Interventions to reduce dependency in personal activities of daily living in community dwelling adults who use homecare services: a systematic review

Objectives: To identify interventions that aim to reduce dependency in activities of daily living (ADL) in homecare service users. To determine: content; effectiveness in improving ability to perform ADL; and whether delivery by qualified occupational therapists influences effectiveness. Data sources: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, OTseeker, PEDro, Web of Science, CIRRIE, and ASSIA. Review methods: We included: randomised controlled trials, non-randomised controlled trials and controlled before and after studies. Two reviewers independently screened studies for inclusion, assessed risk of bias and extracted data. A narrative synthesis of the findings was conducted. Results: Thirteen studies were included, totalling 4975 participants. Ten (77%) were judged to have risk of bias. Interventions were categorised as those termed ‘re-ablement’ or ‘restorative homecare’ (n=5/13); and those involving separate components which were not described using this terminology (n=8/13). Content of the intervention and level of health professional input varied within and between studies. Effectiveness on ADL: eight studies included an ADL outcome, five favoured the intervention group, only two with statistical significance, both these were controlled before and after studies judged at high risk of bias. ADL outcome was reported using seven different measures. Occupational therapy: there was insufficient evidence to determine whether involvement of qualified occupational therapists influenced effectiveness. Conclusion: There is limited evidence that interventions targeted at personal ADL can reduce homecare service users’ dependency with activities, the content of evaluated interventions varies greatly

Social prescribing: less rhetoric and more reality. A systematic review of the evidence

Objectives: Social prescribing is a way of linking patients in primary care with sources of support within the community to help improve their health and well-being. Social prescribing programmes are being widely promoted and adopted in the UK NHS and so we conducted a systematic review to assess the evidence for their effectiveness. Setting/data sources: Nine databases were searched from 2000 to January 2016 for studies conducted in the UK. Relevant reports and guidelines, websites and reference lists of retrieved articles were scanned to identify additional studies. All the searches were restricted to English language only. Participants: Systematic reviews and any published evaluation of programmes where patient referral was made from a primary care setting to a link-worker or facilitator of social prescribing were eligible for inclusion. Risk of bias for included studies was undertaken independently by two reviewers and a narrative synthesis was performed. Primary and secondary outcome measures: Primary outcomes of interest were any measures of health and wellbeing and or utilisation of health services. Results: We included a total of 15 evaluations of social prescribing programmes. Most were small scale and limited by poor design and reporting. All were rated as a having a high risk of bias. Common design issues included a lack of comparative controls, short follow up durations, a lack of standardised and validated measuring tools, missing data and a failure to consider potential confounding factors. Despite clear methodological shortcomings, most evaluations presented positive conclusions. Conclusions: Social prescribing is being widely advocated and implemented but current evidence fails to provide sufficient detail to judge either success or value for money. If social prescribing is to realise its potential, future evaluations must be comparative by design and consider when, by whom, for whom, how well and at what cost

Effectiveness of psychological interventions for smoking cessation in adults with mental health problems: A systematic review

Purpose: People with long-term mental health problems are heavier smokers than the general population, and suffer greater smoking-related morbidity and mortality. Little is known about the effectiveness of psychological smoking cessation interventions for this group. This review evaluates evidence from randomized controlled trials (RCTs) on the effectiveness of psychological interventions, used alone or with pharmacotherapy, in reducing smoking in adults with mental health problems. Methods: We searched relevant articles between January 1999 and March 2019 and identified 6,200 papers. Two reviewers screened 81 full-text articles. Outcome measures included number of cigarettes smoked per day, 7-day point prevalence abstinence, and continuous abstinence from smoking. Results: Thirteen RCTs, involving 1,497 participants, met the inclusion criteria. Psychological interventions included cognitive behavioural therapy (CBT), motivational interviewing (MI), counselling, and telephone smoking cessation support. Three trials resulted in significant reductions in smoking for patients receiving psychological interventions compared with controls. Two trials showed higher 7-day point prevalence in intervention plus nicotine replacement therapy (NRT) versus standard care groups. Four trials showed that participants who combined pharmacotherapy (bupropion or varenicline) with CBT were more likely to reduce their smoking by 50% than those receiving CBT only. Four out of five trials that compared different psychological interventions (with or without NRT) had positive outcomes regardless of intervention type. Conclusions: This study contributes to our understanding in a number of ways: The available evidence is consistent with a range of psychological interventions being independently effective in reducing smoking by people with mental health problems; however, too few well-designed studies have been conducted for us to be confident about, for example, which interventions work best for whom, and how they should be implemented. Evidence is clearer for a range of psychological interventions – including CBT, MI, and behavioural or supportive counselling – being effective when used with NRT or pharmacotherapy. Telephone-based and relatively brief interventions appear to be as effective as more intense and longer-term ones. There is also good evidence for a strong dose-response relationship – increased attendance predicts improved outcomes – and for interventions having more positive than negative effects on psychiatric symptoms

Should young people be paid for getting tested? A national comparative study to evaluate patient financial incentives for chlamydia screening

<p>Abstract</p> <p>Background</p> <p>Patient financial incentives ("incentives") have been widely used to promote chlamydia screening uptake amongst 15-24 year olds in England, but there is scarce evidence of their effectiveness. The objectives of the study were to describe incentives used to promote chlamydia screening in Primary Care Trusts (PCTs) in England and to evaluate their impact on coverage and positivity rate.</p> <p>Methods</p> <p>PCTs that had used incentives between 1/1/2007 and 30/6/2009 (exposed) were matched by socio-demographic profile and initial screening coverage with PCTs that had not (unexposed). For each PCT, percentage point change in chlamydia screening coverage and positivity for the period before and during the incentive was calculated. Differences in average change of coverage and positivity rate between exposed and unexposed PCTs were compared using linear regression to adjust for matching and potential confounders.</p> <p>Results</p> <p>Incentives had a significant effect in increasing average coverage in exposed PCTs (0.43%, CI 0.04%-0.82%). The effect for voucher schemes (2.35%) was larger than for prize draws (0.16%). The difference was greater in females (0.73%) than males (0.14%). The effect on positivity rates was not significant (0.07%, CI -1.53% to 1.67%).</p> <p>Conclusions</p> <p>Vouchers, but not prize draws, led to a small absolute but large relative increase in chlamydia screening coverage. Incentives increased coverage more in females than males but had no impact on reported positivity rates. These findings support recommendations not to use prize draws to promote chlamydia screening and contribute to the evidence base of the operational effectiveness of using patient incentives in encouraging public health action.</p

A systematic review of the effect of therapists’ internalised models of relationships on the quality of the therapeutic relationship

The quality of the therapeutic relationship has been identified as a key factor in predicting client outcomes, accounting for around 8% of variation (Horvath, Del Re, Flückiger, & Symonds, 2011; Martin, Garske, & Davis, 2000; Wampold, 2001). Although therapist factors have been seen as less relevant to therapeutic relationship quality than client factors, focus on therapist factors has steadily increased in line with the view that the therapist responds differently to different clients, due to their own personal characteristics and unconscious processes. Relational theory suggests that the therapist’s particular qualities combine with the client’s particular qualities to form a unique interpersonal context (e.g. Wachtel, 2008). Safran and Muran (2000) suggest that the interpersonal context is heavily influenced by client and therapist internalised patterns of relating formed in early childhood. Evidence shows that certain therapist factors do affect therapeutic relationship quality; the qualities of dependability, warmth and responsiveness in therapists have all been found to create stronger alliances (Ackerman & Hilsenroth, 2003). The importance of these mostly interpersonal characteristics imply that the internalised relational models of therapists may also be important in determining the type of relationship that is built and the therapeutic processes occurring within

SUPPORT Tools for Evidence-informed Policymaking in health 6: Using research evidence to address how an option will be implemented

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers

Physical activity for people with dementia: A scoping study

Background: This scoping study aimed to identify how physical activity may benefit people with dementia; how and/or if current service provide these benefits; and what support they need to do so. Methods: Methods included an evidence review using literature; mapping current service provision through a survey; and in-depth interviews with a sample of service providers. Results: The 26 studies included in the review indicated the potential effectiveness of physical activity for people with dementia, including improvements in cognition and mood, behaviour and physical condition. Mechanisms of action and the link with outcomes were poorly defined and implemented. The mapping survey and related interviews showed that service providers were delivering a range of services broadly consistent with the scientific evidence. They tended to take a holistic view of possible benefits, and focused on enjoyment and well-being, more than specific cognitive, physical and behavioural outcomes highlighted in literature. Service providers needed more evidence based information and resources to develop services and realise their potential. Conclusion: Despite potential benefits demonstrated in literature and practice, there is a need for further research to optimise interventions and to consider some neglected issues including delivery at home and in communities; impacts for carers; physical activities through ADLs; and individual needs. Studies are needed which take a more holistic approach to the effects of physical activity, and outcomes should be broader and include mental health and wellbeing

The effectiveness of an intervention in increasing community health clinician provision of preventive care: a study protocol of a non-randomised, multiple-baseline trial

<p>Abstract</p> <p>Background</p> <p>The primary behavioural risks for the most common causes of mortality and morbidity in developed countries are tobacco smoking, poor nutrition, risky alcohol use, and physical inactivity. Evidence, guidelines and policies support routine clinician delivery of care to prevent these risks within primary care settings. Despite the potential afforded by community health services for the delivery of such preventive care, the limited evidence available suggests it is provided at suboptimal levels. This study aims to assess the effectiveness of a multi-strategic practice change intervention in increasing clinician's routine provision of preventive care across a network of community health services.</p> <p>Methods/Design</p> <p>A multiple baseline study will be conducted involving all 56 community health facilities in a single health district in New South Wales, Australia. The facilities will be allocated to one of three administratively-defined groups. A 12 month practice change intervention will be implemented in all facilities in each group to facilitate clinician risk assessment of eligible clients, and clinician provision of brief advice and referral to those identified as being 'at risk'. The intervention will be implemented in a non-random sequence across the three facility groups. Repeated, cross-sectional measurement of clinician provision of preventive care for four individual risks (smoking, poor nutrition, risky alcohol use, and physical inactivity) will occur continuously for all three facility groups for 54 months via telephone interviews. The interviews will be conducted with randomly selected clients who have visited a community health facility in the last two weeks. Data collection will commence 12 months prior to the implementation of the intervention in the first group, and continue for six months following the completion of the intervention in the last group. As a secondary source of data, telephone interviews will be undertaken prior to and following the intervention with randomly selected samples of clinicians from each facility group to assess the reported provision of preventive care, and the acceptability of the practice change intervention and implementation.</p> <p>Discussion</p> <p>The study will provide novel evidence regarding the ability to increase clinician's routine provision of preventive care across a network of community health facilities.</p> <p>Trial registration</p> <p>Australian Clinical Trials Registry <a href="http://www.anzctr.org.au/ACTRN12611001284954.aspx">ACTRN12611001284954</a></p> <p>Universal Trial Number (UTN)</p> <p>U1111-1126-3465</p

Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>Anxiety is a common mental health problem seen in primary care. However, its management in clinical practice varies greatly. Clinical practice guidelines (CPGs) have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit. However, uptake and adherence to their recommendations can be low.</p> <p>Method/design</p> <p>This study involves a community based on cluster randomized trial in primary healthcare centres in the Madrid Region (Spain). The project aims to determine whether the use of implementation strategy (including training session, information, opinion leader, reminders, audit, and feed-back) of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion.</p> <p>The number of patients required is 296 (148 in each arm), all older than 18 years and diagnosed with generalized anxiety disorder, panic disorder, and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). They are chosen by consecutive sampling.</p> <p>The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months. Secondary outcome variables include quality of life (EuroQol 5D), and degree of compliance with the CPG recommendations on treatment, information, and referrals to mental health services. Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis.</p> <p>Discussion</p> <p>There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care. Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care patients receive.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN83365316">ISRCTN83365316</a></p