Integrating Evidence-Based Clinical and Community Strategies to Improve Health

Ockene, Judith K.; Edgerton, Elizabeth A.; Teutsch, Steven M.; Marion, Lucy N.; Miller, Therese; Genevro, Janice; Loveland-Cherry, Carol; Fielding, Jonathan E.; Briss, Peter A.

doi:10.1016/j.amepre.2006.11.007

Cited by 88 publications

(72 citation statements)

References 25 publications

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“…37,71 'Reorienting health services also requires stronger attention to health research as well as changes in professional education and training' 27 in addition to opening communication channels and pursuing partnerships that would connect clinical settings with local communities and different segments of society. 27,70 Yet, at the healthcare setting level most eligible studies focused primarily on interventions to build capacity among healthcare professionals via health worker education and training, one of the recommended interventions by the Ottawa Charter for Health Promotion, which were described by a large number (6) of the RCTs in this review. As the role of healthcare systems and their workers in epidemics and emerging diseases is critically linked 'to their ability to cope with challenges' and their timely prevention and control of epidemics, 72 professional development and training interventions focus on improving patient and healthcare delivery outcomes as well as the implementation of safe and protective measures among health workers and their patients (versus individually-focused interventions, which as previously mentioned, deal with personal history and biological characteristics).…”

Section: Community Settingmentioning

confidence: 99%

“…As previously mentioned, this unit of analysis reflects one of the key categories of the Ottawa Charter for Health Promotion ('reorient health services') as well as key principles from the socio-ecological model of public health, which recognizes the importance of clinical-based interventions and, as suggested by other authors, also calls for the integration of such interventions with strategies that engage geographical, ethnic, social, and other kinds of communities. 70 Reorienting health services entails that healthcare institutions and their partners work together to create systems that 'go beyond their responsibility for providing clinical and curative services'. 27 In the context of epidemics and emerging disease outbreaks, healthcare institutions and their professionals are often charged with breaking bad news, dealing with uncertain science and demanding deadlines, and implementing new protocols and practices that will effectively protect patients, health workers, and the workplace.…”

Section: Community Settingmentioning

confidence: 99%

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Communicating risk and promoting disease mitigation measures in epidemics and emerging disease settings

Schiavo

Leung

Brown

2014

Pathogens and Global Health

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Objective: This review aims to identify and assess evidence on interventions to communicate risk and promote disease mitigation measures in epidemics and emerging disease outbreak settings. The study focuses on data that are relevant to low and middle-income country (LMIC) settings. Methods: We conducted a comprehensive literature search using five major electronic databases (Pubmed Medline, Biomed Central, EMBASE, Science of Citation Index, and Cochrane Library) and other sources to identify relevant studies published from January 2002 to July 2013. The review was guided by the socioecological model/perspective of public health and the ideation theory and focused on interventions at the community, healthcare, and multi-sectoral settings, which also reflect key intervention levels of the Ottawa Charter for Health Promotion. Eligible quantitative studies were selected according to specific study criteria and assessed using the Critical Appraisal Skills Program (CASP) framework. Conversely, qualitative studies, reviews, case studies, and editorials were not included. Studies were selected by two independent reviewers. Results: Twenty-nine relevant studies from 16 countries were included. Most studies focused on a single intervention or intervention level, rather than multi-sectoral interventions. The majority of the evidence relates to programs aimed at behavioral and social results (or relevant intermediate steps) within a specific population group. Two studies included implications for improvements in health service delivery, two studies examined the intervention's impact on health systems-related outcomes, and three had also implications for environmental health outcomes. Cost-and health equity-related implications for select evidence were also discussed. Conclusions: The paucity of well-designed quantitative evaluations of interventions to communicate health risk and promote disease control measures in LMICs does not allow for any definitive conclusions. Yet, the review identified several promising interventions and areas for future investigation. Among them, community-based and participatory interventions seemed to be central within epidemic and emerging disease settings, particularly in low-resource settings. Yet, evidence on their effectiveness is not conclusive and needs to be explored by future studies. Other promising areas for future investigation include multicomponent and multi-sectoral approaches to intervention design. Major research gaps referred to any evaluation of the impact of these kinds of interventions on health policy adoption and/or implementation, and social determinants of health. Research on cost-effectiveness also needs to be strengthened. This review identified several research gaps and questions, and discusses potential future directions for increasing capacity for future and more rigorous assessments.

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Section: Community Settingmentioning

confidence: 99%

Section: Community Settingmentioning

confidence: 99%

Communicating risk and promoting disease mitigation measures in epidemics and emerging disease settings

Schiavo

Leung

Brown

2014

Pathogens and Global Health

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“…20 The increased uptake of preventive services observed among users is consistent with the benefi ts observed for other interventions to promote delivery, such as reminders, self-management support, tailored education, clinician-community linkages, and practice redesign. [21][22][23][24][25][26][27][28][29] Interestingly, the services most likely to improve were screening tests and immunizations. Changes were not observed for health behavior counseling, even among users.…”

mentioning

confidence: 99%

Interactive Preventive Health Record to Enhance Delivery of Recommended Care: A Randomized Trial

Krist¹,

Woolf²,

Rothemich³

et al. 2012

The Annals of Family Medicine

100

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PURPOSE Americans receive only one-half of recommended preventive services. Information technologies have been advocated to engage patients. We tested the effectiveness of an interactive preventive health record (IPHR) that links patients to their clinician's record, explains information in lay language, displays tailored recommendations and educational resources, and generates reminders. METHODSThis randomized controlled trial involved 8 primary care practices. Four thousand fi ve hundred patients were randomly selected to receive a mailed invitation to use the IPHR or usual care. Outcomes were measured using patient surveys and electronic medical record data and included IPHR use and service delivery. Comparisons were made between invited and usual-care patients and between users and nonusers among those invited to use the IPHR.RESULTS At 4 and 16 months, 229 (10.2%) and 378 (16.8%) of invited patients used the IPHR. The proportion of patients up-to-date with all services increased between baseline and 16 months by 3.8% among intervention patients (from 11.4% to 15.2%, P <.001) and by 1.5% among control patients (from 11.1% to 12.6%, P = .07), a difference of 2.3% (P = .05). Greater increases were observed among patients who used the IPHR. At 16 months, 25.1% of users were up-todate with all services, double the rate among nonusers. At 4 months, delivery of colorectal, breast, and cervical cancer screening increased by 19%, 15%, and 13%, respectively, among users.CONCLUSIONS Information systems that feature patient-centered functionality, such as the IPHR, have potential to increase preventive service delivery. Engaging more patients to use systems could have important public health benefi ts. Ann Fam Med 2012;10:312-319. doi:10.1370/afm.1383. INTRODUCTIONA mericans receive only one-half of recommended preventive services.1 Among the various causes is poor access to reliable information. Patients need evidence-based information about what is recommended-tailored to their individual risk factors (eg, age, sex, co mbordities, prior testing, family history, health behaviors)-and presented in an understandable format.2 They need reminders when services are due, guidance to deal with inconsistent recommendations, and access to decision aids for choices that require shared decision making. [3][4][5] To act on their choices, patients need written plans and logistical details. 6,7 Clinicians often lack time and resources to provide this information. 8 One proposed solution is to harness the power of information technology, especially personal health records. For the purposes of this article, personal health records are broadly defi ned as health information systems used by patients, whereas electronic health records (EHRs) are systems primarily used by clinicians. 313 INT ER AC T IVE PR E V ENT IV E HE A LT H R ECOR Dgive patients direct access to the EHR of their clinician, 9,10 which is empowering, speeds access to results, and enables patients to discover inaccuracies in their medical record. The next gene...

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“…51 Linkage of clinical and community strategies needs substantial financial investment; supportive local, state, and federal policies; and appropriate training of clinical and community workforces. 47 …”

Section: Link Clinical Interventions and Public Health Interventionsmentioning

confidence: 99%

“…46 Clinical and community interventions are often viewed as discrete when they should be viewed as synergistic and integratable. 47 Use of electronic health records is an excellent way to link knowledge about individuals from both the clinical and community perspectives.…”

Section: Link Clinical Interventions and Public Health Interventionsmentioning

confidence: 99%

Can We Improve Adherence to Preventive Therapies for Cardiovascular Health?

2011

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A lthough mortality rates from cardiovascular disease (CVD) declined by 26% from 1995 to 2005, 1 it remains the leading cause of death for US adults. The American Heart Association (AHA) set a 2020 impact goal to "improve the cardiovascular health of all Americans by 20% while reducing deaths from CVD and stroke by 20%." 2 To this end, the AHA recommended prevention as a first-line strategy and identified "life's simple seven," 3 lifestyle behaviors and risk factors described in Table 1, which, if appropriately followed or adhered to, will improve cardiovascular health. 2 Adherence refers to the extent to which patient behaviors align with clinical recommendations. 4 The prevention behaviors offered by the AHA can be categorized as follows: (1) lifestyle behaviors, (2) screening, and (3) medication use. Lifestyle behaviors include a healthy diet, maintaining a healthy weight, engaging in physical activity, and not smoking. Screenings include those for blood pressure, lipid levels, and diabetes mellitus. Medication use refers to over-thecounter medications such as aspirin and prescription medications such as lipid-lowering agents and antihypertensive medications.Adherence to preventive therapies is suboptimal. For example, only 5% of adults engage in the recommended amount of physical activity. 5 In comparison, about 43% of adults with a history of CVD or equivalent CVD risk take statins 6 and 57% of adults 25 years old had their cholesterol tested at least once in the past 5 years. 7 High-risk lifestyle behaviors are most prevalent in populations with limited income and education, ethnic/racial minority populations, and in low-income communities. 8,9 The challenge is even more complicated because having multiple risk factors is common. 10 A 2001 National Health Interview Survey reported a clustering of smoking, obesity, physical inactivity, and excessive alcohol intake (41% of US adults had 2 and 17% had 3). 8 Increased adherence to preventive therapies would greatly improve cardiovascular health, leading to reduced health disparities and healthcare costs. 11 Adherence to Preventive Therapies for Cardiovascular Health Is a Complex Process Influenced by Multiple FactorsTo improve adherence to preventive therapies, we must first understand the multiple levels that influence adherence. Within the healthcare system, adherence to preventive therapies is affected by patients, clinicians, and systems. 12 The Expanded Chronic Care Model (ECCM), an adaptation of the original CCM, provides a helpful framework for understanding how to integrate healthcare system-based approaches with communitybased health promotion efforts. 13 The CCM contains 4 components: (1) self-management, (2) delivery system design, (3) decision support, and (4) information systems. The ECCM added 3 components relevant to the community: (1) building public health policy, (2) creating supportive environments, and (3) strengthening community action (Figure 1). We review each of the components of the ECCM and provide examples of how they can be implemen...

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Integrating Evidence-Based Clinical and Community Strategies to Improve Health

Cited by 88 publications

References 25 publications

Communicating risk and promoting disease mitigation measures in epidemics and emerging disease settings

Communicating risk and promoting disease mitigation measures in epidemics and emerging disease settings

Interactive Preventive Health Record to Enhance Delivery of Recommended Care: A Randomized Trial

Can We Improve Adherence to Preventive Therapies for Cardiovascular Health?

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