scholarly journals Evaluation of a Spiritual History with Elderly Multi-Morbid Patients in General Practice—A Mixed-Methods Study within the Project HoPES3

2022 ◽  
Vol 19 (1) ◽  
pp. 538
Author(s):  
Ruth Mächler ◽  
Noemi Sturm ◽  
Eckhard Frick ◽  
Friederike Schalhorn ◽  
Regina Stolz ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Social Activity ◽  
Intervention Group ◽  
Care Program ◽  
Cluster Randomized Trial ◽  
Mixed Methods Study ◽  
Spiritual Needs ◽  
Cluster Randomized ◽  
Spiritual History

Background: The “Holistic Care Program for Elderly Patients to Integrate Spiritual Needs, Social Activity and Self-Care into Disease Management in Primary Care” (HoPES3) examines the implementation of a spiritual history (SH) as part of a multifaceted intervention in German general practices. While the effectiveness of the interventions was evaluated in a cluster-randomized trial, this article investigates the patients’ views concerning the acceptability of the SH and its effects. Methods: A mixed-methods study was conducted in which 133 patients of the intervention group filled in a standardized questionnaire after the intervention. Later, 29 of these patients took part in qualitative semi-standardized interviews. Results: According to the survey, 63% (n = 77) of patients found the SH helpful. In the interviews, however, many indicated that they either kept the conversation brief or declined the offer to talk about spirituality. Contents of longer conversations referred to difficult life events, personal sources of strength, and experiences with religious institutions. Many patients who had a longer conversation about spirituality reported that their relationship with their general practitioner (GP) had improved. Almost all patients recommended integrating a personal conversation of this kind into primary care. Conclusions: The SH seems to be a possible ‘door opener’ for a trusting doctor-patient relationship, which can then be built upon.

scholarly journals Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention

Endocrine ◽  
2021 ◽  
Author(s):  
Marleen Kunneman ◽  
Megan E. Branda ◽  
Jennifer L. Ridgeway ◽  
Kristina Tiedje ◽  
Carl R. May ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Decision Making ◽  
Mixed Methods ◽  
Medication Adherence ◽  
Usual Care ◽  
Cluster Randomized Trial ◽  
Patient Knowledge ◽  
Cluster Randomized

Abstract Purpose To determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making. Methods In this mixed methods multicenter cluster randomized trial, we included patients with type 2 diabetes mellitus and their primary care clinicians. We compared usual care with or without a within-encounter SDM conversation aid. We assessed participant-reported decisions made and quality of SDM (knowledge, satisfaction, and decisional conflict), clinical outcomes, adherence, and observer-based patient involvement in decision-making (OPTION12-scale). We used semi-structured interviews with patients to understand their perspectives. Results We enrolled 350 patients and 99 clinicians from 20 practices and interviewed 26 patients. Use of the conversation aid increased post-encounter patient knowledge (correct answers, 52% vs. 45%, p = 0.02) and clinician involvement of patients (Mean between-arm difference in OPTION12, 7.3 (95% CI 3, 12); p = 0.003). There were no between-arm differences in treatment choice, patient or clinician satisfaction, encounter length, medication adherence, or glycemic control. Qualitative analyses highlighted differences in how clinicians involved patients in decision making, with intervention patients noting how clinicians guided them through conversations using factors important to them. Conclusions Using an SDM conversation aid improved patient knowledge and involvement in SDM without impacting treatment choice, encounter length, medication adherence or improved diabetes control in patients with type 2 diabetes. Future interventions may need to focus specifically on patients with signs of poor treatment fit. Clinical trial registration ClinicalTrial.gov: NCT01502891.

scholarly journals A personalized depression intervention prevents anxiety: Secondary study of a cluster randomized trial

2020 ◽  
pp. bjgp20X714041
Author(s):  
Patricia Moreno Peral ◽  
Sonia Conejo-Ceron ◽  
Juan de Dios Luna ◽  
Michael King ◽  
Irwin Nazareth ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomized Trial ◽  
Intervention Group ◽  
Cluster Randomized Trial ◽  
Social Program ◽  
Primary Care Patients ◽  
Secondary Study ◽  
Cluster Randomized ◽  
Personalized Intervention ◽  
Depression Intervention

Abstract Background: In the predictD-intervention, general practitioners (GPs) used a personalized bio-psycho-social program to prevent depression. This reduced the incidence of major depression by 21% although it was not statistically significant. Aim: Was the predictD-intervention effective in preventing anxiety in non-depressive and non-anxious primary care patients? Design and Setting: Secondary study of a cluster randomized trial with practices randomly assigned to either the predictD-intervention or CAU. This study was conducted in seven Spanish cities from October 2010 to July 2012. Methods: In each city, we randomly selected 10 practices and 2 GPs per practice as well as 4-6 patients every recruiting day until there were 26-27 eligible patients for each GP. The endpoint was cumulative incidence of anxiety as measured by the PRIME-MD over 18 months. Results: A total of 3326 non-depressed patients and 140 GPs from 70 practices consented and were eligible to participate, and 328 were removed because they had an anxiety syndrome at baseline. Of the 2998 valid patients, 2597 (86.6%) were evaluated at the end of the study. At 18 months, 10.43% (95%C.I.: 8.73% to 12.13%) of the patients in the predictD-intervention group developed anxiety compared with 13.1% (11.4% to 14.79%) in the CAU group (difference, -2.67% [-5.05% to -0.28%]; P=0.029). Conclusion: A personalized intervention delivered by GPs for the prevention of depression provided a modest but statistically significant reduction in the incidence of anxiety.

scholarly journals Standing Meetings Are Feasible and Effective in Reducing Sitting Time among Office Workers—Walking Meetings Are Not: Mixed-Methods Results on the Feasibility and Effectiveness of Active Meetings Based on Data from the “Take a Stand!” Study

2020 ◽  
Vol 17 (5) ◽  
pp. 1713 ◽  
Author(s):  
Ida H Danquah ◽  
Janne S Tolstrup
Keyword(s):  
Mixed Methods ◽  
Intervention Group ◽  
Cluster Randomized Trial ◽  
Office Workers ◽  
Sitting Time ◽  
Explorative Study ◽  
Multiple Components ◽  
Cluster Randomized ◽  
Objectively Measured

Active meetings (standing or walking) have the potential to reduce sitting time among office workers. The aim of the present study was to explore the feasibility and effectiveness of standing and walking meetings. The “Take a Stand!” study was a cluster-randomized trial, consisting of multiple components including the possibility of active meetings. Analyses were based on the 173 participants in the intervention group. Feasibility was evaluated by questionnaire and interview data from participants, ambassadors and leaders. Effectiveness was assessed as the change in objectively measured sitting time from baseline to 3 months follow-up. Regular standing meetings were implemented at all offices and were generally popular, as they were perceived as more effective and focused. In contrast, only a few walking meetings were completed, and these were generally associated with several barriers and perceived as ineffective. Participants who participated in standing meetings on a regular basis had 59 min less sitting per 8 h workday (95%CI −101;−17) compared to participants who did not participate in standing meetings at all. Walking meeting participation was not significantly associated with changes in sitting time, likely due to the low number of employees who used this option. This explorative study concludes that standing meetings in office workplaces were feasible and well-liked by the employees, and having frequent standing meetings was associated with reduced sitting time. In contrast, walking meetings were unfeasible and less liked, and thus had no effect on sitting time.

scholarly journals Collaborative care for depression in UK primary care: a randomized controlled trial

2007 ◽  
Vol 38 (2) ◽  
pp. 279-287 ◽  
Author(s):  
D. A. Richards ◽  
K. Lovell ◽  
S. Gilbody ◽  
L. Gask ◽  
D. Torgerson ◽  
...  
Keyword(s):  
Primary Care ◽  
Collaborative Care ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Intervention Group ◽  
Cluster Randomized Trial ◽  
Phase Iii ◽  
Control Group ◽  
Randomized Control ◽  
Cluster Randomized

BackgroundCollaborative care is an effective intervention for depression which includes both organizational and patient-level intervention components. The effect in the UK is unknown, as is whether cluster- or patient-randomization would be the most appropriate design for a Phase III clinical trial.MethodWe undertook a Phase II patient-level randomized controlled trial in primary care, nested within a cluster-randomized trial. Depressed participants were randomized to ‘collaborative care’ – case manager-coordinated medication support and brief psychological treatment, enhanced specialist and GP communication – or a usual care control. The primary outcome was symptoms of depression (PHQ-9).ResultsWe recruited 114 participants, 41 to the intervention group, 38 to the patient randomized control group and 35 to the cluster-randomized control group. For the intervention compared to the cluster control the PHQ-9 effect size was 0.63 (95% CI 0.18–1.07). There was evidence of substantial contamination between intervention and patient-randomized control participants with less difference between the intervention group and patient-randomized control group (−2.99, 95% CI −7.56 to 1.58, p=0.186) than between the intervention and cluster-randomized control group (−4.64, 95% CI −7.93 to −1.35, p=0.008). The intra-class correlation coefficient for our primary outcome was 0.06 (95% CI 0.00–0.32).ConclusionsCollaborative care is a potentially powerful organizational intervention for improving depression treatment in UK primary care, the effect of which is probably partly mediated through the organizational aspects of the intervention. A large Phase III cluster-randomized trial is required to provide the most methodologically accurate test of these initial encouraging findings.

scholarly journals An Exploratory Mixed Methods Study of Experiences of Interprofessional Teams Who Received Coaching to Simultaneously Redesign Primary Care Education and Clinical Practice

2021 ◽  
Vol 12 ◽  
pp. 215013272110237
Author(s):  
Patricia A. Carney ◽  
W. Perry Dickinson ◽  
Jay Fetter ◽  
Eric J. Warm ◽  
Brenda Zierler ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Mixed Methods Study ◽  
Local Context ◽  
Primary Care Residency ◽  
Interprofessional Teams ◽  
Coaching Relationship ◽  
Team Coaching ◽  
Primary Care Education ◽  
Health Coaches

Introduction/Objectives: Coaching is emerging as a form of facilitation in health professions education. Most studies focus on one-on-one coaching rather than team coaching. We assessed the experiences of interprofessional teams coached to simultaneously improve primary care residency training and interprofessional practice. Methods: This three-year exploratory mixed methods study included transformational assistance from 9 interprofessional coaches, one assigned to each of 9 interprofessional primary care teams that included family medicine, internal medicine, pediatrics, nursing, pharmacy and behavioral health. Coaches interacted with teams during 2 in-person training sessions, an in-person site visit, and then as requested by their teams. Surveys administered at 1 year and end study assessed the coaching relationship and process. Results: The majority of participants (82% at end of Year 1 and 76.6% at end study) agreed or strongly agreed that their coach developed a positive working relationship with their team. Participants indicated coaches helped them: (1) develop as teams, (2) stay on task, and (3) respond to local context issues, with between 54.3% and 69.2% agreeing or strongly agreeing that their coaches were helpful in these areas. Cronbach’s alpha for the 15 coaching survey items was 0.965. Challenges included aligning the coach’s expertise with the team’s needs. Conclusions: While team coaching was well received by interprofessional teams of primary care professionals undertaking educational and clinical redesign, the 3 primary care disciplines have much to learn from each other regarding how to improve inter- and intra-professional collaborative practice among clinicians and staff as well as with interprofessional learners rotating through their outpatient clinics.

scholarly journals Engaging primary care providers in managing pediatric eating disorders: a mixed methods study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jocelyn Lebow ◽  
Cassandra Narr ◽  
Angela Mattke ◽  
Janna R. Gewirtz O’Brien ◽  
Marcie Billings ◽  
...  
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Mixed Methods ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Mixed Methods Study ◽  
Evidence Based ◽  
Care Providers ◽  
Evidence Based Treatment

Abstract Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

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