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1.
J Natl Cancer Inst Monogr ; 2022(59): 28-41, 2022 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-35788376

RESUMO

In the past 2 decades, the demand for information on health economics research to guide health care decision making has substantially increased. Studies have provided evidence that eliminating or reducing tobacco use; eating a healthy diet, including fruit and vegetables; being physically active; reducing alcohol consumption; avoiding ultraviolet radiation; and minimizing exposure to environmental and occupational carcinogenic agents should substantially reduce cancer incidence in the population. The benefits of these primary prevention measures in reducing cancer incidence are not instantaneous. Therefore, health economics research has an important role to play in providing credible information to decision makers on the health and economic benefits of primary prevention. This article provides an overview of health economics research related to primary prevention of cancer. We addressed the following questions: 1) What are the gaps and unmet needs for performing health economics research focused on primary prevention of cancer? 2) What are the challenges and opportunities to conducting health economics research to evaluate primary prevention of cancer? and 3) What are the future directions for enhancing health economics research on primary prevention of cancer? Modeling primary prevention of cancer is often difficult given data limitations, long delays before the policy or intervention is effective, possible unintended effects of the policy or intervention, and the necessity of outside expertise to understand key inputs or outputs to the modeling. Despite these challenges, health economics research has an important role to play in providing credible information to decision makers on the health and economic benefits of primary prevention of cancer.


Assuntos
Neoplasias , Raios Ultravioleta , Economia Médica , Humanos , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/etiologia , Prevenção Primária , Uso de Tabaco
2.
Front Public Health ; 9: 690067, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34778164

RESUMO

Blue Shield of California's Community Health Advocate Program was created to support whole person-health needs by helping individuals of all socio-economic statuses navigate and access community resources, social services, and medical systems. Blue Shield's Health Reimagined team is partnering with medical providers, community resources centers, and community partners to provide intensive person-centered and technology-enabled care to patients, ensuring social needs are met while promoting health equity. A key aspect of the Health Reimagined initiative embeds Community Health Advocates (CHAs) within physician practices serving patients using a payor-agnostic approach, by which Blue Shield aims to increase access to social services and community resources, improve health outcomes, reduce medical costs, and improve overall patient experience. The purpose of this case study is to understand the provider's perspective of embedding a CHA into the care team and the resulting impact on the practice and patients. Blue Shield also sought to identify best practices and barriers of a CHA program within primary and specialty care practices. As part of an ongoing two-year mixed-methods impact evaluation (2019-2021), 10 semi-structured interviews were conducted with a total of 18 providers and office staff at five primary care and specialty practices where CHAs have been embedded. We also conducted two focus groups with the same five CHAs at different points in time. Several themes emerged from the provider, office staff, and CHA interviews. Provider practices found great value in adding a CHA to their care team as the CHA brings flexibility and continuity to patient care. They also found that having access to a CHA with shared life experiences of the communities they served is a key component to the program's success. Providers and staff reported a new understanding of the social determinants of health that impacts a patient's wellbeing with the embedding of a CHA in the care team. Overall, practitioners expressed high satisfaction with the CHA program. During the COVID-19 pandemic, CHAs have been critically important in care, as social needs have increased, and resources have shifted. The CHA program is constantly adapting to address challenges faced by all stakeholders and applying new knowledge to ensure best practices are implemented within the CHA program.


Assuntos
COVID-19 , Agentes Comunitários de Saúde , Humanos , Pandemias , Atenção Primária à Saúde , SARS-CoV-2
3.
Patient Educ Couns ; 101(9): 1585-1593, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29803565

RESUMO

OBJECTIVE: This study assessed patient-centered communication (PCC) among newly diagnosed colorectal cancer patients. PCC, a key part of patient-centered care, contributes directly and indirectly to health-related quality of life, satisfaction with care, and other outcomes. METHODS: We conducted a survey of patients in North Carolina, using a theoretically-based and validated measure that provides an overall PCC score and subscale scores for six PCC functions. RESULTS: A total of 501 patients participated. The highest scores were for the PCC functions of Fostering Healing Relationships, Exchanging Information, and Making Decisions. The lowest scores were for the functions of Managing Uncertainty and Enabling Self-Management, yet these were functions respondents rated as most important. Respondents who thought about more than one health professional (versus oncologist) reported better communication. PCC also varied by treatment type, mental and physical health status, age, race, and education. CONCLUSION: Most patients reported good communication overall, however patients in poor physical health and mental health reported worse communication. The quality of communication varied across the PCC functions. PRACTICE IMPLICATIONS: Health professionals need to use a PCC approach that builds trust, respects the patient, provides salient information that patients can understand, provides emotional support, and facilitates the patient's engagement in care.


Assuntos
Neoplasias Colorretais/psicologia , Comunicação , Assistência Centrada no Paciente , Relações Profissional-Paciente , Adulto , Idoso , Neoplasias Colorretais/diagnóstico , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Qualidade de Vida , Inquéritos e Questionários
4.
Qual Manag Health Care ; 27(1): 17-23, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29280903

RESUMO

BACKGROUND: Complex system interventions benefit from close attention to factors affecting implementation and resultant outcomes. This article describes a framework for examining these factors in process redesign (PR) and for assessing PR outcomes. METHODS: Using literature scans and expert comment on draft frameworks based on the Consolidated Framework for Implementation Research, a team of researchers developed the PR framework for the Agency for Healthcare Research and Quality. As a case study, an independent team of researchers in a large care system subsequently applied the PR framework to implementation of Lean-based primary care redesigns. RESULTS: The PR framework adds 2 domains to the Consolidated Framework for Implementation Research, focused on relevant measures of implementation and outcomes, as well as some new constructs to the Consolidated Framework for Implementation Research. Using the PR framework to guide a study of primary care PR, researchers found that the health care reform environment encouraged staff recognition of need for redesign, but physicians worried about key redesign issues, including colocation with care team partners and the competencies of the individuals assigned to manage new workflows. Team member acceptance of the redesign was also influenced by other features of the implementation process and contextual features, including the decision style of the local clinic. CONCLUSIONS: The PR framework helped guide the qualitative study and aided researchers in informing their leadership about critical issues affecting PR implementation.


Assuntos
Atitude do Pessoal de Saúde , Atenção Primária à Saúde/organização & administração , Gestão da Qualidade Total/organização & administração , Competência Clínica , Meio Ambiente , Humanos , Liderança , Estudos de Casos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/normas , Pesquisa Qualitativa , Integração de Sistemas , Gestão da Qualidade Total/normas , Fluxo de Trabalho
5.
JAMA ; 316(23): 2531-2543, 2016 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-27997660

RESUMO

Importance: Genital herpes simplex virus (HSV) infection is a prevalent sexually transmitted infection. Vertical transmission of HSV can lead to fetal morbidity and mortality. Objective: To assess the evidence on serologic screening and preventive interventions for genital HSV infection in asymptomatic adults and adolescents to support the US Preventive Services Task Force for an updated recommendation statement. Data Sources: MEDLINE, Cochrane Library, EMBASE, and trial registries through March 31, 2016. Surveillance for new evidence in targeted publications was conducted through October 31, 2016. Study Selection: English-language randomized clinical trials (RCTs) comparing screening with no screening in persons without past or current symptoms of genital herpes; studies evaluating accuracy and harms of serologic screening tests for HSV-2; RCTs assessing preventive interventions in asymptomatic persons seropositive for HSV-2. Data Extraction and Synthesis: Dual review of abstracts, full-text articles, and study quality; pooled sensitivities and specificities of screening tests using a hierarchical summary receiver operating characteristic curve analysis when at least 3 similar studies were available. Main Outcomes and Measures: Accuracy of screening tests, benefits of screening, harms of screening, reduction in genital herpes outbreaks. Results: A total of 17 studies (n = 9736 participants; range, 24-3290) in 19 publications were included. No RCTs compared screening with no screening. Most studies of the accuracy of screening tests were from populations with high HSV-2 prevalence (greater than 40% based on Western blot). Pooled estimates of sensitivity and specificity of the most commonly used test at the manufacturer's cutpoint were 99% (95% CI, 97%-100%) and 81% (95% CI, 68%-90%), respectively (10 studies; n = 6537). At higher cutpoints, pooled estimates were 95% (95% CI, 91%-97%) and 89% (95% CI, 82%-93%), respectively (7 studies; n = 5516). Use of this test at the manufacturer's cutpoint in a population of 100 000 with a prevalence of HSV-2 of 16% (the seroprevalence in US adults with unknown symptom status) would result in 15 840 true-positive results and 15 960 false-positive results (positive predictive value, 50%). Serologic screening for genital herpes was associated with psychosocial harms, including distress and anxiety related to positive test results. Four RCTs compared preventive medications with placebo, 2 in nonpregnant asymptomatic adults who were HSV-2 seropositive and 2 in HSV-2-serodiscordant couples. Results in both populations were heterogeneous and inconsistent. Conclusions and Relevance: Serologic screening for genital herpes is associated with a high rate of false-positive test results and potential psychosocial harms. Evidence from RCTs does not establish whether preventive antiviral medication for asymptomatic HSV-2 infection has benefit.


Assuntos
Herpes Genital/diagnóstico , Programas de Rastreamento/normas , Estudos Soroepidemiológicos , Adolescente , Adulto , Reações Falso-Positivas , Feminino , Herpes Genital/complicações , Herpes Genital/epidemiologia , Herpesvirus Humano 2/isolamento & purificação , Humanos , Masculino , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Sensibilidade e Especificidade
6.
J Healthc Qual ; 37(1): 41-54, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26042376

RESUMO

Evaluating implementation of complex interventions to improve care transitions and comparison across studies is challenging due to issues such as variation in methods and lack of reporting key evaluation elements. This article describes a framework for evaluating implementation of hospital to ambulatory care transitions interventions and application to a case study. We searched published and gray literature for relevant frameworks. We adapted the general Consolidated Framework for Implementation Research, adding elements relevant to other complex interventions. We refined these adaptations through structured expert input and application to case studies. Key adaptations included conceptualization around organizations, not just settings, and around patient- and caregiver-centeredness. Although these interventions are often oriented toward institutional outcomes such as readmissions, tailoring interventions to specific patient needs strengthens effectiveness. Coordination and communication are important between organizations and providers and with patients and caregivers. Roles of those involved in the intervention--providers, administrators, and facilitators from different organizations--are also key constructs. Finally, as these interventions often are tailored to specific settings and adapt over time, assessing intervention design--which components are implemented as part of the bundle, how they are actually implemented, and their differential impact on effectiveness--is critical.


Assuntos
Alta do Paciente/normas , Cuidadores , Insuficiência Cardíaca/terapia , Humanos , Ohio , Estudos de Casos Organizacionais , Readmissão do Paciente , Guias de Prática Clínica como Assunto
7.
Pharmacoepidemiol Drug Saf ; 22(5): 447-58, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23440924

RESUMO

PURPOSE: Under the Food, Drug, and Cosmetic Act, all promotional materials for prescription drugs must strike a fair balance in presentation of risks and benefits. How to best present this information is not clear. We sought to determine if the presentation of quantitative risk and benefit information in drug advertising and labeling influences consumers', patients', and clinicians' information processing, knowledge, and behavior by assessing available empirical evidence. METHODS: We used PubMed for a literature search, limiting to articles published in English from 1990 forward. Two reviewers independently reviewed the titles and abstracts for inclusion, after which we reviewed the full texts to determine if they communicated risk/benefit information either: (i) numerically (e.g., percent) versus non-numerically (e.g., using text such as "increased risk") or (ii) numerically using different formats (e.g., "25% of patients", "one in four patients", or use of pictographs). We abstracted information from included articles into standardized evidence tables. The research team identified a total of 674 relevant publications, of which 52 met our inclusion criteria. Of these, 37 focused on drugs. RESULTS AND CONCLUSIONS: Presenting numeric information appears to improve understanding of risks and benefits relative to non-numeric presentation; presenting both numeric and non-numeric information when possible may be best practice. No single specific format or graphical approach emerged as consistently superior. Numeracy and health literacy also deserve more empirical attention as moderators.


Assuntos
Publicidade/legislação & jurisprudência , Rotulagem de Medicamentos/legislação & jurisprudência , Legislação de Medicamentos , Comunicação , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde/estatística & dados numéricos , Humanos , Padrões de Prática Médica/estatística & dados numéricos , Medicamentos sob Prescrição/efeitos adversos , Medicamentos sob Prescrição/uso terapêutico , Risco , Estados Unidos
8.
Ann Intern Med ; 157(11): 785-95, 2012 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-22964778

RESUMO

BACKGROUND: Suboptimum medication adherence is common in the United States and leads to serious negative health consequences but may respond to intervention. PURPOSE: To assess the comparative effectiveness of patient, provider, systems, and policy interventions that aim to improve medication adherence for chronic health conditions in the United States. DATA SOURCES: Eligible peer-reviewed publications from MEDLINE and the Cochrane Library indexed through 4 June 2012 and additional studies from reference lists and technical experts. STUDY SELECTION: Randomized, controlled trials of patient, provider, or systems interventions to improve adherence to long-term medications and nonrandomized studies of policy interventions to improve medication adherence. DATA EXTRACTION: Two investigators independently selected, extracted data from, and rated the risk of bias of relevant studies. DATA SYNTHESIS: The evidence was synthesized separately for each clinical condition; within each condition, the type of intervention was synthesized. Two reviewers graded the strength of evidence by using established criteria. From 4124 eligible abstracts, 62 trials of patient-, provider-, or systems-level interventions evaluated 18 types of interventions; another 4 observational studies and 1 trial of policy interventions evaluated the effect of reduced medication copayments or improved prescription drug coverage. Clinical conditions amenable to multiple approaches to improving adherence include hypertension, heart failure, depression, and asthma. Interventions that improve adherence across multiple clinical conditions include policy interventions to reduce copayments or improve prescription drug coverage, systems interventions to offer case management, and patient-level educational interventions with behavioral support. LIMITATIONS: Studies were limited to adults with chronic conditions (excluding HIV, AIDS, severe mental illness, and substance abuse) in the United States. Clinical and methodological heterogeneity hindered quantitative data pooling. CONCLUSION: Reduced out-of-pocket expenses, case management, and patient education with behavioral support all improved medication adherence for more than 1 condition. Evidence is limited on whether these approaches are broadly applicable or affect longterm medication adherence and health outcomes. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.


Assuntos
Doença Crônica/tratamento farmacológico , Adesão à Medicação , Administração de Caso , Pesquisa Comparativa da Efetividade , Política de Saúde , Humanos , Cobertura do Seguro , Avaliação de Resultados em Cuidados de Saúde , Educação de Pacientes como Assunto , Autoadministração , Estados Unidos
9.
J Womens Health (Larchmt) ; 21(7): 705-12, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22480224

RESUMO

BACKGROUND: Cervical cancer incidence has declined as a result of Papanicolaou (Pap) test use. Current guidelines recommend increasing screening intervals for women of average risk. The objective of this study is to examine current screening intervals, factors associated with recency of Pap testing, and future testing plans. METHODS: We analyzed data from 2915 female respondents, aged 18-64, using the 2007 Health Information National Trends Survey (HINTS), a biennial national survey of access and use of cancer information in the United States. We divided time since last Pap test into ≤1 year (n=1960), >1 to ≤3 years (n=512), >3 years/never had Pap test (n=443). We performed univariate analyses and multivariate logistic regression, using proportional odds model with cumulative logit link. RESULTS: Sixty-five percent of women had their most recent Pap test within 1 year. Most expected to be screened again within 1 year (81%). This expectation was highest among women who were tested within the previous year (90.9%). Having had a test within 1 year was positively associated with age groups 31-45 vs. 46-64 years; with being non-Hispanic black vs. non-Hispanic white; with being a college graduate vs. having less education; with being married, divorced, or separated vs. widowed; with having at least one visit to a healthcare provider in the past year; and with being aware of the human papillomavirus (HPV). CONCLUSIONS: Most women currently are tested and anticipate future testing at annual intervals. To implement guidelines, increased communication and systematic or policy changes may be needed to reduce overtesting.


Assuntos
Comunicação em Saúde/tendências , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Informação/estatística & dados numéricos , Programas de Rastreamento/psicologia , Teste de Papanicolaou , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/psicologia , Adolescente , Adulto , Distribuição por Idade , Feminino , Inquéritos Epidemiológicos , Humanos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Infecções por Papillomavirus/patologia , Modelos de Riscos Proporcionais , Fatores Socioeconômicos , Estados Unidos , Esfregaço Vaginal/estatística & dados numéricos
10.
Evid Rep Technol Assess (Full Rep) ; (208.4): 1-685, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24422970

RESUMO

OBJECTIVES: To assess the effectiveness of patient, provider, and systems interventions (Key Question [KQ] 1) or policy interventions (KQ 2) in improving medication adherence for an array of chronic health conditions. For interventions that are effective in improving adherence, we then assessed their effectiveness in improving health, health care utilization, and adverse events. DATA SOURCES: MEDLINE®, the Cochrane Library. Additional studies were identified from reference lists and technical experts. REVIEW METHODS: Two people independently selected, extracted data from, and rated the risk of bias of relevant trials and systematic reviews. We synthesized the evidence for effectiveness separately for each clinical condition, and within each condition, by type of intervention. We also evaluated the prevalence of intervention components across clinical conditions and the effectiveness of interventions for a range of vulnerable populations. Two reviewers graded the strength of evidence using established criteria. RESULTS: We found a total of 62 eligible studies (58 trials and 4 observational studies) from our review of 3,979 abstracts. These studies included patients with diabetes, hyperlipidemia, hypertension, heart failure, myocardial infarction, asthma, depression, glaucoma, multiple sclerosis, musculoskeletal diseases, and multiple chronic conditions. Fifty-seven trials of patient, provider, or systems interventions (KQ 1) evaluated 20 different types of interventions; 4 observational studies and one trial of policy interventions (KQ 2) evaluated the effect of reduced out-of-pocket expenses or improved prescription drug coverage. We found the most consistent evidence of improvement in medication adherence for interventions to reduce out-of-pocket expenses or improve prescription drug coverage, case management, and educational interventions across clinical conditions. Within clinical conditions, we found the strongest support for self-management of medications for short-term improvement in adherence for asthma patients; collaborative care or case management programs for short-term improvement of adherence and to improve symptoms for patients taking depression medications; and pharmacist-led approaches for hypertensive patients to improve systolic blood pressure. CONCLUSIONS: Diverse interventions offer promising approaches to improving medication adherence for chronic conditions, particularly for the short term. Evidence on whether these approaches have broad applicability for clinical conditions and populations is limited, as is evidence regarding long-term medication adherence or health outcomes.


Assuntos
Administração de Caso/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Motivação , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/normas , Melhoria de Qualidade/estatística & dados numéricos , Autoadministração/estatística & dados numéricos , Humanos , Estados Unidos/epidemiologia
11.
Cancer Invest ; 28(7): 735-42, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20590449

RESUMO

Evaluation of HER2 status is critical in determining appropriate treatment for breast cancer. Currently, Fluorescence In Situ Hybridization (FISH) and Immunohistochemistry (IHC) are the FDA-approved tests. Studies show, FISH is superior to IHC in accuracy and prediction of clinical outcomes with respect to response to anti-human epidermal growth factor receptor 2 (HER2) therapy trastuzumab. The impact of factors on choice of test for HER2 detection was determined using logistic regression. We show that geographic location, cancer stage, and diagnosis date have significant effects on choice of test. These findings indicate that disparities may be present in breast cancer care, and highlight the importance of testing guidelines.


Assuntos
Biomarcadores Tumorais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Comportamento de Escolha , Genes erbB-2 , Imuno-Histoquímica , Hibridização in Situ Fluorescente , Fatores Etários , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Biomarcadores Tumorais/genética , Neoplasias da Mama/patologia , Receptores ErbB/metabolismo , Feminino , Humanos , Seguradoras , Modelos Biológicos , Guias de Prática Clínica como Assunto , Trastuzumab
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