Implementing preventive services. Success and failure in an outpatient trial

Belcher, Donald W.

doi:10.1001/archinte.150.12.2533

Cited by 57 publications

(22 citation statements)

References 31 publications

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“…Despite this, the above data, in combination with our own results, suggest that the level of compliance with therapeutic guidelines increases with the level of awareness within the care setting. This lends support to the notion that specialized clinics devoted to health promotion and preventive interventions can substantially increase the level of compliance with these guidelines, as proposed by BELCHER [19] and GLASSROTH et al [17].…”

Section: Discussionsupporting

confidence: 60%

Adherence to guidelines for the prevention of HIV-related respiratory diseases

Montaner¹,

Phillips²,

Zala³

et al. 1996

Eur Respir J

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A Ad dh he er re en nc ce e t to o g gu ui id de el li in ne es s f fo or r t th he e p pr re ev ve en nt ti io on n o of f H HI IV V--r re el la at te ed d r re es sp pi ir ra a--t to or ry y d di is se ea as se es s ABSTRACT: In this study we characterized the pattern of use of preventive therapies for specific respiratory diseases within a cohort of homosexual men and assessed the impact of targeted feedback on the level of compliance with guidelines for these diseases. All human immunodeficiency virus seronegative (HIV-) (n=169) and acquired immune deficiency syndrome (AIDS)-free human immunodeficiency virus seropositive (HIV+) (n=154) participants in our cohort, who completed four annual visits between October 1989 and December 1993, were identified. Information about the use of purified protein derivative (PPD) (tuberculin) testing, history of pneumococcal vaccinations, influenza vaccinations, use of Pneumocystis carinii pneumonia (PCP) prophylaxis, symptoms and CD4 counts was obtained yearly for each subject. In 1992, participating physicians were provided with feedback regarding the overall levels of compliance with contemporary guidelines for the prevention of respiratory disease. As part of this exercise, the guidelines were distributed and discussed.The percentage of HIV+ patients who underwent PPD testing increased from 43 to 65% during the study (p=0.001). Significantly more HIV+ than HIV-patients underwent PPD testing (p<0.001). A total of 144 (94%) HIV+ men received at least one influenza vaccination compared to 60 (35%) HIV-men (p<0.001). Utilization of influenza vaccination in the HIV+ group significantly increased from 78% in 1992 to 92% in 1993 (p<0.001). A total of 104 (68%) HIV+ men received pneumococcal vaccination compared to 2 (1%) HIV-men (p<0.001). Among HIV+ individuals whose absolute CD4+ count was less than 200 cells·mm -3 , the percentage of men who received primary PCP prophylaxis was 0, 86, 72 and 88 for the years 1990-1993, respectively. Among HIV+ patients whose only eligibility criterion for PCP prophylaxis was a CD4+ percentage <20%, compliance was 55, 30, 37 and 50% for the years 1990-1993, respectively. Among HIV+ subjects, increases in the compliance level were noted for all preventive therapies after targeted feedback was provided during the last quarter of 1992. However, only utilization of influenza vaccine exceeded a 90% compliance in 1993.These data demonstrate that a suboptimal level of compliance with current guidelines for the prevention of respiratory disease among human immunodeficiency virus-infected individuals can be significantly improved using targeted feedback. Although it is likely that similar effects could be achieved in other populations or the community at large, this remains to be demonstrated.

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Section: Discussionsupporting

confidence: 60%

Adherence to guidelines for the prevention of HIV-related respiratory diseases

Montaner¹,

Phillips²,

Zala³

et al. 1996

Eur Respir J

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“…Four RCTs (7,9,19,44) and 10 observational studies (26,27,29,30,32,35,36,39,41,42) assessed delivery of clinical preventive services as a result of the PHE. The overall GRADE classification of the evidence assessing these outcomes ranged from low to high.…”

Section: Summary Of Results From the Best Available Evidence On Benefmentioning

confidence: 99%

Systematic Review: The Value of the Periodic Health Evaluation

et al. 2007

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“…First, the trials were very heterogeneous, so the above comparisons could be invalid. 31,92,105 not done) (some trials in the Grimshaw review quoted more than one result; it is therefore possible for a study to feature in both positive and negative effect categories).…”

Section: Resultsmentioning

confidence: 99%

Contamination in trials of educational interventions

Keogh-Brown¹,

Bachmann²,

Shepstone³

et al. 2007

Health Technol Assess

125

112

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Implementing preventive services. Success and failure in an outpatient trial

Cited by 57 publications

References 31 publications

Adherence to guidelines for the prevention of HIV-related respiratory diseases

Adherence to guidelines for the prevention of HIV-related respiratory diseases

Systematic Review: The Value of the Periodic Health Evaluation

Contamination in trials of educational interventions

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