1.
Evaluating the Effect of Comprehensive Intervention on Cerebro-Vascular Function in Population at High Risk of Stroke.
Liu, X, Gu, Y, Zhang, Y, Zhang, Y, Tan, X
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2019;(9):2543-2554
Abstract
BACKGROUND Today there exists few intervention researches on cerebro-vascular function in populations at high risk of stroke in China. METHODS Patients more than 40 years old, with at least 1 of stroke risk factors were recruited from outpatient department in 3 hospitals. A quasi-experimental design was performed by assigning participants into 3 groups: comprehensive intervention group, health education group, and control group. Participants in the control group received no intervention but were informed of risk factors of stroke. For health education group, a health education class was performed. Except to the health education program, participants in the comprehensive intervention group received an additional health life and behavior guidance. RESULTS After the intervention, the Cerebro-Vascular Function Scores (CVFS) had significant differences among 3 groups (F = 5.252, P < 0.05). There was a significant increase in CVFS compared to the control group (P = 0.003, 95%CI: 1.552-8.493). Significantly changes in obesity were observed in comprehensive intervention group before and after the intervention (χ2 = 9.0747, P = 0.0026). The results of logistic regression showed that comprehensive intervention group had a significant decrease in prevalence of obesity (OR = 0.482, 95% CI: 0.242-0.961) compared to the control group. CONCLUSION Health education on stroke in a high-risk population combined with guidance on proper health life and behavior can be effective in preventing stroke.
2.
The effectiveness of a coordinated preventive care approach for healthy ageing (UHCE) among older persons in five European cities: A pre-post controlled trial.
Franse, CB, van Grieken, A, Alhambra-Borrás, T, Valía-Cotanda, E, van Staveren, R, Rentoumis, T, Markaki, A, Bilajac, L, Marchesi, VV, Rukavina, T, et al
International journal of nursing studies. 2018;:153-162
Abstract
BACKGROUND Older persons often have multiple health and social problems and need a variety of health services. A coordinated preventive approach that integrates the provision of health and social care services could promote healthy ageing. Such an approach can be organised differently, depending on the availability and organizational structures in the local context. Therefore, it is important to evaluate the effectiveness of a coordinated preventive care approach in various European settings. OBJECTIVES This study explored the effects of a coordinated preventive health and social care approach on the lifestyle, health and quality of life of community-dwelling older persons in five European cities. DESIGN International multi-center pre-post controlled trial. SETTING Community settings in cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain. PARTICIPANTS 1844 community-dwelling older persons (mean age = 79.5; SD = 5.6). METHODS The Urban Health Centres Europe (UHCE) approach consisted of a preventive multidimensional health assessment and, if a person was at-risk, coordinated care-pathways targeted at fall risk, appropriate medication use, loneliness and frailty. Intervention and control sites were chosen based on their location in distinct neighbourhoods in the participating cities. Persons in the catchment area of the intervention sites 'the intervention group' received the UHCE approach and persons in catchment areas of the control sites 'the control group' received care as usual. A questionnaire and two measurements were taken at baseline and at one-year follow-up to assess healthy lifestyle, fall risk, appropriate medication use, loneliness level, frailty, level of independence, health-related quality of life and care use. To evaluate differences in outcomes between intervention group and control group for the total study population, for those who received follow-up care-pathways and for each city separately (multilevel) logistic and linear regression analyses were used. RESULTS Persons in the intervention group had less recurrent falls (OR = 0.65, 95% CI = 0.48; 0.88) and lower frailty (B=-0.43, 95% CI= -0.65 to -0.22) at follow-up compared with persons in the control group. Physical health-related quality of life and mental well-being was better (B = 0.95; 95% CI = 0.14-1.76; and B = 1.50; 95% CI = 0.15-2.84 respectively). The effects of the UHCE approach were stronger in the subgroup of persons (53.6%) enrolled in care-pathways. CONCLUSIONS Our study found promising but minor effects for the use of a coordinated preventive health and social care approach for the promotion of healthy ageing of older persons. Future studies should further evaluate effects of coordinated preventive health and social care aimed at healthy ageing. TRIAL REGISTRATION ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.
3.
Electronic patient registries improve diabetes care and clinical outcomes in rural community health centers.
Pollard, C, Bailey, KA, Petitte, T, Baus, A, Swim, M, Hendryx, M
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. 2009;(1):77-84
Abstract
CONTEXT Diabetes care is challenging in rural areas. Research has shown that the utilization of electronic patient registries improves care; however, improvements generally have been described in combination with other ongoing interventions. The level of basic registry utilization sufficient for positive change is unknown. PURPOSE The goal of the current study was to examine differential effects of basic registry utilization on diabetes care processes and clinical outcomes according to level of registry use in a rural setting. METHODS Patients with diabetes (N = 661) from 6 Federally Qualified Health Centers in rural West Virginia were entered into an electronic patient registry. Data from pre- and post-registry were compared among 3 treatment and control groups that had different levels of registry utilization: low, medium, or high (for example, variations in the use of registry-generated progress notes examined at the point-of-care and in the accuracy of registry-generated summary reports to track patients' care). Data included care processes (annual exams, screens to promote wellness, education, and self-management goal-setting) and clinical outcomes (HbA1c, LDL, HDL, cholesterol, triglycerides, blood pressure). FINDINGS The registry assisted in significantly improving 12 of 13 care processes and 3 of 6 clinical outcomes (HbA1c, LDL, cholesterol) for patients exposed to at least medium levels of registry utilization, but not for the controls. For example, the percent of patients who had received an annual eye exam at follow-up was 11%, 34%, and 38% for the low, medium, and high utilization groups, respectively; only the latter groups improved. CONCLUSIONS As an initial step to achieving control of diabetes, basic registry utilization may be sufficient to drive improvements in provider-patient care processes and in patient outcomes in rural clinics with few resources.
4.
Effects of preventive group education on the resistance of LDL against oxidation and risk factors for coronary heart disease in bypass surgery patients.
Palomäki, A, Miilunpalo, S, Holm, P, Mäkinen, E, Malminiem, K
Annals of medicine. 2002;(4):272-83
Abstract
BACKGROUND Comprehensive preventive education for heart patients is effective in reducing cardiac events. However, very demanding counselling protocols cannot easily be implemented as an integral part of clinical practice in hospitals. AIM: To evaluate whether recurrent preventive group education for coronary artery bypass grafting patients affects the resistance of LDL against oxidation and the classical risk factors for coronary heart disease. METHODS A prospective, controlled study with one-year follow-up was carried out in Southern Finland. Coronary artery bypass patients were allocated late (> or = 18 months) after the operation in the intervention and control groups. RESULTS Seventy two patients (65 men and 7 women) completed the study. Twelve-hour group education on healthy life-style had a significant (25%, P = 0.01) but transient positive effect on the resistance of LDL against oxidation. There was a trend towards increased physical activity in the intervention group. The impact of education on patients' weight was also more consistent (1.2 kg at 12 months, P < 0.05), whereas long-term effects on fibrinogen and serum lipids were small. CONCLUSIONS Repeated group education applied as an economically feasible part of specialist care had only small positive effects on patients' risk factors. There was a significant, but transient, increase in the resistance of LDL against oxidation. However, effective lipid lowering drug treatment is indicated for most coronary artery bypass patients rather than repeated health education alone.