Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Designing Patient-facing Health Information Technologies for the Outpatient Settings: A Literature Review
Full text link Introduction: The implementation of health information technologies (HITs) has changed the dynamics of doctor–patient communication in outpatient settings. Designing patient-facing HITs provides patients with easy access to healthcare information during the visit and has the potential to enhance the patient-centred care. Objectives: The objectives of this study are to systematically review how the designs of patient-facing HITs have been suggested and evaluated, and how they may potentially affect the doctor–patient communication and patient-centred care. Method: We conducted an online database search to identify articles published before December 2014 relevant to the objectives of this study. A total of nine papers have been identified and reviewed in this study. Results: Designing patient-facing HITs is at an early stage. The current literature has been exploring the impact of HITs on doctor–patient communication dynamics. Based on the findings of these studies, there is an emergent need to design more patient-centred HITs. There are also some papers that focus on the usability evaluation of some preliminary prototypes of the patient-facing HITs. The design styles of patient-facing HITs included sharing the health information with the patients on: (1) a separate patient display, (2) a projector, (3) a portable tablet, (4) a touch-based screen and (5) a shared computer display that can be viewed by both doctors and patients. Each of them had the strengths and limitations to facilitate the patient-centred care, and it is worthwhile to make a comparison of them in order to identify future research directions. Conclusion: The designs of patient-facing HITs in outpatient settings are promising in facilitating the doctor-patient communication and patient engagement. However, their effectiveness and usefulness need to be further evaluated and improved from a systems perspective.
Physical Activity in Ankylosing Spondylitis: evaluation and analysis of an eHealth tool
Full text linkBackground Ankylosing spondylitis (AS) is a chronic inflammatory condition characterised by spinal arthritis and exercise is often recommended to reduce the symptoms and improve mobility. However, very little evidence exists for the value of exercise in AS.Objectives Firstly, this pilot study aimed to evaluate an eHealth tool, the AS Observer, specifically designed to monitor symptoms, quality of life and physical activity in AS, in terms of patient experience and suitability in generating data for epidemiological studies. Secondly, it also investigated the collected data to determine if physical activity benefited individuals with AS.Methods The AS Observer was designed to enable weekly monitoring of AS symptoms and exercise using a web based platform. Participants with AS (n = 223) were recruited to use the AS observer. They provided baseline data and completed online weekly data entry for 12 weeks (e.g. Bath Ankylosing Spondylitis Activity Index (BASDAI), howRu, International Physical Activity Questionnaire (IPAQ)). Panel data analysis with fixed effects models investigated associations between variables. Activity type data and exit questionnaires were subjected to qualitative thematic analysis.Results In general, the AS Observer was well received and considered useful by participants, with 66% providing a positive response. The collected data suggested that IPAQ is inversely associated with total BASDAI, stiffness, tenderness and pain, but not fatigue. Stratified analysis demonstrated differential associations between BASDAI, IPAQ and howRU based on sex, HLA-B27 status and disease duration. Approximately half of the participants frequently did therapy and three-quarters undertook at least some vigorous activity ranging from formal exercise to recreation and (house) work. Despite some technical challenges, tool evaluation suggested that the AS Observer was a useful self-monitoring tool for participants.Conclusions This pilot study demonstrated that increased exercise intensity and duration were associated with an improved BASDAI symptom score in a cohort of participants with AS. Furthermore, it provided further evidence of the value of using eHealth tools for clinical purposes and data collection for research, inclusive of the development of treatment pathways and disease management strategies
Digital literacy knowledge and needs of pharmacy staff: A systematic review
Full text linkObjective To explore the digital literacy knowledge and needs of pharmacy staff including pharmacists, graduate (pre-registration) pharmacists, pharmacy technicians, dispensing assistants and medicine counter assistants.Methods A systematic review was conducted following a pre-published protocol. Two reviewers systematically performed the reproducible search, followed by independent screening of titles/abstracts then full papers, before critical appraisal and data extraction. Full articles matching the search terms were eligible for inclusion. Exclusions were recorded with reasons. Kirkpatrick’s 4 level model of training evaluation (reaction, learning, behaviour and results) was applied as an analytical framework.Results Screening reduced the initial 86 papers to 5 for full review. Settings included hospital and community pharmacy plus education in Australia, Canada and the US. No studies of pharmacy staff other than pharmacists were identified. Main findings indicate that pharmacy staff lack digital literacy knowledge with minimal research evidenced at each level of Kirkpatrick’s model.Conclusions As a society, we acknowledge that technology is an important part of everyday life impacting on the efficiency and effectiveness of working practices but, in pharmacy, do we take cognisance, ‘that technology can change the nature of work faster than people can change their skills’? It seems that pharmacy has embraced technology without recognised occupational standards, definition of baseline skills or related personal development plans. There is little evidence that digital literacy has been integrated into pharmacy staff training, which remains an under-researched area
The acceptability to patients of video-consulting in general practice: semi-structured interviews in three diverse general practices.
No full textBackground & Objective: To improve patient access to healthcare, the UK government has encouraged technology-based approaches including internet video-consulting. However, little is known about patient acceptance of video-consulting as a consulting method. We aimed to explore primary care patients’ views video-consulting.Method & Results: We used semi-structured interviews to survey 270 patients in NHS Lothian. Three diverse General Practices were chosen purposively and sequential patients attending the practice at a range of different times of day were invited to participate. Patients were asked to indicate their level of computer proficiency and provide their views on the use of video-call consulting and what specific applications it might have. We found that 135 of 270 respondents (50%, 95% CI 43.9%-56.1%) would use video-consulting. Patients under 60 years were over two times more likely to use it (OR 2.2, 95% CI 2.1-6.6, n = 248) and evidence of a positive trend between increasing computer proficiency and those who would video-consult was found, (χ2 = 43.97, p < 0.0005, n=270). Patients who had previously used video-calling services (such as Skype™)were approximately six times more likely to favour video-consulting than those who had not (OR 5.9, 95% CI 3.5-9.9, n = 270).Conclusions: This suggests strong patient interest in video-consulting in primary care, however, it is possible that in the short to medium term there may be access inequality favouring younger and more technically able people. Further studies are needed to determine the content, safety, efficacy and cost-effectiveness of employing this medium
Accuracy of Screening Tools for Pap Smears in General Practice
Full text linkBackground Data extraction tools (DETs) are increasingly being used for research and audit of general practice, despite their limitations.Objective This study explores the accuracy of Pap smear rates obtained with a DET compared to that of the Pap smear rate obtained with a manual file audit.Method A widely available DET was used to establish the rate of Pap smears in a large multi-general practice (multi-GP) in regional New South Wales followed by a manual audit of patient files. The main outcome measure was identification of possible discrepancies between the rates established.Results The DET used significantly underestimated the level of cervical screening compared to the manual audit. In some instances, the patient file contained phone/specialist record of Pap smear conducted elsewhere, which accounted for the failure of the DET to detect some smears. Those patients who had Pap smears whose pathology codes differed between time intervals, i.e. from different pathology providers or from within the same provider but using a different code, were less likely to have had their most recent Pap smear detected by the DET (p < 0.001).Conclusion Data obtained from DETs should be used with caution as they may not accurately reflect the rate of Pap smears from electronic medical records.How this fits in DETs are increasingly being used for research and audit of general practice. This study explores the accuracy of Pap smear rates obtained with a DET compared to that of the Pap smear rate obtained with a manual file audit The DET tested significantly underestimated the level of cervical screening compared to manual screening. Data obtained from DETs should be used with caution as they may not accurately reflect the rate of Pap smears from electronic medical record
Accessible Modelling of Complexity in Health (AMoCH) and associated data flows: asthma as an exemplar
No full textBackground Modelling is an important part of information science. Models are abstractions of reality. We use models in the following contexts: (1) to describe the data and information flows in clinical practice to information scientists, (2) to compare health systems and care pathways, (3) to understand how clinical cases are recorded in record systems and (4) to model health care business models.Asthma is an important condition associated with a substantial mortality and morbidity. However, there are difficulties in determining who has the condition, making both its incidence and prevalence uncertain.Objective To demonstrate an approach for modelling complexity in health using asthma prevalence and incidence as an exemplar.Method The four steps in our process are:1. Drawing a rich picture, following Checkland’s soft systems methodology;2. Constructing data flow diagrams (DFDs);3. Creating Unified Modelling Language (UML) use case diagrams to describe the interaction of the key actors with the system;4. Activity diagrams, either UML activity diagram or business process modelling notation diagram.Results Our rich picture flagged the complexity of factors that might impact on asthma diagnosis. There was consensus that the principle issue was that there were undiagnosed and misdiagnosed cases as well as correctly diagnosed. Genetic predisposition to atopy; exposure to environmental triggers; impact of respiratory health on earnings or ability to attend education or participate in sport, charities, pressure groups and the pharmaceutical industry all increased the likelihood of a diagnosis of asthma. Stigma and some factors within the health system diminished the likelihood of a diagnosis. The DFDs and other elements focused on better case finding.Conclusions This approach flagged the factors that might impact on the reported prevalence or incidence of asthma. The models suggested that applying selection criteria may improve the specificity of new or confirmed diagnosis
Visualization approaches to support healthy aging: A systematic review
Full text linkBackground: Health technologies have the potential to support the growing number of older adults who are aging in place. Many tools include visualizations (data visualizations, visualizations of physical representations). However, the role of visualizations in supporting aging in place remains largely unexplored.Objective: To synthesize and identify gaps in the literature evaluating visualizations (data visualizations and visualizations of physical representations), for informatics tools to support healthy aging.Methods: We conducted a search in CINAHL, Embase, Engineering Village, PsycINFO, PubMed, and Web of Science using a priori defined terms for publications in English describing community-based studies evaluating visualizations used by adults aged ≥65 years.Results: Six out of the identified 251 publications were eligible. Most studies were user studies and varied methodological quality. Three visualizations of virtual representations supported performing at-home exercises. Participants found visual representations either (a) helpful, motivational, and supported their understanding of their health behaviors or (b) not an improvement over alternatives. Three data visualizations supported understanding of one’s health. Participants were able to interpret data visualizations that used precise data and encodings that were more concrete better than those that did not provide precision or were abstract. Participants found data visualizations helpful in understanding their overall health and granular data.Conclusions: Studies we identified used visualizations to promote engagement in exercises or understandings of one’s health. Future research could overcome methodological limitations of studies we identified to develop visualizations that older adults could use with ease and accuracy to support their health behaviors and decision-making
The critical components of an electronic care plan tool for primary care: an exploratory qualitative study
Full text linkBackground A critical need exists for effective electronic tools that facilitate multidisciplinary care for complex patients in patient-centered medical homes.Objective To identify the essential components of a primary care (PC) based electronic care plan (ECP) tool that facilitates coordination of care for complex patients.Methods Three focus groups and nine semi-structured interviews were conducted at an academic PC practice in order to identify the ideal components of an ECP.Results Critical components of an ECP identified included: 1) patient background information, including patient demographics, care team member designation and key patient contacts, 2) user- and patient-centric task management functionalities, 3) a summary of a patient’s care needs linked to the responsible member of the care team and 4) integration with the electronic medical record. We then designed an ECP mockup incorporating these components.Conclusion Our investigation identified key principles that healthcare software developers can integrate into PC and patient-centered ECP tools
Using the diffusion of innovations theory to assess socio-technical factors in planning the implementation of an electronic health record alert across multiple primary care clinics
Full text linkBackground: Adverse drug events (ADEs) are a leading cause of death in the United States. Patients with stage 3 and 4 chronic kidney disease (CKD) are at particular risk because many medications are cleared by the kidneys. Alerts in the electronic health record (EHR) about drug appropriateness and dosing at the time of prescription have been shown to reduce ADEs for patients with stage 3 and 4 CKD in inpatient settings, but more research is needed about the implementation and effectiveness of such alerts in outpatient settings.Objective: To explore factors that might inform the implementation of an electronic drug–disease alert for patients with CKD in primary care clinics, using Rogers’ diffusion of innovations theory as an analytic framework.Methods: Interviews were conducted with key informants in four diverse clinics using various EHR systems. Interviews were audio recorded and transcribed. results Although all clinics had a current method for calculating glomerular filtration rate (GFR), clinics were heterogeneous with regard to current electronic decision support practices, quality improvement resources, and organizational culture and structure.Conclusion: Understanding variation in organizational culture and infrastructure across primary care clinics is important in planning implementation of an intervention to reduce ADEs among patients with CKD