The Effectiveness of a Motivational Interviewing Intervention on Mutuality Between Patients With Heart Failure and Their Caregivers

background mutuality, defined as "the positive quality of the relationship between a caregiver and a care receiver", was found to be associated with self-care and caregiver contribution to self-care in heart failure (HF). however, no studies were conducted to evaluate whether motivational interviewing (MI) can improve mutuality in patients with HF and caregivers. objectives the aim of this study was to evaluate the effectiveness of MI on mutuality in HF patient-caregiver dyads. methodsThis is a secondary outcome analysis of the MOTIVATE-HF randomized controlled trial, the primary aim of which was to evaluate the effect of MI on improving self-care in patients with HF. participants were randomized into 3 arms: (1) MI for patients only, (2) MI for both patients and caregivers, and (3) standard care. to assess the HF patients' and caregivers' mutuality, the mutuality scale was used in its patient and caregiver versions. results patients with HF had a median age of 74 years, and there were more men (58%). most patients were retired (76.2%). caregivers had a median age of 55 years and were mostly women (75.5%). most patients were in new york heart association class II (61.9%) and had an ischemic HF etiology (33.6%). the motivational interviews did not show any impact on changes in the patient and caregiver mutuality during the follow-up time (3, 6, 9, and 12 months from baseline). the condition of living together between the patient and the caregiver was significantly associated with better mutuality between the patient and the caregiver. conclusions motivational interviewing performed by nurses was not effective in improving mutuality in patients with HF and caregivers, but the target variable of the intervention was patient self-care. stronger effects of MI on mutuality were observed in patients with HF and caregivers who live together. future studies should target mutuality to see whether MI is really effective

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Background Current NHS policy favours the expansion of diagnostic testing services in community and primary care settings. Objectives Our objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community. Review methods We performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. Results We identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed. Conclusions In the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control. Limitations We have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers. Future work There is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area. Funding The National Institute for Health Research Health Services and Delivery Research programme

Analisi del bisogno formativo nell'ambito del triage infermieristico di pronto soccorso

Il triage è un processo metodologico, il cui fine è identificare le priorità assistenziali degli utenti, attraverso l'attribuzione di un codice che definisce l'ordine di accesso ai trattamenti e l'avvio ai percorsi diagnostico-terapeutico-assistenziali. La letteratura scientifica suggerisce che una formazione adeguata e continua riduce i rischi di una errata attribuzione di codice di priorità, aumentando i livelli di appropriatezza dell'intervento, nonché la qualità e la sicurezza della prestazione erogata. Scopo. Lo studio ha la finalità di valutare il bisogno formativo auto-riferito dagli infermieri di tre pronto soccorso della provincia di Reggio Emilia. Materiali e Metodi. E' stato condotto uno studio descrittivo, lo strumento utilizzato un questionario sottoposto a tutti gli infermieri dei tre Pronto Soccorso di Scandiano, Montecchio e Castelnovo né Monti. Risultati. Il campione è costituito da 40 infermieri, la percentuale di risposta ai questionari è risultata pari al 97%. Il 61% del campione è donna, ha un'età media di 42 anni, 12 dei quali di attività in Pronto Soccorso; il 69% ha conseguito il Diploma di Infermiere Professionale e il 41% ha frequentato oltre il corso base di triage anche il retraining del corso base. L'ambito nel quale gli infermieri dichiarano di essere meno preparati sono gli aspetti medico legali per il 46% del campione. Il bisogno formativo individuato dal 20% degli infermieri è la valutazione del paziente pediatrico. La propria preparazione viene giudicata buona per il 38% DEGLI infermieri. Le modalità didattiche di apprendimento attivo sono quelle preferite dal 92% del campione. L'iper-affollamento è per il 37% degli infermieri la condizione che mette maggiormente in difficoltà l'operatore di triage. Conclusioni. Al fine di orientare la pianificazione didattica al bisogno formativo emerso, i dati della ricerca saranno discussi con le singole unità operative e presentate ai coordinatori e al direttore dei servizi

La valutazione del processo di triage infermieristico: analisi delle sottostime e sovrastime nell\u2019assegnazione del codice giallo

Introduzione L\u2019obiettivo del processo di triage \ue8 garantire una presa in carico della persona attraverso l\u2019assegnazione di una codifica appropriata che ottimizzi il processo di cura, garantendo il tempestivo avvio dei trattamenti e l\u2019attenta sorveglianza dei pazienti in attesa. Il principale errore che pu\uf2 essere commesso nella valutazione infermieristica \ue8 l\u2019assegnazione al paziente di un codice di priorit\ue0 inferiore (sottostima) o superiore (sovrastima). Poich\ue9 dall\u2019analisi dei dati relativi agli accessi a tre Pronto Soccorso dell\u2019Emilia Romagna \ue8 risultato che circa il 20% dei pazienti afferenti sono stati codificati come codice giallo ma solo il 10% di essi \ue8 stato dimesso con la medesima codifica, si \ue8 reso necessario verificare l\u2019appropriatezza del triage infermieristico mediante un\u2019analisi delle sottostime e delle sovrastime del codice giallo. Materiali e metodi Lo studio \ue8 stato realizzato attraverso un\u2019analisi retrospettiva delle schede triage a cui \ue8 stato attribuito il codice giallo nell\u2019anno 2010 in tre Pronto Soccorso, mediante l\u2019analisi dei casi in cui la codifica di accesso e quella di dimissione erano discordanti e il confronto con i protocolli di triage. Risultati Tra i 274 casi discordanti rilevati sono state identificate 10 schede di triage errate per sottostima e 56 per sovrastima del codice assegnato. Le principali cause di errore sono da identificare nella incompleta raccolta o errata interpretazione dei parametri vitali, della sintomatologia dolorosa, unitamente ad una parziale conoscenza dei protocolli relativi in particolare a dispnea, addominalgia, sincope, trauma e disturbi del sensorio. Discussione Il tasso di sovrastima rilevato rientra negli standard regionali, mentre per quanto riguarda il tasso di sottostima \ue8 stato rilevato uno sforamento del range di riferimento in uno dei 3 Pronto Soccorso. Conclusioni Al fine di migliorare la qualit\ue0 del triage infermieristico, in accordo con la letteratura di riferimento, \ue8 stato programmato un progetto formativo per la comunicazione degli esiti della ricerca e l\u2019approfondimento delle tematiche ritenute maggiormente rilevanti

Technology-delivered motivational interviewing to improve health outcomes in patients with chronic conditions: a systematic review of the literature

Aims Provide an overview of remote motivational interviewing (MI) interventions for chronically ill patients, and understand their degree of effectiveness on different health outcomes. Methods and results A systematic review with meta-analysis was conducted using the following databases: PubMed, CINAHL, PsychInfo, and Web of Science. Eligibility criteria included studies that administered remote MI alone or in combination with other remote approaches. A narrative synthesis and two meta-analyses were performed. Fifteen studies met the inclusion criteria. MI administration almost exclusively occurred by telephone and individual sessions. Eight studies reported treatment fidelity aspects, and four declared adopting a theoretical framework. Most targeted outcomes were therapeutic adherence, physical activity, depression, quality of life, and mortality. Risk of bias varied markedly, with the largest source resulting from selection process and intervention performance. The two meta-analyses indicated a significant effect of MI on depression [standardized mean difference = -0.20, 95% confidence interval (CI): -0.34, -0.05, Z = 2.73, P = 0.006, I-2 = 0%], and no effect of MI on glycosylated haemoglobin (mean difference = -0.02, 95% CI: -0.48, 0.45, P = 0.94, I-2 = 84%). Conclusion Remote MI can be a promising approach for improving depression in chronic disease patients. However, studies are inconclusive due to risks of bias, heterogeneity, and lack of reporting of interventionist's training, treatment fidelity, and theoretical frameworks' use. More studies with solid designs are needed to inform clinical decision-making and research. Registration PROSPERO: CRD42021241516

Remote motivational interviewing to improve patient self-care and caregiver contribution to self-care in heart failure (REMOTIVATE-HF): Rationale, design, and methodology for a multicentre randomized controlled trial

In patients with heart failure (HF), self-care, and caregiver contribution to self-care (i.e., the daily management of the disease by patients and caregivers) are essential for improving patient outcomes. However, patients and caregivers are often inadequate in their self-care and contribution to self-care, respectively, and struggle to perform related tasks. Face-to-face motivational interviewing (MI) effectively improves self-care and caregiver contribution to self-care, but the evidence on remote MI is scarce and inconclusive. The aims of this randomized controlled trial will be to evaluate whether remote MI performed via video call in patients with HF: (1) is effective at improving self-care maintenance in patients (primary outcome); (2) is effective for the following secondary outcomes: (a) for patients: self-care management, self-care monitoring, and self-efficacy; HF symptoms; generic and disease-specific quality of life; anxiety and depression; use of healthcare services; and mortality; and (b) for caregivers: contribution to self-care, self-efficacy, and preparedness. We will conduct a two-arm randomized controlled trial. We will enroll and randomize 432 dyads (patients and their informal caregivers) in Arm 1, in which patients and caregivers will receive MI or, in Arm 2, standard care. MI will be delivered seven times over 12 months. Outcomes will be assessed at baseline and 3 (primary outcome), 6, 9, and 12 months from enrollment. This trial will demonstrate whether an inexpensive and easily deliverable intervention can improve important HF outcomes. With the restrictions on in-person healthcare professional interventions imposed by the COVID-19 pandemic, it is essential to evaluate whether MI is also effective remotely