Monitoring lithium therapy in a CMHRS during the COVID-19 pandemic

AimsThe COVID-19 pandemic has presented a challenge in ensuring that routine monitoring can still be offered and occur in a safe and effective manner. Our aim was to continue the regular physical health monitoring of North East Hampshire CMHRS patients who are prescribed lithium during the COVID-19 pandemic, and to achieve above 90% compliance for the monitoring standards. Lithium monitoring clinics have been established in our CMHRS since 2017, Lithium is a high-risk medication as recognised by a National Patient Safety Alert in 2009. Previous annual POMH-UK audits have identified suboptimal monitoring of Lithium patients at local and national levels.MethodThe ‘Plan-Do-Study-Act’ (PDSA) approach was utilised and a ‘QI Bundle’ formed. A database of patients who are prescribed lithium has been created and maintained. Synchronised standardised reminder letters are sent to the patients twice yearly. NICE recommends that patients on lithium have their lithium levels checked every 3 months for the first year and then at least every 6 months, plus TFTs, U&Es, calcium and weight every 6 months (or more frequently if impaired). The Specialist Pharmacist Service advise that during the COVID-19 pandemic, if patients are not in the at-risk category then monitoring intervals can be extended by up to 3 months, but that patients in the at-risk category should have their normal monitoring intervals continued.Lithium clinics have been held every April and October since 2017 by the Junior Doctors allocated to NE Hampshire CMHRS. This year they were conducted via telephone appointment or face to face where safe to do so with clinician in full PPE. An audit was subsequently carried out in December 2020 to assess our patient's compliance with the aforementioned NICE recommendations for lithium monitoring, the results of which were compared to previous annual audits.ResultSeventeen patients were currently prescribed lithium within the NE Hampshire CMHRS. Over 90% compliance with monitoring was achieved in December 2020 apart from the checking of calcium levels which was slightly below target at 82%, and weight which was at 88%. There was no significant reduction in monitoring standards obtained compared to data from the previous three years.ConclusionRoutine monitoring for our patients who are prescribed Lithium was effectively and safely continued during the pandemic. Above 90% compliance with lithium monitoring standards was nearly obtained across all areas. We will continue to offer lithium monitoring twice yearly.

How Research Affects Policy: Experimental Evidence from 2,150 Brazilian Municipalities

Can research findings change political leaders’ beliefs and policies? We use experiments with 2,150 Brazilian municipalities to measure mayors’ demand for and response to research information. In one experiment, we find that mayors are willing to pay to learn the results of evaluation studies, and update their beliefs when informed of the findings. They value larger-sample studies more, while not distinguishing between studies in rich and poor countries. In a second experiment, we find that informing mayors about research on a simple and effective policy, taxpayer reminder letters, increases the probability the policy is implemented by 10 percentage points. (JEL D72, D78, D83, O17, O18)

Assessing the implementation of interventions addressing socioeconomic inequalities in cancer screening in high-income countries

Background: The context of an intervention may influence its effectiveness and success in meeting the needs of the targeted population. Implementation science frameworks have been developed, but previous literature in this field has been mixed. This paper aimed to assess the implementation success of interventions, identified from a systematic review, that reduced inequalities in cancer screening between people in low and high socioeconomic groups.Design and Methods: The implementation framework by Proctor et al. was utilised to assess the potential success of 6 studies reporting on 7 interventions in the “real-world” environment. A standardised rating system to identify the overall implementation success of each intervention was established.Results: Four interventions (57%) demonstrated high potential to be implemented successfully. Interventions included enhanced reminder letters and GP-endorsed screening invitations, containing evidence on the acceptability, from participants and stakeholders, appropriateness and direct cost of the intervention. Conclusion: While some interventions reduced socioeconomic inequalities in cancer screening participation, there have been missed opportunities to integrate the experiences of the targeted population into design and evaluation components. This has limited the potential for transferability of outcomes to other settings.

The impact of interventions addressing socioeconomic inequalities in cancer-related outcomes in high-income countries: A systematic review

Background: High cancer mortality is a major source of burden. Population-wide programs have been developed to improve cancer outcomes, and although effective in improving outcomes overall, the socioeconomically disadvantaged population have disproportionately benefited. This systematic review evaluated interventions aimed at addressing inequalities in cancer-related outcomes between low and high socioeconomic groups within high-income countries.Materials and Methods: The Cochrane Register of Controlled Trials, EMBASE, and PubMed searches were completed in October 2018. Data extraction and quality appraisal were guided by established mechanisms. Impact of interventions, using odds ratios, with respective 95% confidence intervals were presented, where available.Results: Sixteen studies reporting on 19 interventions were included. Seven interventions (37%) reduced socioeconomic inequalities in cancer-related outcomes, focusing on participation in cancer screening. Interventions included pre-formulated implementation intentions; GP-endorsed screening invitations; enhanced reminder letters; text message reminders; and implementation of an organised screening program.Conclusions: This systematic review found limited evidence on the efficacy of existing interventions that aimed to reduce inequalities in cancer-related outcomes between people living in low and high socioeconomic areas among high-income countries. Future interventions should consider the specific needs of people living in socioeconomically disadvantaged areas to improve the efficacy of an intervention.

Effectiveness of nudges on small business tax compliance behavior

There has been a surge of basic and applied interest in exploring how small changes in decision contexts might be used to improve heuristic decision-making, “nudging” decision-makers toward choices that increase individual and social utility. The present study tested the impact of three types of nudges on tax compliance among delinquent businesses (n=3,130) in the state of Pennsylvania: (1) sending reminder letters that almost identically matched original tax delinquency notices, (2) sending redesigned reminder letters that simplified text and layout, increased the salience of critical information, and included an “Act Now” urgency statement, and (3) sending redesigned reminder letters with handwritten notes on the envelope. Redesigned reminder letters significantly increased the number of business owners who responded and the amount of delinquency paid within 15 days of receiving the notices. The addition of a handwritten note on the outside of the envelope did not additionally increase response rates or payment amount. Although the effect sizes observed in this study were small, the potential impact is large given the number of delinquent businesses and the average amount of taxes owed in Pennsylvania.

Effect of Various Invitation Schemes on the Use of Fecal Immunochemical Tests for Colorectal Cancer Screening: Protocol for a Randomized Controlled Trial

Background Fecal occult blood testing has been offered for many years in the German health care system, but participation rates have been notoriously low. Objective The aim of this study is to evaluate the effect of various personal invitation schemes on the use of fecal immunochemical tests (FITs) in persons aged 50-54 years. Methods This study consists of a three-armed randomized controlled trial: (1) arm A: an invitation letter from a health insurance plan including a FIT test kit, (2) arm B: an invitation letter from a health insurance plan including an offer to receive a free FIT test kit by mail upon easy-to-handle request (ie, by internet, fax, or reply mail), and (3) arm C: an information letter on an existing colonoscopy offer (ie, control). Within arms A and B, a random selection of 50% of the study population will receive reminder letters, the effects of which are to be evaluated in a substudy. Results A total of 17,532 persons aged 50-54 years in a statutory health insurance plan in the southwest of Germany—AOK Baden-Wuerttemberg—were sent an initial invitation, and 5825 reminder letters were sent out. The primary end point is FIT usage within 1 year from receipt of invitation or information letter. The main secondary end points include gender-specific FIT usage within 1 year, rates of positive test results, rates of colonoscopies following a positive test result, and detection rates of advanced neoplasms. The study was launched in September 2017. Data collection and workup were completed in fall 2019. Conclusions This randomized controlled trial will provide important empirical evidence for enhancing colorectal cancer screening offers in the German health care system. Trial Registration German Clinical Trials Register (DRKS) DRKS00011858; https://bit.ly/2UBTIdt International Registered Report Identifier (IRRID) DERR1-10.2196/16413

Self-reported data in environmental health studies: mail vs. web-based surveys

Background Internet has been broadly employed as a facilitator for epidemiological surveys, as a way to provide a more economical and practical alternative to traditional survey modes. A current trend in survey research is to combine Web-based surveys with other survey modes by offering the participant the possibility of choosing his/her preferred response method (i.e. mixed-mode approach). However, studies have also demonstrated that the use of different survey modes may produce different responses to the same questions, posing potential challenges on the use of mixed-mode approaches. Methods In this paper, we have implemented a statistical comparison between mixed-mode survey responses collected via mail (i.e. paper) and Web methods obtained from a cross-sectional study in non-urban areas of Denmark. Responses provided by mail and Web participants were compared in terms of: 1) the impact of reminder letters in increasing response rates; 2) differences in socio-demographic characteristics between response groups; 3) changes on the likelihood of reporting health symptoms and negative attitudes towards environmental stressors. Comparisons were mainly performed by two sample t-test, Pearson’s Chi-squared test and multinomial logistic regression models. Results Among 3104 contacted households, 1066 residents decided to participate on the study. Out of those, 971 selected to respond via mail, whereas 275 preferred the Web method. The majority of socio-demographic characteristics between these two groups of respondents were shown to be statistically different. The use of mailed surveys increased the likelihood of reporting health symptoms and negative attitudes towards environmental stressors, even after controlling for demographic characteristics. Furthermore, the use of reminder letters had a higher positive impact in increasing responses of Web surveys when compared to mail surveys. Conclusions Our main findings suggest that the use of mail and Web surveys may produce different responses to the same questions posed to participants, but, at the same time, may reach different groups of respondents, given that the overall characteristics of both groups considerably differ. Therefore, the tradeoff between using mixed-mode survey as a way to increase response rate and obtaining undesirable measurement changes may be attentively considered in future survey studies.