Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Community-based screening for cardiovascular risk using a novel mHealth tool in rural Kenya
Full text linkBackground: An increasing burden of cardiovascular disease (CVD) in low-resource settings demands innovative public health approaches.Objectives: To design and test a novel mHealth tool for use by community health workers (CHWs) to identify individuals at high CVD risk who would benefit from education and/or pharmacologic interventions.Methods: We designed and implemented a novel two-way mobile phone application, “AFYACHAT,” to rapidly screen for CVD risk in rural Kenya. AFYACHAT collects and stores SMS text message data entered by a CHW on a subject’s age, sex, smoking, diabetes, and systolic blood pressure, and returns as SMS text message the category of 10-year CVD risk: “GREEN” (140mmHg), diabetes, and tobacco use were 23%, 3.2%, and 22%, respectively. Overall, the 10-year risk of CVD among patients was <10% in 2778 (97%) patients, 10 to <20% in 65 (2.3%), 20 to <30% in 12 (0.4%), and ≥30% in 10 (0.2%).Conclusion: We have developed a mHealth tool that can be used by CHWs to screen for CVD risk factors, demonstrating proof-of-concept in rural Kenya
Completeness and accuracy of anthropometric measurements in electronic medical records for children attending primary care
Full text linkBackground: Electronic medical records (EMRs) from primary care may be a feasible source of height and weight data. However the use of EMRs in research has been impeded by lack of standardization of EMRs systems, data access and concerns about the quality of the data.Objectives: The study objectives were to determine the data completeness and accuracy of child heights and weights collected in primary care EMRs, and to identify factors associated with these data quality attributes.Methods: A cross-sectional study examining height and weight data for children <19 years from EMRs through the Electronic Medical Records Administrative data Linked Database (EMRALD), a network of family practices across the province of Ontario. Body mass index z-scores were calculated using the WHO Growth Standards and Reference.Results: A total of 54,964 children were identified from EMRALD. Overall, 93% had at least 1 complete set of growth measurements to calculate a BMI z-score. 66.2% of all primary care visits had complete BMI z-score data. After stratifying by visit type 89.9% of well-child visits and 33.9% of sick visits had complete BMI z-score data; incomplete BMI z-score was mainly due to missing height measurements. Only 2.7% of BMI z-score data were excluded due to implausible values.Conclusions: Data completeness at well-child visits and overall data accuracy were greater than 90%. EMRs may be a valid source of data to provide estimates of obesity in children who attend primary care
Designing health information technology tools for behavioral health clinicians integrated within a primary care team
No full textBackground: Electronic health records (EHRs) are a key tool for primary care practice. However, EHR functionality is not keeping pace with the evolving informational and decision-support needs of behavioral health clinicians (BHCs) working on integrated teams. Objective: Describe workflows and tasks of BHCs working with integrated teams, identify their health information technology needs, and develop EHR tools to address them. Method: A mixed-methods, comparative-case study of six community health centers (CHCs) in Oregon, each with at least one BHC integrated in their primary care team. We observed clinical work and conducted interviews to understand workflows and clinical tasks, aiming to identify how effectively current EHRs supported integrated care delivery, including transitions, documentation, information sharing, and decision making. We analyzed these data and employed a user-centered design process to develop EHR tools addressing the identified needs. Results: BHCs used the primary care EHR for documentation and communication with other team members, but the EHR lacked the functionality to fully support integrated care. Needs include the ability to: (1) automate and track paper-based screening; (2) document behavioral health history; (3) access patient social and medical history relevant to behavioral health issues, and (4) rapidly document and track progress on goals. To meet these needs, we engaged users and developed a set of EHR tools called the BH e-Suite. Conclusion: Integrated primary care teams, and particularly BHCs, have unique information needs, workflows and tasks. These needs can be met and supported by the EHR with a moderate level of modification
Newborn screening data management: proposing a framework for Iran
Full text linkINTRODUCTION: Different countries use a variety of methods to manage the newborn screening data. In this study, we aimed to compare the experiences of the selected countries to propose a framework for managing the newborn screening data in Iran.METHODS: In this comparative study, data were collected using electronic databases and the official website of the Department of Health in America, England and Australia. Data related to the process of newborn screening in Iran were collected using an open-ended questionnaire and reviewing the published documents.RESULTS: In this study, a framework for newborn screening data management was proposed which consisted of six main areas, namely; objectives, involved organisations, data elements, data collection processes, data classification systems and the methods of controlling data quality.CONCLUSION: The framework suggested in this study can help to re-organise the process of newborn screening with more focus on data management. These data can be used in conducting research and setting strategies for improving the quality of child health in the country
The effect of a birth place decision support tool on women's decision making and information gathering behaviours during pregnancy: MyBirthplace Study Protocol
Full text linkAbstractBackground: The recent Maternity Review for England highlighted the need for more choice for women with more accessible information to support decisions. This study assesses the effect of an unique Decision Support Tool (DST) called MyBirthplace on decision making and information gathering behaviours of pregnant women regarding birth place choice. The study seeks to understand women’s views and opinions about using the DST and their feelings about how well the DST supports them to make a decision. Methods: A mixed method sequential exploratory design will be utilised to meet the above aim. This three phase study will involve a proposed sample of 169 women from a large maternity hospital in the United Kingdom. Phase one will be a questionnaire survey with women pre and post access to the DST, which is given to them by their midwife at the initial appointment. The questionnaire will look at baseline data, knowledge level and decision making using the Stages of Decision making scale (SDMS). A follow up questionnaire at 28 weeks (phase 2) will review the SDMS to enable the usefulness of Mybirthplace to be evaluated and to seek women’s opinion on various aspects of MyBirthplace. The proposed sample size was determined by a power calculation based on changes attributed to the DST as measured by the SDMS. Phase three involves qualitative interviews with a minimum of 10 purposely chosen women at approximately 36 weeks gestation, and is followed by collating data on where the women actually give birth. Discussion: This study is the first study to assess the effect of a DST in supporting women’s choice of place of birth. It will add to current DST literature. It is also one of very few studies to utilise the stages of decision making scale with DST in pregnancy and thus will build on the existing literature; whilst broaching key concepts highlighted in the National Maternity Review.
Interoperability in Health and Social Care: Organizational Issues are the Biggest Challenge.
Full text linkA great asset of any healthcare system is “information” which includes, but not limited to patient data, clinical history and treatments. It is no secret that there is a growing demand for healthcare, however, this demand is yet to be achieved due to the challenge in the limitation of resources and the complexity of the problem area
Mental health service users' perceptions of data sharing and data protection: a qualitative report
No full textBACKGROUND: To improve health services, social, economic and health data should be shared and linked to create a full narrative of lived experience. Mental health data sharing is often considered a particularly sensitive area.OBJECTIVE: To assess mental health service users’ perceptions regarding the current practice of administrative data-driven research.METHOD: We conducted a focus group using case study scenarios. Themes and subthemes were analysed using qualitative methods.RESULTS: Participants were generally happy for data owners to share their health, social and economic data if the purpose was transparent and if the information would inform and improve health policy and practice. Participants were less keen on sharing data through digital applications.CONCLUSION: This case study informs a data linkage study protocol. Research teams and database owners should strive to educate service users on data protection and create dissent opportunities.
Towards understanding healthcare professionals’ adoption and use of technologies in clinical practice: Using Qmethodology and models of technology acceptance.
Full text linkBackground: Technologies have globally been recognised to improve productivity across different areas of practice including healthcare. This has been achieved due to the expansion of computers and other forms of information technologies. Despite this advancement, there has also been the growing challenge of the adoption and use of these technologies within practice and especially in healthcare. The evolution of information technologies and more specifically e-health within the healthcare practice has its own barriers and facilitators.Methodology: This paper describes a pilot study to explore these factors that influence information and technology adoption and use by health professionals in the clinical area in Sub-Saharan Africa. We report on the use of Q-methodology and the models of technology acceptance used in combination for the first time. The methodology used for this study aims to explore the subjectivity of healthcare professionals and present their shared views (factors) on their adoption and use of e-health within clinical practice.Keywords: E-health, Q-methodology, Healthcare professionals, Technology Acceptance Model, Unified Theory of Acceptance and Use of Technology, Sub-Saharan Africa
In this issue - Assumptions, openness, apps, collaborative working and a new editor
Full text link No abstract - In This Issue for Issue No 4.