qualitative study.SettingThe EDs of three inner London hospitals. The EDs each offer similar services and support a similar local population, which made a comparison of patient outcomes reasonable.ParticipantsAdults diagnosed with epilepsy for ≥ 1 year were prospectively identified from the EDs by presenting symptom/discharge diagnosis. We recruited 85 of 315 patients with 44 forming the intervention group and 41 the comparison group.InterventionIntervention participants were offered two one-to-one outpatient sessions delivered by an ENS who aimed to optimise self-management skills and knowledge of appropriate emergency service use. The first session lasted for 45–60 minutes and the second for 30 minutes.Main outcome measuresThe primary outcome was the number of ED visits that participants reported making over the 6 months preceding the 12-month follow-up. Secondary outcomes were visits reported at the 6-month follow-up and scores on psychosocial measures.ResultsIn the year preceding recruitment, the 85 participants together made 270 ED visits. The frequency of their visits was positively skewed, with 61% having attended multiple times. The mean number of visits per participant was 3.1 [standard deviation (SD) 3.6] and the median was two (interquartile range 1–4). Mean patient service cost was £2355 (SD £2455). Compared with findings in the general epilepsy population, participants experienced more seizures and had greater anxiety, lower epilepsy knowledge and greater perceived stigma. Their outpatient care was, however, consistent with National Institute for Health and Clinical Excellence recommendations. In total, 81% of participants were retained at the 6- and 12-month follow-ups, and 80% of participants offered the intervention attended. Using intention-to-treat analyses, including those adjusted for baseline differences, we found no significant effect of the intervention on ED use at the 6-month follow-up [adjusted incidence rate ratio (IRR) 1.75, 95% confidence interval (CI) 0.93 to 3.28] or the 12-month follow-up (adjusted IRR 1.92, 95% CI 0.68 to 5.41), nor on any psychosocial outcomes. Because they spent less time as inpatients, however, the average service cost of intervention participants over follow-up was less than that of TAU participants (adjusted difference £558, 95% CI –£2409 to £648). Lower confidence in managing epilepsy and more felt stigma at baseline best predicted more ED visits over follow-up. Interviews revealed that patients generally attended because they had no family, friend or colleague nearby who had the confidence to manage a seizure. Most participants receiving the intervention valued it, including being given information on epilepsy and an opportunity to talk about their feelings. Those reporting most ED use at baseline perceived the most benefit.ConclusionsAt baseline, > 60% of participants who had attended an ED in the previous year had reattended in the same year. In total, 50% of their health service costs were accounted for by ED use and admissions. Low confidence in their ability to manage their epilepsy and a greater sense of stigma predicted frequent attendance. The intervention did not lead to a reduction in ED use but did not cost more, partly because those receiving the intervention had shorter average hospital stays. The most common reason reported by PWE for attending an ED was the lack of someone nearby with sufficient experience of managing a seizure. Those who attended an ED frequently and received the intervention were more likely to report that the intervention helped them. Our findings on predictors of ED use clarify what causes ED use and suggest that future interventions might focus more on patients' perceptions of stigma and on their confidence in managing epilepsy. If addressed, ED visits might be reduced and efficiency savings generated.Trial registrationCurrent Controlled Trials ISRCTN06469947.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 1, No. 9. See the HSDR programme website for further project information.

Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

2021 ◽  
pp. 1-14
Author(s):  
Nina Reinholt ◽  
Morten Hvenegaard ◽  
Anne Bryde Christensen ◽  
Anita Eskildsen ◽  
Carsten Hjorthøj ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Well Being ◽  
Major Depressive ◽  
Outpatient Mental Health ◽  
End Of Treatment

<b><i>Introduction:</i></b> The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. <b><i>Objective:</i></b> This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. <b><i>Methods:</i></b> In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. <b><i>Results:</i></b> At end-of-treatment, WHO-5 mean scores for patients in UP (<i>n</i> = 148) were non-inferior to those of patients in dCBT (<i>n</i> = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. <b><i>Conclusions:</i></b> This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

scholarly journals 83 A Medication Self-Management Intervention to Improve Medication Adherence For Older People with Multimorbidity: A Pilot Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C Yang ◽  
Z Hui ◽  
S Zhu ◽  
X Wang ◽  
G Tang ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Older People ◽  
Intervention Group ◽  
Self Management ◽  
Control Group ◽  
Medication Knowledge ◽  
Management Intervention ◽  
Patient Reported

Abstract Introduction Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity. Method This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations. Results Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P &lt; 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up. Conclusions The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

Frequent use of emergency departments for mental and substance use disorders

2018 ◽  
Vol 35 (4) ◽  
pp. 220-225 ◽  
Author(s):  
Karen Urbanoski ◽  
Joyce Cheng ◽  
Jürgen Rehm ◽  
Paul Kurdyak
Keyword(s):  
Substance Use ◽  
Mental Disorders ◽  
Substance Use Disorders ◽  
Service Use ◽  
Secondary Analysis ◽  
Mental Healthcare ◽  
Specialist Care ◽  
Ed Visits ◽  
Administrative Health Databases

ObjectivesWe described the population of people who frequently use ED for mental disorders, delineating differences by the number of visits for substance use disorders (SUDs), and predicted the receipt of follow-up services and 2-year mortality by the level of ED use for SUD.MethodsThis retrospective observational study included all Ontario residents 15 years and older who had five or more ED visits during any 12-month period from 2010 to 2012 (n=263 346). The study involved a secondary analysis of administrative health databases capturing emergency, hospital and ambulatory care. Frequent ED users for mental disorders (n=5416) were grouped into nested categories based on the number of ED visits for SUD. Logistic regression was used to examine group differences in the receipt of follow-up services and mortality, controlling for sociodemographics, comorbidities and past service use.ResultsThe majority of frequent ED users for mental disorders had at least one ED visit for SUD, most commonly involving alcohol. Relative to people with no visits for SUD, those with ED visits for SUD were older and more likely to be men (Ps <0.001). As the number of ED visits for SUD increased, the likelihood of receiving follow-up care, particularly specialist mental healthcare, declined while 2-year mortality steadily increased (Ps <0.001). These associations remained after controlling for comorbidities and past service use.ConclusionsFindings highlight disparities in the receipt of specialist care based on use of ED services for SUD, coupled with a greater mortality risk. There is a need for policies and procedures to help address unmet needs for care and to connect members of this vulnerable subgroup with services that are better able to support recovery and improve survival.

scholarly journals Findings from a pilot randomised trial of a social network self-management intervention in COPD

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lindsay Welch ◽  
Rosanna Orlando ◽  
Sharon X. Lin ◽  
Ivaylo Vassilev ◽  
Anne Rogers
Keyword(s):  
Social Network ◽  
Randomised Trial ◽  
Self Management ◽  
Management Intervention

scholarly journals P101 ‘Best Foot Forward Workshops’: a novel supported self-management approach for foot health

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Sue Connett ◽  
Colin Beevor ◽  
Sam Ward ◽  
Ernest Wong ◽  
Lindsey Cherry
Keyword(s):  
Service Use ◽  
Self Management ◽  
Management Approach ◽  
Education Session ◽  
Foot Health ◽  
Notification System ◽  
Clinical Models ◽  
The Impact ◽  
Clinical Appointment

Abstract Background Rheumatic foot health challenges can be multiple and wide-ranging, leading to reduced mobility or quality of life. However, the provision of foot health services is disparate. There is a need to innovate new approaches to personalised foot health care outside of traditional clinical models of service delivery. A new healthcare model was co-designed by patients, academics and clinicians from secondary and primary care Trusts, to support self-management. Part of this model included the development of ‘best foot forward’ workshops. There is a need to: minimise the impact of the demonstrated gap between what service users need or want and what services are providing; reduce waiting times; empower self-management; improve MDT availability for those in need; reduce the number of appointments needed to get resolution; reduce service costs; maintain patient satisfaction. Methods The team co-designed a series of foot health workshops, at 8-week intervals. The novel workshop design extended beyond a traditional patient education session and consisted of: 1. an education session about anatomy and physiology for the lower limb, 2. social networking time, 3. a themed education session, 4. opportunity for group discussion, 5. opportunity for individual question and answer with a health professional, 6. Access to direct request for follow-up appointment. Electronic invitations were sent to all patients registered within a single rheumatology department enrolled on the electronic notification system. Posters advertising the workshops were displayed in waiting areas. After three workshops data regarding patient attendance, satisfaction, and health service use up to four weeks after the workshop was collected. Results Nineteen, 22 and 30 patients attended the workshops respectively. Seven people attended multiple workshops. All patients reported having an unmet foot health need and would have otherwise sought a clinical appointment. Allowing for session preparation time (approx. 3 hours per session) 20 hours of clinical time was saved; the clinical waiting list was reduced by 12 sessions (6 weeks). Three patients (4%) requested one follow-up clinical appointment immediately after the workshop. No patients requested additional appointments in the four weeks after each workshop; enabling patient led review saved 71 further appointments. Patients reported content, venue and satisfactions scores of 9.6, 8.7 and 9.6/10 respectively. Conclusion Further research is needed to confirm that patients’ needs are being fully met, in addition to enabling supported self-management and improving clinical outcomes. There is potential for these workshops to be co-ordinated and facilitated by expert patient partners. The role of group interaction as a therapeutic mechanism to aid supported self-management is worthy of further study. Best foot forward workshops could represent a viable supported self-management alternative to traditional clinical models for people with rheumatic conditions. Disclosures S. Connett None. C. Beevor None. S. Ward None. E. Wong None. L. Cherry None.

scholarly journals The Impact of an Internet-Based Self-Management Intervention (HeLP-Diabetes) on the Psychological Well-Being of Adults with Type 2 Diabetes: A Mixed-Method Cohort Study

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Megan Hofmann ◽  
Charlotte Dack ◽  
Chris Barker ◽  
Elizabeth Murray
Keyword(s):  
Type 2 Diabetes ◽  
Mixed Method ◽  
Self Efficacy ◽  
Qualitative Data ◽  
Well Being ◽  
Self Management ◽  
Psychological Well Being ◽  
Management Intervention ◽  
The Impact

This mixed-method study assessed the impact of an internet-based, self-management intervention (“HeLP-Diabetes”) on the psychological well-being of adults with type 2 diabetes. Nineteen participants were recruited from 3 general practices. Data were collected at baseline and at 6 weeks follow-up. Access to HeLP-Diabetes was associated with a significant decrease in participants’ diabetes-related distress (Z=2.04,p=0.04, andd=0.28). No significant differences were found in emotional distress or self-efficacy. The qualitative data found that participants reported improvements including increased self-efficacy and support, better management of low mood, greater diabetes awareness, and taking the condition more seriously. Participants also reported making improvements to their eating habits, exercise routine, and medical management. Some negative experiences associated with using the intervention were mentioned including feelings of guilt for not using the intervention as suggested or not making any behavioral changes, as well as technical and navigational frustrations with the intervention. Internet-based self-management interventions may have the potential to decrease diabetes-related distress in people with type 2 diabetes. The qualitative data also suggests internet interventions can positively impact both psychological and behavioural outcomes of adults with type 2 diabetes.

scholarly journals Screening and Referral is Not Enough: A Qualitative Exploration of Barriers to Access and Uptake of Mental Health Services in Patients With Cardiovascular Diseases

2020 ◽  
Author(s):  
Catherine M Collopy ◽  
Suzanne M Cosh ◽  
Phillip J Tully
Keyword(s):  
Mental Health ◽  
Cardiovascular Diseases ◽  
Mental Health Services ◽  
Health Services ◽  
Peer Support ◽  
Service Use ◽  
Information Provision ◽  
Cardiac Events ◽  
Structured Interviews

Abstract Background: Cardiovascular diseases (CVD) are commonly comorbid with mental health disorders, portending poorer cardiac prognosis. Despite the high prevalence of depression and anxiety, and guidelines recommending routine depression screening and referral, uptake of mental healthcare in CVD populations remains low. Reasons for the underutilisation of mental health and psychological services for this population remain largely unknown.Methods: Thirteen CVD patients with clinically significant psychological symptoms (depression, anxiety and/or stress) participated in one-on-one in-depth semi-structured interviews. Data were analysed using inductive thematic analysis.Results: Barriers to uptake included the timing of referral and screening, with patients reporting a need for longer term follow-up. A lack of information provision and understanding around mental health and services, especially following cardiac-events were further barriers. A reluctance to report mental health or engage in services was also identified, with patients indicating a preference for informal peer support networks. A range of practical barriers such as mobility, transport and cost were also reported. Conclusions: Longer term follow-up and routine mental health assessment may be beneficial to facilitate use of mental health services. Upskilling of practitioners around mental health may be a further avenue to promote information provision and enhance service use. Further focus on enhancing informal peer support may be a valuable initial approach for the CVD population. The implications for improving services and enhancing service use are discussed.

scholarly journals An online supported self-management toolkit for relatives of people with psychosis or bipolar experiences: the IMPART multiple case study

2020 ◽  
Vol 8 (37) ◽  
pp. 1-248
Author(s):  
Fiona Lobban ◽  
Duncan Appelbe ◽  
Victoria Appleton ◽  
Golnar Aref-Adib ◽  
Johanna Barraclough ◽  
...  
Keyword(s):  
Digital Health ◽  
Well Being ◽  
Health Interventions ◽  
Self Management ◽  
Factors Affecting ◽  
Multiple Case ◽  
The Mean

Background Digital health interventions have the potential to improve the delivery of psychoeducation to people with mental health problems and their relatives. Despite substantial investment in the development of digital health interventions, successful implementation into routine clinical practice is rare. Objectives Use the implementation of the Relatives’ Education And Coping Toolkit (REACT) for psychosis/bipolar disorder to identify critical factors affecting uptake and use, and develop an implementation plan to support the delivery of REACT. Design This was an implementation study using a mixed-methods, theory-driven, multiple case study approach. A study-specific implementation theory for REACT based on normalisation process theory was developed and tested, and iterations of an implementation plan to address the key factors affecting implementation were developed. Setting Early-intervention teams in six NHS mental health trusts in England (three in the north and three in the south). Participants In total, 281 staff accounts and 159 relatives’ accounts were created, 129 staff and 23 relatives took part in qualitative interviews about their experiences, and 132 relatives provided demographic data, 56 provided baseline data, 21 provided data at 12 weeks’ follow-up and 20 provided data at 24 weeks’ follow-up. Interventions REACT is an online supported self-management toolkit, offering 12 evidence-based psychoeducation modules and support via a forum, and a confidential direct messaging service for relatives of people with psychosis or bipolar disorder. The implementation intervention was developed with staff and iteratively adapted to address identified barriers. Adaptations included modifications to the toolkit and how it was delivered by teams. Main outcome measures The main outcome was factors affecting implementation of REACT, assessed primarily through in-depth interviews with staff and relatives. We also assessed quantitative measures of delivery (staff accounts and relatives’ invitations), use of REACT (relatives’ logins and time spent on the website) and the impact of REACT [relatives’ distress (General Health Questionnaire-28), and carer well-being and support (Carer Well-being and Support Scale questionnaire)]. Results Staff and relatives were generally positive about the content of REACT, seeing it as a valuable resource that could help services improve support and meet clinical targets, but only within a comprehensive service that included face-to-face support, and with some additional content. Barriers to implementation included high staff caseloads and difficulties with prioritising supporting relatives; technical difficulties of using REACT; poor interoperability with trust information technology systems and care pathways; lack of access to mobile technology and information technology training; restricted forum populations leading to low levels of use; staff fears of managing risk, online trolling, or replacement by technology; and uncertainty around REACT’s long-term availability. There was no evidence that REACT would reduce staff time supporting relatives (which was already very low), and might increase it by facilitating communication. In all, 281 staff accounts were created, but only 57 staff sent relatives invitations. In total, 355 relatives’ invitations were sent to 310 unique relatives, leading to the creation of 159 relatives’ accounts. The mean number of logins for relatives was 3.78 (standard deviation 4.43), but with wide variation from 0 to 31 (median 2, interquartile range 1–8). The mean total time spent on the website was 40.6 minutes (standard deviation 54.54 minutes), with a range of 0–298 minutes (median 20.1 minutes, interquartile range 4.9–57.5 minutes). There was a pattern of declining mean scores for distress, social dysfunction, depression, anxiety and insomnia, and increases in relatives’ well-being and eHealth literacy, but no changes were statistically significant. Conclusions Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, with staff and service user input, as part of a long-term strategy to develop integrated technology-enabled services. Implementation strategies must instil a sense of ownership for staff and ensure that they have adequate training, risk protocols and resources to deliver the technology. Cost-effectiveness and impact on workload and inequalities in accessing health care need further testing, along with the generalisability of our findings to other digital health interventions. Limitations REACT was offered by the same team running the IMPlementation of A Relatives’ Toolkit (IMPART) study, and was perceived by staff and relatives as a time-limited research study rather than ongoing clinical service, which affected engagement. Access to observational data was limited. Trial registration Current Controlled Trials ISRCTN16267685. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 37. See the NIHR Journals Library website for further project information.

scholarly journals Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial

2018 ◽  
Vol 75 (5) ◽  
pp. 321-327 ◽  
Author(s):  
Bethany Barone Gibbs ◽  
Andrea L Hergenroeder ◽  
Sophy J Perdomo ◽  
Robert J Kowalsky ◽  
Anthony Delitto ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Sedentary Behaviour ◽  
Chronic Low Back Pain ◽  
Controlled Trial ◽  
Randomised Trial ◽  
Sitting Time ◽  
Self Management ◽  
Low Back

ObjectiveThe Stand Back study evaluated the feasibility and effects of a multicomponent intervention targeting reduced prolonged sitting and pain self-management in desk workers with chronic low back pain (LBP).MethodsThis randomised controlled trial recruited 27 individuals with chronic LBP, Oswestry Disability Index (ODI) >10% and desk jobs (sitting ≥20 hours/week). Participants were randomised within strata of ODI (>10%–<20%, ≥20%) to receive bimonthly behavioural counselling (in-person and telephone), a sit-stand desk attachment, a wrist-worn activity-prompting device and cognitive behavioural therapy for LBP self-management or control. Self-reported work sitting time, visual analogue scales (VAS) for LBP and the ODI were assessed by monthly, online questionnaires and compared across intervention groups using linear mixed models.ResultsBaseline mean (SD) age was 52 (11) years, 78% were women, and ODI was 24.1 (10.5)%. Across the 6-month follow-up in models adjusted for baseline value, work sitting time was 1.5 hour/day (P<0.001) lower comparing intervention to controls. Also across follow-up, ODI was on average 8 points lower in intervention versus control (P=0.001). At 6 months, the relative decrease in ODI from baseline was 50% in intervention and 14% in control (P=0.042). LBP from VAS was not significantly reduced in intervention versus control, though small-to-moderate effect sizes favouring the intervention were observed (Cohen’s d ranged from 0.22 to 0.42).ConclusionAn intervention coupling behavioural counselling targeting reduced sedentary behaviour and pain self-management is a translatable treatment strategy that shows promise for treating chronic LBP in desk-bound employees.Trial registration numberNCT0224687; Pre-results.

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