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Loitz CC, Johnston JC, Johansen S, Spackman E, Devolin M. Cost analysis of COVID-19 test result notification using an automated messaging system compared to a staff caller practice in Alberta. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:207-217. [PMID: 36795278 PMCID: PMC9933816 DOI: 10.17269/s41997-023-00748-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023]
Abstract
SETTING In Alberta, polymerase chain reaction (PCR) COVID-19 tests were an important step in detecting and isolating contagious individuals throughout the pandemic. Initially, a staff member provided results to all PCR COVID-19 test clients by phone. As the number of tests increased, new approaches were essential for timely result notification. INTERVENTION An innovative automated IT system was introduced during the pandemic to reduce workloads and support timely result notification. At the time of the COVID-19 test booking and again following swabbing, clients had an option to consent to receive their test results via an automated text or voice message. Prior to implementation, a privacy impact assessment was approved, a pilot was undertaken, and changes to lab information systems were made. OUTCOMES Health administration data were used in a cost analysis to compare the unique costs associated with the novel automated IT practice (e.g., administration, integration, messages, staffing costs) and a hypothetical staff caller practice (e.g., administration, staffing costs) for negative test results. The costs of sharing 2,161,605 negative test results in 2021 were assessed. The automated IT practice demonstrated a cost savings of $6,272,495 over the staff caller practice. A follow-up analysis determined the cost savings threshold of 46,463 negative tests to break even. IMPLICATIONS Using an automated IT practice for consenting clients can be a cost-effective approach to reach clients in a timely manner during a pandemic or other instances warranting direct notification. This approach is being explored for test result notification of other communicable diseases in other contexts.
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Affiliation(s)
- Christina C Loitz
- Provincial Population and Public Health, Alberta Health Services, Edmonton, AB, Canada.
| | - J Cyne Johnston
- Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sandra Johansen
- Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maureen Devolin
- Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
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Rahman MM, Johnson C, Whyte M, Ewell J, Cope AB, Chandler Y, Bennett TS, Gray T, Gruber D, Peterman TA. Electronic Messaging for Gonorrhea and Chlamydia Test Result Notification, Improving Treatment and Patient Satisfaction. Sex Transm Dis 2022; 49:257-261. [PMID: 34813578 PMCID: PMC10214497 DOI: 10.1097/olq.0000000000001584] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 20% of chlamydia (CT) and gonorrhea (GC) cases in Louisiana are diagnosed at Parish Health Units. Patient notification of CT and GC test results involves nurses' phone calls and letters to positive patients, which is time-consuming and inefficient. METHODS In December 2018, electronic results notification was implemented in Caddo Parish Health Unit using Chexout software to notify enrolled patients via text or email when test results are ready to view in a patient portal. We compared the timeliness of GC/CT results notification and treatment pre-Chexout (December 2017 to November 2018) and post-Chexout (December 2018 to November 2019) implementation. A random sample of patients was interviewed to assess acceptability. RESULTS During December 2018 to November 2019, 5432 patients were tested for CT/GC, 3924 (72%) enrolled in Chexout, and notifications were sent to 3884 (99%). Among CT-positives, 472 of 568 (83%) viewed results in the portal compared with 2451 of 3356 (73%) CT-negatives. Among GC-positives, 300 of 353 (85%) viewed results compared with 2657 of 3571 (74%) GC-negatives. Treatment success for CT improved from 493 of 670 (74%) to 506 of 568 (89%), and for GC, from 332 of 409 (81%) to 325 of 353 (92%). Mean time to treatment decreased for CT (13.4-10.7 days) and GC (11.3-9.2 days). Enrolled patients found Chexout notification satisfactory in 168 of 169 (99%) and easy to use in 130 of 141 (92%). Reasons for declining electronic notification included lack of personal cell phone for 55 of 86 (64%) and confidentiality concerns for 42 of 86 (49%). CONCLUSIONS Electronic messaging decreased time to notification and increased treatment success. Nurses spent less time notifying patients leaving more time for patient care.
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Affiliation(s)
- Mohammad M. Rahman
- Louisiana Department of Health- STD/HIV/Hepatitis Program, New Orleans, LA
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Chaquetta Johnson
- Louisiana Department of Health- STD/HIV/Hepatitis Program, New Orleans, LA
| | - Martha Whyte
- Louisiana Department of Health – Office of Public Health, Caddo Parish, LA
| | - Joy Ewell
- Louisiana Department of Health- STD/HIV/Hepatitis Program, New Orleans, LA
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Anna B. Cope
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
- North Carolina Department of Health and Human Services, Raleigh, NC
| | - Yolanda Chandler
- Louisiana Department of Health – Office of Public Health, Caddo Parish, LA
| | - Tammy S. Bennett
- Louisiana Department of Health – Bureau of Family Health, New Orleans, LA
| | - Terri Gray
- Louisiana Department of Health- STD/HIV/Hepatitis Program, New Orleans, LA
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - DeAnn Gruber
- Louisiana Department of Health – Bureau of Infectious Diseases, New Orleans, LA
| | - Thomas A. Peterman
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Godongwana M, Chewparsad J, Lebina L, Golub J, Martinson N, Jarrett BA. Ethical Implications of eHealth Tools for Delivering STI/HIV Laboratory Results and Partner Notifications. Curr HIV/AIDS Rep 2021; 18:237-246. [PMID: 33772406 PMCID: PMC8057984 DOI: 10.1007/s11904-021-00549-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
Purpose of Review eHealth tools are increasingly utilized for communication with patients. Although efficacious and cost-effective, these tools face several barriers that challenge their ethical use in sexual health. We reviewed literature from the past decade to pick illustrative studies of eHealth tools that deliver results of laboratory tests for sexually transmitted infections, including the human immunodeficiency virus, as well as partner notifications. We describe ethical implications for such technologies. Recent Findings Our review found that despite widespread research on the use of eHealth tools in delivering laboratory results and partner notifications, these studies rarely measured or reported on the ethical implications. Such implications can be organized according to the four major principles in bioethics: beneficence, patient autonomy, non-maleficence, and justice. The beneficence of eHealth typically measures efficacy in comparison to existing standards of care. Patient autonomy includes the ability to opt in or out of eHealth tools, right-based principles of consent, and sovereignty over healthcare data. To adhere to the principle of non-maleficence, relevant harms must be identified and measured—such as unintentional disclosure of illness, sexual orientation, or sexual activity. Justice must also be considered to accommodate all users equally, irrespective of their literacy level, with easy-to-use platforms that provide clear messages. Summary Based on case studies from this review, we developed a list of recommendations for the ethical development and evaluation of eHealth platforms to deliver STI/HIV results to patients and notifications to partners.
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Affiliation(s)
- Motlatso Godongwana
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,Programme in Demography and Population Studies, University of the Witwatersrand, Schools of Public Health and Social Sciences, Johannesburg, South Africa.
| | - Juanita Chewparsad
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Golub
- Center for TB Research, Johns Hopkins University, Baltimore, MD, USA
| | - Neil Martinson
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brooke A Jarrett
- Programme in Demography and Population Studies, University of the Witwatersrand, Schools of Public Health and Social Sciences, Johannesburg, South Africa.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Assessing Patient Opinions About Electronic Messaging for Gonorrhea and Chlamydia Result Notification and Partner Services, Durham, North Carolina. Sex Transm Dis 2020; 46:625-628. [PMID: 31181032 DOI: 10.1097/olq.0000000000001021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Text or e-mail messages can provide timely notification of sexually transmitted disease results to patients. We assessed sexually transmitted disease clinic patient opinions about text/e-mail notification via a service called Chexout. Among 113 patients who opted in, the majority found results notification via texts/e-mails to be satisfactory (99.0%) and easy (92.9%).
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Livingood WC, Bilello L, Lukens-Bull K, Smotherman C, Choe U. Implementation Research as Applied Science: Bridging the Research to Practice Gap. Health Promot Pract 2019; 21:49-57. [PMID: 31253063 DOI: 10.1177/1524839919858082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Implementation research is intended to address challenges posed by the slow adoption of evidence-based science by the medical and health promotion practice community. A case study approach is used to illustrate and discuss the use of Quality improvement and Evaluation as an applied approach to implementation science in contrast of more classic purposes of research. Quality improvement was the implementation model used to facilitate organizational change needed to adopt the use of texting to report sexually transmitted infection test results in over a fifth of Florida's larger county health departments. Both quantitative and qualitative methods were used to evaluate implementation. All seven participating county health departments were successful in enrolling clients in texting with extensive variation (24% to 72%) in texting enrollment at the end of the 10-month study. Statistically significant outcomes for those enrolled in texting were recorded through Florida's online sexually transmitted infection reporting system in the form of increased number of people receiving early (1-4 days) treatment and reductions in delayed (≥8 days) or no treatment. This study illustrates an applied approach to implementation research which may be critical to adapt emerging evidence and technologies to the multiple and complex characteristics of the diverse populations served by health promotion institutions.
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Affiliation(s)
| | | | | | | | - Ulyee Choe
- Florida Department of Health in Pinellas County, St. Petersburg, FL, USA
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Livingood WC, Bilello L, Lukens-Bull K. Seeing the quality improvement forest through the quality improvement trees: A meta-synthesis of case studies in Florida and Georgia. SAGE Open Med 2019; 7:2050312119845703. [PMID: 31041099 PMCID: PMC6477764 DOI: 10.1177/2050312119845703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/02/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To identify important characteristics of quality improvement applications for population health and healthcare settings and to explore the use of quality improvement as a model for implementing and disseminating evidence-based or best practices. METHODS A meta-synthesis was used to examine published quality improvement case studies. A total of 10 published studies that were conducted in Florida and Georgia were examined and synthesized using meta-synthesis (a qualitative research methodology) for meaningful insights and lessons learned using defined meta-synthesis inclusion criteria. The primary focus of the analysis and synthesis were the reported processes and findings that included responses to structured questioning in addition to emergent results from direct observation and semi-structured open-ended interviewing. RESULTS The key insights for the use of quality improvement in public health and healthcare settings included (1) the essential importance of data monitoring, analysis, and data-based decision making; (2) the need to focus on internal mutable factors within organizations; (3) the critical role of quality improvement team group dynamics; (4) the value of using a quality improvement collaborative or multi-clinic quality council/committee for sharing and comparing performance on key metrics; and (5) the need to identify a quality improvement approach and methods for clarification as a structured quality improvement intervention. CONCLUSION In addition to the advantages of using quality improvement to enhance or improve healthcare and public health services, there is also potential for quality improvement to serve as a model for enhancing the adoption of evidence-based practices within the context of dissemination and implementation research.
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Affiliation(s)
- William C Livingood
- Center for Health Equity and Quality Research,
University of Florida College of Medicine – Jacksonville, Jacksonville, FL,
USA
| | - Lori Bilello
- Center for Health Equity and Quality Research,
University of Florida College of Medicine – Jacksonville, Jacksonville, FL,
USA
| | - Katryne Lukens-Bull
- Center for Health Equity and Quality Research,
University of Florida College of Medicine – Jacksonville, Jacksonville, FL,
USA
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