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1.
The importance of service‐users’ perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programmes 下载免费PDF全文
Katy Sutcliffe PhD G. J. Melendez‐Torres DPhil RN Helen E. D. Burchett PhD Michelle Richardson PhD Rebecca Rees PhD James Thomas PhD 《Health expectations》2018,21(3):563-573
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Joseph Rujumba James K Tumwine Thorkild Tylleskär Stella Neema Harald K Heggenhougen 《BMC health services research》2012,12(1):3
Background
The implementation and utilization of programmes for the prevention of mother-to-child transmission (PMTCT) of HIV in most low income countries has been described as sub-optimal. As planners and service providers, the views of health workers are important in generating priorities to improve the effectiveness of the PMTCT programme in Uganda. We explored the lessons learnt by health workers involved in the provision of PMTCT services in eastern Uganda to better understand what more needs to be done to strengthen the PMTCT programme. 相似文献4.
Objective
Patient‐mediated interventions (PMIs) directed at patients and/or physicians improve patient or provider behaviour and patient outcomes. However, what constitutes a PMI is not clear. This study described interventions explicitly labelled as “patient‐mediated” in primary research.Methods
MEDLINE, EMBASE, Allied and Complementary Medicine, PsychINFO, HealthSTAR, Social Work Abstracts, CINAHL and Cochrane Library were searched from inception on 1 January 2017 for English language studies that developed or evaluated behavioural interventions referred to as “patient‐mediated” or “patient mediated” in the full text. Screening and data extraction were independently duplicated. Data were extracted and summarized on study and intervention characteristics. Interventions were categorized as 1 of 4 PMI pathways.Results
Eight studies (4 randomized controlled trials, 1 observational study and 3 qualitative studies) were included. No studies explicitly defined PMI, and few PMIs were described in terms of content and format. Although 3 studies employed physician interventions, only patient interventions were considered PMIs. One study achieved positive improvement in patient behaviour.Conclusions
Research is needed to generate consensus on the PMI concept, employ theory when designing or evaluating PMIs, establish the effectiveness of different types of PMIs, and understand when and how to employ PMIs alone or combined with other interventions. 相似文献5.
Chee G 《The International journal of health planning and management》2003,18(3):205-220
Despite much discussion of the role of private health care providers, there are no tried and tested models for supporting for-profit providers in ways that produce cost-effective public health outcomes. This paper examines the cost effectiveness of using a loan mechanism to motivate a for-profit provider to deliver family planning services. The intervention examined directly resulted in a private provider delivering family planning services, however, it did not create a long-term financial incentive for the private provider to promote the use of family planning. The cost effectiveness of this intervention is analysed using a methodology that captures long term sustainability of the intervention within a traditional family planning outcome measure, such as couple years protection (CYP), by discounting future expected CYPs. Depending on the method for analysing costs and assumptions regarding future CYPs, this intervention produced family planning outcomes at no or very low cost (0 dollars-4.11 dollars per CYP). The analysis demonstrates that innovative family planning interventions with private providers should be considered as they can be more cost effective than traditional programmes. 相似文献
6.
Identification of factors contributing to successful self‐directed weight loss: a qualitative study 下载免费PDF全文
Background
Despite the number of weight management programmes and their wide promotion, most overweight and obese individuals tend to lose weight on their own. The present study aimed to understand the characteristics and strategies of those who successfully engage in self‐directed weight loss, which could empower other overweight and obese individuals with information and strategies to manage their weight on their own.Methods
Men and women who had lost at least 5% of their body weight without direct interaction with professionals or weight management programmes were recruited. Demographic data were collected by questionnaire and participants' weight‐loss experiences were explored using semi‐ structured interviews to elicit in‐depth individual experiences and perspectives. Iterative thematic method data analysis was used to generate themes describing contributing factors to the success of self‐directed weight loss identified by participants.Results
Most characteristics of those who successfully self‐managed their weight loss were in line with those reported by successful weight losers participating in professional‐led projects. However, strategies such as early embedding of new lifestyle behaviours into daily routine, the ability to learn from previous weight‐loss experiences, and not requiring social support were identified as distinctive factors that contributed to the success of self‐directed weight loss by participants of the present study.Conclusions
Overweight or obese individuals with strong internal motivation, problem‐solving skills and self‐reliance are more likely to be successful at achieving self‐directed weight loss. The patients identified with these characteristics could be encouraged to self‐manage their weight‐loss process, leaving the places available in more resource‐intensive professional‐led programmes to those individuals unlikely to succeed on their own.7.
Involving service users in the development of the Support at Home: Interventions to Enhance Life in Dementia Carer Supporter Programme for family carers of people with dementia 下载免费PDF全文
Karen J. Burnell BSc MSc PhD Amber Selwood MBChB MSc MRCPsych Theresa Sullivan BSc Fiona Poland BAEcon MAEcon PhD Martin Orrell PhD FRCPsych 《Health expectations》2015,18(1):95-110
Background
Involving service users in research can be an effective way of improving the practicalities and acceptability of interventions for target end users.Objectives
The current paper presented two consensus methods, not commonly used in consultation with service users, to develop a peer support intervention for family carers of people with dementia (SHIELD Carer Supporter Programme).Design
Study 1 was a modified Delphi process combined with a consensus conference to explore details of the intervention from the carer and volunteer perspective. Study 2 was an anonymous reader consultation to develop informed consent documents for the intervention trial. Median scores were used to measure and establish consensus. Open‐ended responses were thematically analysed.Setting and participants
Study 1: twenty‐five delegates participated (eight were current/former carers) in the first round Delphi questionnaire, with 21 attending the conference. Five completed the Round 2 questionnaire. Study 2: six family carers and 11 people with dementia took part in the consultation.Results
Study 1: the role of the peer supporters was developed in terms of relational and practical aspects of the intervention. Study 2: changes were made to the documents, reflecting service user input, but the effectiveness of this less discursive type of service user involvement was unclear.Discussion and conclusions
Study 1 methods allowed for service users to contribute significantly and meaningfully, but maybe limiting some design innovation. Study 2 took a more traditional and less collaborative approach. This has implications for balancing the needs of the research with meaningful service user involvement in research. 相似文献8.
Yabroff KR Mangan P Mandelblatt J 《The Journal of the American Board of Family Practice / American Board of Family Practice》2003,16(3):188-203
BACKGROUND: Many women fail to adhere to Papanicolaou smear screening guidelines. Although many interventions have been developed to increase screening, the effectiveness of different types of interventions is unclear. METHODS: We performed a systematic review of interventions to increase Papanicolaou smear use published between 1980 and April 2001 and included concurrently or randomized controlled studies with defined outcomes. Interventions were classified as targeted to patients, providers, patients and providers, or health care systems and as behavioral, cognitive, sociologic, or a combination based on the expected action of the intervention. Effect sizes and 95% confidence intervals were calculated for each intervention. RESULTS: Forty-six studies with 63 separate interventions were included. Most interventions increased Papanicolaou smear use, although in many cases the increase was not statistically significant. Behavioral interventions targeted to patients (eg, mailed or telephone reminders) increased Papanicolaou smear use by up to 18.8%; cognitive and sociologic interventions were only marginally effective, although a single culturally specific, sociologic intervention using a lay health worker increased use by 18.0% (95% confidence interval [CI]: 7.6, 28.4). Provider-targeted interventions were heterogeneous. Interventions that targeted both patients and providers did not appear to be any more effective than interventions targeted to either patients or providers alone. One of the most effective interventions, which introduced a system change by integrating a nurse-practitioner and offered same-day screening, increased screening by 32.7% (95% CI: 20.5, 44.9). CONCLUSIONS: Overall, most interventions increased Papanicolaou smear use, although there was tremendous variability in their effectiveness. Selection of intervention strategies will depend on provider and patient population characteristics and feasibility of implementation. 相似文献
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Policy Points:
- Policymakers seek to transform the US health care system along two dimensions simultaneously: alternative payment models and new models of provider organization.
- This transformation is supposed to transfer risk to providers and make them more accountable for health care costs and quality.
- The transformation in payment and provider organization is neither happening quickly nor shifting risk to providers. The impact on health care cost and quality is also weak or nonexistent.
- In the longer run, decision makers should be prepared to accept the limits on transformation and carefully consider whether to advocate solutions not yet supported by evidence.
Context
There is a widespread belief that the US health care system needs to move “from volume to value.” This transformation to value (eg, quality divided by cost) is conceptualized as a two‐fold movement: (1) from fee‐for‐service to alternative payment models; and (2) from solo practice and freestanding hospitals to medical homes, accountable care organizations, large hospital systems, and organized clinics like Kaiser Permanente.Methods
We evaluate whether this transformation is happening quickly, shifting risk to providers, lowering costs, and improving quality. We draw on recent evidence on provider payment and organization and their effects on cost and quality.Findings
Data suggest a low prevalence of provider risk payment models and slow movement toward new payment and organizational models. Evidence suggests the impact of both on cost and quality is weak.Conclusions
We need to be patient in expecting system improvements from ongoing changes in provider payment and organization. We also may need to look for improvements in other areas of the economy or to accept and accommodate prospects of modest improvements over time. 相似文献10.
Philip Ayieko Angela O Akumu Ulla K Griffiths Mike English 《Cost effectiveness and resource allocation : C/E》2009,7(1):1-13