Health promotion in basque local primary care centers: results from
                        implementation strategy optimization and evaluation

Abstract Background The most efficient procedures to engage and guide healthcare professionals in collaborative processes that seek to optimize practice are unknown. The PREDIAPS project aims to assess the effectiveness and feasibility of different procedures to perform a facilitated interprofessional collaborative process to optimize type 2 diabetes prevention in routine primary care. Methods A type II hybrid cluster randomized implementation trial was conducted in nine primary care centers of the Basque Health Service. All centers received training on effective healthy lifestyle promotion. Headed by a local leader and an external facilitator, centers conducted a collaborative structured process—the PVS-PREDIAPS implementation strategy—to adapt the intervention and its implementation to their specific context. The centers were randomly allocated to one of two groups: one group applied the implementation strategy globally, promoting the cooperation of all health professionals from the beginning, and the other performed it sequentially, centered first on nurses, who later sought the pragmatic cooperation of physicians. The following patients were eligible for inclusion: all those aged ≥ 30 years old with at least one known cardiovascular risk factor and an impaired fasting glucose level (≥ 110-125 mg/dl) but without diabetes who attended centers during the study period. The main outcome measures concerned changes in type 2 diabetes prevention practice indicators after 12 months. Results After 12 months, 3273 eligible patients at risk of type 2 diabetes had attended their family physician at least once, and of these, 490 (15%) have been addressed by assessing their healthy lifestyles in both comparison groups. The proportion of at-risk patients receiving a personalized prescription of lifestyle change was slightly higher (8.6%; range 13.5-5.9% vs 6.8%; range 7.2-5.8%) and 2.3 times more likely (95% CI for adjusted hazard ratio, 1.38-3.94) in the sequential than in the global centers, after 8 months of the intervention program implementation period. The probability of meeting the recommended levels of physical activity and fruit and vegetable intake were four- and threefold higher after the prescription of lifestyle change than only assessment and provision of advice. The procedure of engagement in and execution of the implementation strategy does not modify the effect of prescribing healthy habits (p interaction component of intervention by group, p > 0.05). Discussion Our results show that the PVS-PREDIAPS implementation strategy manages to integrate interventions with proven efficacy in the prevention of type 2 diabetes in clinical practice in primary care. Further, they suggest that implementation outcomes were somewhat better with a sequential facilitated collaborative process focused on enhancing the autonomy and responsibility of nurses who subsequently seek a pragmatic cooperation of GPs. Trial registration Clinicaltrials.gov identifier: NCT03254979. Registered 16 August 2017—retrospectively registered.

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Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

BMC Family Practice ◽

10.1186/s12875-021-01410-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Eva Seckler ◽

Verena Regauer ◽

Melanie Krüger ◽

Anna Gabriel ◽

Joachim Hermsdörfer ◽

...

Keyword(s):

Primary Care ◽

Data Collection ◽

Older People ◽

Process Evaluation ◽

Feasibility Study ◽

Health Professionals ◽

Implementation Strategy ◽

Care Pathway ◽

Main Trial ◽

Telephone Helpline

Abstract Background Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. Methods This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. Results A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Conclusion Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Trial registration Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).

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Self-Care, Stress Management, and Primary Care: From Salutogenesis and Health Promotion to Mind-Body Medicine

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/327415 ◽

2013 ◽

Vol 2013 ◽

pp. 1-2 ◽

Cited By ~ 2

Author(s):

Tobias Esch ◽

Gregory L. Fricchione ◽

Stefanie Joos ◽

Michael Teut

Keyword(s):

Primary Care ◽

Health Promotion ◽

Stress Management ◽

Self Care ◽

Mind Body Medicine

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Impact of mental illness on in-patient hospital costs for somatic disorders and associated factors

European Journal of Public Health ◽

10.1093/eurpub/ckz185.038 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Michel ◽

A J Hammami ◽

K Chevreul

Keyword(s):

Primary Care ◽

Health Promotion ◽

Mental Illness ◽

Mental Disorders ◽

Economic Burden ◽

Mentally Ill ◽

Hospital Costs ◽

Healthcare Systems ◽

Interaction Terms

Abstract Background People suffering from mental disorders are in poorer somatic health that the general population. This is due in part to poor quality of care in primary care settings, which can in turn have a major impact on hospitals and healthcare systems, in particular in terms of costs. Our objective was to assess the economic burden of acute care admissions for somatic diseases in patients with a mental illness compared to other patients and analyse the factors associated with it. Methods An exhaustive study using French hospital discharge databases was carried out between 2009 and 2013. Total acute hospital costs were calculated from the all payer perspective (statutory health insurance, private health insurances and patient out-of pocket payments). A multivariate regression modelled the association between mental illness and hospital costs while adjusting for other explanatory variables, with and without interaction terms. Results 37,458,810 admissions were included in the analysis. 1,163,972 patients (6.54%) were identified as being mentally ill. Mean total hospital costs at five years per patient were €8,114. Costs per mentally ill patient were on average 34% higher than for a non-mentally patient (€10,637 vs. €7,949). A longitudinal analysis of costs showed a widening of the gap between the two groups as time went by, from 1.60% in 2009 to 10.51% in 2013. In the multivariate model, mental disorders were significantly associated with increased costs, and interaction terms found an increased impact of mental illness on costs in deprived patients. Conclusions Improving quality of primary care and health promotion in people with a mental illness both for their own sake and to decrease the economic burden on the healthcare system, is of vital importance. Key messages There is a significant increase in hospital costs for somatic care in patients with a mental illness compared to other patients, in particular in patients who are also deprived. It is necessary to improve primary care and health promotion in mentally ill patients, for their sake and for the sake of healthcare systems.

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The gap in human resources to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico

Human Resources for Health ◽

10.1186/s12960-017-0220-5 ◽

2017 ◽

Vol 15 (1) ◽

Cited By ~ 4

Author(s):

Jacqueline Elizabeth Alcalde-Rabanal ◽

Gustavo Nigenda ◽

Till Bärnighausen ◽

Héctor Eduardo Velasco-Mondragón ◽

Blair Grant Darney

Keyword(s):

Primary Care ◽

Health Promotion ◽

Human Resources ◽

Rural Primary Care ◽

Care Facilities ◽

Prevention And Health Promotion

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Health promotion in pharmacy practice and primary care

Health Promotion for Pharmacists ◽

10.1093/acprof:oso/9780192630445.003.0005 ◽

1999 ◽

pp. 76-98

Author(s):

Alison Blenkinsopp ◽

Rhona Panton ◽

Claire Anderson

Keyword(s):

Primary Care ◽

Health Promotion ◽

Pharmacy Practice

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Choosing Healthy Eating for Infant Health (CHErIsH) study: protocol for a feasibility study

BMJ Open ◽

10.1136/bmjopen-2019-029607 ◽

2019 ◽

Vol 9 (8) ◽

pp. e029607

Author(s):

Karen Matvienko-Sikar ◽

Elaine Toomey ◽

Michelle Queally ◽

Caragh Flannery ◽

Kate O Neill ◽

...

Keyword(s):

Primary Care ◽

Childhood Obesity ◽

Infant Feeding ◽

Process Evaluation ◽

Feasibility Study ◽

Healthy Eating ◽

Implementation Strategy ◽

Infant Health ◽

Intervention Delivery ◽

Electronic Delivery

IntroductionChildhood obesity is a public health challenge. There is evidence for associations between parents’ feeding behaviours and childhood obesity risk. Primary care provides a unique opportunity for delivery of infant feeding interventions for childhood obesity prevention. Implementation strategies are needed to support infant feeding intervention delivery. The Choosing Healthy Eating for Infant Health (CHErIsH) intervention is a complex infant feeding intervention delivered at infant vaccination visits, alongside a healthcare professional (HCP)-level implementation strategy to support delivery.Methods and analysisThis protocol provides a description of a non-randomised feasibility study of an infant feeding intervention and implementation strategy, with an embedded process evaluation and economic evaluation. Intervention participants will be parents of infants aged ≤6 weeks at recruitment, attending a participating HCP in a primary care practice. The intervention will be delivered at the infant’s 2, 4, 6, 12 and 13 month vaccination visits and involves brief verbal infant feeding messages and additional resources, including a leaflet, magnet, infant bib and sign-posting to an information website. The implementation strategy encompasses a local opinion leader, HCP training delivered prior to intervention delivery, electronic delivery prompts and additional resources, including a training manual, poster and support from the research team. An embedded mixed-methods process evaluation will examine the acceptability and feasibility of the intervention, the implementation strategy and study processes including data collection. Qualitative interviews will explore parent and HCP experiences and perspectives of delivery and receipt of the intervention and implementation strategy. Self-report surveys will examine fidelity of delivery and receipt, and acceptability, suitability and comprehensiveness of the intervention, implementation strategy and study processes. Data from electronic delivery prompts will also be collected to examine implementation of the intervention. A cost–outcome description will be conducted to measure costs of the intervention and the implementation strategy.Ethics and disseminationThis study received approval from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Study findings will be disseminated via peer-reviewed publications and conference presentations.

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Tackling inequalities through health promotion centres in primary care in Slovenia

European Journal of Public Health ◽

10.1093/eurpub/cky213.393 ◽

2018 ◽

Vol 28 (suppl_4) ◽

Author(s):

R Pribakovic Brinovec ◽

T Albreht ◽

S Vrbovšek ◽

V-K Petric

Keyword(s):

Primary Care ◽

Health Promotion

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A novel income security intervention to address poverty in a primary care setting: a retrospective chart review

BMJ Open ◽

10.1136/bmjopen-2016-014270 ◽

2017 ◽

Vol 7 (8) ◽

pp. e014270 ◽

Cited By ~ 7

Author(s):

Marcella K Jones ◽

Gary Bloch ◽

Andrew D Pinto

Keyword(s):

Primary Care ◽

Health Promotion ◽

Financial Literacy ◽

Chart Review ◽

Community Services ◽

Expert Advice ◽

Advisory Group ◽

Healthcare Team ◽

Income Security ◽

The Impact

ObjectiveTo examine the development and implementation of a novel income security intervention in primary care.DesignA retrospective, descriptive chart review of all patients referred to the Income Security Heath Promotion service during the first year of the service (December 2013–December 2014).SettingA multisite interdisciplinary primary care organisation in inner city Toronto, Canada, serving over 40 000 patients.ParticipantsThe study population included 181 patients (53% female, mean age 48 years) who were referred to the Income Security Health Promotion service and engaged in care.InterventionThe Income Security Health Promotion service consists of a trained health promoter who provides a mixture of expert advice and case management to patients to improve income security. An advisory group, made up of physicians, social workers, a community engagement specialist and a clinical manager, supports the service.Outcome measuresSociodemographic information, health status, referral information and encounter details were collected from patient charts.ResultsEncounters focused on helping patients with increasing their income (77.4%), reducing their expenses (58.6%) and improving their financial literacy (26.5%). The health promoter provided an array of services to patients, including assistance with taxes, connecting to community services, budgeting and accessing free services. The service could be improved with more specific goal setting, better links to other members of the healthcare team and implementing routine follow-up with each patient after discharge.ConclusionsIncome Security Health Promotion is a novel service within primary care to assist vulnerable patients with a key social determinant of health. This study is a preliminary look at understanding the functioning of the service. Future research will examine the impact of the Income Security Health Promotion service on income security, financial literacy, engagement with health services and health outcomes.

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