Home About us Contact
|
Home About us Contact | ||
|
|
||
Intervention Outcomes (intervention + outcome)
Selected AbstractsClinical medication review by a pharmacist of elderly people living in care homes: pharmacist interventionsINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2007David P Alldred research clinical pharmacist Objectives To describe the rate and nature of pharmacist interventions following clinical medication review of elderly people living in care homes. Setting Care home residents aged 65+ years, prescribed at least one repeat medication, living in nursing, residential and mixed care homes for older people in Leeds, UK. Method Analysis of data from care home residents receiving clinical medication review in the intervention arm of a randomised controlled trial. Intervention outcomes for each medicine were evaluated for each resident. Key findings Three-hundred and thirty-one residents were randomised to receive a clinical medication review and 315 (95%) were reviewed by the study pharmacist; 256 (77%) residents had at least one recommendation made to the general practitioner. For the 2280 medicines prescribed, there were 672 medicine-related interventions: medicines for cardiovascular system (167 (25%)), nutrition and blood (121 (18%)), central nervous system (113 (17%)) and gastrointestinal conditions (86 (13%)) accounted for 487 (73%) of medicine-related interventions. There were 75 non-medicine-related interventions. The most common interventions were ,technical' (225 (30%)), ,test to monitor medicine' (161 (22%)), ,stop drug' (100 (13%)), ,test to monitor conditions' (75 (10%)), ,start drug' (76 (10%)), ,alter dose' (40 (5%)) and ,switch drug' (37 (5%)). Recommendations to stop a medicine were most common for CNS drugs (32 (32%)). The most common medicine to be recommended to be started was calcium and vitamin D (45 (59%)). Following a recommendation to test to monitor a medicine, 23 (14%) medicines required a change. Conclusions This study has demonstrated that clinical medication review by a pharmacist can identify medicine problems in approximately 80% of care home residents, requiring intervention in 1 in 4 of their prescribed medications. [source] Lifestyle intervention for prevention of diabetes: determinants of success for future implementationNUTRITION REVIEWS, Issue 3 2009Cheryl Roumen Lifestyle interventions are reported to reduce the risk of type 2 diabetes in high-risk individuals after mid- and long-term follow-up. Information on determinants of intervention outcome and adherence and the mechanisms underlying diabetes progression are valuable for a more targeted implementation. Weight loss seems a major determinant of diabetes risk reduction, whereas physical activity and dietary composition may contribute independently. Body composition and genetic variation may also affect the response to intervention. Lifestyle interventions are cost-effective and should be optimized to increase adherence and compliance, especially for individuals in the high-risk group with a low socioeconomic status, so that public health policy can introduce targeted implementation programs nationwide. The aims of this review are to summarize the mid- and long-term effects of lifestyle interventions on impaired glucose tolerance and type 2 diabetes mellitus and to provide determinants of intervention outcome and adherence, which can be used for future implementation of lifestyle interventions. [source] Treatment fidelity as a predictor of behaviour change in parents attending group-based parent trainingCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 5 2009C. Eames Abstract Background Change in parenting skills, particularly increased positive parenting, has been identified as the key component of successful evidence-based parent training (PT), playing a causal role in subsequent child behaviour change for both prevention and treatment of Conduct Disorder. The amount of change in parenting skills observed after PT varies and may be accounted for by both the content of the programme and by the level of PT implementer process skills. Such variation in implementer skills is an important component in the assessment of treatment fidelity, itself an essential factor in successful intervention outcome. Aims To establish whether the Leader Observation Tool, a reliable and valid process skills fidelity measure, can predict change in parenting skills after attendance on the Incredible Years PT programme. Results Positive leader skills categories of the Leader Observation Tool significantly predicted change in both parent-reported and independently observed parenting skills behaviour, which in turn, predicted change in child behaviour outcome. Conclusions Delivering an intervention with a high level of treatment fidelity not only preserves the behaviour change mechanisms of the intervention, but can also predict parental behaviour change, which itself predicts child behaviour change as a result of treatment. [source] The Leader Observation Tool: a process skills treatment fidelity measure for the Incredible Years parenting programmeCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 3 2008C. Eames Abstract Background Despite recognition of the need to deliver evidence-based programmes in the field of mental health, there is little emphasis on implementing such programmes with fidelity. Attempts by programme developers to ensure adherence to their programmes include the development of training, manuals and content scales, but these alone may be insufficient to ensure fidelity in replication. Observational measures lend themselves as a potentially useful assessment of intervention outcomes, providing accurate and objective accounts of the intervention process. Aim To develop a reliable and valid observational treatment fidelity tool of process skills required to deliver the Incredible Years (IY) BASIC parenting programme effectively. Methods An objective observational fidelity measure was developed to assess adherence to the IY BASIC parenting programme protocol. Observations were conducted on 12 IY BASIC parenting programme groups, attended by parents of pre-school children displaying signs of early onset conduct disorder. Results The Leader Observation Tool (LOT) achieved high internal reliability and good code,recode and inter-rater reliability. Evidence of concurrent validity was also obtained. Conclusions Having demonstrated that the LOT is a reliable and valid measure of implementation fidelity, further research is necessary to examine the relationship between LOT scores and intervention outcome. [source] A psychometric evaluation of the Chinese version of the stage of change-readiness and treatment-eagerness scaleJOURNAL OF CLINICAL NURSING, Issue 17 2009Mei-Yu Yeh Aims., The present study analysed the psychometric properties of a Chinese version of the stage of change-readiness and treatment-eagerness scale among alcohol-dependent patients and investigated whether a three-factor structure fit the data. Background., The stage of change-readiness and treatment-eagerness scale is a 19-item instrument designed to measure alcohol-dependent patients' motivation for change. However, this instrument had not been translated and validated for use in Taiwan. Design., Survey. Methods., A sample of 161 alcohol-dependent patients receiving alcohol-related treatment in psychiatric hospital outpatient and inpatient units was included. Confirmatory factor analyses were conducted on three-factor measurement models of the stage of change-readiness and treatment-eagerness scale. Results., Confirmatory factor analyses supported the presence of a three-factor modified model (ambivalence, recognition and taking steps) among alcohol-dependent patients. Higher internal item consistency was found for the recognition and taking step factors, while the ambivalence factor was shown to have lower internal consistency. Convergent, discriminant and concurrent validity were obtained for the assessment of severity of alcohol dependence. Conclusions., The results indicated that the 11-item, three-factor modified Chinese version of the stage of change readiness and treatment eagerness scale provided best goodness of fit for the data in this study. This study demonstrated that the Chinese version of the stage of change readiness and treatment eagerness scale is a reliable and valid self-report measure for the assessment of changing motivation in alcohol-dependent patients. Relevance to clinical practice., The Chinese version of stage of change readiness and treatment eagerness scale is applicable for use in clinical treatment and research, predicting motivation for change and evaluating intervention outcomes in Taiwan. [source] A systematic review of evaluation in formal continuing medical educationTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 1 2007Jing Tian MD Abstract Introduction: Physicians spend a considerable amount of time in Continuing Medical Education (CME) to maintain their medical licenses. CME evaluation studies vary greatly in evaluation methods, levels of evaluation, and length of follow-up. Standards for CME evaluation are needed to enable comparison among different studies and to detect factors influencing CME evaluation. Methods: A review of the CME evaluation literature was conducted on primary research studies published from January 2000 to January 2006. Studies assessing only satisfaction with CME were excluded, as were studies where fewer than 50% of the participants were practicing physicians. Thirty-two studies were included in the analyses. Determinations were made about evaluation methods, outcome measures, and follow-up assessment. Results: Only 2 of 32 reviewed studies addressed all evaluation levels: physician changes in knowledge and attitudes (level 2), practices (level 3), and improved patient health status (level 4). None of the studies using self-developed instruments (n = 10) provided reliability and validity information. Only 6 studies used validated scales. Twenty studies had a follow-up period of 6 months or less, and 11 had a follow-up period between 1 and 2 years. Discussion: A gold standard for evaluating the effectiveness of CME would include assessment of all 4 levels of evaluation. A valid, reliable, and adaptable CME evaluation questionnaire addressing variables in the second level is needed to allow comparison of effectiveness across CME interventions. A minimum 1-year postintervention follow-up period may also be indicated to investigate the sustainability of intervention outcomes. [source] Managers' Active Support when Implementing Teams: The Impact on Employee Well-BeingAPPLIED PSYCHOLOGY: HEALTH AND WELL-BEING, Issue 3 2009Karina Nielsen Research has shown that a variety of organisational change interventions can be effective but the powerful positive results of an intervention do not always generalise to other similar settings. Problems with implementation and a difficult intervention context have been shown to undermine the effectiveness of promising interventions. The impact that middle managers have on the change process and intervention outcomes has not been widely researched. This longitudinal intervention study was carried out in the elderly care sector in a large Danish local government organisation (N = 188), where poor social support, and lack of role clarity and meaningful work had been identified as significant problems. To tackle these problems, teamwork was implemented, with teams having some degree of self-management. It examined whether middle managers' active support for the intervention mediated its impact on working conditions, well-being and job satisfaction. Structural equation modelling showed that middle managers' active involvement in implementing the change partially mediated the relationship between working conditions at time 1 and time 2. Working conditions at time 2 were in turn related to time 2 job satisfaction and well-being. These results suggest that the degree to which employees perceive their middle managers to play an active role in implementing change is related to intervention outcomes. [source] Urban,rural differences in psychiatric rehabilitation outcomesAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2010Srinivasan Tirupati Abstract Objective:,Employing rural and urban patient populations, the aim of the study was to examine the differences in rehabilitation intervention outcomes, particularly in regard to the social and clinical determinants. Design:,The study employed a retrospective, cross-sectional analysis of patient outcome and characteristics. Setting:,Community-based psychiatric rehabilitation service in regional and rural Australia. Participants:,A total of 260 patients were included in the service evaluation phase of the study and 86 in the second part of the study. Participants were community-based and suffered from a chronic mental illness. Main outcome measure(s):,Clinical and functional outcomes were measured using the Health of Nations Outcome Scale and the 16-item Life Skills Profile. The outcome score employed was the difference between scores at intake and at the last complete assessment. Clinical and sociodemographic characters were recorded using a proforma developed for the study. Results:,Patients from rural Maitland had a significantly larger mean reduction in total scores and classified more often as ,Improved' on both the Health of Nations Outcome Scale and Life Skills Profile than patients from either of the urban areas (P < 0.01). Study of randomly selected patients showed that those from an urban area had a more complex illness with multiple needs and less often received family support than their rural counterparts. Conclusions:,For rural communities the improvement in rehabilitation outcomes might be attributable to a more benign form of the illness and the availability of higher levels of social capital. [source] The Leader Observation Tool: a process skills treatment fidelity measure for the Incredible Years parenting programmeCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 3 2008C. Eames Abstract Background Despite recognition of the need to deliver evidence-based programmes in the field of mental health, there is little emphasis on implementing such programmes with fidelity. Attempts by programme developers to ensure adherence to their programmes include the development of training, manuals and content scales, but these alone may be insufficient to ensure fidelity in replication. Observational measures lend themselves as a potentially useful assessment of intervention outcomes, providing accurate and objective accounts of the intervention process. Aim To develop a reliable and valid observational treatment fidelity tool of process skills required to deliver the Incredible Years (IY) BASIC parenting programme effectively. Methods An objective observational fidelity measure was developed to assess adherence to the IY BASIC parenting programme protocol. Observations were conducted on 12 IY BASIC parenting programme groups, attended by parents of pre-school children displaying signs of early onset conduct disorder. Results The Leader Observation Tool (LOT) achieved high internal reliability and good code,recode and inter-rater reliability. Evidence of concurrent validity was also obtained. Conclusions Having demonstrated that the LOT is a reliable and valid measure of implementation fidelity, further research is necessary to examine the relationship between LOT scores and intervention outcome. [source] Commentary: At the Center of Decision Making in Mental Health Services and Interventions Research: Patients, Clinicians, or Relationships?CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 1 2006Lisa A. Cooper Wills and Holmes-Rovner (2006) highlight the fact that despite growing interest in the role of patient preferences and shared decision making with clinicians in the general health services research community, relatively little is known about the impact of these preferences and processes on actual decisions, service delivery engagement, or intervention outcomes in the mental health field. This commentary expands on three important points raised in Wills and Holmes-Rovner's article: (a) the need for more and better research on values assessment, (b) contextual factors in the decision-making process, and (c) the measurement of patient preferences regarding their level of involvement in decision making. [source] Social deprivation and the outcomes of crisis resolution and home treatment for people with mental health problems: a historical cohort studyHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2010Richard Kingsford BA (Hons) MA DipSW MSc Abstract The development of crisis resolution and home treatment (CRHT) teams has been central to the UK Government's objective of reducing reliance on hospital-based care and is supported by a growing body of evidence. However, there has been no research specifically exploring the relationship between social deprivation and CRHT teams, in spite of evidence of an association between social deprivation and increased pressure on inpatient services. This article reports a study which tested the hypothesis that social deprivation is associated with the outcome of CRHT interventions. Using a historical cohort study design, we examined a total of 260 accepted referrals to a CRHT. Social deprivation was measured by the Index of Multiple Deprivation (Office of the Deputy Prime Minister 2004) as a predictor of CRHT interventions outcomes. CRHT outcomes were dichotomised into successful and unsuccessful and were defined with reference to the CRHT operational policy. Univariate analysis found that people who lived in more socially deprived areas had a poorer outcome, as did older people and those referred from the enhanced community mental health team (CMHT). Logistic regression analysis found that age and referral source were independently associated with outcome. Analysis of the demographic data also suggested a non-significant trend towards men having less successful outcomes. Further analysis exploring the characteristics of the different referral sources to the CRHT found that those referred from the enhanced CMHT were significantly more likely to be from the most deprived area. This suggested a relationship between an enhanced level of mental health need, social deprivation and poor outcome of CRHT intervention. [source] | |||||||||||||