Annals of family medicine
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Annals of family medicine · Jan 2023
Randomized Controlled TrialEvaluation of a Virtual Pre-Consultation Tool for Older Adults in Primary Care: Results from a Randomized Trial.
Context: Virtual pre-consultation screening of patient needs may offer opportunities to improve the care and health outcomes of older patients in primary care, especially those with multiple care needs. Objective: We sought to implement and evaluate the effectiveness of a multidimensional virtual pre-consultation tool in the primary care setting to support rapid and standardized needs assessment for older persons. Study Design and Analysis: Pragmatic, multi-center, 1:1 individually randomized trial design. ⋯ Final results of the intention-to-treat analysis will be presented overall and stratified by urban and rural sites. Conclusions: Intended consequences of this intervention include an increased responsiveness of consultations for providers resulting in improved care of older patients. Overall, we hope results will support the implementation of evidence-based, multidimensional and virtual pre-consultation tools for older persons in the primary care setting.
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Annals of family medicine · Jan 2023
Randomized Controlled TrialComparative Effectiveness RCT of Two Weight Loss Strategies in Primary Care Patients: MyPlate.gov vs Calorie Counting.
Context: Since 2011, the U. S. government has supported two approaches to achieve healthier body fat composition: the Diabetes Prevention Program calorie counting (CC) approach, and adherence to federal nutrition guidelines at www.choosemyplate.gov (MyPlate). Objective: Compare the effect of the CC versus MyPlate approach on satiety/satiation and on achieving healthier body fat composition in the primary care setting. ⋯ Conclusions: A MyPlate-based intervention may be a practical alternative to the more traditional CC approach to promoting satiety and facilitating reduction in central adiposity among low-income mostly Latina overweight primary care patients. Our results align with recommendations favoring a diet rich in diverse, fiber-rich foods. More research is warranted to investigate satiety-enhancing approaches to desirable weight control in diverse populations and the use of community health workers as change agents.
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Annals of family medicine · Jan 2023
Randomized Controlled TrialEvaluating the Feasibility of Enhanced Care Planning and Clinical-Community Linkages for Primary Care Teams to Better Address.
Context: Patients with MCC have a range of needs that extend beyond traditional medical care including behavioral, mental health, and social needs. While primary care does its best to address these needs, few practices can undertake a systematic approach without broader health system and coordinated community support. We are conducting a randomized controlled trial to compare a package of four tools (an online health risk assessment called My Own Health Report (MOHR), patient navigator, community health worker, and linkage to community programs) versus usual care to better address these root causes of poor health. ⋯ Conclusions: Helping patients create care plans and connecting them with a patient navigator for the short-term may have long-term benefits for patients and care teams. Yet, this model of team-based care is not currently feasible for many practices. Primary care will benefit from increased health system and community support to make this model more viable to better support the complex needs of patients with MCCs.
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Annals of family medicine · May 2022
Randomized Controlled TrialReducing Readmission of Hospitalized Patients With Depressive Symptoms: A Randomized Trial.
To determine if hospitalized patients with depressive symptoms will benefit from post-discharge depression treatment with care transition support. ⋯ Care transition support and post-discharge depression treatment can reduce unplanned hospital use with sufficient uptake of the RED-D intervention.
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Annals of family medicine · May 2022
Randomized Controlled TrialConsiderations Before Selecting a Stepped-Wedge Cluster Randomized Trial Design for a Practice Improvement Study.
Despite the growing popularity of stepped-wedge cluster randomized trials (SW-CRTs) for practice-based research, the design's advantages and challenges are not well documented. The objective of this study was to identify the advantages and challenges of the SW-CRT design for large-scale intervention implementations in primary care settings. ⋯ The challenges experienced by EvidenceNOW grantees suggest that certain favorable real-world conditions constitute a context that increases the odds of a successful SW-CRT. An existing infrastructure can support the recruitment of many practices. Strong retention plans are needed to continue to engage sites waiting to start the intervention. Finally, study outcomes should be ones already captured in routine practice; otherwise, funders and investigators should assess the feasibility and cost of data collection.VISUAL ABSTRACT.