Effectiveness of interventions utilising telephone follow up in reducing hospital readmission within 30 days for individuals with chronic disease: a systematic review

Background: Rates of readmission to hospital within 30 days are highest amongst those with chronic diseases. Effective interventions to reduce unplanned readmissions are needed. Providing support to patients with chronic disease via telephone may help prevent unnecessary readmission. This systematic review aimed to determine the methodological quality and effectiveness of interventions utilising telephone follow up (TFU) alone or in combination with other components in reducing readmission within 30 days amongst patients with cardiovascular disease, chronic respiratory disease and diabetes. Methods: A systematic search of MEDLINE, the Cochrane Library and EMBASE were conducted for articles published from database inception to 19th May 2015. Interventions which included TFU alone, or in combination with other components, amongst patients with chronic disease, reported 30 day readmission outcomes and met Effective Practice and Organisation of Care design criteria were included. The titles and abstracts of all identified articles were initially assessed for relevance and rejected on initial screening by one author. Full text articles were assessed against inclusion criteria by two authors with discrepancies resolved through discussion. Results: Ten studies were identified, of which five were effective in reducing readmissions within 30 days. Overall, the methodological quality of included studies was poor. All identified studies combined TFU with other intervention components. Interventions that were effective included three studies which provided TFU in addition to pre-discharge support; and two studies which provided TFU with both pre- and post-discharge support which included education, discharge planning, physical therapy and dietary consults, medication assessment, home visits and a resident curriculum. There was no evidence that TFU and telemedicine or TFU and post-discharge interventions was effective, however, only one to two studies examined each of these types of interventions. Conclusions: Evidence is inconclusive for the effectiveness of interventions utilising TFU alone or in combination with other components in reducing readmissions within 30 days in patients with chronic disease. High methodological quality studies examining the effectiveness of TFU in a standardised way are needed. There is also potential importance in focusing interventions on enhancing provider skills in patient education, transitional care and conducting TFU

Methodological quality of teaching communication skills to undergraduate medical students: a mapping review

Abstract Background Patient-clinician communication training is a core component of the undergraduate medical program. As with all areas of medicine, the best available evidence for teaching these skills should be incorporated into training programs. Examining the volume, type and design-quality of publications in this field can help to determine whether research is following a natural scientific progression to inform interactional skills training. This study aimed to review: (i) whether the proportion of publications examining teaching interactional skills to undergraduate medical students by study type, across three time-periods (2007–2008, 2011–2012, 2015–2016), changed over time (i.e. measurement, descriptive or interventions studies); and (ii) the proportion of intervention studies meeting Cochrane Effective Practice and Organisation of Care (EPOC) research design criteria. Methods Medline, PubMed, PsycInfo and the Cochrane Database were searched for studies published in English from 2007 to 2016. Title and abstract reviews were performed for the included years. Articles were examined against the inclusion/exclusion criteria and those included were coded into descriptive, measurement or intervention categories. Results A total of 243 relevant publications were identified. Fifty-two were published from 2007 to 2008, 75 from 2011 to 2012 and 116 from 2015 to 2016. Most identified studies were descriptive (63%), followed by measurement studies (22%) and intervention studies (15%). The proportion of descriptive studies increased significantly over time. However, the proportion of intervention studies did not change and the proportion of measures studies significantly decreased. Of the 37 intervention studies identified within the three time-periods, only 16 (43%) met EPOC study design criteria. Conclusions The largest proportion of identified studies were descriptive, however, descriptive research is not sufficient to ensure communication skills training can effectively improve interactions between clinicians and patients. A more rigorous approach to research in this area is needed to inform education strategies

Resource allocation for depression management in general practice: A simple data-based filter model.

BackgroundThis study aimed to illustrate the potential utility of a simple filter model in understanding the patient outcome and cost-effectiveness implications for depression interventions in primary care.MethodsModelling of hypothetical intervention scenarios during different stages of the treatment pathway was conducted.ResultsThree scenarios were developed for depression related to increasing detection, treatment response and treatment uptake. The incremental costs, incremental number of successes (i.e., depression remission) and the incremental costs-effectiveness ratio (ICER) were calculated. In the modelled scenarios, increasing provider treatment response resulted in the greatest number of incremental successes above baseline, however, it was also associated with the greatest ICER. Increasing detection rates was associated with the second greatest increase to incremental successes above baseline and had the lowest ICER.ConclusionsThe authors recommend utility of the filter model to guide the identification of areas where policy stakeholders and/or researchers should invest their efforts in depression management

Additional file 1: of Methodological quality of teaching communication skills to undergraduate medical students: a mapping review

Search Strategy. The database search strategy used to identify relevant articles is included in this document. (DOC 32 kb

The validity of the state-trait anxiety inventory and the brief scale for anxiety in an inpatient sample with alcohol use disorder

Background and AimsThe Brief Scale for Anxiety (BSA) and the State–Trait Anxiety Inventory Form Y‐2 (STAI‐Y‐2) are self‐report scales used to gauge anxiety symptoms in clinical settings. Co‐occuring anxiety is common in alcohol use disorder (AUD); however, no studies have assessed the validity of the BSA and STAI‐Y‐2 compared with a clinical diagnostic tool of anxiety in alcohol treatment programs. We aimed to examine the validity of the BSA and STAI‐Y‐2 to predict a clinical diagnosis of an anxiety disorder (via the Structured Clinical Interview for DSM [SCID]) in AUD patients.DesignParticipants were administered the BSA (n = 1005) on day 2 and the STAI‐Y‐2 (n = 483) between days 2 and 10 of the detoxification program. SCID‐based clinical diagnoses of AUD and anxiety were made approximately on day 10.Setting and participantsIndividuals seeking treatment for AUD admitted to an inpatient unit at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD, USA (n = 1010).MeasurementsInclusion criteria included a current diagnosis of alcohol dependence (AD) according to DSM‐IV‐TR or moderate to severe AUD according to DSM‐5‐RV, as well as available baseline BSA and/or STAI Y‐2 data. Empirical receiver operating characteristic (ROC) curves were generated using estimates of sensitivity, 1‐specificity and positive and negative predictive values for each cut‐point to determine the accuracy of scale outcomes in relation to SCID diagnoses.FindingsThe BSA demonstrated low accuracy relative to a clinical diagnosis of anxiety with an area under the curve (AUC) of 0.67 at the optimal cut‐point of ≥ 10. The STAI‐Y‐2 had moderate accuracy relative to a clinical diagnosis of anxiety with an AUC of 0.70 at the optimal cut‐point of ≥ 51. The accuracy of the STAI‐Y‐2 increased (AUC = 0.74) when excluding post‐traumatic stress disorder and obsessive–compulsive disorder from anxiety disorder classification.ConclusionsUse of the Brief Scale for Anxiety (BSA) and/or State–Trait Anxiety Inventory Form Y‐2 (STAI‐Y‐2) does not appear to be a reliable substitute for clinical diagnoses of anxiety disorder among inpatients with alcohol use disorder. The BSA and STAI‐Y‐2 could serve as a screening tool to reject the presence of anxiety disorders rather than for detecting an anxiety disorder

A consumer register: an acceptable and cost-effective alternative for accessing patient populations

Abstract Background Population-based registries are increasingly used to recruit patient samples for research, however, they have several limitations including low consent and participation rates, and potential selection bias. To improve access to samples for research, the utility of a new model of recruitment termed the ‘Consumer Register’, that allows for direct patient recruitment from hospitals, was examined. This paper reports: (i) consent rates onto the register; (ii) preferred methods and frequency of contact; and (iii) the feasibility of establishing the register, including: (a) cost per person recruited to the register; (b) the differential cost and consent rates of volunteer versus paid data collectors; and (c) participant completion rates. Methods A cross-sectional survey was conducted in five outpatient clinics in Australia. Patients were approached by volunteers or paid data collectors and asked to complete a touch-screen electronic survey. Consenting individuals were asked to indicate their willingness and preferences for enrolment onto a research register. Descriptive statistics were used to examine patient preferences and linear regression used to model the success of volunteer versus paid data collectors. The opportunity and financial costs of establishing the register were calculated. Results A total of 1947 patients (80.6 %) consented to complete the survey, of which, 1486 (76.3 %) completed the questionnaire. Of the completers, the majority (69.4 %, or 1032 participants) were willing to be listed on the register and preferred to be contacted by email (50.3 %). Almost 39 % of completers were willing to be contacted three or more times in a 12 month period. The annual opportunity cost of resources consumed by the register was valued at $37,187, giving an opportunity cost per person recruited to the register of$36. After amortising fixed costs, the annual financial outlay was $23,004 or$22 per person recruited to the register. Use of volunteer data collectors contributed to an annual saving of $14,183, however paid data collectors achieved significantly higher consent rates. Successful enrolment onto the register was completed for 42 % of the sample. Conclusions A Consumer Register is a promising and feasible alternative to population-based registries, with the majority of participants willing to be contacted multiple times via low-resource methods such as email. There is an effectiveness/cost trade off in the use of paid versus volunteer data collectors

Investigating the effect of an online enhanced care program on the emotional and physical wellbeing of patients discharged from hospital with acute decompensated heart failure: Study protocol for a randomised controlled trial: Enhanced care program for heart failure

Objective Depression is highly prevalent and associated with increased hospitalisations and mortality among patients with heart failure (HF). This study will evaluate the effectiveness and cost-effectiveness of an online wellbeing program for patients discharged from hospital with acute decompensated heart failure (ADHF) in (i) improving emotional and physical wellbeing, and (ii) decreasing healthcare utilisation. Methods Two-arm randomised controlled trial. Eligible patients with ADHF will be recruited pre-discharge from two hospitals. Five hundred and seventy participants will be randomised to receive the intervention (online enhanced care program for HF: ‘Enhanced HF Care’) or usual care. Enhanced HF Care includes health education (11 micro-learning modules) and monitoring of depression and clinical outcomes via fortnightly/monthly surveys for 6 months, with participants offered tailored advice via video email and SMS. Cardiac nurses track real-time patient data from a dashboard and receive automated email alerts when patients report medium- or high-risk levels of depression or clinical symptoms, to action where needed. General practitioners also receive automated alerts if patients report medium- or high-risk survey responses and are encouraged to schedule a patient consultation. Results Sixty-five participants enrolled to-date. Co-primary outcomes (‘Minnesota Living with Heart Failure Questionnaire’ Emotional and Physical subscales) and healthcare utilisation (secondary outcome) at 1- and 6-month post-recruitment will be compared between treatment arms using linear mixed effects regression models. Conclusions This study has the potential to reduce the burden of depression for patients with HF by prioritising urgent mental health needs and clinical symptoms while simultaneously empowering patients with self-care knowledge. Trial registration The trial was prospectively registered via the Australian New Zealand Clinical Trials Registry: ACTRN12622001289707. Issue date: 4 October 2022