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Wilson SN, Noble H, Ordoñez WJN, Wong GZ, Rodríguez MJ, Checa DO, Warne M, Senturia K, LaGrone LN. Implementing point-of-care medical information systems into trauma and general surgeon practice in a middle-income country: a qualitative study utilizing the Consolidated Framework for Implementation Research. Implement Sci Commun 2023; 4:38. [PMID: 37024984 PMCID: PMC10078056 DOI: 10.1186/s43058-023-00397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/04/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Point-of-care medical information systems (POCMIS) can provide an efficient and effective means of strengthening health systems globally through their encouragement of continued medical education. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, this research provides suggestions for improved implementation of POCMIS in low- and middle-income countries informed by an intervention implemented across public and military hospitals in Lima, Peru. METHODS Analysis is based on qualitative interviews conducted with 12 Peruvian surgeons across eight public hospitals and one military hospital who received an intervention that provided free access to UpToDate and introduced Google Translate. The post-intervention interviews were transcribed, translated, and analyzed for themes overlapping with CFIR constructs to expose barriers to implementation and suggestions for improved implementation of future interventions. RESULTS Barriers included a lack of seniority buy-in and engaged leadership, an overabundance of personal preferences for multiple POCMIS, and a culture of assumption that inhibited open communication regarding access to and use of POCMIS. Suggestions for improved implementation focused on the adaptation of the intervention. Namely, surgeons discussed regionally-specific adaptations as well as adaptations specific to their surgical specialty including visual, rather than written, representation of the information available via POCMIS. CONCLUSIONS Results indicate necessary adaptations for implementing interventions including POCMIS in LMICs, mimicking much of the implementation science literature on intervention adaptation. In addition to explicit suggestions provided by surgeons, we also suggest actionable steps to adapt to barriers identified in our data. Rapid assessment procedures (RAP) are one established methodological technique useful for assessing organization culture prior to implementation, allowing for necessary cultural adaptations. Dynamic adaption process (DAP) is another useful and established method that breaks implementation into four phases allowing for adaptations based on the initial assessment of the intervention site.
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Affiliation(s)
| | - Helen Noble
- Northern Pacific Global Health Fogarty International Program, University of Washington, Seattle, WA, USA
| | | | | | | | | | - Maria Warne
- University of Colorado Health, Denver, CO, USA
| | | | - Lacey Nicole LaGrone
- Department of Surgery, Medical Center of the Rockies, University of Colorado Health, Loveland, CO, USA.
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Noble H, Ordoñez WJN, Zavala Wong G, Rodríguez MJ, Ortega Checa D, Warne M, Senturia K, Jin Y, Peterson R, Nicole LaGrone L. Does Access to Point-of-Care Medical Information Improve Trauma and General Surgeons' Clinical Knowledge in a Middle-Income Country? A Mixed-Methods Study with Random Assignment. J Am Coll Surg 2023; 236:484-494. [PMID: 36729680 PMCID: PMC9924957 DOI: 10.1097/xcs.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Investing in continued medical education strengthens surgical systems. This study assessed the effectiveness of an evidence-based practice (EBP) tutorial and access to UpToDate (UTD) to improve EBP and understand how and why providers practice using evidence. STUDY DESIGN This is a mixed-methods, implementation study at 9 public hospitals in Peru consisting of a didactic session for surgeons on EBP and Google Translate and support of applications for UTD access. Change in clinical knowledge scores (CKS), access and use of UTD, and impact of language pre-and postintervention were measured. Qualitative interviews uncovered reasons for these changes. RESULTS Intervention participants had lower CKS at follow-up compared with baseline (odds ratio [OR] of higher score 0.41 [0.18,0.98]; p = 0.044), and this effect was modified (p = 0.003) to the extent that the reverse was true for control participants (OR 2.30 [1.13,4.71]; p = 0.022). Participants with 1 to 20 years of experience had significantly improved CKS compared with students/residents (1 to 10 years: OR 4.5 [1.1,18]; 11 to 20 years: OR 4.9 [1.4,17]); there was no evidence of a different CKS between providers with >20 years of experience compared with students/residents (OR 1.3 [0.5,3.7]). Administrative disconnect, usability, motivation, education, time, resources, and age influenced point-of-care medical information systems impact on knowledge and EBP. Participants reporting low English proficiency translated medical literature mostly used Google Translate. Those with low/no English reading proficiency had higher odds of reporting a negative impact on research than those with working (p = 0.007) or professional (p < 0.001) proficiency. CONCLUSIONS Providing education on EBP, free UTD access, and translation solutions did not correlate with increased CKS due to complex barriers to using point-of-care medical information systems.
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Affiliation(s)
- Helen Noble
- From the Northern Pacific Global Health Fogarty International Program (Noble)
| | | | | | - Manuel J Rodríguez
- Department of Surgery (Rodriguez), Universidad Peruana Cayetano Heredia, Lima, Perú
| | - David Ortega Checa
- Sociedad de Cirujanos Generales del Perú, Lima, Perú (Ordoñez, Ortega Checa)
- Department of Surgery, Hospital Rebagliati, Lima, Perú (Ortega Checa)
| | - Maria Warne
- Department of Surgery, University of Colorado Health, Medical Center of the Rockies, Loveland, CO (Warne, LaGrone)
| | - Kirsten Senturia
- Department of Health Services (Senturia), University of Washington, Seattle, WA
| | - Ying Jin
- University of Colorado Anschutz Medical Campus, Aurora, CO (Jin, Peterson)
| | - Ryan Peterson
- University of Colorado Anschutz Medical Campus, Aurora, CO (Jin, Peterson)
| | - Lacey Nicole LaGrone
- Department of Surgery, University of Colorado Health, Medical Center of the Rockies, Loveland, CO (Warne, LaGrone)
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Singh K, Lima G, Cha M, Cha C, Kulshrestha J, Ahn YY, Varol O. Misinformation, believability, and vaccine acceptance over 40 countries: Takeaways from the initial phase of the COVID-19 infodemic. PLoS One 2022; 17:e0263381. [PMID: 35139117 PMCID: PMC8827463 DOI: 10.1371/journal.pone.0263381] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 01/18/2022] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic has been damaging to the lives of people all around the world. Accompanied by the pandemic is an infodemic, an abundant and uncontrolled spread of potentially harmful misinformation. The infodemic may severely change the pandemic’s course by interfering with public health interventions such as wearing masks, social distancing, and vaccination. In particular, the impact of the infodemic on vaccination is critical because it holds the key to reverting to pre-pandemic normalcy. This paper presents findings from a global survey on the extent of worldwide exposure to the COVID-19 infodemic, assesses different populations’ susceptibility to false claims, and analyzes its association with vaccine acceptance. Based on responses gathered from over 18,400 individuals from 40 countries, we find a strong association between perceived believability of COVID-19 misinformation and vaccination hesitancy. Our study shows that only half of the online users exposed to rumors might have seen corresponding fact-checked information. Moreover, depending on the country, between 6% and 37% of individuals considered these rumors believable. A key finding of this research is that poorer regions were more susceptible to encountering and believing COVID-19 misinformation; countries with lower gross domestic product (GDP) per capita showed a substantially higher prevalence of misinformation. We discuss implications of our findings to public campaigns that proactively spread accurate information to countries that are more susceptible to the infodemic. We also defend that fact-checking platforms should prioritize claims that not only have wide exposure but are also perceived to be believable. Our findings give insights into how to successfully handle risk communication during the initial phase of a future pandemic.
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Affiliation(s)
| | - Gabriel Lima
- Institute for Basic Science, Daejeon, South Korea
- School of Computing, KAIST, Daejeon, South Korea
| | - Meeyoung Cha
- Institute for Basic Science, Daejeon, South Korea
- School of Computing, KAIST, Daejeon, South Korea
- * E-mail: (MC); (CC)
| | - Chiyoung Cha
- College of Nursing, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, South Korea
- * E-mail: (MC); (CC)
| | - Juhi Kulshrestha
- Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | - Yong-Yeol Ahn
- Center for Complex Networks and Systems Research, Luddy School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, United States of America
- Indiana University Network Science Institute, Indiana University, Bloomington, IN, United States of America
- Connection Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Onur Varol
- Faculty of Engineering and Natural Sciences, Sabanci University, Istanbul, Turkey
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Lin SW, Shen CF, Liu CC, Cheng CM. A Paper-Based IL-6 Test Strip Coupled With a Spectrum-Based Optical Reader for Differentiating Influenza Severity in Children. Front Bioeng Biotechnol 2021; 9:752681. [PMID: 34692664 PMCID: PMC8527092 DOI: 10.3389/fbioe.2021.752681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/21/2021] [Indexed: 01/08/2023] Open
Abstract
Influenza virus infection is a major worldwide public health problem. Influenza virus infections are associated with a high hospitalization rate in children between the ages of 5 and 14. The predominant reason for poor influenza prognosis is the lack of any effective means for early diagnosis. Early diagnosis of severe illness is critical to improving patient outcome, and could be especially useful in areas with limited medical resources. Accurate, inexpensive, and easy-to-use diagnostic tools could improve early diagnosis and patient outcome, and reduce overall healthcare costs. We developed an interleukin-6 paper-based test strip that used colloidal gold-conjugated antibodies to detect human interleukin-6 protein. These complexes were captured on a paper-based test strip patterned with perpendicular T lines that were pre-coated with anti-human interleukin-6 antibodies. Applied serum samples interacted with these antibodies and presented as colored bands that could be read using a spectrum-based optical reader. The full-spectrum of the reflected light interleukin-6 protein signal could be obtained from the spectral optics module, and the standard could be used to quantitatively analyze interleukin 6 level in serum. We retrospectively evaluated 10 children (23 serum samples) with severe influenza virus infections, 26 children (26 serum samples) with mild influenza virus infections, and 10 healthy children (10 serum samples). Our system, the combined use of a paper-based test strip and a spectrum-based optical reader, provided both qualitative and quantitative information. When used with the optical reader, the detection limit was improved from a qualitative, naked-eye level of 400 pg/ml to a quantitative, optical reader level of 76.85 pg/ml. After monitoring serum interleukin-6 level via our system, we found a high correlation between our system results and those obtainable using a conventional sandwich enzyme-linked immunosorbent assay method (Rho = 0.706, p < 0.001). The sensitivity and specificity for differentiating between severe and mild influenza using our combined method (test strip coupled with optical reader) were 78.3 and 50.0%, respectively. When interleukin-6 was combined with serum C-reaction protein, the sensitivity and specificity were 85.7 and 95.5%, and the receiver operating characteristic area-under-the-curve was quite high (AUC = 0.911, p < 0.001). The potential advantages of our system, i.e., a paper-based test strip coupled with a spectrum-based optical reader, are as follows: 1) simple user operation; 2) rapid turnaround times–within 20 min; 3) high detection performance; and, 4) low-cost fabrication.
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Affiliation(s)
- Sheng-Wen Lin
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Chuan Liu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
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Miller K, Rosenberg J, Pickard O, Hawrusik R, Karlage A, Weintraub R. Segmenting clinicians’ usage patterns of a digital health tool in limited resource settings: methodology and initial results (Preprint). JMIR Form Res 2021; 6:e30320. [PMID: 35532985 PMCID: PMC9127647 DOI: 10.2196/30320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Evidence-based digital health tools allow clinicians to keep up with the expanding medical literature and provide safer and more accurate care. Understanding users’ online behavior in low-resource settings can inform programs that encourage the use of such tools. Our program collaborates with digital tool providers, including UpToDate, to facilitate free subscriptions for clinicians serving in low-resource settings globally. Objective We aimed to define segments of clinicians based on their usage patterns of UpToDate, describe the demographics of those segments, and relate the segments to self-reported professional climate measures. Methods We collected 12 months of clickstream data (a record of users’ clicks within the tool) as well as repeated surveys. We calculated the total number of sessions, time spent online, type of activity (navigating, reading, or account management), calendar period of use, percentage of days active online, and minutes of use per active day. We defined behavioral segments based on the distributions of these statistics and related them to survey data. Results We enrolled 1681 clinicians from 75 countries over a 9-week period. We based the following five behavioral segments on the length and intensity of use: short-term, light users (420/1681, 25%); short-term, heavy users (252/1681, 15%); long-term, heavy users (403/1681, 24%); long-term, light users (370/1681, 22%); and never-users (252/1681, 15%). Users spent a median of 5 hours using the tool over the year. On days when users logged on, they spent a median of 4.4 minutes online and an average of 71% of their time reading medical content as opposed to navigating or managing their account. Over half (773/1432, 54%) of the users actively used the tool for 48 weeks or more during the 52-week study period. The distribution of segments varied by age, with lighter and less use among those aged 35 years or older compared to that among younger users. The speciality of medicine had the heaviest use, and emergency medicine had the lightest use. Segments varied strongly by geographic region. As for professional climate, most respondents (1429/1681, 85%) reported that clinicians in their area would view the use of a online tool positively, and compared to those who reported other views, these respondents were less likely to be never-users (286/1681, 17% vs 387/1681, 23%) and more likely to be long-term users (655/1681, 39% vs 370/1681, 22%). Conclusions We believe that these behavioral segments can help inform the implementation of digital health tools, identify users who may need assistance, tailor training and messaging for users, and support research on digital health efforts. Methods for combining clickstream data with demographic and survey data have the potential to inform global health implementation. Our forthcoming analysis will use these methods to better elucidate what drives digital health tool use.
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Affiliation(s)
- Kate Miller
- Better Evidence, Ariadne Labs, Boston, MA, United States
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Julie Rosenberg
- Better Evidence, Ariadne Labs, Boston, MA, United States
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Olivia Pickard
- Better Evidence, Ariadne Labs, Boston, MA, United States
| | | | - Ami Karlage
- Better Evidence, Ariadne Labs, Boston, MA, United States
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Mousavi T, Nikfar S, Abdollahi M. Achieving Equitable Access to Medicines and Health Services: A COVID-19-time Recalled Matter. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2021; 20:450-466. [PMID: 35194459 PMCID: PMC8842612 DOI: 10.22037/ijpr.2021.116120.15709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
In the 21st century, while some people seek to use artificial intelligence for health services delivery, others have to surrender their health rights to meet basic needs. The gradient in health has become more pronounced in the COVID-19 crisis considering discrepancies in disease prevalence, geographical accessibility, availability, affordability, quality/safety of health services, and human resources. Through PubMed, GoogleScholar, Scopus, WHO, OECD, and UN databases, the English documents and global statistics were collected. Determining the role of health equity-related factors and introducing mechanisms to maintain regional and international justice in health, specifically during the COVID-19 pandemic, were among the core concepts of this paper. Social determinants of health (SDH), interregional and intraregional bodies are the main drivers of discrimination in health services. Governments should relish chief health strategists' role in possessing legitimacy, accountability, direction, transparent performance, fairness, and good governance in one word. Improving health literacy and telemedicine, providing income support, and reforming insurance where needed, are other national mechanisms to amend inequity. Among interregional issues, what is concerning is the matter of sanctions on access to health services, which is against the Universal Declaration of Human Rights. Shortage of vital medications, ventilators, test kits, COVID-19 vaccines, pharmaceutical raw materials, foreign currency, decreased national currency value, purchasing power parity, and quality/safety of health services resulted from such oppression. The article also provides practical suggestions, paving the way for re-establishing global solidarity and developing health justice in deprived regions.
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Affiliation(s)
- Taraneh Mousavi
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran. ,Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Shekoufeh Nikfar
- Evidence-Based Evaluation of Cost-Effectiveness and Clinical Outcomes Group, Pharmaceutical Sciences Research Center (PSRC), and the Pharmaceutical Management and Economics Research Center (PMERC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran. ,Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Abdollahi
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran. ,Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. ,Corresponding author: E-mail:
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