Informatics in Primary Care (BCS, The Chartered Institute for IT)
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When your words count: a discriminative model to predict approval of referrals
Get PDFObjective To develop and test a statistical model which correctly predicts the approval of outpatient referrals when reviewed by a specialty service based on nine discriminating variables.
Design Retrospective cross-sectional study.
Setting Large public county hospital system in a southern US city.
Participants Written documents and associated data from 500 random adult referrals made by primary care providers to various specialty services during the course of one month.
Main outcome measures The resulting correct prediction rates obtained by the model.
Results The model correctly predicted 78.6% of approved referrals using all nine discriminating variables, 75.3% of approved referrals using all variables in a stepwise manner and 74.7% of approved referrals using only the referral total word count as a single discriminating variable.
Conclusions Three iterations of the model correctly predicted at least 75% of the approved referrals in the validation set. A correct prediction of whether or not a referral will be approved can be made in three out of four cases
The online outpatient booking system 'Choose and Book' improves attendance rates at an audiology clinic: a comparative audit
Get PDFBackground The 'Choose and Book' system provides an online booking service which primary care professionals can book in real time or soon after a patient's consultation. It aims to offer patients choice and improve outpatient clinic attendance rates.
Objective An audit comparing attendance rates of new patients booked into the Audiological Medicine Clinic using the 'Choose and Book' system with that of those whose bookings were made through the traditional booking system.
Methods Data accrued between 1 April 2008 and 31 October 2008 were retrospectively analysed for new patient attendance at the department, and the age and sex of the patients, method of appointment booking used and attendance record were collected. Patients were grouped according to booking system used - 'Choose and Book' or the traditional system. The mean ages of the groups were compared by a t test. The standard error of the difference between proportions was used to compare the data fromthe two groups. A P value of - 0.05 was considered to be significant.
Results 'Choose and Book' patients had a significantly better rate of attendance than traditional appointment patients, P 0.1 (95% CI _3.0, 16.2%). The 'Choose and Book' patients, however, were significantly older than the traditional appointment patients, P < 0.001 (95% CI 4.35, 12.95%).
Conclusion This audit suggests that when primary care agents book outpatient clinic appointments online it improves outpatient attendance
An analysis of healthcare providers' online ratings
Get PDFBackground Many websites allow consumers to evaluate their healthcare experience yet scant data exist that explore the type and content of reviews.
Objective To evaluate and describe online healthcare provider reviews.
Methods We analysed 16 703 ratings on 6101 providers from four US cities. Ratings spanned five categories and an overall provider score. We also performed text analyses of narrative commentary (n = 15 952).
Results Providers had a high mean score for each category (3.7_4.0 out of 5). Higher overall scores were associated with higher staff (adjusted odds ratio (aOR) 3.0, 95% CI 2.9_3.0, P< 0.01) and punctuality scores (aOR 2.1, 95% CI 2.05_2.15, P< 0.01). Review frequency was inversely associated with scores, (aOR 0.94, 95% CI 0.92_0.96, P<0.01). Analyses of narrative commentaries revealed more positive than negative terms (P< 0.01).
Conclusions Online ratings were largely positive. Future research must discern how online surveys affect patient referrals, provider reputations and patients' perceptions of quality of care
Information technology (IT) system users must be allowed to decide on the future direction of major national IT initiatives. But the task of redistributing power equally amongst stakeholders will not be an easy one
Get PDFImplementation of telehealth support for patients with type 2 diabetes using insulin treatment: an exploratory study
Get PDFBackground Initiating and adjusting insulin treatment for people with type 2 diabetes (T2D) requires frequent clinician contacts both face-to-face and by telephone. We explored the use of a telehealth system to offer additional support to these patients.
Methods Twenty-three patients with uncontrolled T2D were recruited from nine general practices to assess the feasibility and acceptability of telehealth monitoring and support for insulin initiation and adjustment. The intervention included a standard algorithm for self-titration of insulin dose, a Bluetooth enabled glucose meter linked to a mobile phone, an integrated diary to record insulin dose, feedback of charted blood glucose data and telehealth nurse review with telephone follow-up. Additional contact with patients was initiated when no readings were transmitted for >3 days or when persistent hyper- or hypoglycaemia was identified. Reponses of patients and clinicians to the system were assessed informally.
Results The mean (SD) patient age was 58 years (12) with 78% male. The mean (SD) diabetes duration was 6.4 years (4.5), HbA1c at baseline was 9.5% (2.2), and the decrease in HbA1c at three months was 0.52% (0.91) with an insulin dose increase of 9 units (26). A mean (SD) of 160 (93) blood glucose readings was transmitted per patient in these three months. Practice nurses and general practitioners (GPs) viewed the technology as having the potential to improve patient care. Most patients were able to use the equipment with training and welcomed review of their blood glucose readings by a telehealth nurse.
Conclusions Although the concept of telehealth monitoring is unfamiliar to most patients and practice nurses, the technology improved the support available for T2D patients commencing insulin treatment
Documentation-based clinical decision support to improve antibiotic prescribing for acute respiratory infections in primary care: a cluster randomised controlled trial
Get PDFBackground and objective Clinical guidelines discourage antibiotic prescribing for many acute respiratory infections (ARIs), especially for non-antibiotic appropriate diagnoses. Electronic health record (EHR)-based clinical decision support has the potential to improve antibiotic prescribing for ARIs.
Methods We randomly assigned 27 primary care clinics to receive an EHR-integrated, documentation based clinical decision support system for the care of patients with ARIs - the ARI Smart Form - or to offer usual care. The primary outcome was the antibiotic prescribing rate for ARIs in an intent-to-intervene analysis based on administrative diagnoses.
Results During the intervention period, patients made 21 961 ARI visits to study clinics. Intervention clinicians used the ARI Smart Form in 6% of 11 954 ARI visits. The antibiotic prescribing rate in the intervention clinics was 39% versus 43% in the control clinics (odds ratio (OR), 0.8; 95% confidence interval (CI), 0.6_1.2, adjusted for clustering by clinic). For antibiotic appropriate ARI diagnoses, the antibiotic prescribing rate was 54% in the intervention clinics and 59% in the control clinics (OR, 0.8; 95% CI, 0.5_1.3). For non-antibiotic appropriate diagnoses, the antibiotic prescribing rate was 32% in the intervention clinics and 34% in the control clinics (OR, 0.9; 95% CI, 0.6_1.4). When the ARI Smart Form was used, based on diagnoses entered on the form, the antibiotic prescribing rate was 49% overall, 88% for antibiotic appropriate diagnoses and 27% for non-antibiotic appropriate diagnoses. In an as-used analysis, the ARI Smart Form was associated with a lower antibiotic prescribing rate for acute bronchitis (OR, 0.5; 95% CI, 0.3_0.8).
Conclusions The ARI Smart Form neither reduced overall antibiotic prescribing nor significantly improved the appropriateness of antibiotic prescribing for ARIs, but it was not widely used. When used, the ARI Smart Form may improve diagnostic accuracy compared to administrative diagnoses and may reduce antibiotic prescribing for certain diagnoses
Wii have a problem: a review of self-reported Wii related injuries
Get PDFPurpose The increasing popularity of the Wii video game console has been associated with a number of gameplay related traumas. We sought to investigate if there were any identifiable injury patterns associated with Wii use.
Methods Utilising a database of self-reported Wii related injuries, the data was categorised by type of injury and game title being played at the time of injury.
Findings We found that of 39 reported Wii related injuries over a two-year span, 46% occurred while playing the Wii Sports Tennis software. Further, we identified 14 distinct injury patterns sustained during gameplay. Of these injuries, hand lacerations were the most common, accounting for 44% of the total number of reported cases.
Conclusions Injury associated with video game play is not unique to the Wii, nor is it a new phenomenon. However, the Wii console appears to have a higher rate of associated injuries than traditional game consoles because of its unique user interface. We review the literature and discuss some of the medical complications associated with the Wii and other video game consoles
Physicians' attitudes towards eprescribing: a comparative web survey in Austria and Sweden
Get PDFBackground The eHealth Action Plan required the member states of the European Union (EU) to provide online services such as eprescribing of pharmaceuticals by the end of 2008. So far, implementation activities and efforts of the member states have been uneven. While in Austria pilot projects and feasibility studies have been conducted, Sweden has always been one of the leading countries in the field of eprescribing.
Objective To identify potential success factors for the implementation of eprescribing in Sweden, by comparing the attitudes of Austrian and Swedish physicians.
Method In a web survey, we asked 1824 Austrian and 427 Swedish physicians within primary care and other disciplines to declare to what extent they agreed with ten statements regarding their attitudes towards eprescribing. We deployed the chi-square test for testing the relationship between the country of residence of physicians and their attitudes towards eprescribing.
Results We demonstrated a relationship between the country of residence of physicians and their attitudes towards eprescribing (P<0.001) for all the responses. Of the Swedish physicians, 92% regarded eprescribing as time-saving, 88.1% as being safer and 96.0%as providing a better service for patients. Although less strongly supportive, the attitudes of the Austrian physicians were mainly positive.
Conclusion We found that the major potential success factors for the implementation of eprescribing in Sweden were saving of time for the physician, improved safety and better service for patients. The mainly positive attitudes of the Austrian physicians may enable implementation of eprescribing in due course