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Rakers M, van Hattem N, Plag S, Chavannes N, van Os HJA, Vos RC. Population health interventions for cardiometabolic diseases in primary care: a scoping review and RE-AIM evaluation of current practices. Front Med (Lausanne) 2024; 10:1275267. [PMID: 38239619 PMCID: PMC10794664 DOI: 10.3389/fmed.2023.1275267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Cardiometabolic diseases (CMD) are the leading cause of death in high-income countries and are largely attributable to modifiable risk factors. Population health management (PHM) can effectively identify patient subgroups at high risk of CMD and address missed opportunities for preventive disease management. Guided by the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework, this scoping review of PHM interventions targeting patients in primary care at increased risk of CMD aims to describe the reported aspects for successful implementation. Methods A comprehensive search was conducted across 14 databases to identify papers published between 2000 and 2023, using Arksey and O'Malley's framework for conducting scoping reviews. The RE-AIM framework was used to assess the implementation, documentation, and the population health impact score of the PHM interventions. Results A total of 26 out of 1,100 studies were included, representing 21 unique PHM interventions. This review found insufficient reporting of most RE-AIM components. The RE-AIM evaluation showed that the included interventions could potentially reach a large audience and achieve their intended goals, but information on adoption and maintenance was often lacking. A population health impact score was calculated for six interventions ranging from 28 to 62%. Discussion This review showed the promise of PHM interventions that could reaching a substantial number of participants and reducing CMD risk factors. However, to better assess the generalizability and scalability of these interventions there is a need for an improved assessment of adoption, implementation processes, and sustainability.
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Affiliation(s)
- Margot Rakers
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Nicoline van Hattem
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Sabine Plag
- Health Campus the Hague, Leiden University Medical Center, The Hague, Netherlands
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Hendrikus J. A. van Os
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Rimke C. Vos
- Health Campus the Hague, Leiden University Medical Center, The Hague, Netherlands
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Golan-Tripto I, Ben Shmuel A, Muallem L, Yahav L, Andre N, Shaki D, Horev A. Pediatricians' confidence level in diagnosing and treating children with atopic dermatitis in Israel, based on a self-efficacy survey. Eur J Pediatr 2023; 182:5223-5230. [PMID: 37718387 DOI: 10.1007/s00431-023-05197-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
Atopic dermatitis (AD) is one of childhood's most common skin conditions. Although pediatricians often diagnose and manage it, more than half refer even mild cases to dermatologists. In this study, we aimed to evaluate pediatric residents' and pediatricians' self-confidence regarding their ability to diagnose and manage AD. A cross-sectional questionnaire study was conducted with Israeli pediatric residents and pediatricians in 2022. The questionnaire was designed to distinguish participants with high vs. low self-confidence characteristics regarding their ability to diagnose and treat AD. In total, 171 participants completed the questionnaire (59.4% women; age, 41.1 ± 10.6 years); 39.1% of the participants were residents, while 60.9% were board-certified pediatricians. Overall, 64.4% of the responders reported below or average confidence (score ≤ 3, on a scale of 1-5) in diagnosing and treating AD in children. The group with higher self-confidence was significantly older (44.39 vs. 39.14 years, P = 0.003), had more years of experience in evaluating pediatric AD (P = 0.004), had trained in dermatology during their residency (P = 0.02) with a longer training period (P = 0.01), and with more than three training methods (P = 0.009). Multivariable logistic regression analysis showed that high self-confidence was associated with age older than 40 years and training in dermatology during residency (odds ratios = 5.63 [P = 0.04] and 3.36 [P = 0.05], respectively). Conclusion: Most pediatric residents and pediatricians were not particularly confident in treating children with AD. Those with high self-confidence were older, had been exposed to more patients, and had been trained in dermatology during their residency with various methods and for longer periods. Therefore, we encourage the implementation of a training program in dermatology during pediatric residency programs. What is Known: • Atopic dermatitis (AD) is one of childhood's most common skin conditions and often presents to pediatricians for diagnosis and management. • Many pediatricians refer children with even mild cases of AD to dermatologists. What is New: • Most pediatric residents and pediatricians report low confidence in diagnosing and treating pediatric AD. • Physicians with high self- confidence were older, exposed to more AD patients, and had been trained in dermatology during their residency with various methods and for longer periods. Therefore, the implementation of a training program in dermatology during pediatric residency programs is warranted.
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Affiliation(s)
- Inbal Golan-Tripto
- Pediatrics Department, Soroka University Medical Center, Beer Sheva, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel.
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.
| | - Atar Ben Shmuel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel
- School of Health Profession Education, Maastricht University, Maastricht, the Netherlands
| | - Liezl Muallem
- Pediatrics Department, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel
| | - Lior Yahav
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel
| | - Nicolas Andre
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel
| | - David Shaki
- Pediatrics Department, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel
| | - Amir Horev
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitzhak Rager Ave, PO Box 151, 8410101, Beer Sheva, Israel
- Pediatric Dermatology Service, Soroka University Medical Center, Beer Sheva, Israel
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Dulay M, Bowen JL, Weppner WG, Eastburn A, Poppe AP, Spanos P, Wojtaszek D, Printz D, Kaminetzky CP. Interprofessional population health advocacy: Developing and implementing a panel management curriculum in five Veterans Administration primary care practices. J Interprof Care 2023; 37:S75-S85. [PMID: 29746221 DOI: 10.1080/13561820.2018.1469476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 12/04/2017] [Accepted: 04/23/2018] [Indexed: 10/16/2022]
Abstract
Health care systems expect primary care clinicians to manage panels of patients and improve population health, yet few have been trained to do so. An interprofessional panel management (PM) curriculum is one possible strategy to address this training gap and supply future primary care practices with clinicians and teams prepared to work together to improve the health of individual patients and populations. This paper describes a Veterans Administration (VA) sponsored multi-site interprofessional PM curriculum development effort. Five VA Centers of Excellence in Primary Care Education collaborated to identify a common set of interprofessionally relevant desired learning outcomes (DLOs) for the PM and to develop assessment instruments for monitoring trainees' PM learning. Authors cataloged teaching and learning activities across sites. Results from pilot testing were systematically discussed leading to iterative revisions of curricular elements. Authors completed a retrospective self-assessment of curriculum implementation for the academic year 2015-16 using a 5-point scale: contemplation (score = 0), pilot (1), action (2), maintenance (3), and embedded (4). Implementation scores were analyzed using descriptive statistics. DLOs were organized into five categories (individual patients, populations, guidelines/measures, teamwork, and improvement) along with a developmental continuum and mapped to program competencies. Instruction and implementation varied across sites based on resources and priorities. Between 2015 and 2016, 159 trainees (internal medicine residents, nurse practitioner students and residents, pharmacy residents, and psychology post-doctoral fellows) participated in the PM curriculum. Curriculum implementation scores for guidelines/measures and improvement DLOs were similar for all trainees; scores for individual patients, populations, and teamwork DLOs were more advanced for nurse practitioner and physician trainees. In conclusion, collaboratively identified DLOs for PM guided development of assessment instruments and instructional approaches for panel management activities in interprofessional teams. This PM curriculum and associated tools provide resources for educators in other settings.
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Affiliation(s)
- Maya Dulay
- Center of Excellence in Primary Care Education, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Judith L Bowen
- Schools of Medicine and Nursing, Oregon Health & Science University, Portland, WA, USA
- Office of Academic Affiliations, Department of Veterans Affairs (VA), Washington DC, USA
| | - William G Weppner
- Center of Excellence in Primary Care Education, Boise VA Medical Center, Boise, ID, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Abigail Eastburn
- Center of Excellence in Primary Care Education, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Anne P Poppe
- Center of Excellence in Primary Care Education, Seattle, WA, USA
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Pete Spanos
- Center of Excellence in Primary Care Education, Louis Stokes Cleveland VAMC, Cleveland, OH, USA
| | - Danielle Wojtaszek
- West Haven Center of Excellence in Primary Care Education, VA Connecticut Health Care System, West Haven, CT, USA
| | - Destiny Printz
- Center of Excellence in Primary Care Education, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
| | - Catherine P Kaminetzky
- VA Puget Sound Health Care System, Seattle, WA, USA
- School of Medicine, University of Washington, Seattle, WA
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E-Learning for Population Health Management: An Educational Innovation to Prepare Student and Practicing Nurses for Value-Based Care. Nurs Educ Perspect 2021; 42:E117-E119. [PMID: 34265821 DOI: 10.1097/01.nep.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT To educate nursing students and practicing registered nurses about population health management (PHM), a team of faculty and PHM clinical leaders created an innovative, scalable, turnkey ready, multimedia e-learning module. The module has four lessons; takes approximately three hours to complete; and can be accessed using a weblink from computers, smart phones, and tablets. The module engages learners with videos, flashcards, case studies, and a variety of interactive knowledge checks. Each learner can obtain a record of completion, which can be shared with faculty. Faculty implemented the module with 48 senior prelicensure nursing students who reported improved self-efficacy in PHM.
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Naghipour M, Joukar F, Salari A, Asgharnezhad M, Hassanipour S, Mansour-Ghanaei F. Epidemiologic Profile of Hypertension in Northern Iranian Population: The PERSIAN Guilan Cohort Study (PGCS). Ann Glob Health 2021; 87:14. [PMID: 33614420 PMCID: PMC7879995 DOI: 10.5334/aogh.3027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Estimates region-related prevalence of hypertension and attempts to identify its related factors at the district levels are required for prevention and management of hypertension. Objective The aim of this study was to investigate the epidemic features and related factors of hypertension and its awareness, treatment, and control rates among the northern Iranian population. Methods It was a community based cross-sectional study based on data from PERSIAN Guilan Cohort Study (PGCS). In total, 10,520 participants (aged 35-70 years) from the Guilan Province in northern Iran included in this study, between October 8, 2014, and January 20, 2017. Hypertension was defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or a prior diagnosis of hypertension or being on antihypertensive medication. Potential correlates of hypertension and its awareness, treatment and control were analyzed by multivariate logistic regression adjusted for demographic factors, anthropometric characteristics, lifestyle variables, past medical history, and laboratory data. Results The prevalence of hypertension was 43.2% and the hypertension awareness, treatment, and control rate were 53.4%, 49.8%, and 73.7%, respectively. The multivariate logistic regression analyses revealed that older age, urbanization, lower education, overweight and obesity, lower physical activity, prediabetes and diabetes, cardiovascular disease, psychiatric disorder, positive family history of hypertension and raised serum creatinine were independently associated with presence of hypertension. Awareness of hypertension was greater in the female sex, older age, rural residency, higher education and patient with comorbidities. Older age, rural residency and comorbidities were associated with treatment of hypertension. Control of hypertension was better among younger age, higher education, normal weight and higher physical activity. Conclusion Hypertension is highly prevalent in the northern Iranian population. About half of affected persons are unaware of their disease and untreated. Modifying risk factors (such as weight lose and increase physical activity) and increasing hypertension awareness (by screening) is essential for primary and secondary prevention of high blood pressure in this population, especially in urban areas and among males, younger ages, and less educated.
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Affiliation(s)
- Mohammadreza Naghipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Arsalan Salari
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehrnaz Asgharnezhad
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Hassanipour
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Ghadiri R, Alimohammadi M, Majdabadi HA. Determination of the psychometric properties of the Patients' Self-Efficacy Scale in blood pressure patients. Interv Med Appl Sci 2018; 10:87-94. [PMID: 30363355 PMCID: PMC6167625 DOI: 10.1556/1646.10.2018.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction This study was designed to determine self-efficacy and its related factors in patients with hypertension. Materials and methods This study is descriptive-sectional from the correlation. A total of 250 patients from a blood pressure clinic of Semnan city (in Iran) completed Medication Understanding and Use Self-Efficacy Scale were randomly selected in 2017. Data were analyzed using variance, Pearson’s Correlation, and χ2 using the LISREL 8.8 software. Results The items 1, 6, 7, and 8 have high correlation (at least higher than 0.60), indicating the possibility of aggregation of these four variables in the first factor (taking medication), and the four items 2, 3, 4, and 5 are highly correlated with each other, which are the second factor (learning about medication). In addition, Cronbach’s α of reliability (taking medication) for the first factor was 0.67 and 0.63 for the second factor (learning about medication) and 0.69 for the whole scale. Conclusion The effectiveness of blood pressure self-efficacy is an appropriate tool for measure-taking responsibility for the time and taking medications by patients, and researchers can use it as a valid tool in therapeutic, psychological, and health research.
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Affiliation(s)
- Raheleh Ghadiri
- Semnan Health Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Masoumeh Alimohammadi
- Psychology Unit, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
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Loeb DF, Leister E, Ludman E, Binswanger IA, Crane L, Dickinson M, Kline DM, deGruy FV, Nease D, Bayliss EA. Factors associated with physician self-efficacy in mental illness management and team-based care. Gen Hosp Psychiatry 2018; 50:111-118. [PMID: 29156252 PMCID: PMC5842160 DOI: 10.1016/j.genhosppsych.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Danielle F. Loeb
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, USA;
| | - Erin Leister
- Department of Biostatistics & Informatics, Colorado School of Public Health, The Adult and Child Center for Outcomes Research and Delivery Science, Aurora, USA.
| | | | - Ingrid A. Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Denver, USA; Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, USA
| | - Lori Crane
- The Adult and Child Center for Outcomes Research and Delivery Science, Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, USA.
| | - Miriam Dickinson
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, USA; Department of Family Medicine, University of Colorado, Aurora, USA.
| | - Danielle M. Kline
- Division of General Internal Medicine, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, USA;
| | | | - Donald Nease
- Department of Family Medicine, University of Colorado, Aurora, USA.
| | - Elizabeth A. Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA; Department of Family Medicine, University of Colorado, Aurora, CO, USA;
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Kaminetzky CP, Beste LA, Poppe AP, Doan DB, Mun HK, Woods NF, Wipf JE. Implementation of a novel population panel management curriculum among interprofessional health care trainees. BMC MEDICAL EDUCATION 2017; 17:264. [PMID: 29273028 PMCID: PMC5741920 DOI: 10.1186/s12909-017-1093-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 12/04/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Gaps in chronic disease management have led to calls for novel methods of interprofessional, team-based care. Population panel management (PPM), the process of continuous quality improvement across groups of patients, is rarely included in health professions training for physicians, nurses, or pharmacists. The feasibility and acceptance of such training across different healthcare professions is unknown. We developed and implemented a novel, interprofessional PPM curriculum targeted to diverse health professions trainees. METHODS The curriculum was implemented annually among internal medicine residents, nurse practitioner students and residents, and pharmacy residents co-located in a large, academic primary care site. Small groups of interprofessional trainees participated in supervised quarterly seminars focusing on chronic disease management (e.g., diabetes mellitus, hypertension, or chronic obstructive pulmonary disease) or processes of care (e.g., emergency department utilization for nonacute conditions or chronic opioid management). Following brief didactic presentations, trainees self-assessed their clinic performance using patient-level chart review, presented individual cases to interprofessional staff and faculty, and implemented subsequent feedback with their clinic team. We report data from 2011 to 2015. Program evaluation included post-session participant surveys regarding attitudes, knowledge and confidence towards PPM, ability to identify patients for referral to interprofessional team members, and major learning points from the session. Directed content analysis was performed on an open-ended survey question. RESULTS Trainees (n = 168) completed 122 evaluation assessments. Trainees overwhelmingly reported increased confidence in using PPM and increased knowledge about managing their patient panel. Trainees reported improved ability to identify patients who would benefit from multidisciplinary care or referral to another team member. Directed content analysis revealed that trainees viewed team members as important system resources (n = 82). CONCLUSIONS Structured interprofessional training in PPM is both feasible and acceptable to trainees across multiple professions. Curriculum participants reported improved panel management skills, increased confidence in using PPM, and increased confidence in identifying candidates for interprofessional care. The curriculum could be readily exported to other programs and contexts.
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Affiliation(s)
- Catherine P. Kaminetzky
- VA Puget Sound Health Care System, Seattle, WA USA
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | - Lauren A. Beste
- VA Puget Sound Health Care System, Seattle, WA USA
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | - Anne P. Poppe
- VA Puget Sound Health Care System, Seattle, WA USA
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA USA
| | - Daniel B. Doan
- VA Puget Sound Health Care System, Seattle, WA USA
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
| | | | - Nancy Fugate Woods
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA USA
- de Tornyay Center for Healthy Aging, University of Washington School of Nursing, Seattle, WA USA
| | - Joyce E. Wipf
- VA Puget Sound Health Care System, Seattle, WA USA
- Division of General Internal Medicine, University of Washington, Seattle, WA USA
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Hobson A, Curtis A. Improving the care of veterans: The role of nurse practitioners in team-based population health management. J Am Assoc Nurse Pract 2017; 29:644-650. [PMID: 28857487 DOI: 10.1002/2327-6924.12506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/02/2017] [Accepted: 07/11/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE Improving healthcare delivery for U.S. veterans is a national priority. The Veterans Health Administration (VHA) employs a variety of team-based, population health strategies to address critical issues in veterans' health including the effective management of chronic disease. Nurse practitioners (NPs) are integral members of the VHA patient care team with a substantial role to play in the organization and delivery of healthcare services for veterans. This report explores the contributions of NPs in team-based, population health strategies within the VHA. METHODS This review of the literature examines peer-reviewed articles published between 2006 and 2017 to explore the contributions of NPs in team-based, population health strategies within the VHA. Search words include veterans, VHA, NPs, population health, panel management, and chronic disease. CONCLUSIONS NPs are vital members of the VHA primary care team; however, there is a dearth of available evidence reflecting the unique contribution of NPs within VHA team-based, population health management strategies. IMPLICATIONS FOR PRACTICE The VHA adoption of full practice authority for NP practice provides NPs with an expanded capacity to lead improvements in veterans' health. Future research is needed to fully understand the unique role of the NP in the delivery of population health management strategies for veterans.
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Affiliation(s)
- Alexandra Hobson
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California
| | - Alexa Curtis
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California
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Sedlander E, Barboza KC, Jensen A, Skursky N, Bennett K, Sherman S, Schwartz M. Veterans' Preferences for Remote Management of Chronic Conditions. Telemed J E Health 2017; 24:229-235. [PMID: 28745941 DOI: 10.1089/tmj.2017.0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Veterans Health Administration (VA) is investing considerable resources into providing remote management care to patients for disease prevention and management. Remote management includes online patient portals, e-mails between patients and providers, follow-up phone calls, and home health devices to monitor health status. However, little is known about patients' attitudes and preferences for this type of care. This qualitative study was conducted to better understand patient preferences for receiving remote care. METHODS Ten focus groups were held comprising 77 patients with hypertension or tobacco use history at two VA medical centers. Discussion questions focused on experience with current VA remote management efforts and preferences for receiving additional care between outpatient visits. RESULTS Most participants were receptive to remote management for referrals, appointment reminders, resource information, and motivational and emotional support between visits, but described challenges with some technological tools. Participants reported that remote management should be personalized and tailored to individual needs. They expressed preferences for frequency, scope, continuity of provider, and mode of communication between visits. Most participants were open to nonclinicians contacting them as long as they had direct connection to their medical team. Some participants expressed a preference for a licensed medical professional. All groups raised concerns around confidentiality and privacy of healthcare information. Female Veterans expressed a desire for gender-sensitive care and an interest in complementary and alternative medicine. CONCLUSIONS The findings and specific recommendations from this study can improve existing remote management programs and inform the design of future efforts.
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Affiliation(s)
- Erica Sedlander
- 1 Milken Institute School of Public Health, George Washington University , Washington, District of Columbia.,2 VA New York Harbor Healthcare System , New York, New York
| | - Katherine C Barboza
- 3 Department of Population Health, NYU School of Medicine , New York, New York
| | - Ashley Jensen
- 4 Cumming School of Medicine, University of Calgary , Calgary, Canada
| | - Nicole Skursky
- 3 Department of Population Health, NYU School of Medicine , New York, New York
| | | | - Scott Sherman
- 2 VA New York Harbor Healthcare System , New York, New York.,5 Lifeworks , Austin, Texas
| | - Mark Schwartz
- 2 VA New York Harbor Healthcare System , New York, New York.,3 Department of Population Health, NYU School of Medicine , New York, New York
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Dixon BE, Barboza K, Jensen AE, Bennett KJ, Sherman SE, Schwartz MD. Measuring Practicing Clinicians' Information Literacy. An Exploratory Analysis in the Context of Panel Management. Appl Clin Inform 2017; 8:149-161. [PMID: 28197620 PMCID: PMC5373760 DOI: 10.4338/aci-2016-06-ra-0083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 12/05/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND As healthcare moves towards technology-driven population health management, clinicians must adopt complex digital platforms to access health information and document care. OBJECTIVES This study explored information literacy, a set of skills required to effectively navigate population health information systems, among primary care providers in one Veterans' Affairs (VA) medical center. METHODS Information literacy was assessed during an 8-month randomized trial that tested a population health (panel) management intervention. Providers were asked about their use and comfort with two VA digital tools for panel management at baseline, 16 weeks, and post-intervention. An 8-item scale (range 0-40) was used to measure information literacy (Cronbach's α=0.84). Scores between study arms and provider types were compared using paired t-tests and ANOVAs. Associations between self-reported digital tool use and information literacy were measured via Pearson's correlations. RESULTS Providers showed moderate levels of information literacy (M= 27.4, SD 6.5). There were no significant differences in mean information literacy between physicians (M=26.4, SD 6.7) and nurses (M=30.5, SD 5.2, p=0.57 for difference), or between intervention (M=28.4, SD 6.5) and control groups (M=25.1, SD 6.2, p=0.12 for difference). Information literacy was correlated with higher rates of self-reported information system usage (r=0.547, p=0.001). Clinicians identified data access, accuracy, and interpretability as potential information literacy barriers. CONCLUSIONS While exploratory in nature, cautioning generalizability, the study suggests that measuring and improving clinicians' information literacy may play a significant role in the implementation and use of digital information tools, as these tools are rapidly being deployed to enhance communication among care teams, improve health care outcomes, and reduce overall costs.
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Affiliation(s)
- Brian E Dixon
- Brian E. Dixon, MPA, PhD, Regenstrief Institute, 1101 W. 10th St., RF 336, Indianapolis, Indiana 46202,
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Elshatarat RA, Yacoub MI, Khraim FM, Saleh ZT, Afaneh TR. Self-efficacy in treating tobacco use: A review article. PROCEEDINGS OF SINGAPORE HEALTHCARE 2016. [DOI: 10.1177/2010105816667137] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Globally, tobacco use continues to be a major health care concern. Despite strong recommendations to quit smoking, tobacco users are experiencing difficulties in quitting. The purpose of this integrative review is to discuss self-efficacy theory as an important behavioral therapy for treating tobacco use and nicotine dependence. Moreover, the paper proposes a literature-derived model that employs self-efficacy as a central component for treating tobacco use and nicotine dependence. Eleven relevant articles were included in this review. Self-efficacy has an important role in smoking cessation. Improving self-efficacy enhances the individual’s success in quitting tobacco use and preventing relapse. Moreover, incorporating self-efficacy as a cognitive behavioral intervention has shown various degrees of success for treating tobacco use and nicotine dependence. In order to offer guidance to health care providers assisting in quitting tobacco, a model that integrates self-efficacy as a central component of the quitting process is proposed.
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Affiliation(s)
- Rami Azmi Elshatarat
- Department of Medical and Surgical Nursing, Taibah University, Madinah, Kingdom of Saudi Arabia
| | - Mohammed Ibrahim Yacoub
- Department of Medical and Surgical Nursing, Taibah University, Madinah, Kingdom of Saudi Arabia
- Clinical Nursing Department, The University of Jordan, Amman, Jordan
| | - Fadi Marwan Khraim
- Department of Medical and Surgical Nursing, Taibah University, Madinah, Kingdom of Saudi Arabia
- School of Nursing, Memorial University of Newfoundland, Canada
| | - Zyad Taher Saleh
- Clinical Nursing Department, The University of Jordan, Amman, Jordan
| | - Tareq Rateb Afaneh
- Nursing Education Department, Security Forces Hospital, Makkah, Kingdom of Saudi Arabia
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Schwartz MD, Jensen A, Wang B, Bennett K, Dembitzer A, Strauss S, Schoenthaler A, Gillespie C, Sherman S. Panel Management to Improve Smoking and Hypertension Outcomes by VA Primary Care Teams: A Cluster-Randomized Controlled Trial. J Gen Intern Med 2015; 30:916-23. [PMID: 25666215 PMCID: PMC4471025 DOI: 10.1007/s11606-015-3204-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 11/10/2014] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Panel Management can expand prevention and chronic illness management beyond the office visit, but there is limited evidence for its effectiveness or guidance on how best to incorporate it into practice. OBJECTIVE We aimed to test the effectiveness of incorporating panel management into clinical practice by incorporating Panel Management Assistants (PMAs) into primary care teams with and without panel management education. DESIGN We conducted an 8-month cluster-randomized controlled trial of panel management for improving hypertension and smoking cessation outcomes among veterans. PATRICIPANTS Twenty primary care teams from the Veterans Affairs New York Harbor were randomized to control, panel management support, or panel management support plus education groups. Teams included 69 clinical staff serving 8,153 hypertensive and/or smoking veterans. INTERVENTIONS Teams assigned to the intervention groups worked with non-clinical Panel Management Assistants (PMAs) who monitored care gaps and conducted proactive patient outreach, including referrals, mail reminders and motivational interviewing by telephone. MAIN MEASURES Measurements included mean systolic and diastolic blood pressure, proportion of patients with controlled blood pressure, self-reported quit attempts, nicotine replacement therapy (NRT) prescriptions, and referrals to disease management services. KEY RESULTS Change in mean blood pressure, blood pressure control, and smoking quit rates were similar across study groups. Patients on intervention teams were more likely to receive NRT (OR = 1.4; 95% CI 1.2-1.6) and enroll in the disease management services MOVE! (OR = 1.2; 95% CI 1.1-1.6) and Telehealth (OR = 1.7, 95% CI 1.4-2.1) than patients on control teams. CONCLUSIONS Panel Management support for primary care teams improved process, but not outcome variables among veterans with hypertension and smoking. Incorporating PMAs into teams was feasible and highly valued by the clinical staff, but clinical impact may require a longer intervention.
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