An Outreach Intervention Increases Bone Densitometry Testing in Older Women

OBJECTIVES: To evaluate the performance of a patient recall intervention that relies on an outreach coordinator with a bachelor's degree to prompt women by mail and telephone about their eligibility for bone densitometry (dual-energy X-ray absorptiometry (DXA)) screening and allow them to schedule an examination without a medical provider visit ahead of time.
DESIGN: Observational.
SETTING: Academic general internal medicine practice.
INTERVENTION: Mail- and telephone-based patient recall for DXA.
PARTICIPANTS: Five hundred sixty-four women aged 65 to 79 at average risk for osteoporosis without a history of DXA.
MEASUREMENTS: Rates of DXA completion and the change in proportion of screened women during a 7-month intervention period, case finding for clinically significant bone loss, frequency of appropriate clinical follow-up, DXA no-show rates compared with usual care, and clinician satisfaction.
RESULTS: Through patient recall, rates of DXA screening rose significantly ( P <.001), and the proportion of the eligible clinic population screened increased 13%. Thirty percent of patients had clinically significant bone loss, with almost all of these receiving follow-up. DXA no-show rates were comparable with usual care, and provider acceptance was high.
CONCLUSION: A patient recall intervention substantially increased DXA screening, allowing pharmacological therapy to be started much earlier in some women with significant bone loss. It imposed minimal burden on providers and enhanced patient convenience. This type of program may have utility for additional preventive services.     

The Impact of Intensive Outreach on HIV Prevention Activities of Homeless, Runaway, and Street Youth in San Francisco: The AIDS Evaluation of Street Outreach Project (AESOP)

We evaluated the impact of an HIV prevention intervention combining street outreach, storefront prevention services, and subculture-specific activities for homeless, runaway, and street youth. Using systematic, street-based sampling techniques, we conducted 1,146 interviews in cross-sectional surveys at intervention and comparison sites prior to and during intervention implementation. Youth in both sites reported high rates of risky sexual and injection drug use behaviors. In logistic regression the intervention did not impact HIV risk behaviors, but was independently associated with increased outreach worker (OW) contact and referrals for services. Higher levels of OW contact were associated with following through with HIV-related referrals and using new syringes. Youth-oriented needle exchange increased use of new syringes. While our study did not demonstrate an intervention effect on HIV risk behaviors, intensive, subculture-specific outreach, including needle exchange, may improve the lives of street youth.     

Online Outreach Services Among Men Who Use the Internet to Seek Sex With Other Men (MISM) in Ontario,Canada: An Online Survey

Background

Men who use the Internet to seek sex with other men (MISM) are increasingly using the Internet to find sexual health information and to seek sexual partners, with some research suggesting HIV transmission is associated with sexual partnering online. Aiming to “meet men where they are at,” some AIDS service organizations (ASOs) deliver online outreach services via sociosexual Internet sites and mobile apps.

Objective

To investigate MISM''s experiences and self-perceived impacts of online outreach.

Methods

From December 2013 to January 2014, MISM aged 16 years or older were recruited from Internet sites, mobile apps, and ASOs across Ontario to complete a 15-minute anonymous online questionnaire regarding their experience of online outreach. Demographic factors associated with encountering online outreach were assessed using backward-stepwise multivariable logistic regression (P<.05 was considered significant).

Results

Of 1830 MISM who completed the survey, 8.25% (151/1830) reported direct experience with online outreach services. Encountering online outreach was more likely for Aboriginal versus white MISM, MISM from Toronto compared with MISM from either Eastern or Southwestern Ontario, and MISM receiving any social assistance. MISM who experienced online outreach felt the service provider was friendly (130/141, 92.2%), easy to understand (122/140, 87.1%), helpful (115/139, 82.7%), prompt (107/143, 74.8%), and knowledgeable (92/134, 68.7%); half reported they received a useful referral (49/98, 50%). Few MISM felt the interaction was annoying (13/141, 9.2%) or confusing (18/142, 12.7%). As a result of their last online outreach encounter, MISM reported the following: better understanding of (88/147, 59.9%) and comfort with (75/147, 51.0%) their level of sexual risk; increased knowledge (71/147, 48.3%); and feeling less anxious (51/147, 34.7%), better connected (46/147, 31.3%), and more empowered (40/147, 27.2%). Behaviorally, they reported using condoms more frequently (48/147, 32.7%) and effectively (35/147, 23.8%); getting tested for HIV (43/125, 34.4%) or STIs (42/147, 28.6%); asking for their partners’ HIV statuses (37/147, 25.2%); and serosorting (26/147, 17.7%). Few MISM reported no changes (15/147, 10.2%) and most would use these services again (98/117, 83.8%). Most MISM who did not use online outreach said they did not need these services (1074/1559, 68.89%) or were unaware of them (496/1559, 31.82%).

Conclusions

This is the first online outreach evaluation study of MISM in Canada. Online outreach services are a relatively new and underdeveloped area of intervention, but are a promising health promotion strategy to provide service referrals and engage diverse groups of MISM in sexual health education.     

Evaluation of a community-based outreach worker program for children with asthma

OBJECTIVE: An asthma outreach worker (AOW) can provide home-based education about asthma management and methods to minimize home environmental asthma triggers. A theory-based AOW program was implemented by a community partnership and its effectiveness was evaluated. DESIGN: Baseline and follow-up surveys were used to evaluate the effectiveness of the AOW. SAMPLE: The convenience sample consisted of 60 caregivers whose children received AOW services. MEASURES: Quality of life, use of asthma management plans, medication use, health care utilization, home environmental behavior changes to reduce triggers, and satisfaction with AOW services were self-reported by caregivers. RESULTS: Caregivers reported significantly higher quality of life at follow-up than at baseline. At follow-up, 93% of the children had asthma management plans as compared with 31% at baseline. Self-reported hospitalizations were significantly reduced. All of the families made changes to minimize household asthma triggers. Caregivers reported high satisfaction with the AOW and 90% of them felt that the home environmental assessment conducted by the AOW helped improve their child's asthma. CONCLUSION: Short-term community-based AOW services for children can be effective in enhancing self-management capabilities, improving the quality of life, increasing the use of asthma management plans, and helping families reduce asthma triggers in the home environment.     

Do either early warning systems or emergency response teams improve hospital patient survival? A systematic review

Background

For critical care to be effective it must have a system in place to achieve optimal care for the deteriorating ward patient.

Objectives

To systematically review the available literature to assess whether either early warning systems or emergency response teams improve hospital survival. In the event of there being a lack of evidence regarding hospital survival, secondary outcome measures were considered (unplanned ICU admissions, ICU mortality, length of ICU stay, length of hospital stay, cardiac arrest rates).

Methods

The Ovid Medline, EMBASE, CINAHL, Web of Science, Cochrane library and NHS databases were searched in September 2012 along with non-catalogued resources for papers examining the effect of early warning systems or emergency response teams on hospital survival. Inclusion criteria were original clinical trials and comparative studies in adult inpatients that assessed either an early warning system or emergency response team against any of the predefined outcome measures. Exclusion criteria were previous systematic reviews, non-English abstracts and studies incorporating paediatric data. Studies were arranged in to sections focusing on the following interventions:

Early warning systems

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Single parameter systems

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Aggregate weighted scoring systems (AWSS)

Emergency response teams

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Medical emergency teams

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Multidisciplinary outreach services

In each section an appraisal of the level of evidence and a recommendation has been made using the SIGN grading system.

Results

43 studies meeting the review criteria were identified and included for analysis. 2 studies assessed single parameter scoring systems and 4 addressed aggregate weighted scoring systems. A total of 20 studies examined medical emergency teams and 22 studies examined multidisciplinary outreach teams.

Limitations

The exclusion of non English studies and those including paediatric patients does limit the applicability of this review.

Conclusions

Much of the available evidence is of poor quality. It is clear that a ‘whole system’ approach should be adopted and that AWSS appear to be more effective than single parameter systems. The response to deterioration appears most effective when a clinician with critical care skills leads it. The need for service improvement differs between health care systems.