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Keuper J, van Tuyl LHD, de Geit E, Rijpkema C, Vis E, Batenburg R, Verheij R. The impact of eHealth use on general practice workload in the pre-COVID-19 era: a systematic review. BMC Health Serv Res 2024; 24:1099. [PMID: 39300456 DOI: 10.1186/s12913-024-11524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 09/02/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND In recent years, eHealth has received much attention as an opportunity to increase efficiency within healthcare organizations. Adoption of eHealth might consequently help to solve perceived health workforce challenges, including labor shortages and increasing workloads among primary care professionals, who serve as the first point of contact for healthcare in many countries. The purpose of this systematic review was to investigate the impact of general eHealth use and specific eHealth services use on general practice workload in the pre-COVID-19 era. METHODS The databases of CINAHL, Cochrane, Embase, IEEE Xplore, Medline ALL, PsycINFO, Web of Science, and Google Scholar were searched, using combinations of keywords including 'eHealth', 'workload', and 'general practice'. Data extraction and quality assessment of the included studies were independently performed by at least two reviewers. Publications were included for the period 2010 - 2020, before the start of the COVID-19 pandemic. RESULTS In total, 208 studies describing the impact of eHealth services use on general practice workload were identified. We found that two eHealth services were mainly investigated within this context, namely electronic health records and digital communication services, and that the largest share of the included studies used a qualitative study design. Overall, a small majority of the studies found that eHealth led to an increase in general practice workload. However, results differed between the various types of eHealth services, as a large share of the studies also reported a reduction or no change in workload. CONCLUSIONS The impact of eHealth services use on general practice workload is ambiguous. While a small majority of the effects indicated that eHealth increased workload in general practice, a large share of the effects also showed that eHealth use reduced workload or had no impact. These results do not imply a definitive conclusion, which underscores the need for further explanatory research. Various factors, including the study setting, system design, and the phase of implementation, may influence this impact and should be taken into account when general practices adopt new eHealth services. STUDY REGISTRATION NUMBER PROSPERO (International Prospective Register of Systematic Reviews) CRD42020199897; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=199897 .
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Affiliation(s)
- Jelle Keuper
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands.
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, Tilburg, 5037DB, Netherlands.
| | - Lilian H D van Tuyl
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
| | - Ellemarijn de Geit
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
| | - Corinne Rijpkema
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, Tilburg, 5037DB, Netherlands
| | - Elize Vis
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
- Department of Sociology, Radboud University Nijmegen, Thomas van Aquinostraat 4, Nijmegen, 6525GD, Netherlands
| | - Robert Verheij
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118, Utrecht, 3513CR, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, Tilburg, 5037DB, Netherlands
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Maaß L, Angoumis K, Freye M, Pan CC. Mapping Digital Public Health Interventions Among Existing Digital Technologies and Internet-Based Interventions to Maintain and Improve Population Health in Practice: Scoping Review. J Med Internet Res 2024; 26:e53927. [PMID: 39018096 PMCID: PMC11292160 DOI: 10.2196/53927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/31/2024] [Accepted: 05/15/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The rapid progression and integration of digital technologies into public health have reshaped the global landscape of health care delivery and disease prevention. In pursuit of better population health and health care accessibility, many countries have integrated digital interventions into their health care systems, such as web-based consultations, electronic health records, and telemedicine. Despite the increasing prevalence and relevance of digital technologies in public health and their varying definitions, there has been a shortage of studies examining whether these technologies align with the established definition and core characteristics of digital public health (DiPH) interventions. Hence, the imperative need for a scoping review emerges to explore the breadth of literature dedicated to this subject. OBJECTIVE This scoping review aims to outline DiPH interventions from different implementation stages for health promotion, primary to tertiary prevention, including health care and disease surveillance and monitoring. In addition, we aim to map the reported intervention characteristics, including their technical features and nontechnical elements. METHODS Original studies or reports of DiPH intervention focused on population health were eligible for this review. PubMed, Web of Science, CENTRAL, IEEE Xplore, and the ACM Full-Text Collection were searched for relevant literature (last updated on October 5, 2022). Intervention characteristics of each identified DiPH intervention, such as target groups, level of prevention or health care, digital health functions, intervention types, and public health functions, were extracted and used to map DiPH interventions. MAXQDA 2022.7 (VERBI GmbH) was used for qualitative data analysis of such interventions' technical functions and nontechnical characteristics. RESULTS In total, we identified and screened 15,701 records, of which 1562 (9.94%) full texts were considered relevant and were assessed for eligibility. Finally, we included 185 (11.84%) publications, which reported 179 different DiPH interventions. Our analysis revealed a diverse landscape of interventions, with telemedical services, health apps, and electronic health records as dominant types. These interventions targeted a wide range of populations and settings, demonstrating their adaptability. The analysis highlighted the multifaceted nature of digital interventions, necessitating precise definitions and standardized terminologies for effective collaboration and evaluation. CONCLUSIONS Although this scoping review was able to map characteristics and technical functions among 13 intervention types in DiPH, emerging technologies such as artificial intelligence might have been underrepresented in our study. This review underscores the diversity of DiPH interventions among and within intervention groups. Moreover, it highlights the importance of precise terminology for effective planning and evaluation. This review promotes cross-disciplinary collaboration by emphasizing the need for clear definitions, distinct technological functions, and well-defined use cases. It lays the foundation for international benchmarks and comparability within DiPH systems. Further research is needed to map intervention characteristics in this still-evolving field continuously. TRIAL REGISTRATION PROSPERO CRD42021265562; https://tinyurl.com/43jksb3k. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/33404.
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Affiliation(s)
- Laura Maaß
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
- Digital Health Section, European Public Health Association - EUPHA, Utrecht, Netherlands
| | - Konstantinos Angoumis
- University of Bielefeld, Bielefeld, Germany
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Merle Freye
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
- University of Bremen, Institute for Information, Health and Medical Law - IGMR, Bremen, Germany
| | - Chen-Chia Pan
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research - IPP, Bremen, Germany
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Braddock AS, Bosworth KT, Ghosh P, Proffitt R, Flowers L, Montgomery E, Wilson G, Tosh AK, Koopman RJ. Clinician Needs for Electronic Health Record Pediatric and Adolescent Weight Management Tools: A Mixed-Methods Study. Appl Clin Inform 2024; 15:368-377. [PMID: 38458233 PMCID: PMC11078569 DOI: 10.1055/a-2283-9036] [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: 10/09/2023] [Accepted: 02/21/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Clinicians play an important role in addressing pediatric and adolescent obesity, but their effectiveness is restricted by time constraints, competing clinical demands, and the lack of effective electronic health record (EHR) tools. EHR tools are rarely developed with provider input. OBJECTIVES We conducted a mixed method study of clinicians who provide weight management care to children and adolescents to determine current barriers for effective care and explore the role of EHR weight management tools to overcome these barriers. METHODS In this mixed-methods study, we conducted three 1-hour long virtual focus groups at one medium-sized academic health center in Missouri and analyzed the focus group scripts using thematic analysis. We sequentially conducted a descriptive statistical analysis of a survey emailed to pediatric and family medicine primary care clinicians (n = 52) at two private and two academic health centers in Missouri. RESULTS Surveyed clinicians reported that they effectively provided health behavior lifestyle counseling at well-child visits (mean of 60 on a scale of 1-100) and child obesity visits (63); however, most felt the current health care system (27) and EHR tools (41) do not adequately support pediatric weight management. Major themes from the clinician focus groups were that EHR weight management tools should display data in a way that (1) improves clinical efficiency, (2) supports patient-centered communication, (3) improves patient continuity between visits, and (4) reduces documentation burdens. An additional theme was (5) clinicians trust patient data entered in real time over patient recalled data. CONCLUSION Study participants report that the health care system status quo and currently available EHR tools do not sufficiently support clinicians working to manage pediatric or adolescent obesity and provide health behavior counseling. Clinician input in the development and testing of EHR weight management tools provides opportunities to address barriers, inform content, and improve efficiencies of EHR use.
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Affiliation(s)
- Amy S. Braddock
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - K. Taylor Bosworth
- School of Medicine, University of Missouri, Columbia, Missouri, United States
| | - Parijat Ghosh
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Rachel Proffitt
- School of Health Professions, University of Missouri, Columbia, Missouri, United States
| | - Lauren Flowers
- School of Medicine, University of Missouri, Columbia, Missouri, United States
| | - Emma Montgomery
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Gwendolyn Wilson
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Aneesh K. Tosh
- Department of Child Health, University of Missouri, Columbia, Missouri, United States
| | - Richelle J. Koopman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
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Li-Wang J, Townsley A, Katta R. Cognitive Ergonomics: A Review of Interventions for Outpatient Practice. Cureus 2023; 15:e44258. [PMID: 37772235 PMCID: PMC10526922 DOI: 10.7759/cureus.44258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
Doctoring is difficult mental work, involving many cognitively demanding processes such as diagnosing, decision-making, parallel processing, communicating, and managing the emotions of others. According to cognitive load theory (CLT), working memory is a limited cognitive resource that can support a finite amount of cognitive load. While the intrinsic cognitive load is the innate load associated with a task, the extraneous load is generated by inefficiency or suboptimal work conditions. Causes of extraneous cognitive load in healthcare include inefficiency, distractions, interruptions, multitasking, stress, poor communication, conflict, and incivility. High levels of cognitive load are associated with impaired function and an increased risk of burnout among physicians. Cognitive ergonomics is the branch of human factors and ergonomics (HFE) focused on supporting the cognitive processes of individuals within a system. In health care, where the cognitive burden on physicians is high, cognitive ergonomics can establish practices and systems that decrease extraneous cognitive load and support pertinent cognitive processes. In this review, we present cognitive ergonomics as a useful framework for conceptualizing an oft-overlooked dimension of labor and apply theory to practice by summarizing evidence-based cognitive ergonomics interventions for outpatient care settings. Our proposed interventions are structured within four general recommendations: 1. minimize distractions, interruptions, and multitasking; 2. optimize the use of the electronic health record (EHR); 3. optimize the use of health information systems (HIS); and 4. support good communication and teamwork. Best practices in cognitive ergonomics can benefit patients, minimize practice inefficiency, and support physician career longevity.
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Affiliation(s)
| | | | - Rajani Katta
- Internal Medicine, Baylor College of Medicine, Houston, USA
- Dermatology, University of Texas Health Science Center at Houston, Houston, USA
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Bosworth KT, Flowers L, Proffitt R, Ghosh P, Koopman RJ, Wilson G, Tosh AK, Braddock AS. Mixed-methods study of development and design needs for CommitFit, an adolescent mHealth App. Mhealth 2023; 9:22. [PMID: 37492126 PMCID: PMC10364000 DOI: 10.21037/mhealth-22-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/01/2023] [Indexed: 07/27/2023] Open
Abstract
Background Adolescent obesity remains a significant public health issue within the United States. Mobile application technology growth and popularity offer new opportunities for research and health improvement. The development of a consolidated mobile health application (mHealth app) for adolescents on these platforms has the potential to improve health outcomes. Thus, this study describes the co-development process working with adolescent users. The aims are as follows: (I) to explore the visual design and functional requirements when developing the CommitFit mHealth app, (II) to uncover the gamification techniques that incentivize adolescents to set and achieve healthy lifestyle goals, and (III) to identify adolescent expectations when using the CommitFit mHealth application. Methods In this mixed method study, we used semi-structured interviews/task analysis and surveys of adolescents (aged 13 to 15 years) to understand their user requirements and design preferences during the development of the CommitFit mHealth app. Interviews were conducted online, via Zoom. The survey included the user design industry-standard System Usability Scale (SUS) paired with a supplemental questionnaire on the specific features and functionalities of the CommitFit mHealth app. Participants were recruited from the electronic health record from the University of Missouri Healthcare system. Results Ten adolescents, aged 13 to 15 years (average of 13.6 years), were interviewed and surveyed to explore adolescent preferences with visual app design and functionality. Our inductive thematic analysis found that adolescents preferred colorful, user-friendly interfaces paired with gamification in the CommitFit mHealth app. Our analysis of SUS survey data validated our user-centered and human-system design and adolescents confirmed their design, feature, and functionality preferences. Overall, adolescent users were able to confirm their preference to have educational resources, goal recommendations, leaderboard, points, reminders, and an avatar in the app. Conclusions Adolescent feedback is crucial in the successful development of our adolescent-targeted mHealth app, CommitFit. Adolescents preferred vibrant colors, easy-to-use interface, gamification, customizable and personalized, and mature graphics. Adolescents were especially motivated by gamification techniques to maintain their interest in the application and their health behavior goals. Additional research is now needed to explore the clinical effectiveness of the CommitFit mHealth app, as a health and lifestyle intervention.
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Affiliation(s)
- K. Taylor Bosworth
- School of Medicine, Family and Community Medicine, University of Missouri, Columbia, MO, USA
- School of Medicine, Translational Biosciences Graduate Program, University of Missouri, Columbia, MO, USA
| | - Lauren Flowers
- School of Medicine, Columbia, University of Missouri, Columbia, MO, USA
| | | | - Parijat Ghosh
- School of Medicine, Family and Community Medicine, University of Missouri, Columbia, MO, USA
| | - Richelle J. Koopman
- School of Medicine, Family and Community Medicine, University of Missouri, Columbia, MO, USA
| | - Gwen Wilson
- School of Medicine, Family and Community Medicine, University of Missouri, Columbia, MO, USA
| | - Aneesh K. Tosh
- Department of Child Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Amy S. Braddock
- School of Medicine, Family and Community Medicine, University of Missouri, Columbia, MO, USA
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Liebhart JL, Goodman AB, Lindros J, Krafft C, Cook SR, Baker A, Hassink SG. Key Predictors of Primary Care Providers' Self-Efficacy in Caring for Children with Overweight or Obesity. Acad Pediatr 2022; 22:1158-1166. [PMID: 35247645 PMCID: PMC10291564 DOI: 10.1016/j.acap.2022.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Self-efficacy is a crucial factor in enabling pediatric primary care providers (PCPs) to deliver recommended care to children with overweight and obesity. This study, conducted with a large, national sample of PCPs, aimed to identify key factors, which may contribute to PCP self-efficacy for obesity-related care, from a list of previously reported barriers and facilitators. METHODS A national random sample of American Academy of Pediatrics members was surveyed in 2017 (analytic n = 704). Factor analysis was used to identify self-efficacy variables from relevant indicators and assess fit. Multivariable linear regression analyses were conducted to identify key predictors of PCP self-efficacy from reported facilitators or barriers to care, including characteristics of the PCP, practice, community, and payment systems. RESULTS Two PCP self-efficacy variables were identified: health risk assessment and patient-centered counseling. Both were positively predicted by relevant training, the belief that pediatricians play an important role in obesity, and awareness of barriers to payment for dietitians or weight management programs. Both were negatively predicted by a perceived lack of available PCP time for counseling and inadequacy of available referral resources to assist with treatment. Additional predictors of counseling self-efficacy included PCP beliefs that they are paid for treatment (+) and that patients/families lack time for healthy behaviors (-). Electronic health record clinical decision supports or registries and patient social disadvantage were not predictive. CONCLUSIONS Results suggest multiple potential roles and strategies for local and national organizations seeking to facilitate improvements to PCP self-efficacy in caring for children with overweight and obesity.
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Affiliation(s)
- Janice L Liebhart
- Institute for Healthy Childhood Weight, American Academy of Pediatrics (JL Liebhart, J Lindros, A Baker, and SG Hassink), Itasca, Ill.
| | - Alyson B Goodman
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention (AB Goodman), Atlanta, Ga
| | - Jeanne Lindros
- Institute for Healthy Childhood Weight, American Academy of Pediatrics (JL Liebhart, J Lindros, A Baker, and SG Hassink), Itasca, Ill
| | - Catherine Krafft
- Golisano Children's Ambulatory Care Facility, University of Rochester Medical Center (C Krafft and SR Cook), Rochester, NY
| | - Stephen R Cook
- Golisano Children's Ambulatory Care Facility, University of Rochester Medical Center (C Krafft and SR Cook), Rochester, NY
| | - Alison Baker
- Institute for Healthy Childhood Weight, American Academy of Pediatrics (JL Liebhart, J Lindros, A Baker, and SG Hassink), Itasca, Ill
| | - Sandra G Hassink
- Institute for Healthy Childhood Weight, American Academy of Pediatrics (JL Liebhart, J Lindros, A Baker, and SG Hassink), Itasca, Ill
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Walczak R, Kludacz-Alessandri M, Hawrysz L. Use of Telemedicine Technology among General Practitioners during COVID-19: A Modified Technology Acceptance Model Study in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710937. [PMID: 36078650 PMCID: PMC9518366 DOI: 10.3390/ijerph191710937] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 05/31/2023]
Abstract
During the COVID-19 pandemic, telehealth became a popular solution for the remote provision of primary care by General Practitioners (GPs) in Poland. This study aimed to assess the GPs' acceptance of telehealth during the COVID-19 pandemic in Poland and to explain the factors that drive GPs' need to implement a telehealth system in primary care using the modified Technology Acceptance Model (TAM). In Poland, 361 GPs from a representative sample of 361 clinics drawn from 21,500 outpatient institutions in Poland participated in the empirical study. Structural equation modelling (SEM) was used to evaluate the causal relationships that were formulated in the proposed model. Research has shown that Polish GPs reported a positive perception and high acceptance of the telehealth system during the COVID-19 pandemic. Overall, the results show that the social factors (image, decision autonomy, perception of patient interaction) significantly positively influence the technological factors (perceived ease of use and perceived usefulness) that influence the need to implement a telehealth system. The proposed socio-technological model can serve as a theoretical basis for future research and offer empirical predictions for practitioners and researchers in health departments, governments, and primary care settings.
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Affiliation(s)
- Renata Walczak
- Faculty of Civil Engineering, Mechanics and Petrochemistry, Warsaw University of Technology, 09-400 Plock, Poland
| | | | - Liliana Hawrysz
- Faculty of Management, Wrocław University of Science and Technology, 50-370 Wrocław, Poland
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Paquette J, Théorêt L, Veilleux L, Graham J, Paradis M, Chamberland N, Lanctôt G, Breault P, Pelletier M, Boudreault S. Childhood obesity diagnosis and management remains a challenge despite the use of electronic health records: A retrospective study. Health Sci Rep 2022; 5:e763. [PMID: 35949682 PMCID: PMC9358539 DOI: 10.1002/hsr2.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background The use of electronic health records (EHR) has revolutionized medical practice by improving the quality of care. Childhood obesity (CO) increases the risk of developing other chronic diseases and has a serious psychosocial impact on children. Using EHR may improve this clinical condition since early diagnosis is a crucial means of preventing its negative impacts. Objectives The aim of the study was to assess the diagnosis and management of CO in a Canadian academic family medicine group unit (FMG-U) that uses EHR with an integrated CO diagnosis tool. Methods This is a retrospective study conducted in an FMG-U in the province of Quebec. The clinical practice guidelines established by the World Health Organization (WHO) were used to assess diagnosis and management of CO. EHR of every patient from 5 to 12 years old who had a medical appointment at the FMG-U in 2017 (n = 618) were analyzed. EHR use by clinicians was assessed by a closed-ended online survey sent to clinicians who provided pediatric care at that clinic in 2017. Results We identified 69 patients as obese according to the WHO, of whom 40 had been diagnosed by health professionals at the clinic. Of these, 33 received nutritional counseling; 33 received physical activity counseling; 13 received parent involvement counseling; 19 were referred to another health professional; and 12 were followed up within 6 months. Ten out of 15 clinicians responded to the survey. They all used the EHR integrated CO diagnosis tool but only 20% were truly familiar with it. Conclusions This study shows that CO is still underdiagnosed in primary care, notwithstanding the use of EHR with integrated tools. This affects the quality of care. Moreover, even if CO were correctly diagnosed, its management remains incomplete. Knowledge translation by medical organizations plays an important role in addressing this problem.
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Affiliation(s)
- Jean‐Sébastien Paquette
- ARIMED Laboratory, Groupe de Médecine de Famille Universitaire du Nord de Lanaudière, CISSS LanaudièreJolietteQuebecCanada
- Départment de Médecine Familiale et de Médecine d'urgence, Faculté de MédecineUniversité LavalQuebec CityQuebecCanada
- VITAM, Centre de Recherche en Santé DurableUniversité LavalQuebec CityQuebecCanada
| | - Laurence Théorêt
- ARIMED Laboratory, Groupe de Médecine de Famille Universitaire du Nord de Lanaudière, CISSS LanaudièreJolietteQuebecCanada
- Départment de Médecine Familiale et de Médecine d'urgence, Faculté de MédecineUniversité LavalQuebec CityQuebecCanada
| | - Laurence Veilleux
- ARIMED Laboratory, Groupe de Médecine de Famille Universitaire du Nord de Lanaudière, CISSS LanaudièreJolietteQuebecCanada
- Départment de Médecine Familiale et de Médecine d'urgence, Faculté de MédecineUniversité LavalQuebec CityQuebecCanada
| | - Johann Graham
- Départment de Médecine Familiale et de Médecine d'urgence, Faculté de MédecineUniversité LavalQuebec CityQuebecCanada
| | - Marie‐Pier Paradis
- Départment de Médecine Familiale et de Médecine d'urgence, Faculté de MédecineUniversité LavalQuebec CityQuebecCanada
| | - Nathalie Chamberland
- Départment de Médecine Familiale et de Médecine d'urgence, Faculté de MédecineUniversité LavalQuebec CityQuebecCanada
| | - Gabrielle Lanctôt
- Départment de Médecine Familiale et de Médecine d'urgence, Faculté de MédecineUniversité LavalQuebec CityQuebecCanada
| | - Pascale Breault
- ARIMED Laboratory, Groupe de Médecine de Famille Universitaire du Nord de Lanaudière, CISSS LanaudièreJolietteQuebecCanada
- Départment de Médecine Familiale et de Médecine d'urgence, Faculté de MédecineUniversité LavalQuebec CityQuebecCanada
| | - Mathieu Pelletier
- ARIMED Laboratory, Groupe de Médecine de Famille Universitaire du Nord de Lanaudière, CISSS LanaudièreJolietteQuebecCanada
- Départment de Médecine Familiale et de Médecine d'urgence, Faculté de MédecineUniversité LavalQuebec CityQuebecCanada
| | - Samuel Boudreault
- ARIMED Laboratory, Groupe de Médecine de Famille Universitaire du Nord de Lanaudière, CISSS LanaudièreJolietteQuebecCanada
- Départment de Médecine Familiale et de Médecine d'urgence, Faculté de MédecineUniversité LavalQuebec CityQuebecCanada
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Braddock A, Koopman RJ, Smith J, Lee AS, Holt McNair S, Hampl S, Wareg N, Clary M, Miller N, Turer CB. A Longitudinal Effectiveness Study of a Child Obesity Electronic Health Record Tool. J Am Board Fam Med 2022; 35:742-750. [PMID: 35896456 PMCID: PMC10443903 DOI: 10.3122/jabfm.2022.04.210385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/12/2022] [Accepted: 02/14/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Primary-care providers, clinic staff, and nurses play an important role in reducing child obesity; yet time restraints and clinical demands compete with effective pediatric weight management and prevention. METHODS To investigate the potential impact of an electronic health record (EHR) enabled tool to assist primary care teams in addressing child obesity, we conducted a controlled effectiveness study of FitTastic compared with usual care on the BMI pattern of 291 children (2 to 17 years) up to 4 years later. RESULTS Per χ2 analysis, a greater proportion of children with baseline overweight/obesity in the EHR tool group than the control group had a favorable BMI pattern (32% vs 13%, P = .03). In logistic regression, FitTastic children were more likely than control children to have a favorable BMI pattern at follow-up (OR 3.8, 95% CI 1.1 to 13.2), adjusted for age, gender, race, and parental education. CONCLUSION Study findings suggest that EHR-enabled tools to assist primary care teams in managing child obesity may be useful for helping to address the weight in children with overweight/obesity, especially in younger children (2 to 5 years). Digital and EHR-enabled technologies may prove useful for partnering health care teams and families in the important tasks of setting positive, family-centered healthy lifestyle behavioral goals and managing child overweight and obesity.
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Affiliation(s)
- Amy Braddock
- From University of Missouri, Columbia, MO (AB, RJK, JS, NW, MC); University of Missouri School of Medicine, Columbia, MO (ASL, SHM); General Pediatrics and Weight Management, Children's Mercy Hospital Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, University of MO-Kansas City School of Medicine (SH); Cahaba Family Medicine, Pelham, AL (NM); Internal Medicine-Pediatrics, University of Texas Southwestern, Dallas, Texas (CBT).
| | - Richelle J Koopman
- From University of Missouri, Columbia, MO (AB, RJK, JS, NW, MC); University of Missouri School of Medicine, Columbia, MO (ASL, SHM); General Pediatrics and Weight Management, Children's Mercy Hospital Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, University of MO-Kansas City School of Medicine (SH); Cahaba Family Medicine, Pelham, AL (NM); Internal Medicine-Pediatrics, University of Texas Southwestern, Dallas, Texas (CBT)
| | - Jamie Smith
- From University of Missouri, Columbia, MO (AB, RJK, JS, NW, MC); University of Missouri School of Medicine, Columbia, MO (ASL, SHM); General Pediatrics and Weight Management, Children's Mercy Hospital Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, University of MO-Kansas City School of Medicine (SH); Cahaba Family Medicine, Pelham, AL (NM); Internal Medicine-Pediatrics, University of Texas Southwestern, Dallas, Texas (CBT)
| | - Andy S Lee
- From University of Missouri, Columbia, MO (AB, RJK, JS, NW, MC); University of Missouri School of Medicine, Columbia, MO (ASL, SHM); General Pediatrics and Weight Management, Children's Mercy Hospital Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, University of MO-Kansas City School of Medicine (SH); Cahaba Family Medicine, Pelham, AL (NM); Internal Medicine-Pediatrics, University of Texas Southwestern, Dallas, Texas (CBT)
| | - Samuel Holt McNair
- From University of Missouri, Columbia, MO (AB, RJK, JS, NW, MC); University of Missouri School of Medicine, Columbia, MO (ASL, SHM); General Pediatrics and Weight Management, Children's Mercy Hospital Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, University of MO-Kansas City School of Medicine (SH); Cahaba Family Medicine, Pelham, AL (NM); Internal Medicine-Pediatrics, University of Texas Southwestern, Dallas, Texas (CBT)
| | - Sarah Hampl
- From University of Missouri, Columbia, MO (AB, RJK, JS, NW, MC); University of Missouri School of Medicine, Columbia, MO (ASL, SHM); General Pediatrics and Weight Management, Children's Mercy Hospital Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, University of MO-Kansas City School of Medicine (SH); Cahaba Family Medicine, Pelham, AL (NM); Internal Medicine-Pediatrics, University of Texas Southwestern, Dallas, Texas (CBT)
| | - Nuha Wareg
- From University of Missouri, Columbia, MO (AB, RJK, JS, NW, MC); University of Missouri School of Medicine, Columbia, MO (ASL, SHM); General Pediatrics and Weight Management, Children's Mercy Hospital Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, University of MO-Kansas City School of Medicine (SH); Cahaba Family Medicine, Pelham, AL (NM); Internal Medicine-Pediatrics, University of Texas Southwestern, Dallas, Texas (CBT)
| | - Megan Clary
- From University of Missouri, Columbia, MO (AB, RJK, JS, NW, MC); University of Missouri School of Medicine, Columbia, MO (ASL, SHM); General Pediatrics and Weight Management, Children's Mercy Hospital Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, University of MO-Kansas City School of Medicine (SH); Cahaba Family Medicine, Pelham, AL (NM); Internal Medicine-Pediatrics, University of Texas Southwestern, Dallas, Texas (CBT)
| | - Natalie Miller
- From University of Missouri, Columbia, MO (AB, RJK, JS, NW, MC); University of Missouri School of Medicine, Columbia, MO (ASL, SHM); General Pediatrics and Weight Management, Children's Mercy Hospital Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, University of MO-Kansas City School of Medicine (SH); Cahaba Family Medicine, Pelham, AL (NM); Internal Medicine-Pediatrics, University of Texas Southwestern, Dallas, Texas (CBT)
| | - Christy B Turer
- From University of Missouri, Columbia, MO (AB, RJK, JS, NW, MC); University of Missouri School of Medicine, Columbia, MO (ASL, SHM); General Pediatrics and Weight Management, Children's Mercy Hospital Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, University of MO-Kansas City School of Medicine (SH); Cahaba Family Medicine, Pelham, AL (NM); Internal Medicine-Pediatrics, University of Texas Southwestern, Dallas, Texas (CBT)
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Abstract
OBJECTIVE Human factors and ergonomics (HF/E) frameworks and methods are becoming embedded in the health informatics community. There is now broad recognition that health informatics tools must account for the diverse needs, characteristics, and abilities of end users, as well as their context of use. The objective of this review is to synthesize the current nature and scope of HF/E integration into the health informatics community. METHODS Because the focus of this synthesis is on understanding the current integration of the HF/E and health informatics research communities, we manually reviewed all manuscripts published in primary HF/E and health informatics journals during 2020. RESULTS HF/E-focused health informatics studies included in this synthesis focused heavily on EHR customizations, specifically clinical decision support customizations and customized data displays, and on mobile health innovations. While HF/E methods aimed to jointly improve end user safety, performance, and satisfaction, most HF/E-focused health informatics studies measured only end user satisfaction. CONCLUSION HF/E-focused health informatics researchers need to identify and communicate methodological standards specific to health informatics, to better synthesize findings across resource intensive HF/E-focused health informatics studies. Important gaps in the HF/E design and evaluation process should be addressed in future work, including support for technology development platforms and training programs so that health informatics designers are as diverse as end users.
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Deng Q, Zheng Y, Lu J, Zeng Z, Liu W. What factors predict physicians' utilization behavior of contrast-enhanced ultrasound? Evidence from the integration of the Theory of Planned Behavior and Technology Acceptance Model using a structural equation modeling approach. BMC Med Inform Decis Mak 2021; 21:173. [PMID: 34059025 PMCID: PMC8165765 DOI: 10.1186/s12911-021-01540-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/25/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The promotion of early diagnosis is undoubtedly effective in reducing the burden of disease. Contrast-enhanced ultrasound (CEUS) is a diagnostic technology for liver cancer, but its implementation faces some challenges. Understanding the influencing factors of CEUS utilization is crucial for its successful implementation. However, such research is rare. The aims of this study were to investigate the status of CEUS utilization and its predictors in China. METHODS Through multistage random sampling, a cross-sectional study design was conducted among physicians in charge of direct use of CEUS working at liver disease-related departments of sampled health institutions. To access the potential influencing factors of physicians' CEUS utilization, a structured questionnaire was developed based on the theoretical model, which was developed by integration of the Theory of Planned Behavior (TPB) and Technology Acceptance Model (TAM). Structural equation modeling was used to verify the proposed hypotheses, and analyze the relationship and mechanism between the factors. RESULTS A total of 309 physicians were enrolled. The mean score of utilization behavior was 2.04 (SD = 1.07), and 37.22% above the mean. The favorable fitting results demonstrated that the integration of TAM and TPB was an acceptable model. SEM results also identified physicians' intentions to use CEUS was directly associated with utilization behavior (β = 0.287, P < 0.001). Attitude (β = 0.272, P < 0.001), subjective norm (β = 0.172, P = 0.013), perceived behavioral control (β = 0.491, P < 0.001) and perceived usefulness (β = 0.108, P = 0.027) significantly influenced physicians' intentions. Besides, subjective norm (β = 0.065, P = 0.021), perceived behavioral control (β = 0.141, P = 0.003), and perceived ease of use (β = 0.022, P = 0.033) indirectly affected physicians' CEUS utilization. CONCLUSIONS The findings provide a reference for understanding the factors associated with physicians' utilization of CEUS. Additionally, the proposed measures such as building innovative and incentive environment, providing high quality and adequate training, etc., will help promote the utilization of CEUS, thereby increasing the detection rate of liver cancer, and improving the survival rate and the quality of life for liver cancer patients.
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Affiliation(s)
- Qingwen Deng
- Department of Health Management, Room 108 in the Building for School of Public Health, Fujian Medical University, No. 1 Xuefubei Road, Minhou District, Fuzhou, 350122, China
| | - Yuhang Zheng
- Department of Health Management, Room 108 in the Building for School of Public Health, Fujian Medical University, No. 1 Xuefubei Road, Minhou District, Fuzhou, 350122, China
| | - Junhong Lu
- Department of Health Management, Room 108 in the Building for School of Public Health, Fujian Medical University, No. 1 Xuefubei Road, Minhou District, Fuzhou, 350122, China
| | - Zhichao Zeng
- Department of Health Management, Room 108 in the Building for School of Public Health, Fujian Medical University, No. 1 Xuefubei Road, Minhou District, Fuzhou, 350122, China
| | - Wenbin Liu
- Department of Health Management, Room 108 in the Building for School of Public Health, Fujian Medical University, No. 1 Xuefubei Road, Minhou District, Fuzhou, 350122, China.
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Baik SY, Ryu GW, Lee H, Lee S, Choi M. Association Between Symptoms of Patients With Heart Failure and Patient Outcomes Based on Electronic Nursing Records. Comput Inform Nurs 2021; 39:1027-1034. [PMID: 34029266 PMCID: PMC8663513 DOI: 10.1097/cin.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We examined the association between symptoms (ie, dyspnea and pain) and patient outcomes (ie, length of stay, 30-day readmission, and death in hospital) among patients with heart failure using EMRs. This was a descriptive study that was conducted from July 1, 2014, to November 30, 2017. Participants were 754 hospitalized patients with heart failure (mean age, 70.62 ± 14.78 years; male-to-female ratio, 1:1.1). Data were analyzed using descriptive statistics, χ2 tests, and logistic regression analyses. Patients' average length of stay was 8.92 ± 13.12 days. Thirty-two patients (4.2%) were readmitted, and 100 patients (13.3%) died during hospitalization. Two-thirds (67.7%) experienced dyspnea, and 367 (48.7%) experienced pain. Symptoms and ICU admission were significantly related to patient outcomes. In the regression analyses, dyspnea, pain, and ICU admission were significantly related to higher-than-average lengths of stay. Dyspnea and ICU admission were related to death in hospital. Information regarding patients' symptoms, which was extracted from records, was a valuable resource in examining the relationship between symptoms and patient outcomes. The use of EMRs may be more advantageous than self-reported surveys when examining patients' symptom and utilizing big data.
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