How usual is usual care in pragmatic intervention studies in primary care? An overview of recent trials

Smelt, Antonia F. H.; Weele, Gerda M van der; Blom, Jeanet W.; Gussekloo, Jacobijn; Assendelft, W.J.J.

doi:10.3399/bjgp10x514819

Cited by 86 publications

(67 citation statements)

References 76 publications

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“…We used a cluster randomized design with general practice as the unit of randomization to prevent contamination. 16 The study was approved by the Ethical Committee of the Leiden University Medical Center.…”

Section: Methodsmentioning

confidence: 99%

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A proactive approach to migraine in primary care: a pragmatic randomized controlled trial

Smelt

Blom

Dekker

et al. 2012

CMAJ

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Section: Methodsmentioning

confidence: 99%

“…16 These physicians received no additional information on the diagnosis and treatment of headache, and they were not informed as to which patients had agreed to participate in the study. Control patients were not told to which group they had been allocated.…”

Section: Usual Carementioning

confidence: 99%

A proactive approach to migraine in primary care: a pragmatic randomized controlled trial

Smelt

Blom

Dekker

et al. 2012

CMAJ

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“…Professionals in both groups used the EasyCare-TOS instrument, which may have led to "enhanced" usual care in the control group. 32 We tried to minimize this effect by instructing the control practices not to start new activities related to the intervention, such as improved collaboration, making care plans, and starting medication reviews during the study period. Third, outcome assessors were not blinded to the intervention since this was not feasible.…”

Section: Discussionmentioning

confidence: 99%

Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial

Ruikes

Zuidema

Akkermans

et al. 2016

The Journal of the American Board of Family Medicine

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Background:The increasing number of community-dwelling frail elderly people poses a challenge to general practice. We evaluated the effectiveness of a general practitioner-led extensive, multicomponent program integrating cure, care, and welfare for the prevention of functional decline.Methods: We performed a cluster controlled trial in 12 general practices in Nijmegen, the Netherlands. Community-dwelling frail elderly people aged >70 years were identified with the EASY-Care twostep older persons screening instrument. In 6 general practices, 287 frail elderly received care according to the CareWell primary care program. This consisted of proactive care planning, case management, medication reviews, and multidisciplinary team meetings with a general practitioner, practice and/or community nurse, elderly care physician, and social worker. In another 6 general practices, 249 participants received care as usual. The primary outcome was independence in functioning during (instrumental) activities of daily living (Katz-15 index). Secondary outcomes were quality of life [EuroQol (EQ5D؉C) instrument], mental health and health-related social functioning (36-item RAND Short

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“…46 Seeing a patient regularly during a study can modify the behavior of both the patient and the general practitioner. 51,52 In our study, we observed a significant decrease in cannabis use in both the intervention group and control group among patients aged 18 years and older. Among patients younger than 18 years, however, consumption decreased in the intervention group but increased in the control group, with a significant difference at 6 months, consistent with another trial conducted in primary care.…”

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confidence: 57%

Cannabis and Young Users—A Brief Intervention to Reduce Their Consumption (CANABIC): A Cluster Randomized Controlled Trial in Primary Care

et al. 2017

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PURPOSE Brief intervention to reduce cannabis is a promising technique that could be adapted for use in primary care, but it has not been well studied in this setting. We tested the efficacy of a brief intervention conducted by general practitioners among cannabis users aged 15 to 25 years. METHODSWe performed a cluster randomized controlled trial with 77 general practitioners in France. The intervention consisted of an interview designed according to the FRAMES (feedback, responsibility, advice, menu, empathy, selfefficacy) model, while the control condition consisted of routine care. RESULTSThe general practitioners screened and followed up 261 young cannabis users. After 1 year, there was no significant difference between the intervention and control groups in the median number of joints smoked per month among all users (17.5 vs 17.5; P = .13), but there was a difference in favor of the intervention among nondaily users (3 vs 10 ; P = .01). After 6 months, the intervention was associated with a more favorable change from baseline in the number of joints smoked (-33.3% vs 0%, P = .01) and, among users younger than age of 18, smoking of fewer joints per month (12.5 vs 20, P = .04).CONCLUSIONS Our findings suggest that a brief intervention conducted by general practitioners with French young cannabis users does not affect use overall. They do, however, strongly support use of brief intervention for younger users and for moderate users. INTRODUCTIONC annabis is the first illegal substance used by young people worldwide.1 Across continents, 7% to 12% of adolescents and teenagers younger than 18 years and 6.6% to 25% of young adults aged 18 to 25 years are monthly users. [1][2][3][4] In Europe, France has the highest consumption of cannabis.3 As of 2014, 25.5% of French adolescents (aged 15 to 17 years) and 17% of young adults (aged 18 to 25 years) were monthly users of cannabis. 5,6 Current data are clear about the risks of cannabis use, 7 which include social and psychiatric risks (eg, anxiety, depression, and an increased incidence of schizophrenia in vulnerable individuals), 8,9 risks of lung and otorhinolaryngeal cancers, 10,11 and cardiovascular risk. [12][13][14] Use before driving increases the likelihood of motor vehicle collision-related morbidity and mortality. [15][16][17][18] During adolescence, cannabis use causes cerebral microstructural changes that are not always reversible and have been implicated in cognitive and psychiatric disorders. 19 In France, 80% of youth aged 15 to 25 years have visited their general practitioner in the preceding year.5 These visits could represent a privileged opportunity to identify young cannabis users and intervene to reduce their consumption. Motivational interviewing is a method of interaction centered on the patient and intended to modify behavior. 33,34 or the general public following media calls for participation. [35][36][37][38][39][40] The initial levels of consumption varied greatly, from once a year 19 to weekly 11,13,14,16 to monthly, [20][21][22]...

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How usual is usual care in pragmatic intervention studies in primary care? An overview of recent trials

Cited by 86 publications

References 76 publications

A proactive approach to migraine in primary care: a pragmatic randomized controlled trial

A proactive approach to migraine in primary care: a pragmatic randomized controlled trial

Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial

Cannabis and Young Users—A Brief Intervention to Reduce Their Consumption (CANABIC): A Cluster Randomized Controlled Trial in Primary Care

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