Drummond Jane, Wiebe Natasha, So Sylvia, Schnirner Laurie, Bisanz Jeffrey, Williamson Deanna L, Mayan Maria, Templeton Laura, Fassbender Konrad
Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, T6G 1C9, Alberta, Canada.
Department of Medicine, University of Alberta, Edmonton, Canada.
Trials. 2016 Jul 22;17:343. doi: 10.1186/s13063-016-1444-8.
Increasing access to health and social services through service-integration approaches may provide a direct and sustainable way to improve health and social outcomes in low-income families.
We did a community-based randomized trial evaluating the effects of two service-integration practices (healthy family lifestyle and recreational activities for children) among low-income families in Alberta, Canada. These two practices in combination formed four groups: Self-Directed (no intervention), Family Healthy Lifestyle, Family Recreation, and Comprehensive (Family Healthy Lifestyle plus Family Recreation programs). The primary outcome was the total number of service linkages.
We randomized 1168 families, 50 % of which were retained through the last follow-up visit. The number of service linkages for all three intervention groups was not significantly different from the number of linkages in the Self-Directed group (Comprehensive 1.15 (95 % CI 0.98-1.35), Family Healthy Lifestyle 1.17 (0.99-1.38), and Family Recreation 1.12 (0.95-1.32) rate ratios). However, when we explored the number of linkages by the categories of linkages, we found significantly more healthcare service linkages in the Comprehensive group compared to the Self-Directed group (1.27 (1.06-1.51)) and significantly more linkages with child-development services in the Family Healthy Lifestyle group compared to the Self-Directed group (3.27 (1.59-6.74)). The monthly hours of direct intervention was much lower than the assigned number of hours (ranging from 5 to 32 % of the assigned hours).
Our findings are relevant to two challenges faced by policymakers and funders. First, if funds are to be expended on service-integration approaches, then, given the lack of intervention fidelity found in this study, policymakers need to insist, and therefore fund a) a well-described practice, b) auditing of that practice, c) retention of family participants, and d) examination of family use and outcomes. Second, if child-development services are widely required and are difficult for low-income families to access, then current policy needs to be examined.
ClinicalTrials.gov, NCT00705328 . Registered on 24 June 2008.
通过服务整合方法增加获得健康和社会服务的机会，可能为改善低收入家庭的健康和社会状况提供一种直接且可持续的方式。
我们开展了一项基于社区的随机试验，评估加拿大艾伯塔省低收入家庭中两种服务整合措施（健康家庭生活方式和儿童娱乐活动）的效果。这两种措施相结合形成了四组：自主导向组（无干预）、家庭健康生活方式组、家庭娱乐组和综合组（家庭健康生活方式加家庭娱乐项目）。主要结局是服务联系的总数。
我们将1168个家庭随机分组，其中50%的家庭在最后一次随访时仍参与研究。所有三个干预组的服务联系数量与自主导向组的联系数量无显著差异（综合组1.15（95%CI 0.98 - 1.35），家庭健康生活方式组1.17（0.99 - 1.38），家庭娱乐组1.12（0.95 - 1.32）率比）。然而，当我们按联系类别探讨联系数量时，发现综合组的医疗保健服务联系数量显著多于自主导向组（1.27（1.06 - 1.51）），家庭健康生活方式组与儿童发展服务的联系数量显著多于自主导向组（3.27（1.59 - 6.74））。直接干预的每月时长远低于分配的时长（占分配时长的5%至32%）。
我们的研究结果与政策制定者和资助者面临的两个挑战相关。第一，如果要将资金用于服务整合方法，鉴于本研究中发现的干预保真度不足，政策制定者需要坚持并因此资助：a）详细描述的措施，b）对该措施的审核，c）家庭参与者的留存，以及d）对家庭使用情况和结局的检查。第二，如果儿童发展服务需求广泛且低收入家庭难以获得，那么需要审视当前政策。
ClinicalTrials.gov，NCT00705328。于2008年6月24日注册。
