Articles: community-health-services.
-
Preventive medicine · Mar 2007
Randomized Controlled Trial Comparative StudyRecruiting pregnant smokers into a clinical trial: using a network-model managed care organization versus community-based practices.
Recruiting pregnant smokers into smoking cessation intervention trials is challenging. Changes in health care systems offer new opportunities to overcome many of the obstacles encountered by researchers attempting to address the significant harm from maternal smoking. Investigators could facilitate smoking cessation study recruitment by collaborating with health care systems that systematically collect patient smoking status and record it in a centralized, retrievable fashion. This paper reports the results of utilizing this novel approach and compares it with a typical decentralized practice-based recruitment strategy. ⋯ A recruitment strategy using a health plan's centralized system was more efficient than a practice-based recruitment strategy at identifying potential study participants, but less efficient at generating study participants from the referrals received. Importantly, participants recruited by the two strategies differed by socioeconomic, but not cessation-related, characteristics. To date, recruiting pregnant smokers into intervention studies remains resource intensive and time consuming. Participant identification and recruitment will be greatly enhanced by health system innovations such as implementation of electronic medical records.
-
Health Technol Assess · Mar 2007
Randomized Controlled Trial Comparative StudyExercise Evaluation Randomised Trial (EXERT): a randomised trial comparing GP referral for leisure centre-based exercise, community-based walking and advice only.
To evaluate and compare the effectiveness and cost-effectiveness of a leisure centre-based exercise programme, an instructor-led walking programme and advice-only in patients referred for exercise by their GPs. ⋯ The results of this trial suggest that referral for tailored advice, supported by written materials, including details of locally available facilities, supplemented by detailed assessments may be effective in increasing physical activity. The inclusion of supervised exercise classes or walks as a formal component of the scheme may not be more effective than the provision of information about their availability. On cost-effectiveness grounds, assessment and advice alone from an exercise specialist may be appropriate to initiate action in the first instance. Subsidised schemes may be best concentrated on patients at higher absolute risk, or with specific conditions for which particular programmes may be beneficial. Walking appears to be as effective as leisure centre classes and is cheaper. Efforts should be directed towards maintenance of increased activity, with proven measures such as telephone support. Further research should include an updated meta-analysis of published exercise interventions using the standardised mean difference approach.
-
Randomized Controlled Trial
A quasi-experimental study on a community-based stroke prevention programme for clients with minor stroke.
The aim of this study was to determine the effectiveness of a community-based stroke prevention programme in (1) improving knowledge about stroke; (2) improving self-health-monitoring practice; (3) maintaining behavioural changes when adopting a healthy lifestyle for stroke prevention. ⋯ Effective educational intervention by professional nurses helped clients integrate their learned knowledge into their real-life practice. This empowering, that is, the taking of responsibility by clients for their own self-care management on a daily basis, affirms that patient education has moved beyond teaching people facts.
-
Preventive medicine · Feb 2007
Randomized Controlled Trial Clinical TrialEvaluating a community-based walking intervention for hypertensive older people in Taiwan: a randomized controlled trial.
To study the effect of a community-based walking intervention on blood pressure among older people. ⋯ Among hypertensive older people, a six-month community-based walking intervention was effective in increasing their exercise self-efficacy and reducing systolic blood pressure.
-
Randomized Controlled Trial
The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial.
Adherence to dementia guidelines is poor despite evidence that some guideline recommendations can improve symptoms and delay institutionalization of patients. ⋯ A dementia guideline-based disease management program led to substantial improvements in quality of care for patients with dementia. Current Controlled Trials identifier: ISRCTN72577751.