scholarly journals The relative clinical effectiveness and cost-effectiveness of three contrasting approaches to partner notification for curable sexually transmitted infections: a cluster randomised trial in primary care

2015 ◽  
Vol 19 (5) ◽  
pp. 1-116 ◽  
Author(s):  
Jackie A Cassell ◽  
Julie Dodds ◽  
Claudia Estcourt ◽  
Carrie Llewellyn ◽  
Stefania Lanza ◽  
...  
Keyword(s):  
General Practice ◽  
Young People ◽  
Health Technology Assessment ◽  
Sexually Transmitted Infections ◽  
Technology Assessment ◽  
Partner Notification ◽  
Health Technology ◽  
Web Based ◽  
Sexually Transmitted ◽  
Cluster Randomised

BackgroundPartner notification is the process of providing support for, informing and treating sexual partners of individuals who have been diagnosed with sexually transmitted infections (STIs). It is traditionally undertaken by specialist sexual health services, and may involve informing a partner on a patient’s behalf, with consent. With an increasing proportion of STIs diagnosed in general practice and other community settings, there is a growing need to understand the best way to provide partner notification for people diagnosed with a STI in this setting using a web-based referral system.ObjectiveWe aimed to compare three different approaches to partner notification for people diagnosed with chlamydia within general practice.DesignCluster randomised controlled trial.SettingGeneral practices in England and, within these, patients tested for and diagnosed with genital chlamydia or other bacterial STIs in that setting using a web-based referral system.InterventionsThree different approaches to partner notification: patient referral alone, or the additional offer of either provider referral or contract referral.Main outcome measures(1) Number of main partners per index patient treated for chlamydia and/or gonorrhoea/non-specific urethritis/pelvic inflammatory disease; and (2) proportion of index patients testing negative for the relevant STI at 3 months.ResultsAs testing rates for chlamydia were far lower than expected, we were unable to scale up the trial, which was concluded at pilot stage. We are not able to answer the original research question. We present the results of the work undertaken to improve recruitment to similar studies requiring opportunistic recruitment of young people in general practice. We were unable to standardise provider and contract referral separately; however, we also present results of qualitative work aimed at optimising these interventions.ConclusionsExternal recruitment may be required to facilitate the recruitment of young people to research in general practice, especially in sensitive areas, because of specific barriers experienced by general practice staff. Costs need to be taken into account together with feasibility considerations. Partner notification interventions for bacterial STIs may not be clearly separable into the three categories of patient, provider and contract referral. Future research is needed to operationalise the approaches of provider and contract partner notification if future trials are to provide generalisable information.Trial registrationCurrent Controlled Trials ISRCTN24160819.FundingThis project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 5. See the NIHR Journals Library website for further project information.

scholarly journals The Notijoves Project: Protocol for a Randomized Controlled Trial About New Communication Technologies and Gamification to Promote Partner Notification of Sexually Transmitted Infections Among Young People (Preprint)

2018 ◽  
Author(s):  
Dolors Carnicer-Pont ◽  
Eva Loureiro-Varela ◽  
Josep Mª Manresa ◽  
Montse Martinez ◽  
Àngels Avecilla-Palau ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Young People ◽  
Early Diagnosis ◽  
Sexually Transmitted Infections ◽  
Controlled Trial ◽  
Partner Notification ◽  
Communication Technologies ◽  
Web Based ◽  
Sexually Transmitted ◽  
Randomized Controlled

BACKGROUND An increase in sexually transmitted infections (STIs) as well as an increase in the use of new information and communication technologies among young people in Catalonia is the inspiration behind the idea of designing a smartphone app to promote partner notification of STIs. OBJECTIVE The main objective of this study is to design a Web-based tool adapted to smartphones for partner notification of STIs among youth who are 16 to 24 years old. Additionally, the objective is to evaluate the Web-based tool’s role in increasing the patient referral partner notification. METHODS This is a multicenter randomized controlled trial with a proportional stratification of the sample by center and random allocation of participants to the 3 arms of the study (simple Web-based intervention, game Web-based intervention, and control). This study is being conducted by midwives, gynecologists, and physicians in the sexual and reproductive areas of the primary health care centers. RESULTS The primary outcome measure is the number and proportion of partner notifications. Additional outcome measures are the yield of early diagnosis and treatment of those exposed and infected, acceptability, barriers, and preferences for partner notification. Expected results include an increase in the yield of partner notification, early diagnosis and treatment among youth using Web-based interventions compared with those receiving the traditional advice to notify, and a description of sexual networks among those participating in the study. CONCLUSIONS The Notijoves is expected to have a sustainable positive impact in the partner notification practice among youth and contribute to increasing the awareness of STI prevention. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12896

scholarly journals Web-based toolkit to facilitate European collaboration on evidence generation on promising health technologies

2009 ◽  
Vol 25 (S2) ◽  
pp. 68-74 ◽  
Author(s):  
Fabienne Quentin ◽  
Cédric Carbonneil ◽  
Céline Moty-Monnereau ◽  
Elena Berti ◽  
Wim Goettsch ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Information Sharing ◽  
Technology Assessment ◽  
Web Site ◽  
Health Technology ◽  
Web Based ◽  
Health Technologies ◽  
European Collaboration ◽  
Evidence Generation ◽  
The Web

Background: Several countries have developed policy frameworks allowing timely access to promising health technologies on the condition that additional evidence is generated. However, an important barrier to evidence generation is the lack of structured collaboration among health technology assessment (HTA) agencies.Objectives: One of the aims of Work Package 7 (WP7) of the European network for Health Technology Assessment (EUnetHTA) Project was to determine the types of structured collaboration that could facilitate evidence generation and to develop a Web-based toolkit to support such collaboration.Methods: Collaboration modalities were defined by all WP7 Partners. Initial emphasis was on information sharing. Standardized forms for information sharing were developed and tested. An information technology development phase followed with the creation of the Web-based toolkit (Web site).Results: Three levels of collaboration were agreed on: (i) sharing information, (ii) coordinated action, and (iii) joint action. The Web site allows access to structured and standardized forms for requesting information, posting information in response to a request, and posting information spontaneously. An online database contains all of the information requested or posted. Pilot tests on twenty-one promising technologies were satisfactory.Conclusions: This new Web site for sharing information on evidence generation should help countries reach robust decisions on the timely adoption of promising health technologies. It will only become fully operational if EUnetHTA Partners supply relevant, accurate, and updated information, and regularly use the Web site.

IMPLEMENTING HEALTH TECHNOLOGY ASSESSMENT-BASED RECOMMENDATIONS IN FINLAND: MANAGED UPTAKE OF MEDICAL METHODS

2017 ◽  
Vol 33 (4) ◽  
pp. 430-433 ◽  
Author(s):  
Sinikka Sihvo ◽  
Tuija Ikonen ◽  
Marjukka Mäkelä
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Joint Venture ◽  
Short Form ◽  
Health Technology ◽  
Web Based ◽  
Medical Specialties ◽  
Organizational Effects ◽  
Successes And Challenges

Objectives: The Managed Uptake of Medical Methods Program (MUMM) started 10 years ago as a joint venture of the Finnish Office for Health Technology Assessment (Finohta) and the twenty hospital districts in Finland. The aim is to offer information on the effectiveness, safety, organizational effects, and costs of new medical methods to support decisions concerning their uptake in secondary care. In this article, we discuss the successes and challenges of implementing the MUMM program.Methods: A study of awareness and use of five MUMM recommendations for various medical specialties with short-form web-based surveys to hospitals.Results: The recommendations were noticed and considered relevant. In overall assessment they received a mean rating of 8.4 (range: 4 to 10). Two thirds of the respondents thought MUMM recommendations were useful for practice, but only a third had actually used them in decision making.Conclusions: HTA-based MUMM recommendations were well received by physicians but in practice they are less used than clinical practice guidelines. Short-form electronic surveys were a useful way of gathering information about awareness and implementation. The surveys also functioned as another method of informing key physicians about the recommendations.

scholarly journals Accelerated partner therapy (APT) partner notification for people withChlamydia trachomatis: protocol for the Limiting Undetected Sexually Transmitted infections to RedUce Morbidity (LUSTRUM) APT cross-over cluster randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e034806 ◽  
Author(s):  
Claudia S Estcourt ◽  
Alison R Howarth ◽  
Andrew Copas ◽  
Nicola Low ◽  
Fiona Mapp ◽  
...  
Keyword(s):  
Sexually Transmitted Infections ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Partner Notification ◽  
Cluster Randomised Controlled Trial ◽  
Sex Partners ◽  
Sexually Transmitted ◽  
Cluster Randomised ◽  
Heterosexual Women ◽  
Randomised Controlled

IntroductionPartner notification (PN) is a process aiming to identify, test and treat the sex partners of people (index patients) with sexually transmitted infections (STIs). Accelerated partner therapy (APT) is a PN method whereby healthcare professionals assess sex partners, by telephone consultation, before giving the index patient antibiotics and STI self-sampling kits to deliver to their sex partner(s). The Limiting Undetected Sexually Transmitted infections to RedUce Morbidity programme aims to determine the effectiveness of APT in heterosexual women and men with chlamydia and determine whether APT could affectChlamydia trachomatistransmission at population level.Methods and analysisThis protocol describes a cross-over cluster randomised controlled trial of APT, offered as an additional PN method, compared with standard PN. The trial is accompanied by an economic evaluation, transmission dynamic modelling and a qualitative process evaluation involving patients, partners and healthcare professionals. Clusters are 17 sexual health clinics in areas of England and Scotland with contrasting patient demographics. We will recruit 5440 heterosexual women and men with chlamydia, aged ≥16 years.The primary outcome is the proportion of index patients testing positive forC. trachomatis12-16 weeks after the PN consultation. Secondary outcomes include: proportion of sex partners treated; cost effectiveness; model-predicted chlamydia prevalence; experiences of APT.The primary outcome analysis will be by intention-to-treat, fitting random effects logistic regression models that account for clustering of index patients within clinics and trial periods. The transmission dynamic model will be used to predict change in chlamydia prevalence following APT. The economic evaluation will use mathematical modelling outputs, taking a health service perspective. Qualitative data will be analysed using interpretative phenomenological analysis and framework analysis.Ethics and disseminationThis protocol received ethical approval from London—Chelsea Research Ethics Committee (18/LO/0773). Findings will be published with open access licences.Trial registration numberISRCTN15996256.

Effectiveness, Safety and Cost-Effectiveness of Homeopathy in General Practice – Summarized Health Technology Assessment

2006 ◽  
Vol 13 (2) ◽  
pp. 19-29 ◽  
Author(s):  
Gudrun Bornhöft ◽  
Ursula Wolf ◽  
Klaus von Ammon ◽  
Marco Righetti ◽  
Stefanie Maxion- Bergemann ◽  
...  
Keyword(s):  
General Practice ◽  
Cost Effectiveness ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology

scholarly journals A web-based health technology assessment in tele-echocardiography: the experience within an Italian project

2009 ◽  
Vol 45 (4) ◽  
Author(s):  
Daniele Giansanti ◽  
Sandra Morelli ◽  
Giovanni Maccioni ◽  
Lorenzo Guerriero ◽  
Remo Bedini ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Web Based

Standards for comprehensive sexual health services for young people under 25 years

2002 ◽  
Vol 13 (6) ◽  
pp. 420-424 ◽  
Author(s):  
K E Rogstad ◽  
I H Ahmed-Jushuf ◽  
A J Robinson
Keyword(s):  
General Practice ◽  
Young People ◽  
Health Service ◽  
Health Services ◽  
Sexual Health ◽  
Sexually Transmitted Infections ◽  
Sexually Transmitted ◽  
Sexual Health Service ◽  
Contraceptive Services ◽  
Level 2

This document is a first response to the need to develop sexual health services for young people on a single site whilst awaiting research from pilot studies of 'one stop shops' suggested in the Sexual Health and HIV strategy. It is a document which is intended to be a tool to use for those wishing to set up a service providing testing for sexually transmitted infections and provision of contraceptive services for those under 25 years. It is not intended that such a service would replace existing specialist or general practice care but complement it, allowing clients to choose the service most appropriate and acceptable to them, with close links and clear pathways of care for referral between services. This paper should be used as a template when initiating and monitoring a clinic but some of the standards may not be achievable without significant financial input. However, economic limitations should not detract from striving to achieve the best possible care for those most at risk from sexually transmitted infections and unwanted pregnancies. For example, not all clinics will be able to provide the recommended tests for the diagnosis for gonorrhoea and chlamydia immediately, but should work towards achieving them. Although the upper age limit in this document is defined as 25 years, some providers may wish to limit clinics to those under 20 depending on local needs. Detailed information on specific issues such as consent and confidentiality, provision of contraception, investigation of non-sexually transmitted vaginal infections and sexually transmitted infection management and diagnosis are referenced and we recommend these are accessed by the users of this document. Many of the references themselves are live documents available on the worldwide web, and are constantly updated. The Sexual Health and HIV Strategy has now been published and these standards are aimed at those who wish to provide a level 2 sexual health service for young people wherever the setting e.g. genitourinary outreach clinic, contraceptive services, general practice. This document is a starting point to be reviewed and updated as new research becomes available, as the Sexual Health Strategy is implemented and with further input from providers of care (family planning, general practice, genitourinary medicine, gynaecology and paediatrics) and service users. All service providers must maintain a high quality of care and have networks both with those who provide more specialized services (Level 3) and Level 1 services. This document is an initial attempt to ensure that there is equity of clinical provision wherever a Level 2 sexual health service is provided and should be a useful tool for those setting up or monitoring services.

Telephone or internet delivered talking therapy can alleviate irritable bowel symptoms

BMJ ◽  
2019 ◽  
pp. l4962
Author(s):  
Rob Cook ◽  
Peter Davidson ◽  
Rosie Martin
Keyword(s):  
Irritable Bowel Syndrome ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Treatment As Usual ◽  
Web Based ◽  
Assessment Programme ◽  
Bowel Symptoms ◽  
Health Technology Assessment Programme ◽  
Irritable Bowel

The studyEveritt H, Landau G, Little P. Therapist telephone-delivered CBT and web-based CBT compared with treatment as usual in refractory irritable bowel syndrome: the ACTIB three-arm RCT. Health Technol Assess 2019;23:1-154.This project was funded by the NIHR Health Technology Assessment Programme (project number 11/69/02).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000784/irritable-bowel-syndrome-helped-by-telephone-or-internet-cbt

scholarly journals The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study

2016 ◽  
Vol 20 (1) ◽  
pp. 1-198 ◽  
Author(s):  
Fiona Lecky ◽  
Wanda Russell ◽  
Gordon Fuller ◽  
Graham McClelland ◽  
Elspeth Pennington ◽  
...  
Keyword(s):  
Head Injury ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Ambulance Service ◽  
The North ◽  
Cluster Randomised ◽  
Severity Of Injury ◽  
Secondary Transfer ◽  
Gcs Score

BackgroundReconfiguration of trauma services, with direct transport of traumatic brain injury (TBI) patients to neuroscience centres (NCs), bypassing non-specialist acute hospitals (NSAHs), could potentially improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) and the difficulties in reliably identifying TBI at scene may make this practice deleterious compared with selective secondary transfer from nearest NSAH to NC. National Institute for Health and Care Excellence guidance and systematic reviews suggested equipoise and poor-quality evidence – with regard to ‘early neurosurgery’ in this cohort – which we sought to address.MethodsPilot cluster randomised controlled trial of bypass to NC conducted in two ambulance services with the ambulance station (n = 74) as unit of cluster [Lancashire/Cumbria in the North West Ambulance Service (NWAS) and the North East Ambulance Service (NEAS)]. Adult patients with signs of isolated TBI [Glasgow Coma Scale (GCS) score of < 13 in NWAS, GCS score of < 14 in NEAS] and stable ABC, injured nearest to a NSAH were transported either to that hospital (control clusters) or bypassed to the nearest NC (intervention clusters). Primary outcomes: recruitment rate, protocol compliance, selection bias as a result of non-compliance, accuracy of paramedic TBI identification (overtriage of study inclusion criteria) and pathway acceptability to patients, families and staff. ‘Open-label’ secondary outcomes: 30-day mortality, 6-month Extended Glasgow Outcome Scale (GOSE) and European Quality of Life-5 Dimensions.ResultsOverall, 56 clusters recruited 293 (169 intervention, 124 control) patients in 12 months, demonstrating cluster randomised pre-hospital trials as viable for heath service evaluations. Overall compliance was 62%, but 90% was achieved in the control arm and when face-to-face paramedic training was possible. Non-compliance appeared to be driven by proximity of the nearest hospital and perceptions of injury severity and so occurred more frequently in the intervention arm, in which the perceived time to the NC was greater and severity of injury was lower. Fewer than 25% of recruited patients had TBI on computed tomography scan (n = 70), with 7% (n = 20) requiring neurosurgery (craniotomy, craniectomy or intracranial pressure monitoring) but a further 18 requiring admission to an intensive care unit. An intention-to-treat analysis revealed the two trial arms to be equivalent in terms of age, GCS and severity of injury. No significant 30-day mortality differences were found (8.8% vs. 9.1/%;p > 0.05) in the 273 (159/113) patients with data available. There were no apparent differences in staff and patient preferences for either pathway, with satisfaction high with both. Very low responses to invitations to consent for follow-up in the large number of mild head injury-enrolled patients meant that only 20% of patients had 6-month outcomes. The trial-based economic evaluation could not focus on early neurosurgery because of these low numbers but instead investigated the comparative cost-effectiveness of bypass compared with selective secondary transfer for eligible patients at the scene of injury.ConclusionsCurrent NHS England practice of bypassing patients with suspected TBI to neuroscience centres gives overtriage ratios of 13 : 1 for neurosurgery and 4 : 1 for TBI. This important finding makes studying the impact of bypass to facilitate early neurosurgery not plausible using this study design. Future research should explore an efficient comparative effectiveness design for evaluating ‘early neurosurgery through bypass’ and address the challenge of reliable TBI diagnosis at the scene of injury.Trial registrationCurrent Controlled Trials ISRCTN68087745.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 1. See the NIHR Journals Library website for further project information.

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