Role of community health workers in improving cost efficiency in an active case finding tuberculosis programme: an operational research study from rural Bihar, India

ObjectivesCost-efficient active case finding (ACF) approaches are needed for their large-scale adoption in national tuberculosis (TB) programmes. Our aim was to assess if community health workers’ (CHW) knowledge about families’ health status can improve the cost efficiency of the ACF programme without adversely affecting the delivery of other health services for which they are responsible.DesignQuasi-experimental design.InterventionsWe evaluated an ACF programme in the Samastipur district in Bihar, India, between July 2017 and June 2018. CHWs called Accredited Social Health Activists generated referrals of individuals at risk of TB and conducted symptom-based screening to identify patients with presumptive TB. They also helped them undergo testing and provided treatment support for confirmed TB cases.Primary and secondary outcome measuresWe compared the notification rate from the intervention region with that from a control region in the same district with similar characteristics. We analysed operational data to calculate the cost per TB case diagnosed. We used routine programmatic data from the public health system to estimate the impact on other services provided by CHWs.FindingsCHWs identified 9895 patients with presumptive TB. Of these, 5864 patients were tested for TB, and 1236 were confirmed as TB cases. Annual public case notification rate increased sharply in the intervention region from 45.8 to 105.8 per 100 000 population, whereas it decreased from 50.7 to 45.3 in the control region. There was no practically or statistically significant impact on other output indicators of the CHWs, such as institutional deliveries (−0.04%). The overall cost of the intervention was about US$134 per diagnosed case. Main cost drivers were human resources, and commodities (drugs and diagnostics), which contributed 37.4% and 32.5% of the cost, respectively.ConclusionsACF programmes that use existing CHWs in the health system are feasible, cost efficient and do not adversely affect other healthcare services delivered by CHWs.

Evaluation of the Impact of a Regional Educational Advertising Campaign on Harm Perceptions of E-Cigarettes, Prevalence of E-Cigarette Use, and Quit Attempts Among Smokers

Introduction We evaluated how effective an advertising campaign that was piloted by Cancer Research UK in January/February 2018 was at promoting quit attempts by increasing awareness of the relative harms of e-cigarettes compared with smoking. Methods Adults (≥16 years, n = 2217) living in Greater Manchester (campaign region), Yorkshire & Humber and the North East of England (control regions) completed cross-sectional surveys immediately before and after the campaign period. Surveys measured socio-demographics, perceptions and use of e-cigarettes, and motivation and attempts to quit smoking. We tested interactions between time (pre, post) and region (campaign, control). Results 36.7% (95% CI 33.0%–40.6%) of those in the intervention region recognized the campaign. In the general population, interactions were nonsignificant for all outcomes except for perception of e-cigarettes as effective cessation aids, with smaller increases from pre- to post-campaign in the campaign (49.9% to 54.0%) compared with the control region (40.5% to 55.0%; odds ratio [OR] = 0.66, 95% CI .45–0.98). Among smokers, motivation to quit increased in the intervention region (44.0% to 48.0%) but decreased in the control region (40.5% to 21.5%; OR = 2.97, 95% confidence interval [CI] 1.25–7.16), with no other significant differences between regions over time. Bayes factors confirmed that nonsignificant results were inconclusive. Conclusions Compared with the control region, the campaign was associated with an increase in smokers’ motivation to quit but a smaller increase in adults’ perception of e-cigarettes as an effective cessation aid. There was insufficient evidence to determine whether the campaign affected other outcomes. Implications Past extended mass media tobacco control campaigns have been shown to change public attitudes towards smoking, improve motivation to quit smoking, and reduce smoking prevalence. Much less is known about shorter, targeted campaigns. Here we show that using mass media to communicate accurate information about the relative harms of e-cigarettes compared with smoking may be an effective strategy in increasing smokers’ motivation to quit. Moreover, even when only run for a month, such campaigns can reach a large proportion of the targeted population. Further research is needed to evaluate effects on quit attempts and success.

Impact of a regional educational advertising campaign on harm perceptions of e-cigarettes, prevalence of e-cigarette use, and quit attempts among smokers

ABSTRACTBackgroundWe evaluated how effective an advertising campaign that was piloted by Cancer Research UK in January/February 2018 was at promoting quit attempts by increasing awareness of the relative harms of e-cigarettes compared with smoking.MethodsAdults (≥16 years, n = 2217) living in Greater Manchester (campaign region) and Yorkshire & Humber and the North East of England (control regions) completed cross-sectional surveys immediately before and after the campaign period. Surveys measured socio-demographics, perceptions and use of e-cigarettes, and motivation and attempts to quit smoking. We tested interactions between time (pre, post) and region (campaign, control).Results36.7% (95% CI 33.0% – 40.6%) of those in the intervention region recognised the campaign. In the general population, interactions were non-significant for all outcomes except for perception of e-cigarettes as effective cessation aids, with smaller increases from pre-to post-campaign in the campaign (49.9% to 54.0%) compared with the control region (40.5% to 55.0%; OR = 0.66, 95% CI 0.45 – 0.98). Among smokers, motivation to quit increased in the intervention region (44.0% to 48.0%) but decreased in the control region (40.5% to 21.5%; OR = 2.97, 95% CI 1.25 – 7.16), with no other significant differences between regions over time. A Bayesian analysis confirmed that non-significant results were inconclusive.ConclusionsCompared with the control region, the campaign was associated with an increase in smokers’ motivation to quit but a smaller increase in adults’ perception of e-cigarettes as an effective cessation aid. There was insufficient evidence to determine whether the campaign affected other outcomes.

A Community-Based Intervention for Improving Medication Adherence for Elderly Patients with Hypertension in Korea

The chronic disease management program, a community-based intervention including patient education, recall and remind service, and reduction of out-of-pocket payment, was implemented in 2005 in Korea to improve patients’ adherence for antihypertensive medications. This study aimed to assess the effect of a community-based hypertension intervention intended to enhance patient adherence to prescribed medications. This study applied a non-equivalent control group design using the Korean National Health Insurance Big Data. Hongcheon County has been continuously implementing the intervention program since 2012. This study involved a cohort of patients with hypertension aged >65 and <85 years, among residents who lived in the study area for five years (between 2010 and 2014). The final number of subjects was 2685 in both the intervention and control region. The indirect indicators were analyzed as patients’ adherence and level of continuous treatment using the difference-in-difference regression. The proportion of hypertensive patients who continuously received insurance benefits for >240 days in 2014 was 81.0% in the intervention region and 79.7% in the control region. The number of dispensations per prescription and the dispensation days per hypertensive patient in the intervention region increased by approximately 10.88% and 2.2 days on average by month, respectively, compared to those in the control region. The intervention program encouraged elderly patients with hypertension to receive continuous care. Another research is needed to determine whether further improvement in the continuity of comprehensive care will prevent the progression of cardiovascular diseases.

Study protocol for a quasi-experimental claims-based study evaluating 10-year results of the population-based integrated healthcare model ‘Gesundes Kinzigtal’ (Healthy Kinzigtal): the INTEGRAL study

IntroductionPatients often experience interface problems when treated by different specialists and in different healthcare sectors. Integrated care concepts aim to reduce these problems. While most integrated healthcare models focus on individual diseases, the integrated care model ‘Gesundes Kinzigtal’ applies a population-based approach and addresses the full spectrum of morbidities for a population defined by area of residence—the Kinzigtal. A special feature of the model is the joint savings contract between the regional management company and the statutory health insurers. The INTEGRAL study aims at assessing the effectiveness of ‘Gesundes Kinzigtal’ under routine conditions in comparison to conventional care over a period of 10 years in order to understand the benefits but also the potential for (unintended) harms.Methods and analysisDatabaseClaims data from statutory health insurance funds 2005–2015. The evaluation consists of a quasi-experimental study, with Kinzigtal as intervention region, at least 10 further regions with a similar population and healthcare infrastructure as primary controls and an additional random sample of insurees from the federal state of Baden-Württemberg as secondary controls. Model-specific and ‘non-specific’ indicators adopted from the literature and enriched by focus group interviews will be used to evaluate the model’s effectiveness and potential unintended consequences by analysing healthcare utilisation in general. Temporal trends per indicator in the intervention region will be compared with those in each control region. The overall variation in trends for the indicators across all regions provides information about the potential to modify an indicator due to local differences in the healthcare system.Ethics and disseminationEthic Commission of the Faculty of Medicine, Philipps-University Marburg (ek_mr_geraedts_131117). Results will be discussed in workshops, submitted for publication in peer-review journals and presented at conferences.Trial registration numberDRKS00012804.

REHABILITATION OF THE PATIENTS AFTER THE SURGICAL TREATMENT OF HERNIATED INTERVERTEBRAL DISCS

The objectives of the study was to enhance the effectiveness of the rehabilitation of the patients who have undergone the surgical intervention on the herniated intervertebral discs in the lumbosacral spine with the use of general magnetic therapy during their combined treatment. A total of 67 patients were available for the medical examination and treatment. The patients presenting with similar clinical symptoms were allocated to two groups matched for age and gender. All of them received initial therapy including medication, kinetic physical therapy, and hydrokinesitherapy. The patients of the main study group were additionally given magnetic therapy while those in the control group were treated without additional therapy. It has been shown that the introduction of general magnetic therapy into the program of the combined treatment exerts the beneficial influence on the main clinical symptoms of the disease, intensifies the regeneration processes, and improves blood circulation in the surgical intervention region; moreover, it improves the psychoemotional condition and the quality of life in this category of the patients.

An implementation intervention to encourage healthy eating in centre-based child-care services: impact of the Good for Kids Good for Life programme

ObjectiveTo determine the impact of an implementation intervention designed to introduce policies and practices supportive of healthy eating in centre-based child-care services. Intervention strategies included staff training, resources, incentives, follow-up support, and performance monitoring and feedback.DesignA quasi-experimental design was used to assess change over 20 months in healthy eating policy and practice in intervention and comparison child-care services.SettingThe Hunter New England (HNE) region of New South Wales (NSW), Australia.SubjectsAll centre-based child-care services (n 287) in the intervention region (HNE) were invited and 240 (91 % response rate) participated. Two hundred and ninety-six services in the rest of NSW were randomly selected as a comparison region and 191 participated (76 % response rate). A sub-analysis was conducted on those services that provided children food (n 196 at baseline and n 190 at follow-up). Ninety-six provided menus for analysis at baseline (HNE, n 36; NSW, n 50) and 102 provided menus at follow-up (HNE, n 50; NSW, n 52).ResultsServices in the intervention region were significantly more likely to provide only plain milk and water for children (P = 0·018) and to engage parents in nutrition policy or programmes (P = 0·002). They were also more likely (P = 0·056) to have nutrition policy on home packed food. In addition, menus of services that provided lunch were significantly more likely to comply with healthy eating guidelines for sweetened drinks (P < 0·001), fruit (P < 0·001) and vegetables (P = 0·01).ConclusionsAn implementation intervention was able to modify policy and practice in a large number of child-care services so that they were more supportive of healthy eating.

A Community-Based Survey and Screening for Depression in the Elderly

Background: In addition to implementing a depression screening program, conducting a survey beforehand might contribute to suicide risk reduction for the elderly. Aims: This study evaluates outcomes of a community-based program to prevent suicide among individuals aged 60 and over, using a quasiexperimental design with an intervention region (41,337 residents, 35.1% aged 60 and over) and a neighboring reference region. Methods: Our 2-year intervention program included an anonymous survey by random sample in the entire intervention region and, in the second year, a depression screening with follow-up by a psychiatrist in the higher-risk districts. Changes in the risk of completed suicide were estimated by the incidence-rate ratio (IRR). Results: The risk for men in the intervention region was reduced by 61% (age-adjusted IRR = 0.39; 90% CI = 0.18–0.87), whereas there was a (statistically insignificant) 51% risk reduction for women in the intervention region, and no risk reduction for either men or women in the reference region. The ratio of the crude IRR for elderly men in the intervention region to that for all elderly men in Japan was estimated at 0.42 (90% CI = 0.18–0.92), showing that the risk reduction was greater than the national change. Conclusions: The management of depression through a combination of an initial survey and subsequent screening holds clear promise for prompt effectiveness in the prevention of suicide for elderly men, and potentially for women.

Restricting the means of suicide by charcoal burning

SummaryWe conducted an exploratory controlled trial to examine the efficacy of restricting access to charcoal in preventing suicides from carbon monoxide poisoning by charcoal burning in Hong Kong. All charcoal packs were removed from the open shelves of major retail outlets in the intervention region for 12 months; in the control region, charcoal packs were displayed as usual. The suicide rate from charcoal burning was reduced by a statistically significant margin in the intervention region (P<0.05) but not in the control region. We observed no significant change in the suicide rate using other methods in either location.