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Carlsson SV, Preston M, Vickers A, Malhotra D, Ehdaie B, Healey M, Kibel AS. Provider Perceptions of an Electronic Health Record Prostate Cancer Screening Tool. Appl Clin Inform 2024; 15:282-294. [PMID: 38599619 PMCID: PMC11006557 DOI: 10.1055/s-0044-1782619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/12/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES We conducted a focus group to assess the attitudes of primary care physicians (PCPs) toward prostate-specific antigen (PSA)-screening algorithms, perceptions of using decision support tools, and features that would make such tools feasible to implement. METHODS A multidisciplinary team (primary care, urology, behavioral sciences, bioinformatics) developed the decision support tool that was presented to a focus group of 10 PCPs who also filled out a survey. Notes and audio-recorded transcripts were analyzed using Thematic Content Analysis. RESULTS The survey showed that PCPs followed different guidelines. In total, 7/10 PCPs agreed that engaging in shared decision-making about PSA screening was burdensome. The majority (9/10) had never used a decision aid for PSA screening. Although 70% of PCPs felt confident about their ability to discuss PSA screening, 90% still felt a need for a provider-facing platform to assist in these discussions. Three major themes emerged: (1) confirmatory reactions regarding the importance, innovation, and unmet need for a decision support tool embedded in the electronic health record; (2) issues around implementation and application of the tool in clinic workflow and PCPs' own clinical bias; and (3) attitudes/reflections regarding discrepant recommendations from various guideline groups that cause confusion. CONCLUSION There was overwhelmingly positive support for the need for a provider-facing decision support tool to assist with PSA-screening decisions in the primary care setting. PCPs appreciated that the tool would allow flexibility for clinical judgment and documentation of shared decision-making. Incorporation of suggestions from this focus group into a second version of the tool will be used in subsequent pilot testing.
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Affiliation(s)
- Sigrid V. Carlsson
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Division of Urological Cancers, Department of Translational Medicine, Medical Faculty, Lund University, Lund, Sweden
| | - Mark Preston
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Deepak Malhotra
- Organizations, and Markets Unit, Harvard Business School, Boston, Massachusetts, United States
| | - Behfar Ehdaie
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Michael Healey
- Brigham and Women's Hospital Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Adam S. Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Naik A, Syvyk S, Tong J, Wirtalla C, Barg FK, Guerra CE, Mehta SJ, Wender R, Merchant RM, Kelz RR. Factors Associated With Primary Care Physician Decision-making When Making Medication Recommendations vs Surgical Referrals. JAMA Netw Open 2023; 6:e2256086. [PMID: 36790807 PMCID: PMC9932841 DOI: 10.1001/jamanetworkopen.2022.56086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
IMPORTANCE Although objective data are used routinely in prescription drug recommendations, it is unclear how referring physicians apply evidence when making surgeon or hospital recommendations for surgery. OBJECTIVE To compare the factors associated with the hospital or surgeon referral decision-making process with that used for prescription medication recommendations. DESIGN, SETTING, AND PARTICIPANTS This qualitative study comprised interviews conducted between April 26 and May 18, 2021, of a purposive sample of 21 primary care physicians from a large primary care network in the Northeast US. MAIN OUTCOMES AND MEASURES Main outcomes were the factors considered when making prescription medication recommendations vs referral recommendations to specific surgeons or hospitals for surgery. RESULTS All 21 participant primary care physicians (14 women [66.7%]) reported use of evidence-based decision support tools and patient attributes for prescription medication recommendations. In contrast, for surgeon and hospital referral recommendations, primary care physicians relied on professional experience and training, personal beliefs about surgical quality, and perceived convenience. Primary care physicians cited perceived limitations of existing data on surgical quality as a barrier to the use of such data in the process of making surgical referrals. CONCLUSIONS AND RELEVANCE As opposed to the widespread use of objective decision support tools for guidance on medication recommendations, primary care physicians relied on subjective factors when making referrals to specific surgeons and hospitals. The findings of this study highlight the potential to improve surgical outcomes by introducing accessible, reliable data as an imperative step in the surgical referral process.
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Affiliation(s)
- Anusha Naik
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Solomiya Syvyk
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Jason Tong
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Chris Wirtalla
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Frances K. Barg
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Carmen E. Guerra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Shivan J. Mehta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Richard Wender
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raina M. Merchant
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel R. Kelz
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Petry NJ, Baye JF, Frear S, Jacobsen K, Massmann A, Schultz A, Heukelom JV, Christensen K. Progression of precision statin prescribing for reduction of statin-associated muscle symptoms. Pharmacogenomics 2022; 23:585-596. [PMID: 35775396 DOI: 10.2217/pgs-2022-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Statins are among the most commonly prescribed medications, and improve patient outcomes by lowering cholesterol levels, but also have side effects. Variations in statin response can be attributed to a handful of factors that include pharmacogenetics. Methods: While not a true review article, this work was written using various search engines and terms and previous and newly published Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for statins to provide a historical perspective in addition to the current status of statin-related pharmacogenetics and future perspectives. Results: This article provides historical background on statins and associated adverse effects, reviews pharmacogenetic implications, applies clinical-decision support, incorporates the latest CPIC guidelines and addresses future implications. Conclusion: Statins are a beneficial medication, but not without risk. Pharmacogenomics can help mitigate some risk factors. Clinical-decision support, implementation, research and guidelines will continue to influence statin prescribing.
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Affiliation(s)
- Natasha J Petry
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA.,Department of Pharmacy Practice, North Dakota State University, Fargo, ND 58108, USA
| | - Jordan F Baye
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA.,South Dakota State University, College of Pharmacy & Allied Health Professions, SD 57007, USA.,University of South Dakota, Department of Internal Medicine, SD 57105, USA
| | - Samantha Frear
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA
| | - Kristen Jacobsen
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA
| | - Amanda Massmann
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA.,University of South Dakota, Department of Internal Medicine, SD 57105, USA
| | - April Schultz
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA.,University of South Dakota, Department of Internal Medicine, SD 57105, USA
| | - Joel Van Heukelom
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA.,University of South Dakota, Department of Internal Medicine, SD 57105, USA
| | - Kurt Christensen
- Department of Population Medicine, PRecisiOn Medicine Translational Research (PROMoTeR) Center, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA.,Department of Population Medicine, Harvard Medical School, Boston, MA 02215, USA.,Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA
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Sico IP, Oberle A, Thomas SM, Barsanti T, Egbuonu-Davis L, Kennedy DT, Zullig LL, Bosworth HB. Therapeutic Inertia in Prescribing Biologics for Patients with Moderate-to-Severe Asthma: Workshop Summary. Patient Prefer Adherence 2021; 15:705-712. [PMID: 33854304 PMCID: PMC8039536 DOI: 10.2147/ppa.s303841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/19/2021] [Indexed: 01/22/2023] Open
Abstract
Moderate-to-severe asthma represents about a quarter of the nearly 10% of Americans diagnosed with asthma. Many patients with moderate-to-severe asthma have uncontrolled symptoms that lead to exacerbations requiring oral corticosteroids. There are many factors contributing to poor asthma control, including poor adherence to prescribed therapies, the under-prescribing of biologics and therapeutic inertia. We convened an eight-member panel from fields of primary care, pulmonology, immunology, health services and clinical research, behavioral science and pharmaceutical medical affairs, with the goal of identifying contributing factors and solutions to therapeutic inertia with asthma biologics. We used the Capability, Opportunity, and Motivation (COM-B) model to classify patient and provider behavior towards therapeutic inertia. The model incorporates existing behavior theories and is driven by the interaction of capability, opportunity, and motivation. We used a Delphi method to identify and develop six primary solutions: 1) integration of patient-centered outcomes into asthma management practice; 2) provider education about asthma treatment; 3) moderate-to-severe asthma care delivery redesign; 4) harmonized, evidence-based protocol for the management of moderate-to-severe asthma; 5) designated coordinator approach for optimal asthma management; and 6) a case coordination digital support tool. Integration of patient-centered outcomes into asthma management practice and provider education were identified as having the highest potential to impact therapeutic and clinical inertia. The COM-B model is effective in identifying improvement within therapeutic inertia targeting the capabilities, opportunities, and motivations of patients, providers, and payer systems.
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Affiliation(s)
- Isabelle P Sico
- Department of Population Health Science, Duke University School of Medicine, Durham, NC, USA
| | - Amber Oberle
- Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, NC, USA
| | | | | | | | | | - Leah L Zullig
- Department of Population Health Science, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Population Health Science, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Correspondence: Hayden B Bosworth Duke University School of Medicine, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USATel +1 919-286-6936 Email
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Friebe MP, LeGrand JR, Shepherd BE, Breeden EA, Nelson SD. Reducing Inappropriate Outpatient Medication Prescribing in Older Adults across Electronic Health Record Systems. Appl Clin Inform 2020; 11:865-872. [PMID: 33378781 DOI: 10.1055/s-0040-1721398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The American Geriatrics Society recommends against the use of certain potentially inappropriate medications (PIMs) in older adults. Prescribing of these medications correlates with higher rates of hospital readmissions, morbidity, and mortality. Vanderbilt University Medical Center previously deployed clinical decision support (CDS) to decrease PIM prescribing rates, but recently transitioned to a new electronic health record (EHR). OBJECTIVE The goal of this study was to evaluate PIM prescribing rates for older adults before and after migration to the new EHR system. METHODS We reviewed prescribing rates of PIMs in adults 65 years and older, normalized per 100 total prescriptions from the legacy and new EHR systems between July 1, 2014 and December 31, 2019. The PIM prescribing rates before and after EHR migration during November 2017 were compared using a U-chart and Poisson regression model. Secondary analysis descriptively evaluated the frequency of prescriber acceptance rates in the new EHR. RESULTS Prescribing rates of PIMs decreased 5.2% (13.5 per 100 prescriptions to 12.8 per 100 prescriptions; p < 0.0001) corresponding to the implementation of alternatives CDS in the legacy EHR. After migration of the alternative CDS from the legacy to the new EHR system, PIM prescribing rates dropped an additional 18.8% (10.4 per 100 prescriptions; p < 0.0001). Acceptance rates of the alternative recommendations for PIMs was low overall at 11.1%. CONCLUSION The prescribing rate of PIMs in adults aged 65 years and older was successfully decreased with the implementation of prescribing CDS. This decrease was not only maintained but strengthened by the transition to a new EHR system.
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Affiliation(s)
- Michael P Friebe
- Lipscomb University College of Pharmacy and Health Sciences, Nashville, Tennessee, United States
| | - Joseph R LeGrand
- HealthIT, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Elizabeth A Breeden
- Lipscomb University College of Pharmacy and Health Sciences, Nashville, Tennessee, United States
| | - Scott D Nelson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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