Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Using keywords to predict the need for an audiogram: an analysis of referral letters using logistic regression
Get PDFBackground Otolaryngology clinics are often booked without considering the distribution of work for doctors and audiologists. This causes inefficiencies of time and human resources. This may be due to clinics being booked before referrals have been triaged to identify whether a hearing test, known as a pure tone audiogram (PTA), is indicated. A model that can predict the need for PTA without clinician-led triage could be useful to address these booking issues.
Objective To establish if it is possible to predict whether a referred patient requires a PTA based on occurrences of words in the referral letter.
Method Binary logistic regression analysis of 500 letters of referral for otolaryngology outpatients. The derived model was then tested on 50 referral letters. All the referral letters were reviewed by clinicians and classified according to whether or not a PTA would be required.
Results The regression model correctly predicted requirement for a PTA in 42 of 50 referral letters (84%), with a sensitivity of 91% and specificity of 82%.
Conclusion The model is able to predict requirement for a PTA from referral letters with a high degree of accuracy. This method may have a role in assisting administrative/clerical staff or nonspecialist clinicians to book appropriate ear, nose and throat (ENT) clinic appointments, with or without a PTA. As a result, workload would be distributed more evenly, through the clinic for both otolaryngologists and audiologists, increasing efficiency
Liberating the NHS: an information revolution - think beyond the electronic patient record, think service orientated architecture!
Get PDFFacilitating patient self-management through telephony and web technologies in seasonal influenza
Get PDFPurpose The aim of this projectwas to develop and test information technology implementations that could assist patients with influenza self-management in primary care settings. Although testing was conducted in the context of seasonal influenza, the project aimed to develop a blueprint that primary care practices could use in an influenza pandemic.
Methods Four primary care practice-based research networks (PBRNs) systematically designed, implemented, tailored and tested a tiered patient selfmanagement technology model in 12 primary care practices during the peak of the 2007 to 2008 influenza season. Participating clinicians received a customised practice website that included a bilingual influenza self-triage module, a downloadable influenza toolkit and electronic messaging capability. As an alternative option, a bilingual, interactive seasonal influenza telephone hotline that patients could call for assistance was provided.
Results Influenza self-management web pages presented via nine customised practice websites received 1060 hits between February and April of 2008. The Self-management Influenza Toolkit was downloaded 76 times and 185 Influenza Self-Triage Module sessions were completed via practice websites during the course of testing. Logs of the telephony hotline indicated 88 calls between February and April 2008. Seventy-two percent of callers had influenza- like symptoms and 18% were eligible for antiviral therapy. The Spanish language option was selected by 21% of callers. Qualitative feedback from 37 patients (29 English and 8 Spanish) and six clinicians from four PBRNs indicated ease of use, problem-free access and navigation, useful and adequate information that was utilised in various ways by patients and a high level of overall satisfaction with these technologies. Both patients and clinicians provided rich and meaningful feedback about future improvements.
Conclusions Primary care patients and their clinicians can adopt and successfully utilise influenza self-management technologies. Our pilot study suggests that web resources combined with telephony technology are feasible to set up and easy to use in primary care settings
Using routinely collected data to evaluate a leaflet campaign to increase the presentation of people with memory problems to general practice: a locality based controlled study
Get PDFBackground The Alzheimer's Society wished to raise awareness that people with memory problems may benefit fromearly assessment and diagnosis, so that appropriate measures could be put in place and management improved.
Objective To use routinely collected data to determine whether a leaflet campaign to raise awareness of memory problems would result in increased presentation of people with memory problems to their GPs.
Method A locality was identified which met the criteria for locating the pilot intervention. A neighbouring locality was identified which used the same secondary care service and could serve as a comparator. Anonymised routinely collected computer data were gathered before and after the intervention.
Results The intervention locality had a much greater proportion of elderly patients and a higher proportion had memory problems recorded at baseline (OR 1.67; 95% CI 1.47_1.91; P<0.001). In both localities just under 40% of people with memory problems had blood tests. Approximately 80% would be referred to secondary care, and this was more likely for those in the intervention group (OR 1.29; 95% CI 0.99_1.93; P=0.044).
However, the use of antidepressants was greater in the control locality; 34% vs 9% (OR 0.19; 95% CI 0.13_0.27; P<0.001).
Whilst the absolute number of people prescribed cholinesterase inhibitors was greater and increased more in the intervention practices, the proportion of people with memory problems prescribed was not significantly greater (OR 1.21; 95% CI 0.77 - 1.89; P=0.38). The increased prescribing in the intervention practices was due to people restarting therapy. From a lower baseline there was a greater increase in the control locality for all variables for which we had a before and after measure.
Conclusions During a leaflet campaign the recording and management ofmemory problems increased. However, there was greater improvement in the control locality. This study demonstrates the importance of including a control group and the strengths of routine primary care data
Presentation of body mass index within an electronic health record to improve weight assessment and counselling in children and adolescents
Get PDFBackground Assessment of weight and counselling on nutrition and physical activity is infrequently conducted during well child visits, despite recent expert recommendations.
Objective We investigated whether automatic calculation of body mass index (BMI) in an electronic health record improved assessment of weight and counselling on nutrition and physical activity.
Methods Retrospective review of well child visit records of children between two and 18 years of age (n=550) before and after implementation of an electronic health record system at an academic medical centre's paediatric clinic. Body mass index was automatically calculated and presented within the electronic health record. We measured clinicians' documentation of assessment of weight status, and assessment of and counselling for nutrition and physical activity risk factors.
Results Documentation of assessment of BMI and weight status did not increase. There were no consistent increases in assessment for or counselling on specific nutrition and physical activity behaviours, except with respect to high calorie food intake. Although overall assessment of physical activity decreased, physical activity counselling significantly increased. Documentation of the presence of highrisk family history increased significantly; the provision of counselling for high-risk family history did not show any corresponding increase. Patients with higher BMI percentile scores were more completely assessed for weight status. Completeness of weight status assessment was associated with increased counselling for nutrition and physical activity.
Conclusions Passive changes, such as automatic calculation of BMI, are insufficient to result in systematic improvements in assessment of weight and counselling for nutrition and physical activity
The use of Google language tools as an interpretation aid in cross-cultural doctor_patient interaction: a pilot study
Get PDFA bibliometric analysis of Australian general practice publications from 1980 to 2007 using PubMed
Get PDFBackground We analysed Australian general practice (GP) publications in PubMed from 1980 to 2007 to determine journals, authors, publication types, national health priority areas (NHPA) and compared the results with those from three specialities (public health, cardiology and medical informatics) and two countries (the UK and New Zealand).
Method Australian GP publications were downloaded in MEDLINE format using PubMed queries and were written to a Microsoft Access database using a software application. Search Query Language and online PubMed queries were used for further analysis.
Results There were 4777 publications from1980 to 2007. Australian Family Physician (38.1%) and the Medical Journal of Australia (17.6%) contributed 55.7% of publications.Reviews (12.7%), letters (6.6%), clinical trials (6.5%) and systematic reviews (5%) were the main PubMed publication types. Thirty five percent of publications addressed National Health Priority Areas with material on mental health (13.7%), neoplasms (6.5%) and cardiovascular conditions (5.9%). The comparable numbers of publications for the three specialities were: public health - 80 911, cardiology - 15 130 and medical informatics - 3338; total country GP comparisons were: UK - 14 658 and New Zealand - 1111.
Discussion Australian GP publications have shown an impressive growth from 1980 to 2007 with a 15- fold increase. This increase may be due in part to the actions of the Australian government over the past decade to financially support research in primary care, as well as the maturing of academic general practice. This analysis can assist governments, researchers, policy makers and others to target resources so that further developments can be encouraged, supported and monitored
Quality assessment of information about medications in primary care electronic patient record (EPR) systems
Get PDFBackground Many different brands of primary care electronic patient record (EPR) software are available to general practitioners (GPs). Their ability to support GPs in improving prescribing varies greatly.
Objective To assess, using a ten-item tool, the quality of drug information provided by EPR software to support the appropriateness of prescriptions and to propose a list of quality standards for this type of application.
Methods The eight EPR programmes most used in general practice in Italy were assessed by a multidisciplinary team using the ten-item tool. The tool evaluated information on single drugs and drug safety and information on prescription rules in force.
Results Out of eight EPR programmes assessed, none scored more than 55% of the maximum possible score. Two achieved scores higher than 50%, one scored 48%, four ranged from 32% to 39% and one obtained 22%. Information on drug safety, such as the ability to detect interactions, to monitor laboratory parameters or to get updated information on drug safety was particularly limited. None of the eight EPR programmes contained drug information for patients, but two of them contained drug advertising.
Conclusions This project highlighted the poor quality of drug information provided by these EPR programmes. The ten-item tool seems suitable for assessing their quality. Based on this analysis, we have proposed a set of ten quality standards for prescribing software
Evaluation of a new short generic measure of health status: howRu
Get PDFBackground Quality of life is paramount for patients and clinicians, but existing measures of health were not developed for routine use.
Objectives This paper describes the development and testing of a new generic tool for measuring health related quality of life (HRQoL) with direct comparison to the SF-12 Health Survey.
Methods The new tool (howRu) has four items (discomfort, distress, disability and dependence), rated using four levels (none, a little, quite a lot and extreme), providing 256 possible states (44); it has an aggregate scoring scheme with a range from 0 (worst) to 12 (best). Psychometric properties were examined in a telephone survey, which also recorded SF-12.
Results The howRu script is shorter than SF-12 (45 words vs 294 words) and has better readability statistics. 2751 subjects, all with long-term conditions (average age 62, female 62.8%), completed the survey; 21.7% were at the ceiling (no reported problems on any dimension); 0.9% at the floor. Inter-item correlations, Cronbach's alpha and principal factor analysis suggest that a single summary score is appropriate. Correlations between the physical and mental components of both howRu and SF-12 were as expected. Across all patients the howRu score was correlated with PCS-12 (r=0.74), MCS-12 (r=0.49) and the sum of PCS- 12 and MCS-12 (r=0.81). Subjects were classified by howRu score, primary condition, the number of conditions suffered, age group, duration of illness and area of residence. Across all six classifications, the correlation of themean howRu score with the mean PCS-12 for each class was r=0.91, with MCS-12, r=0.45 and with the sum of PCS-12 and MCS-12, r=0.97.
Conclusions howRu is a new short generic measure of HRQoL, with good psychometric properties. It generates similar aggregate results to SF-12. It could provide a quick and easy way for practitioners to monitor the health of patients with long-term conditions