The role of informatics in promoting patient-centered care

Examining the Intervening Roles of Patient-Centered Care and Patient Activation in the Health Impacts of Offline Healthcare Obstacles and Online Health Consultations Among Deaf and Hard-of-Hearing Patients

Deaf and hard-of-hearing (DHH) patients often encounter difficulties in effective communication with healthcare professionals and are less likely to receive quality medical care. However, DHH populations are understudied in health communication research. This study examined how offline healthcare obstacles and online health consultation impact DHH patients' health, and the mediating roles of patient-centered care (PCC) and patient activation. Data from 323 DHH patients were analyzed using structural equation modeling to test the hypothesized mediation pathway model. Results indicate that offline healthcare obstacles negatively affect DHH patients' perception of patient-centeredness, which reduces their ability and confidence in self-care (conceptualized as patient activation in this study). This reduced patient activation may jeopardize DHH patients' physical and psychological health. Meanwhile, online health consultation is positively associated with PCC, and higher levels of PCC can increase patient activation, contributing to better physical and psychological health. Testing the same model with hearing-abled participants (n = 3542) revealed significant differences in these intervening relationships. Overall, this study provides valuable insights into the relationship between DHH patients' healthcare experience and their health outcomes. The findings support interventions that focus on enhancing PCC and patient activation to improve the physical and psychological health outcomes of DHH patients.

High social capital facilitates the alleviation of psychological distress in breast cancer patients: Insights from a cross-sectional study in Anhui Province, China

Differences in social capital have been shown to impact psychological distress in cancer patients, but few studies have examined the relationship between social capital and the distress thermometer (DT) in breast cancer patients who have undergone modified radical surgery. To fill this research gap, our study aimed to investigate the association between social capital and the DT among breast cancer patients who underwent modified radical surgery in Anhui Province, China. This cross-sectional study used multi-stage stratified random sampling. Data on demographic characteristics, eight dimensions of social capital, and the DT were collected using a questionnaire. Logistic regression models were subsequently utilized to assess the relationship between social capital and DT, adjusting for confounding factors. A total of 253 participants were included in the final analysis. Results indicated that individuals with higher levels of social capital, including participation in the local community (OR = 3.437; 95% CI: 1.734-6.814), social agency or proactivity in a social context (OR = 69.700; 95% CI: 20.142-241.195), feelings of trust and safety (OR = 26.287; 95% CI: 7.646-90.374), neighborhood connections (OR = 7.022; 95% CI: 3.020-16.236), family and friend connections (OR = 59.315; 95% CI: 17.182-204.760), tolerance of diversity (OR = 9.785; 95% CI: 4.736-20.216), value of life (OR = 65.142; 95% CI: 19.994-212.242), and work connections (OR = 31.842; 95% CI: 12.612-80.397), had higher odds of reporting poor DT scores compared to those with lower levels of social capital. These findings indicate an association between social capital and DT scores in breast cancer patients who have undergone modified radical surgery, suggesting that social capital may play a crucial role in alleviating psychological distress within this community.

Quality of interaction between clinicians and artificial intelligence systems. A systematic review

Introduction

Artificial intelligence (AI) has the potential to improve healthcare quality when thoughtfully integrated into clinical practice. Current evaluations of AI solutions tend to focus solely on model performance. There is a critical knowledge gap in the assessment of AI-clinician interactions. We systematically reviewed existing literature to identify interaction traits that can be used to assess the quality of AI-clinician interactions.

Methods

We performed a systematic review of published studies to June 2022 that reported elements of interactions that impacted the relationship between clinicians and AI-enabled clinical decision support systems. Due to study heterogeneity, we conducted a narrative synthesis of the different interaction traits identified from this review. Two study authors categorised the AI-clinician interaction traits based on their shared constructs independently. After the independent categorisation, both authors engaged in a discussion to finalise the categories.

Results

From 34 included studies, we identified 210 interaction traits. The most common interaction traits included usefulness, ease of use, trust, satisfaction, willingness to use and usability. After removing duplicate or redundant traits, 90 unique interaction traits were identified. Unique interaction traits were then classified into seven categories: usability and user experience, system performance, clinician trust and acceptance, impact on patient care, communication, ethical and professional concerns, and clinician engagement and workflow.

Discussion

We identified seven categories of interaction traits between clinicians and AI systems. The proposed categories may serve as a foundation for a framework assessing the quality of AI-clinician interactions.

Electronic Decision-Making Tool for Smoking Cessation (Pare de Fumar Conosco) Versus Standard of Care: A Cost-Effectiveness Analysis

OBJECTIVES

The study aimed to evaluate the cost-effectiveness of the Pare de Fumar Conosco software compared with the standard of care adopted in Brazil for the treatment of smoking cessation.

METHODS

In the cohort of smokers with multiple chronic conditions, we developed an decision tree model for the benefit measures of smoking cessation. We adopted the perspectives of the Brazilian Unified Health System and the service provider. Resources and costs were measured by primary and secondary sources and effectiveness by a randomized clinical trial. The incremental cost-effectiveness ratio (ICER) was calculated, followed by deterministic and probabilistic sensitivity analyses and deterministic and probabilistic sensitivity analyses. No willingness to pay threshold was adopted.

RESULTS

The software had a lower cost and greater effectiveness than its comparator. The ICER was dominant in all of the benefits examined (-R$2 585 178.29 to -R$325 001.20). The cost of the standard of care followed by that of the electronic tool affected the ICER of the benefit measures. In all probabilistic analyses, the software was superior to the standard of care (53.6%-82.5%).

CONCLUSION

The Pare de Fumar Conosco software is a technology that results in cost savings in treating smoking cessation.

Integrating sexual and reproductive health into pre-travel consultations

BACKGROUND

Casual sex during travel is a major preventable factor in the global transmission of sexually transmissible infections (STI). Pre-travel consults present an excellent opportunity for practitioners to educate travellers about sexual and reproductive health (SRH) and safety. This scoping review aims to explore and understand the extent to which SRH is included in pre-travel consultations.

METHODS

PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, Medline and Web of Science were systematically searched for primary research articles exploring whether health care practitioners (HCP) included SRH in pre-travel consultations. Extracted findings were synthesized and presented in narrative form.

RESULTS

Findings across 13 articles suggest HCPs infrequently broached SRH in pre-travel consultations with HCP discomfort, and lack of time and resources presented as key barriers. Urban practice settings, HCP experience, training in travel medicine and traveller characteristics such as sexual orientation were positively associated with discussions about SRH. SRH advice reported was general in nature, primarily focusing on safer sex, condoms or unspecified STI advice. Risk assessments based solely on age or stereotypes around sexual preferences led to key aspects of SRH care being missed for some (e.g. SRH was less likely to be discussed with older travellers).

CONCLUSIONS

HCPs frequently miss opportunities to integrate SRH into pre-travel consultations. Strategies to promote HCP confidence and awareness present a promising means to boost the frequency and quality of SRH advice disseminated. Integrating culturally safe and responsive SRH history-taking and advice into pre-travel consultations may contribute to global reductions in STI transmission and promote traveller SRH well-being.

Cancer-related fatigue: Quality, credibility, usability, and readability of information on websites of health care institutions in Germany

OBJECTIVES

This study aimed to portray available information on cancer-related fatigue on German health care institution websites considering the idea of patient empowerment.

METHODS

Based on website quality criteria, we developed a website-rating tool comprising 18 items. Descriptive analyses, a KruskalWallis test, and corresponding post hoc tests comparing rating sum scores between institution groups were performed.

RESULTS

Websites of 283 systematically compiled health care institutions were included in the rating. Cancer-related fatigue was introduced on 21.9% and detailed information was provided on 27.9% of the websites. Information material was offered on 9.2% of the websites, while fatigue treatment offers were presented on 21.6% of the websites. The rating sum scores differed between institution groups (p < 0.001), with Comprehensive Cancer Centers scoring significantly higher than the others.

CONCLUSION

The rating revealed an overall sparse provision of information, with fatigue being addressed on less than half of the websites.

PRACTICE IMPLICATIONS

For patients who have access to at least one introduction about fatigue, institutions need to extend their websites. Patients could further be referred to external institutions or information booklets. The naming of contact persons may help linking patients to providers.

Can ChatGPT be used in oral and maxillofacial surgery?

OBJECTIVE

The aim of this study is to assess the usability of the information generated by ChatGPT in oral and maxillofacial surgery. This assessment will have two components: Firstly, to measure the quality of patient information provided, and secondly, to measure the quality of educational information in this field.

MATERIALS AND METHODS

Commonly asked questions by patients about oral and maxillofacial surgical procedures and technical questions for training purposes were selected to be posed to ChatGPT. The questions were divided into two categories, consisting of 60 Patient Questions and 60 Technical Questions. The specific topics covered were Impacted Teeth, Dental Implants, Temporomandibular Joint Diseases, and Orthognathic Surgery. ChatGPT provided responses to these questions on February 23, 2023. The answers were evaluated by oral and maxillofacial surgeons using a modified global quality scale.

RESULTS

The study involved 33 participating surgeons. The mean score for the answers to the Patient Questions was 4.62±0.78, while the mean score for answers to the Technical Questions was 3.1 ± 1.49. The difference in scores between the two question categories was found to be statistically significant (P<0.001). There was no significant difference between the quality of the answers given to the questions across the different topics (P>0.05).

CONCLUSIONS

ChatGPT has significant potential as a tool for patient information in oral and maxillofacial surgery. However, its use in training may not be completely safe at present. Surgeons should exercise caution when using ChatGPT and consider it as a supplement to their clinical knowledge and experience.

Implementation of Patient-Centered Care by Athletic Training Students during Clinical Experiences: A Report from the Association of Athletic Training Education Research Network

Patient-centered care (PCC) is a core competency that should be required by all healthcare education programs, but little is known about its implementation in athletic training clinical experiences. Therefore, we examined characteristics of patient encounters documented by athletic training students implementing PCC behaviors. A multisite panel design was used to recruit 363 students from twelve professional athletic training programs (five undergraduate, seven graduate). Over 1.5 years, clinical experience patient encounter data were logged in E*Value Case Logs, including student role during the encounter, length of encounter, and clinical site. Generalized estimating equations models characterized the likelihood students included PCC behaviors in 30,522 encounters. Discussing patient goals was associated with student role (χ²(2) = 40.6, p < 0.001) and length of encounter (χ²(4) = 67.6, p < 0.001). Using patient-reported outcome measures was associated with student role (χ²(2) = 21.6, p < 0.001), length of encounter (χ²(4) = 34.5, p < 0.001), and clinical site (χ²(3) = 17.3, p = 0.001). Implementing clinician-rated outcome measures was affected by length of encounter (χ²(4) = 27.9, p < 0.001) and clinical site (χ²(3) = 8.6, p = 0.04). PCC behaviors were largely associated with student role and length of encounters; clinical site had less impact. Athletic training educators should emphasize progressive autonomous supervision with preceptors and encourage students to facilitate slightly longer patient visits, when possible, to incorporate more PCC behaviors.

The Integration of Patient-Centered Care and the Biopsychosocial Model by Athletic Trainers in the Secondary School Setting

Our purpose was to explore the degree to which secondary school athletic trainers (SSATs) perceive they are integrating the principles of patient-centered care (PCC) and the biopsychosocial (BPS) model in their practice. We used a cross-sectional design to explore the primary research question. We used the Global Perceptions of Athletic Trainer Patient-Centered Care (GPATPCC) tool and the Biopsychosocial Model of Health (BPSMH) tool, both measured on a 4-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree, with an unscored "unsure" option). We sent the survey to 5665 SSATs through the National Athletic Trainers' Association. Results indicate participants expressed strong agreement (mode = 4) with 7 of the 14 statements and agreement (mode = 3) with the remaining 7 statements of the GPATPCC tool (grand mean = 3.4 ± 0.8). Overall, participants rated their level of agreement on the BPSMH as agreeing (mode = 3) for each item (grand mean = 3.0 ± 1.0). SSATs perceive they are integrating the principles of PCC and the BPS model in clinical practice. These findings align with two previous studies concluding that patients, parents, and providers believe athletic trainers provide care that is focused on whole-person healthcare.

Athletic Trainer's Varying Levels of Awareness and Use of Disablement Model Frameworks: A Qualitative Study

In healthcare, disablement model frameworks aim to improve the delivery of patient-centered care through the recognition of patient factors beyond impairments, restrictions, and limitations, which include personal, environmental, and societal factors. Such benefits translate directly to athletic healthcare providing a mechanism for athletic trainers (ATs), as well as other healthcare professionals, to ensure that all aspects of the patient are managed prior to returning to work or sport. The purpose of this study was to investigate ATs recognition and use of disablement frameworks in current clinical practice. We used criterion sampling to identify ATs who were currently practicing from a random sample of ATs that participated in a related cross-sectional survey. A total of 13 participants engaged in an online, audio-only, semi-structured interview that was audio-recorded and transcribed verbatim. A consensual qualitative research (CQR) approach was used to analyze the data. A coding team of three individuals used a multi-phase process to construct a consensus codebook that identified common domains and categories among the participants' responses. Four domains emerged regarding ATs' experiences and recognition of disablement model frameworks. The first three domains were related to the application of disablement model frameworks: (1) patient-centered care, (2) limitations and impairments, and (3) environment and support. Participants described varying degrees of competence and consciousness regarding these domains. The fourth domain related to participants' exposure to disablement model frameworks through formal or informal experiences. Findings suggest that ATs largely demonstrate unconscious incompetence regarding the use of disablement frameworks in clinical practice.

Personalized Telehealth: Redesigning Complex Care Delivery for the 65+ During the COVID Pandemic: a Survey of Patients, Caregivers, and Health-care Providers

Background

In the context of the ongoing COVID-19 pandemic, rapid transitions have been made towards telehealth. Optimal use of telehealth in elderly patients remains poorly understood and adaptation challenges persist. Our study aimed at identifying perceptions, barriers, and possible facilitators to telehealth use amongst elderly patients with comorbidities, their caregivers, and health-care providers (HCPs).

Methods

Health-care providers, patients 65 years and older with multiple comorbidities, and caregivers were recruited from outpatient clinics and invited to complete an electronic self-administered or telephone-administered survey on their perceptions of telehealth and of barriers to its implementation.

Results

A total of 39 health-care providers, 40 patients, and 22 caregivers responded to the survey. Most patients (90%), caregivers (82%), and HCPs (97%) had experienced telephone visits, but few were conducted via videoconference platforms. Patients and caregivers showed interest in pursuing some future telehealth visits (68%, 86%, respectively), but felt they lacked access to technology and skills (n=8, 20%), and some felt that telehealth visits may be inferior to in-person visits (n=9, 23%). HCPs showed interest in incorporating telehealth visits into practice (n=32, 82%), but identified challenges in lack of administrative support (n=37), lack of HCP (n=28) and patient (n=37) technological skills, and limited infrastructure (n=37)/internet access (n=33).

Conclusions

Older patients, caregivers, and HCPs show interest in pursuing future telehealth visits but elucidate similar barriers. Facilitating access to technology, as well as to administrative and technology support guides, could promote high quality and equal access to virtual care for the older adult.

Effect of social media interventions on the education and communication among patients with cancer: a systematic review protocol

INTRODUCTION

Cancer is a leading cause of death worldwide. In addition, it accounted for approximately 10 million deaths in 2020 alone. Information and communication technologies have great potential for improving health education and communication. Social media is one of the technologies that can help patients with cancer and healthcare providers communicate and provide educational information. Social media are increasingly being used for health promotion and behaviour change. This is a protocol of systematic review to identify the effect of social media interventions on the education and communication among patients affected by cancer. This study aims to reveal the steps of conducting research that systematically reviews all studies for the specific objective. This study aims to examine the social media interventions to improve awareness and knowledge about the disease for patients with cancer and improve communication among them.

METHODS AND ANALYSIS

This protocol is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist. We will include experimental design studies that report the effect of social media interventions on education and communication among patients with cancer or malignancy and any stage of the disease. Interventions will be inclusive, using all social network platforms for patients' communication and education. We will search PubMed, Web of Science, Scopus and the Cochrane Library from inception until 23 May 2022. Two independent reviewers will screen titles, abstracts and full-text articles with conflicts resolved through discussion or by a third reviewer, as needed. All titles, abstracts and full-text papers will be reviewed independently by two reviewers according to the inclusion and exclusion criteria. Discrepancies will resolve by discussion or SRNK if needed. The two reviewers will also independently complete risk of bias assessments for each included study. The descriptive analysis, including frequency and percentage parameters, will be calculated based on the study's variables. Furthermore, we will report the results of the quality assessment of studies in table format. In the result section, a narrative synthesis will be applied to describe and compare the paper's results.

ETHICS AND DISSEMINATION

Ethics approval will not be needed because the data to be used in this systematic review and meta-analysis will be extracted from published studies. It will be disseminated by publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42022334691.

Patient satisfaction with e-oral health care in rural and remote settings: a systematic review

BACKGROUND

During the past decade e-oral health technology has been used to address the oral health care challenges in rural and remote settings. This review systematically evaluated the literature on patient satisfaction with e-oral health care in rural and remote communities.

METHODS

The systematic review included interventional and observational studies published between 1946 and 2021, in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Global Health. Patient satisfaction with received oral health care using self-reported measures, at any time after the intervention, was the main outcome of the review. The other primary outcomes were undesirable consequences of the health care (e-health or conventional) such as diagnostic error. The secondary outcomes considered were waiting time, number of visits, travel, and the cost of oral health care. Two independent researchers assessed the risk of bias using the ROBINS-I risk of bias assessment tool for non-randomized studies.

RESULTS

Among 898 studies, 16 studies were included in the review. In most studies reporting patient satisfaction, all patients had shown willingness for teleconsultation for a dental problem and they were mostly satisfied due to saved travel time, saved working days, and prompt treatment onset. Most of the studies acknowledged teledentistry as a cost-effective and cost-saving method. Moreover, the teledentistry consultations showed diagnostic reliability and validity values comparable to conventional dental consultations. The majority of studies were considered level 4 and 3b, due to limited sample populations, analysis based on limited alternatives or costs, non-consistent sensitivity analysis, failure to appropriately control known confounders, and/or failure to carry out an appropriate follow-up of patients.

CONCLUSION

Available evidence indicates that e-oral health is associated with higher patient satisfaction and has been found to be an effective and reliable method for patients in rural and remote areas. Therefore, in these areas, the use of e-oral health should be encouraged. However, methodological inconsistencies in the current evidence suggest the need for long-term cohort studies and clinical trials, as well as cost analysis on e-oral health in rural settings.

SYSTEMATIC REVIEW REGISTRATION

The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42016039942.

Virtuosic craft or clerical labour: the rise of the electronic health record and challenges to physicians' professional identity (1950-2022)

The electronic health record (EHR) is a focus of contentious debate, having become as essential to contemporary clinical practice as it is polarising. Debates about the EHR raise questions about physicians' professional identity, the nature of clinical work, evolution of the patient/practitioner relationship, and narratives of technological optimism and pessimism. The metaphors by which clinicians stake our identities-are we historians, detectives, educators, technicians, or something else?-animate the history of the early computer-based medical record in the mid-to-late twentieth-century USA. Proponents and detractors were equally interested in what the EHR revealed about clinician identity, and how it might fundamentally reshape it. This paper follows key moments in the history of the early computer-based patient record from the late 1950s to the EHR of the present day. In linking physician identity development, clinical epistemological structures, and the rise of the computer-based medical record in the USA in the mid-to-late twentieth century, we ask why the EHR is such a polarising entity in contemporary medicine, and situate clinician/EHR tensions in a longer history of aspirational physician identity and a kind of technological optimism that soon gave way to pessimism surrounding computer-based clinical work.

Patient-centered education in dyslipidemia management: a systematic review

Background

Dyslipidemia management is crucial to reduce mortality and morbidity from cardiovascular diseases (CVDs). Patients must be educated and empowered to enable them to manage their own diseases. Various methods of patient education, such as patient-centered education (PCE) or non-PCE (such as didactic education or any traditional form of education), have been implemented.

Objective

To review and determine the effectiveness of PCE for dyslipidemia management compared with usual care. The primary outcome chosen was cholesterol level. Other measures, such as psychosocial or cognitive, behavioral, and other relevant outcomes, were also extracted. Additionally, underlying theories and other contributing factors that may have led to the success of the intervention were also reviewed and discussed.

Methods

We conducted searches in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Google Scholar from inception until April 2021. All studies involving randomized controlled trials were included. Study quality was assessed using the Critical Appraisal Skills Program (CASP) checklist specifically for randomized controlled trials.

Results

The search identified 8,847 records. Of these, 20 studies were eligible for inclusion. Interventions using a PCE approach were largely successful. Contributing factors extracted from the included studies were underlying theories, instant reward system, dietary education, collaborative care, duration of intervention with systematic follow-ups, social support, adherence assessment method, and usage of e-health.

Conclusions

PCE is successful in achieving the desired outcomes in dyslipidemia management. Future studies may incorporate the elements of PCE to improve the management of dyslipidemia in hospital or community settings where appropriate.

Association Between Patient Portal Use and Perceived Patient-Centered Communication Among Adults With Cancer: Cross-sectional Survey Study

BACKGROUND

Patient-centered communication (PCC) plays a vital role in effective cancer management and care. Patient portals are increasingly available to patients and hold potential as a valuable tool to facilitate PCC. However, whether more frequent use of patient portals is associated with increased perceived PCC and which mechanisms might mediate this relationship have not been fully studied.

OBJECTIVE

The goal of this study was to investigate the association between the frequency of access of patient portals and perceived PCC in patients diagnosed with cancer. We further sought to examine whether this association was mediated by patients' self-efficacy in health information-seeking.

METHODS

We used data from the Health Information National Trend Survey 5 (HINTS 5) cycle 3 (2019) and cycle 4 (2020). This analysis includes 1222 individuals who self-reported having a current or past diagnosis of cancer. Perceived PCC was measured with a 7-item HINTS 5-derived scale and classified as low, medium, or high. Patient portal use was measured by a single item assessing the frequency of use. Self-efficacy about health information-seeking was assessed with a 1-item measure assessing confidence in obtaining health information. We used adjusted multinomial logistic regression models to estimate relative risk ratios (RRRs)/effect sizes of the association between patient portal use and perceived PCC. Mediation by health information self-efficacy was investigated using the Baron and Kenny and Karlson-Holm-Breen methods.

RESULTS

A total of 54.5% of the sample reported that they had not accessed their patient portals in the past 12 months, 12.6% accessed it 1 to 2 times, 24.8% accessed it 3 to 9 times, and 8.2% accessed it 10 or more times. Overall, the frequency of accessing the patient portal was marginally associated (P=.06) with perceived PCC in an adjusted multinominal logistic regression model. Patients who accessed their patient portal 10 or more times in the previous 12 months were almost 4 times more likely (RRR 3.8, 95% CI 1.6-9.0) to report high perceived PCC. In mediation analysis, the association between patient portal use and perceived PCC was attenuated adjusting for health information-seeking self-efficacy, but those with the most frequent patient portal use (10 or more times in the previous 12 months) were still almost 2.5 times more likely to report high perceived PCC (RRR 2.4, 95% CI 1.1-5.6) compared to those with no portal use.

CONCLUSIONS

Increased frequency of patient portal use was associated with higher PCC, and an individual's health information-seeking self-efficacy partially mediated this association. These findings emphasize the importance of encouraging patients and providers to use patient portals to assist in patient-centeredness of cancer care. Interventions to promote the adoption and use of patient portals could incorporate strategies to improve health information self-efficacy.

Impact of multidisciplinary chronic disease collaboration management on self-management of hypertension patients: A cohort study

To explore the effect of the interdisciplinary chronic disease management (CDM) model on patients with hypertension. In this intervention study, the subjects were divided into CDM and control groups. Blood pressure control was monitored in both groups. After 1 year of follow-up, the endpoint events of patients and their knowledge, confidence, and behavior in response to the disease were assessed. When compared with the control group, patients in the CDM group obtained higher scores for self-perception and management assessment, and their blood pressure control was also better after discharge. The quality of life and the satisfaction level of patients in the control group were lower than those in the CDM group, while the unplanned readmission rate, incidence of complications, and the average length of hospital stay in the control group were higher than those in the CDM group. CDM model was beneficial to blood pressure control in hypertensive patients. It had also improved the quality of life and the satisfaction level of the hypertensive patients. Our study highlights the importance of the CDM model in the prognosis of hypertensive patients.

Identifying the content, functionalities, and features of a mobile application for contact lens wearers

BACKGROUND

Lack of attention to end-users' requirements and preferences may lead to the failure of health information technology (IT) interventions. Identifying users' needs for designing a mobile application can lead to the development of an acceptable intervention. This study aimed to determine the requirements for designing a mobile application to educate and provide needed information to contact lens (CL) wearers.

METHODS

A qualitative study was conducted on 24 CL wearers and nine eye care practitioners from the three CL clinics in Iran. Data were collected through semi-structured interviews and analyzed using the conventional content analysis proposed by Lundman and Graneheim. Lincoln and Guba's criteria were used to ensure the trustworthiness of the data.

RESULTS

The three main categories that emerged from the interviews were mobile application content, mobile application functionalities, and mobile application features. Ten subcategories and 57 sub-subcategories were also identified. It was determined that mobile content should focus on advice and information for optimizing the CL wearing experience and training regarding the use of CLs. Entering information required for self-care, computational capability, interactivity, updates, and reminders were determined as needed functionalities. The participants recommended features for the structure and user interface of the mobile application and information presentation methods.

CONCLUSION

This study identified the information needed to develop a mobile application for CL wearers. This also provides insights regarding required functionalities when applying IT interventions. These findings can be used by CL clinics, developers of health information systems, policymakers, and health planners to design better CL-related care and compliance interventions.

Development and validation of a case-finding algorithm for the identification of non-small cell lung cancers in a region-wide Italian pathology registry

PURPOSE

To develop and validate a case-finding algorithm for the identification of Non-Small Cell Lung Cancer (NSCLC) cases in a region-wide Italian pathology registry (PR).

MATERIALS AND METHODS

Data collected between 2009 and 2017 in the PR and the Pharmacy Database of the University Hospital of Siena and the PR of Tuscany region were used. A NSCLC-identification algorithm based on free-text keywords and SNOMED morphology and topography codes was designed and tested on data from Siena: indication for drug use (i.e. NSCLC) was the reference standard for sensitivity (SE); positive predictive value (PPV) was estimated through manual review. Algorithm modifications were then tested to improve algorithm performance: PPV was calculated against validated dataset from PR of Siena; a range of SE [min-max] was estimated in PR of Tuscany using analytical formulae that assumed NSCLC incidence equal either to 80% or 90% of overall lung cancer incidence recorded in Tuscany. The algorithm modification with the best performance was chosen as the final version of the algorithm. A random sample of 200 cases was extracted from the PR of Tuscany for manual review.

RESULTS

The first version of the algorithm showed a PPV of 74.7% and SE of 79% in PR of Siena. The final version of the algorithm had a SE in PR of Tuscany that grew with calendar time (2009 = [24.7%-28%]; 2017 = [57.9%-65.1%]) and a PPV of 93%.

CONCLUSIONS

The final NSCLC-finding algorithm showed with very high PPV. SE was in line with the expected contribution of PR to overall cases captured in the regional Cancer Registry, with a trend of increase over calendar time. Given the promising algorithm validity and the wide use of SNOMED terminology in electronic pathology records, the proposed algorithm is expected to be easily adapted to other electronic databases for (pharmaco)epidemiology purposes.

Placing Users at the Center: Evaluating Exam Room Design for Improved User Experience

OBJECTIVE

This article proposes a method for evaluating the design affordances of primary care exam rooms from the perspectives of users using functional scenario (FS) analysis.

GOAL

This study aims to develop quantifiable criteria and spatial metrics for evaluating how exam room design supports the needs of different users. These criteria and metrics can be used in the early stages of the design process to choose between alternatives.

BACKGROUND

The primary care exam room is an essential space in healthcare, as it is the first point of contact between the healthcare provider and the patient. However, there is a lack of rigorous evaluation metrics for exam room design that supports improved user experiences and better health outcomes.

METHOD

A total of nine primary care exam rooms were analyzed using FS analysis. We identified three key user groups involved in the clinical examination process-providers, patients, and care partners-and translated their needs into FSs. We developed spatial metrics for each FS to quantify the extent to which the needs were spatially supported.

RESULTS

We developed 11 FSs in total: three from the providers', five from the patients', and three from the care partners' perspectives. The results revealed possible design strategies for improved user experiences.

CONCLUSIONS

We quantitatively measured the affordance of primary care exam room design for multiple stakeholders. We expect that the criteria and metrics presented in this article will improve the understanding of different users' perspectives and provide new design guidance for improved user experiences.

Designing a Patient-Friendly Website for Newly Diagnosed Cancer Patients with the Participatory Health Research Approach

High-quality and user-friendly patient information material (PIM) is essential for understanding and accepting a new care programme. When optimising the PIM of the integrated, cross-sectoral psycho-oncological (isPO) care programme, the design of the fifth element of the patient information strategy-the patient-friendly website-was still pending. In this paper, the iterative design process of the patient-friendly isPO website is described. We applied the participatory health research (PHR) approach to enable high levels of participation of its respective end-users (e.g., cancer survivors), service providers, and experts. The design included six steps: (1) initiation, (2) planning, (3) initial idea exploration, (4) creation of a first working version, (5) three optimisation loops, and (6) dissemination. An exploratory mixed-methods design has been used. Qualitative data collection included document analysis, interviews, and participatory action research (PAR) loops with focus groups. Finally, the quality of the newly designed website was quantitatively assessed with the UPIM-Check, a user-friendly instrument for assessing and optimising PIM. The PHR approach was indispensable for the design of our needs-oriented, patient-friendly website. Participants' high levels of participation strongly contributed to the products' quality. The final descriptive statistical evaluation shows that the final website was rated very good on average by its end-users.

Adaptation of an In-Person Internship to a Virtual Format for Public Health Undergraduates

The disruption of traditional, in-person learning due to the COVID-19 pandemic necessitated the rapid development and use of revised and novel learning opportunities using a variety of remote instructional methodologies. This viewpoint describes the process used by an undergraduate Public Health program to transition a traditional, in-person, semester-long, 480-hour internship to a virtual-only learning experience guided by the existing student learning outcomes. Working closely with public health professionals at existing internship agencies, alumni from the program, student interns, and program faculty developed a modified virtual internship composed of 6 components. The development of this modified virtual internship model was guided by previous research on the components of successful internships and the elements of high-impact learning practices.

First-Line Pharmacotherapies and Survival among Patients Diagnosed with Non-Resectable NSCLC: A Real-Life Setting Study with Gender Prospective

Simple Summary

Women and men have a different biomolecular profile that could impact drug utilization and survival in non-small cell lung cancer (NSCLC) patients. The aim of the study was to describe first-line pharmacotherapy and overall survival in non-resectable (nr)NSCLC patients by gender. About 4400 incident cases of nrNSCLC were included. We reported a different use of target therapies on the basis of the known biomolecular profile between the two sexes. The survival improved in the last decade, and women and men also showed different survival if diagnosed with a squamous or non-squamous nrNSCLC.

Abstract

(1) Purpose: To describe first-line pharmacotherapy and overall survival in non-resectable non-small cell lung cancer (nrNSCLC) patients by gender. (2) Methods: Incident cases of nrNSCLC recorded between 2009 and 2019 (cohort entry) in the pathology registry of the regional administrative healthcare database of Tuscany were identified. Records of antineoplastic therapies delivered up to 4 months following cohort entry were classified as chemotherapy, target therapies, immunotherapies, and undefined monoclonal antibodies. First-line treatment and survival of patients receiving drug treatment was described. Analyses were stratified according to histology, gender, and cohort entry year. (3) Results: 4393 incident cases of nrNSCLC were included. Women with non-squamous-NSCLC received target-therapy more frequently than men (14.9% vs. 6.5%). Immunotherapy incidence of use varied between 3.8% (2017) and 9.1% (2019). The 2-year survival rate increased over time: for non-squamous-NSCLC, it was 22.3% (2009–2011) and 30.6% (2018–2019), while for squamous-NSCLC, it was 13.5% and 22.5%, respectively. After multivariate analysis, a low reduction in mortality risk in 2018–2019 vs. 2009–2011 was found (non-squamous: HR: 0.95 CI95%: 0.92–0.98; squamous: HR: 0.94 CI95%: 0.90–0.98). Among non-squamous NSCLC, median survival was longer in women than in men (389 vs. 276 days). (4) Conclusion: In light of sex-related biomolecular differences, among non-squamous NSCLC, women received target-therapy more frequently than men. Survival seemed to slightly improve over the study period for both histologies, despite a poor reduction in mortality risk was still observed.

Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework

Background

The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management.

Objective

We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies.

Methods

Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS.

Results

We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation.

Conclusions

VHA’s new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management.

Trial Registration

ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349

Discrepancies in Educational Needs for Transition in Adolescents and Young Adults with Spina Bifida in South Korea: Use of the Borich Needs Assessment Model

PURPOSE

Transition is an important goal for ensuring that adolescents and young adults (AYAs) with spina bifida (SB) lead autonomous lives. This study aimed to identify the educational needs of AYAs with SB based on the discrepancies between perceived importance and proficiency levels during the transition process.

DESIGN AND METHODS

A cross-sectional study was conducted through face-to-face and online surveys from Jan-Dec 2020 of AYAs aged 13-25 years who had previously been diagnosed with SB. The survey consisted of 37 transition-related questions, of which 11 pertained to healthcare environments and 26 pertained to transition education needs SPSS and Excel were used for statistical analysis. Transition educational needs were analyzed by the Borich Needs Assessment Model. Higher the mean weighted discrepancy scores, lower the proficiency as compared to the perceived importance, indicating that the educational needs were high.

RESULTS

Overall, 108 responses were analyzed, and 56 (51.9%) AYAs were diagnosed with lipomyelomeningocele. The highest ranked educational needs were for "Health insurance system", "SB related urinary system diseases management", "SB related nervous system symptoms", and "Self-catheterization management". "The demands for 'SB related work life", "Urinary incontinence management", and "Constipation management" were significantly higher in young adults than adolescents.

CONCLUSIONS

During the transition process, activities perceived as important by AYAs with SB may differ from the activities that they can actually perform proficiently. It is important to assess their needs based on these discrepancies.

PRACTICE IMPLICATIONS

Transition education programs are needed that consider the individual educational needs and developmental stage-specific characteristics of AYAs with SB.

"Nobody Will Tell You. You've Got to Ask!": An Examination of Patient-Provider Communication Needs and Preferences among Black and White Women with Early-Stage Breast Cancer

Patient-provider communication is a critical component of healthcare and is associated with treatment quality and outcomes for women with breast cancer. This qualitative study examines similarities and differences in patient perspectives of communication needs between Black and White breast cancer survivors. We conducted four focus groups (N = 28) involving women with early-stage breast cancer on adjuvant endocrine therapy (AET), stratified by race and length of time on AET (< 6 months and >6 months). Each group was moderated by a race-concordant moderator and analyzed by emergent themes. Participants expressed common patient-provider communication needs, namely increased sensitivity from oncologists during the initial cancer diagnosis, personalized information to facilitate treatment decisions, emotional support during the transition from active treatment to maintenance, and rapid provider responses to mobile app-based queries. Communication differences by race also emerged. Black women were less likely than White women to describe having their informational needs met. White women praised longstanding relationships with providers, while Black women shared personal stories of disempowered interactions and noted the importance of patient advocates. White women more often reported privacy concerns about technology use. Unlike White women, Black women reported willingness to discuss sensitive topics, both online and offline, but believed those discussions made their providers feel uncomfortable. Early-stage breast cancer patients on AET, regardless of race, have similar needs for patient-centered communication with their oncologists. However, Black women were more likely to report experiencing poorer communication with providers than White women, which may be improved by technology and advocates.

A learning health systems approach to integrating electronic patient-reported outcomes across the health care organization

INTRODUCTION

Foundational to a learning health system (LHS) is the presence of a data infrastructure that can support continuous learning and improve patient outcomes. To advance their capacity to drive patient-centered care, health systems are increasingly looking to expand the electronic capture of patient data, such as electronic patient-reported outcome (ePRO) measures. Yet ePROs bring unique considerations around workflow, measurement, and technology that health systems may not be poised to navigate. We report on our effort to develop generalizable learnings that can support the integration of ePROs into clinical practice within an LHS framework.

METHODS

Guided by action research methodology, we engaged in iterative cycles of planning, acting, observing, and reflecting around ePRO use with two primary goals: (1) mobilize an ePRO community of practice to facilitate knowledge sharing, and (2) establish guidelines for ePRO use in the context of LHS practice. Multiple, emergent data collection activities generated generalizable guidelines that document the tangible best practices for ePRO use in clinical care. We organized guidelines around thematic areas that reflect LHS structures and stakeholders.

RESULTS

Three core thematic areas (and 24 guidelines) emerged. The theme of governance reflects the importance of leadership, knowledge management, and facilitating organizational learning around best practice models for ePRO use. The theme of integration considers the intersection of workflow, technology, and human factors for ePROs across areas of care delivery. Lastly, the theme of reporting reflects critical considerations for curating data and information, designing system functions and interactions, and presentation of ePRO data to support the translation of knowledge to action.

CONCLUSIONS

The guidelines produced from this work highlight the complex, multidisciplinary nature of implementing change within LHS contexts, and the value of action research approaches to enable rapid, iterative learning that leverages the knowledge and experience of communities of practice.

Determining the information needs of contact lens wearers for better education and more support: a qualitative study

BACKGROUND

Designing educational interventions tailored to the needs of Contact Lens Wearers (CLWs) are important and necessary. The present study aimed to determine the information needs of CLWs to educate and provide information to them to increase their knowledge and reduce complications and non-compliance behaviors.

METHODS

A qualitative approach was applied and semi-structured interviews were conducted in three contact lenses (CL) clinics in Iran among all their practitioners and 24 purposively selected patients. Data were analyzed using the Lundman and Graneheim conventional content analysis.

RESULTS

The qualitative analysis revealed knowledge and skill themes as two main categories. The knowledge category includes five subcategories of basic information for the CLWs, acquaintance with the CL, caring for CL, hygiene and vigilance of CL, and challenges of using CL. The skill category consists of two subcategories, including handling/insertion and removal of the CL, and stabilization of learned information. Moreover, 36 sub-subcategories emerged from these seven subcategories that reflected the information needs of CLWs.

CONCLUSIONS

A clear understanding of CLWs' information needs can help to design and develop appropriate educational approaches to overcome training barriers such as physicians' time constraints and high workload. Moreover, it can help deal with CLWs' insufficient knowledge and provide the required information simply and practically with the possibility of enough repetition.

Operationalization of the Brief ICF Core Set for Hearing Loss: An ICF-Based e-Intake Tool in Clinical Otology and Audiology Practice

OBJECTIVES

According to the International Classification of Functioning, Disability and Health (ICF), functioning reflects the interplay between an individual's body structures and functions, activities, participation, environmental, and personal factors. To be useful in clinical practice, these concepts need to be operationalized into a practical and integral instrument. The Brief ICF Core Set for Hearing Loss (CSHL) provides a minimum standard for the assessment of functioning in adults with hearing loss. The objective of the present study was to operationalize the Brief CSHL into a digital intake tool that could be used in the otology-audiology practice for adults with ear and hearing problems as part of their intake assessment.

DESIGN

A three-step approach was followed: (1) Selecting and formulating questionnaire items and response formats, using the 27 categories of the Brief CSHL as a basis. Additional categories were selected based on relevant literature and clinical expertise. Items were selected from existing, commonly used disease-specific questionnaires, generic questionnaires, or the WHO's official descriptions of ICF categories. The response format was based on the existing item's response categories or on the ICF qualifiers. (2) Carrying out an expert survey and a pilot study (using the three-step test interview. Relevant stakeholders and patients were asked to comment on the relevance, comprehensiveness, and comprehensibility of the items. Results were discussed in the project group, and items were modified based on consensus. (3) Integration of the intake tool into a computer-based system for use in clinical routine.

RESULTS

The Brief CSHL was operationalized into 62 items, clustered into six domains: (1) general information, including reason for visit, sociodemographic, and medical background; (2) general body functions; (3) ear and hearing structures and functions; (4) activities and participation (A&P); (5) environmental factors (EF); and (6) personal factors (mastery and coping). Based on stakeholders' responses, the instructions of the items on A&P and EF were adapted. The three-step test interview showed that the tool had sufficient content validity but that some items on EF were redundant. Overall, the stakeholders and patients indicated that the intake tool was relevant and had a logical and clear structure. The tool was integrated in an online portal.

CONCLUSIONS

In the current study, an ICF-based e-intake tool was developed that aims to screen self-reported functioning problems in adults with an ear/hearing problem. The relevance, comprehensiveness, and comprehensibility of the originally proposed item list was supported, although the stakeholder and patient feedback resulted into some changes of the tool on item-level. Ultimately, the functioning information obtained with the tool could be used to promote patient-centered ear and hearing care taking a biopsychosocial perspective into account.

Digital Health Training Programs for Medical Students: Scoping Review

BACKGROUND

Medical schools worldwide are accelerating the introduction of digital health courses into their curricula. The COVID-19 pandemic has contributed to this swift and widespread transition to digital health and education. However, the need for digital health competencies goes beyond the COVID-19 pandemic because they are becoming essential for the delivery of effective, efficient, and safe care.

OBJECTIVE

This review aims to collate and analyze studies evaluating digital health education for medical students to inform the development of future courses and identify areas where curricula may need to be strengthened.

METHODS

We carried out a scoping review by following the guidance of the Joanna Briggs Institute, and the results were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We searched 6 major bibliographic databases and gray literature sources for articles published between January 2000 and November 2019. Two authors independently screened the retrieved citations and extracted the data from the included studies. Discrepancies were resolved by consensus discussions between the authors. The findings were analyzed using thematic analysis and presented narratively.

RESULTS

A total of 34 studies focusing on different digital courses were included in this review. Most of the studies (22/34, 65%) were published between 2010 and 2019 and originated in the United States (20/34, 59%). The reported digital health courses were mostly elective (20/34, 59%), were integrated into the existing curriculum (24/34, 71%), and focused mainly on medical informatics (17/34, 50%). Most of the courses targeted medical students from the first to third year (17/34, 50%), and the duration of the courses ranged from 1 hour to 3 academic years. Most of the studies (22/34, 65%) reported the use of blended education. A few of the studies (6/34, 18%) delivered courses entirely digitally by using online modules, offline learning, massive open online courses, and virtual patient simulations. The reported courses used various assessment approaches such as paper-based assessments, in-person observations, and online assessments. Most of the studies (30/34, 88%) evaluated courses mostly by using an uncontrolled before-and-after design and generally reported improvements in students' learning outcomes.

CONCLUSIONS

Digital health courses reported in literature are mostly elective, focus on a single area of digital health, and lack robust evaluation. They have diverse delivery, development, and assessment approaches. There is an urgent need for high-quality studies that evaluate digital health education.

Real-World Utilization of Target- and Immunotherapies for Lung Cancer: A Scoping Review of Studies Based on Routinely Collected Electronic Healthcare Data

Routinely collected electronic healthcare data (rcEHD) have a tremendous potential for enriching pre-marketing evidence on target- and immunotherapies used to treat lung cancer (LC). A scoping review was performed to provide a structured overview of available rcEHD-based studies on this topic and to support the execution of future research by facilitating access to pertinent literature both for study design and benchmarking. Eligible studies published between 2016 and 2020 in PubMed and ISI Web of Science were searched. Data source and study characteristics, as well as evidence on drug utilization and survival were extracted. Thirty-two studies were included. Twenty-six studies used North American data, while three used European data only. Thirteen studies linked ≥1 data source types among administrative/claims data, cancer registries and medical/health records. Twenty-nine studies retrieved cancer-related information from medical records/cancer registries and 31 studies retrieved information on drug utilization or survival from medical records or administrative/claim data. Most part of studies concerned non-small-cell-LC patients (29 out of 32) while none focused on small-cell-LC. Study cohorts ranged between 85 to 81,983 patients. Only two studies described first-line utilization of immunotherapies. Results from this review will serve as a starting point for the execution of future rcEHD-based studies on innovative LC pharmacotherapies.

Same same-but different: using qualitative studies to inform concept elicitation for quality of life assessment in telemedical care: a request for an extended working model

Background

Although telemedical applications are increasingly used in the area of both mental and physical illness, there is no quality of life (QoL) instrument that takes into account the specific context of the healthcare setting. Therefore, the aim of this study was to determine a concept of quality of life in telemedical care to inform the development of a setting-sensitive patient-reported outcome measure.

Methods

Overall, 63 semi-structured single interviews and 15 focus groups with 68 participants have been conducted to determine the impact of telemedical care on QoL. Participants were patients with chronic physical or mental illnesses, with or without telemedicine supported healthcare as well as telemedical professionals. Mayring's content analysis approach was used to encode the qualitative data using MAXQDA software.

Results

The majority of aspects that influence the QoL of patients dealing with chronic conditions or mental illnesses could be assigned to an established working model of QoL. However, some aspects that were considered important (e. g. perceived safety) were not covered by the pre-existing domains. For that reason, we re-conceptualized the working model of QoL and added a sixth domain, referred to as healthcare-related domain.

Conclusion

Interviewing patients and healthcare professionals brought forth specific aspects of QoL evolving in telemedical contexts. These results reinforce the assumption that existing QoL measurements lack sensitivity to assess the intended outcomes of telemedical applications. We will address this deficiency by a telemedicine-related re-conceptualization of the assessment of QoL and the development of a suitable add-on instrument based on the resulting category system of this study.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01807-8.

Promises and Pitfalls of Health Information Technology for Home- and Community-Based Services

Background: Health information technology (HIT) use in home- and community-based services (HCBS) has been hindered by inadequate resources and incentives to support modernization. We sought to understand the ways the Medicaid Balancing Incentive Program (BIP) facilitated increased use of HIT to increase access to HCBS. Method: Qualitative analysis of interviews with 30 Medicaid administrators, service agency providers, and consumer advocates. Results: Although stakeholders perceived several benefits to greater HIT use, they highlighted critical challenges to effective adoption within the long-term services and supports (LTSS) system, including lack of extant expertise/knowledge about HIT, the limited reach of HIT among rural and disabled beneficiaries, burdensome procurement processes, and the ongoing resources required to maintain up-to-date HIT solutions. Conclusion: The structural reforms required by BIP gave states an opportunity to modernize their HCBS systems through use of HIT. However, barriers to HIT adoption persist, underscoring the need for continued support as part of future rebalancing efforts.

The pharmacist informatician: providing an innovative model of care during the COVID-19 crisis

OBJECTIVES

The global coronavirus pandemic has expedited digitisation in every industry, especially healthcare, and has highlighted the potential for informatics pharmacists to provide valuable input into crisis management. Informatics pharmacists can combine their clinical and information technology skills to help provide essential patient safety services related to medication management, procurement and analytics. The objective of this study was to determine the key opportunities for a pharmacist informatician to improve patient care and outcomes during the COVID-19 pandemic.

METHODS

Fourteen expert informatics professionals involved in the provision of digital health in Queensland, Australia, were invited to participate in a brief semistructured interview. Transcripts were manually coded, through iterative readings of the text to identify participant responses related to opportunities for a pharmacist informatician to assist during COVID-19. Inductive thematic analysis as described by Braun and Clarke, was used to identify groups of text related to the provision of digital health, informatics and change of practice during a pandemic. The relevant codes were then grouped into themes to help answer the research question.

KEY FINDINGS

Twelve experts agreed to participate, they included nine informatics pharmacists and three digital health experts from hospital and community. Two key themes and 13 codes related to enabling safer and more efficient workflow and use of data analytics to optimise care were identified. The first theme related to 'social distancing without compromising care' for example, by using the electronic capabilities of digital hospitals and telehealth services. The second theme related to the use of real-time data streaming to optimise patient flow and timely medication procurement and management. Examples of quotes from transcripts were used to provide context and answer the research question.

CONCLUSIONS

The experts interviewed identified areas where informatics pharmacists have the potential to assist with maintaining high quality patient care during this pandemic, and in future disasters. Improving awareness, training, and the integration about informatics roles as a result of this global pandemic will likely assist with future patient management in the event of future disasters.

The Influence of Modern Social Media on Dermatologist Selection by Patients

Objective

Social media have become the platform of choice for people seeking immediate access to information. They have become so ubiquitous and pervasive that many people are using them to research health care providers and communicate with them about their issues. This study looks into this phenomenon, focusing on how it affects people’s thinking when deciding which doctor to see for skin-related concerns.

Methodology

A cross-sectional study was conducted among patients at Derma Clinic in Riyadh, Saudi Arabia. Data were collected using a validated self-administered questionnaire. A total of 365 patients were included in the analysis.

Results

Out of 365 participants, 44.9% visited the center for medical purposes, while 45.8% visited for cosmetic purposes. Sixty-six percent of the participants (n=241) went to a dermatologist they knew, and only 21% of those participants knew their dermatologist from social media (Twitter, Instagram, Snapchat, Facebook, and Telegram). About 44.54% preferred to know more about their dermatologists from Twitter, followed by Instagram 27.96%, Snapchat 24.64%, and Facebook 2.84%. A significant proportion of Instagram users came to the dermatology clinic for cosmetic purposes.

Conclusion

As per the findings of this study, we found the highest preferred way of knowing the doctor for medical or cosmetic purposes was through a friend, followed by a family member and social media. Although most of the participants still preferred to visit a dermatologist based on their friend’s recommendation, social media offer patients a platform upon which to launch their search for a dermatologist. Among social media users, patients who visit dermatology clinics for medical reasons preferred Twitter, while those who came for cosmetic reasons preferred Instagram to follow their doctors, underlining the importance of aesthetic dermatology as a visual field.

Effects of physical activity and stress on the relationship between social capital and quality of life among breast cancer survivors

This study aims to investigate the serial multiple mediation of physical activity and perceived stress in the relationship between individual social capital and quality of life (QOL) in breast cancer survivors (BCSs). This study was conducted among 520 BCSs between March and April 2017 in Shanghai, China. Data were collected using the Individual Social Capital Scale, the Health-Promoting Lifestyle Profile-II, the Perceived Stress Scale-14 and the EORTC QLQ-C30. Ordinary least-squares regression and the bootstrap method was used to test the significance of the serial multiple mediation model. The serial-multiple mediations of physical activity and perceived stress were found significant in the relationship of QOL with all five dimensions of individual social capital. The separate mediations of two single mediating variables were found significant in the relationship of QOL with control over life and feeling about the community. In the relationship of QOL with social participation, social network and social support, the separate mediation of physical activity was significant, while the separate mediation of perceived stress was not significant. A multidisciplinary team approach and a variety of delivery systems are needed to address the social, physical and psychological issues for improving QOL among BCSs.

A mixed methods systematic review of the effects of patient online self-diagnosing in the 'smart-phone society' on the healthcare professional-patient relationship and medical authority

BACKGROUND

As technology continues to advance, the internet is becoming increasingly popular. Self-diagnosis and health information seeking online is growing more common and it will be important to understand the influence this may have on the patient-healthcare professional relationship.

METHODS

A mixed-method systematic review of quantitative, qualitative and mixed method studies concerning the public and healthcare professionals' perceptions of online self-diagnosis and health information seeking and how this can impact the patient-healthcare professional relationship. We searched MEDLINE, EMBASE, CINAHL, ACM & SCOPUS between 2007 and 2018. Relevant data were extracted, and a thematic analysis was conducted and conceptualised using the Normalisation Process Theory framework.

RESULTS

Of 6107 records identified, 25 articles met the review eligibility criteria which included 16 qualitative, 8 quantitative and 1 mixed method study. The findings indicated that patients found the internet as a complementary information source alongside healthcare professionals. Health care professionals were perceived to be the most reliable and valued information source. People feel responsible for their own health and find the internet to be a source that provides information rapidly with accessibility at their convenience. Most healthcare professionals agreed on the importance of collaboration with patients and the need to develop a partnership and shared decision-making process but struggled to find time in the consultation to do so efficiently. Some healthcare professionals felt that the internet was advantageous for patients looking after their own health, while others felt it was due to a lack of trust in their expertise. Patients tended to present information to the healthcare professional to support the therapeutic relationship rather than to challenge it and to become more involved in the decision-making process of their healthcare.

CONCLUSION

The results of this review suggests that patients value healthcare professionals as a source of medical advice more than the internet. While health professionals' views were mixed our findings indicate that online health information seeking can potentially improve the patient-healthcare professional relationship as patients reported they usually conducted an online search to form a partnership with the healthcare professional as opposed to trying to prove them wrong.

Computerized cognitive performance assessments in the Brooklyn Cognitive Impairments in Health Disparities Pilot Study

INTRODUCTION

Detecting cognitive impairment in diverse, health disparities communities is an urgent health care priority.

METHODS

The Brooklyn Cognitive Impairments in Health Disparities Pilot Study investigated quantitative aspects and liking of a computerized cognitive performance assessment, Cognigram, among individuals ≥ 40 years in traditional and nontraditional primary care settings.

RESULTS

Cognigram was piloted in the Emergency Department, Family Medicine, and Geriatric Psychiatry clinics: 58 adults (23 men, 35 women), 67.9 ± 9.8 years (range 43-91), completed the Cognigram and 5-item liking survey. The observed liking range was 2 to maximum score 5 (67% scored 4-5; no sex or age differences).

DISCUSSION

The Cognigram was well liked in waiting rooms of primary care settings. Assistance from a trained adult and clinic endorsement were keys to success. How the Cognigram performs in a geographically compact, population-dense global setting, such as Brooklyn with high vascular disease risk and a plethora of health disparities, is being tested.

Capturing the patient voice: implementing patient-reported outcomes across the health system

PURPOSE

Supporting the capture and use of patient-reported outcomes (PROs) at the point-of-care enriches information about important clinical and quality of life outcomes. Yet the ability to scale PROs across healthcare systems has been limited by knowledge gaps around how to manage the diversity of PRO uses and leverage health information technology. In this study, we report learnings and practice insights from UW Medicine's practice transformation efforts to incorporate patient voice into multiple areas of care.

METHODS

Using a participatory, action research approach, we engaged with UW Medicine clinical and administrative stakeholders experienced with PRO implementation to inventory PRO implementations across the health system, characterize common clinical uses for PROs, and develop recommendations for system-wide governance and implementation of PROs.

RESULTS

We identified a wide breadth of PRO implementations (n = 14) in practice and found that nearly half (47%) of employed PRO measures captured shared clinical domains (e.g., depression). We developed three vignettes (use cases) that illustrate how users interact with PROs, characterize common ways PRO implementations support clinical care across the health system (1) Preventive care, (2) Chronic/Specialty care, and (3) Surgical/Interventional care), and elucidate opportunities to enhance efficient PRO implementations through system-level standards and governance.

CONCLUSIONS

Practice transformation efforts increasingly require integration of the patient voice into clinical care, often through the use of PROs. Learnings from our work highlight the importance of proactively considering how PROs will be used across the layers of healthcare organizations to optimize the design and governance of PROs.

TreC platform. An integrated and evolving care model for patients' empowerment and data repository

INTRODUCTION

Health care has been deeply revolutionized by the new wave of information and communication technology (ICT) development, particularly related to the electronic/personal health record (PHR). The present paper describes the original design and implementation approach followed in the Trentino Province (Italy) to promote an Integrated Care Model for patients' empowerment and data repository, by means of an evolving Personal Health Record - PHR platform, named TreC (Trentino Citizens Clinical Record).

MATERIALS AND METHODS

The TreC Platform is conceived as a communication hub among different stakeholders. The core assumption of the TreC platform strategy is to consider the citizen/patient as main manager and owner of both his/her own health and his/her contacts with the health care systems.

RESULTS

Over the years, the TreC platform has represented the core pillar in the digitalization process promoted at Province level. This has been strategically embedded in the multi-faceted e-government strategy endorsed by the Province of Trento. So far (October 2018), more than 89,000 citizens within the Province of Trento are using TreC platform as a way to communicate with the health care system and access their own personal health records.

CONCLUSIONS

The experience gained through the TreC platform implementation and its results are promising, supporting the idea that a PHR platform can represent a key driving factor in improving health care quality and efficiency, both from a patient and a health care staff perspective.

YouTube Videos as a Source of Information on Colorectal Cancer: What Do Our Patients Learn?

YouTube is the second most visited website in the world. No studies to date have characterized and evaluated YouTube videos on colorectal cancer (CRC) although these videos could influence patient decision-making, notably regarding screening and prevention. This study aims to report the characteristics and quality of these videos as patient education resources for CRC. YouTube's search engine was queried with different search phrases relating to CRC. The first two pages of each search result were analyzed. Two specialists devised a critical appraisal tool with a list of criteria to assess the videos. Quantitative YouTube parameter analyses and criteria assessment were performed. Inter-rater agreement was assessed between three raters. A total of 46 videos were eligible to be included in the study. The videos were on average 4:51 ± 3:27 min long. The videos had 10 times as many likes as dislikes. Less than half the videos discussed risk factors and protective factors. Only 41% of videos mentioned screening tests and only about a quarter discussed them. Palliative care was only mentioned in 2% of videos. A single video could obtain a perfect score on the critical appraisal tool. Length was the unique parameter associated with a high score on the criteria list. There is thus a need for more authoritative and comprehensive videos easily identifiable by the patients. Video popularity is not associated with comprehensiveness. Currently, YouTube might not be an education resource for CRC suited to every patient.

Differences in coping strategies among young adults and the elderly with cancer

BACKGROUND

Coping with cancer and the oncologist-patient relationship can vary depending on the patient's age. Our aim is to examine and compare young and elderly adults with non-metastatic, resected cancer.

METHODS

Two groups of patients were selected, young (< 40 years) and elderly (> 70) with a diagnosis of non-metastatic, resected cancer requiring adjuvant chemotherapy from a pre-exiting, national database (NEOCOPING Study). Epidemiological variables were collected and subjects' emotional responses, perceptions of the physician-patient relationship, support network, fears, and regret about the decision to receive chemotherapy were assessed with questionnaires validated in previous studies: Mini-Mental Adjustment to Cancer, Brief Summary Inventory (18 items), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-C30, Shared Decision-Making Questionnaire-Physician's version, Shared Decision-Making Questionnaire-Patient's version, and Informed Risk (physician and patient versions).

RESULTS

Data from 46 young and 46 elderly participants were collected. The most common neoplasms in both groups were breast (50%) and colorectal (22%). The younger adults had a higher level of education and were actively employed (72% vs. 7%). The leading coping strategy in the younger cohort was hope, and resignation among the elderly. Young adults sought more social support and the impact of diagnosis was more negative for them than for older individuals. No significant differences were detected in quality of life; both age groups demanded more time at their first visit with the doctor, while the older group exhibited greater satisfaction with shared decision-making. At the end of adjuvant chemotherapy, neither age group regretted their decision to receive said treatment.

CONCLUSION

Higher levels of education, greater demands of the labour market, and the advent of the age of information have entailed drastic changes in the physician-patient relationship paradigm. This is especially true in the younger cancer patient population, who require more information and active participation in decision-making, can display more anxiety about their diagnosis, but also greater capacity to fight.

Reconceptualizing the Electronic Health Record for a New Decade: A Caring Technology?

Since the 2009 publication by Petrovskaya et al on, "Dilemmas, Tetralemmas, Reimagining the Electronic Health Record," and passage of the Health Information Technology for Economic Clinical Health (HITECH) Act, 96% of hospitals and 78% of providers have implemented the electronic health record. While many positive outcomes such as guidelines-based clinical decision support and patient portals have been realized, we explore recent issues in addition to those continuing problems identified by Petrovskaya et al that threaten patient safety and integrity of the profession. To address these challenges, we integrate polarity thinking with the tetralemma model discussed by Petrovskaya et al and propose application of a virtue ethics framework focused on cultivation of technomoral wisdom.

Development of EirV3: A Computer-Based Tool for Patient-Reported Outcome Measures in Cancer

PURPOSE

Immediate transfer of patient-reported outcome measures (PROMs) for use in medical consultations is facilitated by electronic assessments. We aimed to describe the rationale and development of Eir version 3 (EirV3), a computer-based symptom assessment tool for cancer, with emphasis on content and user-friendliness.

METHODS

EirV3's specifications and content were developed through multiprofessional, stepwise, and iterative processes (from 2013 to 2016), with literature reviews on traditional and electronic assessment and classification methods, formative iterative usability tests with end-users, and assessment of patient preferences for paper versus electronic assessments.

RESULTS

EirV3 has the following two modules: Eir-Patient for PROMs registration on tablets and Eir-Doctor for presentation of PROMs in a user-friendly interface on computers. Eir-Patient starts with 19 common cancer symptoms followed by specific, in-depth questions for endorsed symptoms. The pain section includes a body map for pain location and intensity, whereas physical functioning, nutritional intake, and well-being are standard questions for all. Data are wirelessly transferred to Eir-Doctor. Symptoms with intensity scores ≥ 3 (on a 0 to 10 scale) are marked in red, with brighter colors corresponding to higher intensity, and supplemented with graphs displaying symptom development over time. Usability results showed that patients and health care providers found EirV3 to be intuitive, easy to use, and relevant. When comparing PROM assessments on paper versus tablets (n = 114), 19% of patients preferred paper, 41% preferred tablets, and 40% had no preference. Median intraclass correlation coefficient between paper and tablets (0.815) was excellent.

CONCLUSION

Iterative test rounds followed by continuous improvements led to a user-friendly, applicable symptom assessment tool, EirV3, developed for and by end-users. EirV3 is undergoing international testing of clinical and cross-cultural adaptability.

Utilizing the Advances in Digital Health Solutions to Manage Care in Cancer Patients

In recent years, the clinical context for cancer has changed, and it is now characterized by extended survival rates and more diverse and complex cancer trajectories and symptomatology. The changes in the landscape of cancer care also include a shift towards the home setting or the outpatient setting with an increased amount of care being delivered at home or transferred to the patients themselves and their family caregivers. These changes have also impacted the type and amount of information required by the patients and their caregivers as well as the type of care needs that are to be addressed by health-care professionals. Finally, the transitions within the health-care setting might also create a caring gap that the patient is left to deal with independently or with minimal support. These changes have led to the emergence of innovative digital/technological solutions for supporting patients during their cancer care continuum.

Development of an e-health education program at the workplace using formative research - Technologies for improving quality of life

BACKGROUND

e-Learning, a means by which to expand people's access to information can be effective in promoting health in the workplace. This study to present steps in the development of an e-health education program at the workplace.

OBJECTIVE

This study aimed to present all steps of develop a telehealth education program for computer users using formative research to identify themes to health education for workers.

METHODS

A team of expert conducted focus groups with administrative workers (n = 36 participants) to identify thematic health to the development of program. Three meetings were audio video recorded, and notes. All data were based on constant analysis, classical content analysis and keywords in-context.

RESULTS

The content of the nine audio videos included four musculoskeletal health topics (Walking Program, Back School, Muscle Relaxation Techniques, and Work-related Musculoskeletal Diseases); three to healthy diet (Eating and Commensality, Ultra-processed Food and Food labeling, and Oil and Fat); two to mental health (Burnout Syndrome and the Meaning of work).

CONCLUSION

The proposed steps in the development of a workplace e-health education program were successfully achieved. The engagement of the workers' staged focus groups was fundamental to the choice of themes relevant to the population in question.