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Lam Shin Cheung V, Kastner M, Sale JE, Straus S, Kaplan A, Boulet LP, Gupta S. Development process and patient usability preferences for a touch screen tablet-based questionnaire. Health Informatics J 2019; 26:233-247. [PMID: 30672358 DOI: 10.1177/1460458218824749] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We sought to design a touch tablet asthma questionnaire while identifying patient preferences for usability features of such questionnaires. We created an evidence-based prototype and employed rapid-cycle design (semi-structured focus group testing, analysis, corresponding modifications, re-testing) with asthma patients aged ⩾16 years. We analyzed transcripts using deductive and inductive content analysis. Quantitative measures included Likert-type-scale responses, the System Usability Scale, and questionnaire completion times. There were 20 participants across five focus groups (15/20 female, age 49.1 ± 15.6 years). Usability-related themes included (1) "Touch Technology" (hygiene, touch technology familiarity, ease of use) and (2) "Questionnaire Design" (visual characteristics, navigation). Completion time was 11.7 ± 5.9 min. Summative Likert-type scale responses suggested high system usability, as did a System Usability Scale score of 84.2 ± 14.7. In summary, Attention to specific technology- and design-related preferences can result in a highly usable patient-facing touch tablet questionnaire. Our findings can inform touch questionnaire design across other diseases.
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Affiliation(s)
| | | | | | - Sharon Straus
- University of Toronto, Canada; St. Michael's Hospital, Canada
| | - Alan Kaplan
- University of Toronto, Canada; Family Physician Airways Group of Canada, Canada
| | | | - Samir Gupta
- University of Toronto, Canada; St. Michael's Hospital, Canada
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Hobden B, Bryant J, Forshaw K, Oldmeadow C, Evans TJ, Sanson-Fisher R. Prevalence and characteristics associated with concurrent smoking and alcohol misuse within Australian general practice patients. AUST HEALTH REV 2018; 44:125-131. [PMID: 30543764 DOI: 10.1071/ah18126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/29/2018] [Indexed: 11/23/2022]
Abstract
Objectives This study sought to determine, among a large sample of Australian general practice patients: (1) the prevalence of smoking among different levels of alcohol misuse; and (2) whether the associations between demographic characteristics and alcohol use differ according to smoking status. Methods A cross-sectional survey was administered from 2010 to 2011 to 3559 patients from 12 Australian urban general practices. Patients reported their demographic details, smoking status and their alcohol intake. Results The overall prevalence of reported concurrent smoking and alcohol misuse was 7.8%. Smokers were 3.81-fold more likely to have a higher level of alcohol consumption than non-smokers (95% confidence interval 3.13-4.63; P<0.0001). There was evidence that smoking was an effect modifier of the relationship between alcohol misuse and chronic illness. Conclusions There was an increasing prevalence of smoking with increasing level of alcohol consumption. In addition, those with chronic conditions who smoked had greater odds of higher levels of alcohol consumption. Preventative interventions for these substances are needed to reduce the burden associated with concurrent smoking and alcohol misuse. What is known about the topic? Tobacco and alcohol are the most commonly used substances and contribute to over 10million deaths annually. The risk of disease is high when using either of these substances, however, concurrent use is associated with a greatly compounded risk. Australian data is limited regarding the prevalence of concurrent tobacco and alcohol misuse, however, international studies suggest variation in prevalence rates between different clinical settings. What does this paper add? This study examined the prevalence of concurrent smoking and alcohol misuse among different levels of alcohol misuse severity within an Australian general practice setting. Additionally it explored whether the associations between demographic characteristics and alcohol use differ according to smoking status. What are the implications for practitioners? This study has important implications for disease prevention and the delivery of preventive health services by general practitioners. Considering one in 100 clinical treatments provided in general practice relate to preventative smoking or alcohol counselling, it is critical that efforts are made to ascertain risk factors such as smoking and alcohol misuse to increase treatment rates. General practitioners should consider screening for smoking and alcohol misuse opportunistically during routine clinical encounters, as well as screening for smoking or alcohol misuse if one or the other is present.
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Affiliation(s)
- Breanne Hobden
- Health Behaviour Research Collaborative, HMRI Building, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Jamie Bryant
- Health Behaviour Research Collaborative, HMRI Building, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Kristy Forshaw
- Health Behaviour Research Collaborative, HMRI Building, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Tiffany-Jane Evans
- Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, HMRI Building, University of Newcastle, Callaghan, NSW 2308, Australia.
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Gupta S, Lam Shin Cheung V, Kastner M, Straus S, Kaplan A, Boulet LP, Sale JEM. Patient preferences for a touch screen tablet-based asthma questionnaire. J Asthma 2018; 56:771-781. [PMID: 29972087 DOI: 10.1080/02770903.2018.1490750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Assessment of asthma control and provision of asthma action plans are seldom performed in practice, partly due to limited time for physicians to ascertain required information. A patient-facing electronic asthma questionnaire could facilitate information collection. We sought to design a touch-tablet asthma questionnaire for use in the clinic waiting room and to describe patient preferences for the content of such a questionnaire. METHODS We created a questionnaire prototype based on best evidence and employed rapid-cycle design (semi-structured focus group testing; analysis; corresponding modifications and re-testing) with asthma patients aged ≥16 years. We analyzed transcripts using deductive and inductive content analysis. Quantitative measures included Likert-scale questions and questionnaire completion times. RESULTS There were 20 participants across five focus groups (15/20 (75%) female, age 49.1 ± 15.6 years). Content-related themes included: 1) comprehensibility (language) (how questionnaire language affected ease and accuracy of comprehension) and b) information collection (issues arising during information collection in the following identified subthemes: personal asthma symptoms and triggers; asthma control; asthma medications and contact information). Average questionnaire completion time was 11.7 ± 5.9 min. Summative Likert scale responses suggested high levels of question comprehension and confidence with responses. CONCLUSIONS Our analysis provides novel insight about how best to formulate and present asthma-related content in an electronic questionnaire. Such questionnaires might facilitate quality improvement by improving efficiency of data collection, enabling better assessment of asthma control and medication adherence, and personalization of asthma action plans. Future studies should measure real-world uptake of such a questionnaire and impact on care.
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Affiliation(s)
- Samir Gupta
- a Li Ka Shing Knowledge Institute of St. Michael's Hospital , Toronto , Canada.,b Department of Medicine , University of Toronto , Toronto , Canada.,c Department of Medicine, Division of Respirology , St. Michael's Hospital , Toronto , Canada
| | | | - Monika Kastner
- d Department of Research and Innovation , North York General Hospital , Toronto , Canada
| | - Sharon Straus
- a Li Ka Shing Knowledge Institute of St. Michael's Hospital , Toronto , Canada.,b Department of Medicine , University of Toronto , Toronto , Canada
| | - Alan Kaplan
- e Department of Family and Community Medicine, University of Toronto , Toronto , Canada.,f Family Physician Airways Group of Canada , Edmonton , Canada
| | - Louis-Philippe Boulet
- g Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval , Québec, Canada
| | - Joanna E M Sale
- h Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.,i Musculoskeletal Health and Outcomes Research , Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada
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Bryant J, Hobden B, Forshaw K, Oldmeadow C, Walsh J, Sanson-Fisher R. How accurately do general practitioners detect concurrent tobacco use and risky alcohol consumption? A cross-sectional study in Australian general practice. Aust J Prim Health 2018; 24:378-384. [PMID: 29898813 DOI: 10.1071/py17122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/11/2018] [Indexed: 11/23/2022]
Abstract
The negative health consequences of tobacco and risky alcohol consumption are compounded when used concurrently. Australian preventative health guidelines recommend that general practitioners (GPs) assess and provide evidence-based intervention. No studies, however, have examined the accuracy of GP detection of concurrent tobacco use and risky alcohol consumption or the factors associated with accurate detection. This study aimed to examine the: (i) accuracy of GP detection of concurrent tobacco and risky alcohol use compared to patient self-report; and (ii) GP and patient characteristics associated with accurate detection following a single clinical encounter. Patients attending 12 Australian general practices completed a survey assessing smoking and alcohol consumption. For each participating patient, GPs completed a checklist to indicate the presence of these risk factors. GP judgements were compared to patient self-report. Fifty-one GPs completed a health risk checklist for 1332 patients. Only 23% of patients who self-reported concurrent tobacco and risky alcohol use identified by their GP. Patients who visited their GP four to six times in the last year were most likely to have concurrent tobacco and risky alcohol use were identified. It is imperative to establish systems to increase detection of preventative health risks in general practice to enable the provision of evidence-based treatments.
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Affiliation(s)
- Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Breanne Hobden
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kristy Forshaw
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | | | - Justin Walsh
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
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Hobden B, Bryant J, Sanson-Fisher R, Oldmeadow C, Carey M. Do rates of depression vary by level of alcohol misuse in Australian general practice? Aust J Prim Health 2017; 23:263-267. [PMID: 27938624 DOI: 10.1071/py16076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 11/03/2016] [Indexed: 11/23/2022]
Abstract
Limited data exist regarding co-occurring alcohol misuse and depression among general practice patients. This study examined the prevalence of depression by level of alcohol misuse, and the sociodemographic factors associated with depression and increased alcohol misuse severity. A cross-sectional survey was administered to 3559 Australian general practice patients. Patients completed their demographic details, the Patient Health Questionnaire (9-item) and the Alcohol Use Disorder Identification Test (Consumption items). The prevalence of alcohol misuse and depression was 6.7%, and depression prevalence varied significantly according to level of alcohol misuse (P<0.001). Age, gender, Aboriginality and number of chronic diseases were associated with depression and higher levels of alcohol misuse. These findings may assist General Practitioners in identifying those at risk of experiencing co-morbid depression and alcohol use, and aid in effective treatment and referral.
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Affiliation(s)
- Breanne Hobden
- Health Behaviour Research Group, HMRI Building, University of Newcastle, NSW 208, Australia
| | - Jamie Bryant
- Health Behaviour Research Group, HMRI Building, University of Newcastle, NSW 208, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Group, HMRI Building, University of Newcastle, NSW 208, Australia
| | - Christopher Oldmeadow
- Public Health Stream, Hunter Medical Research Institute, HMRI Building, NSW 2308, Australia
| | - Mariko Carey
- Health Behaviour Research Group, HMRI Building, University of Newcastle, NSW 208, Australia
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Hobden B, Bryant J, Carey M, Sanson-Fisher R, Oldmeadow C. Computer tablet or telephone? A randomised controlled trial exploring two methods of collecting data from drug and alcohol outpatients. Addict Behav 2017; 71:111-117. [PMID: 28327379 DOI: 10.1016/j.addbeh.2017.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/15/2017] [Accepted: 03/08/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Both computerised and telephone surveys have potential advantages for research data collection. The current study aimed to determine the: (i) feasibility, (ii) acceptability, and (iii) cost per completed survey of computer tablet versus telephone data collection for clients attending an outpatient drug and alcohol treatment clinic. DESIGN Two-arm randomised controlled trial. METHOD Clients attending a drug and alcohol outpatient clinic in New South Wales, Australia, were randomised to complete a baseline survey via computer tablet in the clinic or via telephone interview within two weeks of their appointment. All participants completed a three-month follow-up survey via telephone. RESULTS Consent and completion rates for the baseline survey were significantly higher in the computer tablet condition. The time taken to complete the computer tablet survey was lower (11min) than the telephone condition (17min). There were no differences in the proportion of consenters or completed follow-up surveys between the two conditions at the 3-month follow-up. Acceptability was high across both modes of data collection. The cost of the computer tablet condition was $67.52 greater per completed survey than the telephone condition. CONCLUSION There is a trade-off between computer tablet and telephone data collection. While both data collection methods were acceptable to participants, the computer tablet condition resulted in higher consent and completion rates at baseline, therefore yielding greater external validity, and was quicker for participants to complete. Telephone data collection was however, more cost-effective. Researchers should carefully consider the mode of data collection that suits individual study needs.
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Affiliation(s)
- Breanne Hobden
- Health Behaviour Research Group, HMRI Building, University of Newcastle, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, and Hunter Medical Research Institute, HMRI Building, University of Newcastle, New South Wales 2308, Australia.
| | - Jamie Bryant
- Health Behaviour Research Group, HMRI Building, University of Newcastle, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, and Hunter Medical Research Institute, HMRI Building, University of Newcastle, New South Wales 2308, Australia
| | - Mariko Carey
- Health Behaviour Research Group, HMRI Building, University of Newcastle, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, and Hunter Medical Research Institute, HMRI Building, University of Newcastle, New South Wales 2308, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Group, HMRI Building, University of Newcastle, New South Wales 2308, Australia; Priority Research Centre for Health Behaviour, and Hunter Medical Research Institute, HMRI Building, University of Newcastle, New South Wales 2308, Australia
| | - Christopher Oldmeadow
- Public Health Stream, Hunter Medical Research Institute, HMRI Building, New South Wales 2308, Australia; Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, HMRI Building, New South Wales 2308, Australia
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Hobden B, Bryant J, Sanson-Fisher R, Oldmeadow C, Carey M. Co-occurring depression and alcohol misuse is under-identified in general practice: A cross-sectional study. J Health Psychol 2016; 23:1085-1095. [DOI: 10.1177/1359105316643855] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Depression and alcohol misuse are common co-occurring conditions. This study aimed to determine the accuracy of general practitioner identification of depression and alcohol misuse. Participants from 12 Australian general practices reported demographic and health risk behaviour data. General practitioners were asked to indicate the presence or absence of six health risk factors for individual patients. Accuracy of general practitioner identification was low at 21 per cent. Those with severe alcohol misuse, no chronic diseases and lower education levels were more likely to be identified. Routine screening prior to patient appointments may be a simple and efficient way to increase identification rates.
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Carey M, Turon H, Goergen S, Sanson-Fisher R, Yoong SL, Jones K. Patients' experiences of the management of lower back pain in general practice: use of diagnostic imaging, medication and provision of self-management advice. Aust J Prim Health 2016; 21:342-6. [PMID: 25074025 DOI: 10.1071/py14057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/16/2014] [Indexed: 11/23/2022]
Abstract
Lower back pain is prevalent in the general community. Guidelines recommend against the use of diagnostic imaging unless 'red flags' are present that may indicate a potentially serious cause. This paper reports on a cross-sectional electronic survey to investigate self-reported experiences of lower back pain management among Australian general practice patients. Of the 872 participants, 551 (63%) reported that they had experienced lower back pain in the past 12 months. Approximately 40% of patients who had experienced lower back pain reported that they had consulted their general practitioner (GP) regarding this issue. Among those who sought general practice care, 67% reported being referred for diagnostic imaging. Those who received imaging were more likely to have been prescribed medication by their GP, but received self-management advice at the same rate as those who had not been referred. Rates of self-reported referral for diagnostic imaging were higher than expected, given the low prevalence of potentially serious causes for lower back pain reported in the international literature. However, it remains unclear whether this is due to poor guideline adherence by GPs or lack of specificity in the red flags identified in guidelines. Findings suggest the need for improvements in the provision of evidence-based self-management advice.
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Carey M, Boyes A, Noble N, Waller A, Inder K. Validation of the PHQ-2 against the PHQ-9 for detecting depression in a large sample of Australian general practice patients. Aust J Prim Health 2016; 22:262-266. [DOI: 10.1071/py14149] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/21/2015] [Indexed: 11/23/2022]
Abstract
There is increasing interest in the use of brief screening tools to improve detection of depression in the primary care setting. The aim of the present study was to compare the accuracy of the two-item Patient Health Questionnaire (PHQ-2) against the nine-item Patient Health Questionnaire (PHQ-9) for detecting depression among general practice patients. A cross-sectional sample of 3626 adults attending 12 Australian general practices was recruited. Participants completed the PHQ-2 and PHQ-9 via a touchscreen computer. Depression was defined as a PHQ-9 score ≥10. The area under the curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value were calculated. The PHQ-2 had good overall accuracy relative to the PHQ-9 for discriminating between cases and non-cases of depression, with an AUC of 0.92 (95% confidence interval 0.90–0.93). The PHQ-2 threshold of ≥3 was the best balance between sensitivity (91%) and specificity (78%) for detecting possible cases of depression. For clinical use, the optimal threshold was ≥2, with only 2% of possible cases missed.
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Yusufali A, Bazargani N, Muhammed K, Gabroun A, AlMazrooei A, Agrawal A, Al-Mulla A, Hajat C, Baslaib F, Philip J, Gupta P, Bakir S, Krishnan S, Almahmeed W, Alsheikh-Ali A. Opportunistic Screening for CVD Risk Factors: The Dubai Shopping for Cardiovascular Risk Study (DISCOVERY). Glob Heart 2015; 10:265-72. [PMID: 26271552 DOI: 10.1016/j.gheart.2015.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 03/18/2015] [Accepted: 04/23/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Comprehensive cardiovascular disease risk factor (CVDRF) screening programs are limited in the developing world. Simplifying screening can increase its utility. OBJECTIVES The present study aims to estimate the burden of CVDRF in volunteers and the yield of newly discovered CVDRF comparing different sites and nationalities using this screening method. METHODS Voluntary point-of-care CVDRF screening was conducted in 4 shopping malls, 9 health care facilities, and 3 labor camps in 5 cities in the United Arab Emirates. Follow-up for newly diagnosed diabetes mellitus, hypertension, and dyslipidemia was made 1 month after screening to inquire about physician consultation, confirmation of diagnosis, and lifestyle changes. RESULTS A total of 4,128 subjects were screened (43% at malls, 36% at health care facilities, and 22% at labor camps). Subjects were relatively young (38 ± 11 years), predominantly male (75%), and of diverse nationalities (United Arab Emirates: 7%, other Arabs: 10%, South Asians: 74%, other Asians: 5%, and other nationalities: 5%). CVDRF were frequent (diabetes mellitus: 32%, hypertension: 31%, dyslipidemia: 69%, current smokers: 21%, obesity: 20%, and central obesity: 24%). Most subjects (85%) had ≥1 CVDRF, and many (17%) had ≥3 CVDRF. A new diagnosis of diabetes mellitus, hypertension, or dyslipidemia was uncovered in 61.5%, with the highest yield (74.0%) in labor camps. At follow-up of those with new CVDRF, positive lifestyle changes were reported in 60%, but only 33% had consulted a doctor; of these, diagnosis was confirmed in 63% for diabetes mellitus, 93% for hypertension, and 87% for dyslipidemia. CONCLUSIONS In this relatively young and ethnically diverse cohort, CVDRF burden and yield of screening was high. Screening in these settings is pertinent and can be simplified.
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Affiliation(s)
- Afzalhussein Yusufali
- Dubai Heart Centre, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
| | - Nooshin Bazargani
- Dubai Heart Centre, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Khalifa Muhammed
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Ahmed Gabroun
- Canadian Specialist Hospital, Dubai, United Arab Emirates
| | | | | | - Arif Al-Mulla
- Dubai Heart Centre, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Cother Hajat
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fahad Baslaib
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Jessy Philip
- Dubai Heart Centre, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Pradeep Gupta
- Saif and IBHO Hospital & RAKMSU, Ras al-Khaimah, United Arab Emirates
| | - Sherif Bakir
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Suresh Krishnan
- Dubai Heart Centre, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Wael Almahmeed
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Alawi Alsheikh-Ali
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Waller A, Carey M, Mazza D, Yoong S, Grady A, Sanson-Fisher R. Patient-reported areas for quality improvement in general practice: a cross-sectional survey. Br J Gen Pract 2015; 65:e312-8. [PMID: 25918336 PMCID: PMC4408502 DOI: 10.3399/bjgp15x684841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/02/2015] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND GPs are often a patient's first point of contact with the health system. The increasing demands imposed on GPs may have an impact on the quality of care delivered. Patients are well placed to make judgements about aspects of care that need to be improved. AIM To determine whether general practice patients perceive that the care they receive is 'patient-centred' across eight domains of care, and to determine the association between sociodemographic, GP and practice characteristics, detection of preventive health risks, and receipt of patient-centred care. DESIGN AND SETTING Cross-sectional survey of patients attending Australian general practice clinics. METHOD Patients completed a touchscreen survey in the waiting room to rate the care received from their GP across eight domains of patient-centred care. Patients also completed the Patient Health Questionnaire (PHQ-9) and self-reported health risk factors. GPs completed a checklist for each patient asking about the presence of health risk factors. RESULTS In total 1486 patients and 51 GPs participated. Overall, 83% of patients perceived that the care they received was patient-centred across all eight domains. Patients most frequently perceived the 'access to health care when needed' domain as requiring improvement (8.3%). Not having private health insurance and attending a practice located in a disadvantaged area were significantly associated with perceived need for improvements in care (P<0.05). CONCLUSION Patients in general practice report that accessibility is an aspect of care that could be improved. Further investigation of how indicators of lower socioeconomic status interact with the provision of patient-centred care and health outcomes is required.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Mariko Carey
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary Health Care, Monash University, Victoria, Australia
| | - Serene Yoong
- Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Alice Grady
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
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Prevalence of comorbid depression and obesity in general practice: a cross-sectional survey. Br J Gen Pract 2015; 64:e122-7. [PMID: 24567650 PMCID: PMC3933857 DOI: 10.3399/bjgp14x677482] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background General practice is a common setting for the provision of weight-management advice, as well as the treatment of depression. While there is some evidence of a reciprocal relationship between obesity and depression, there are limited data about the rates of depression among general practice patients who are underweight, normal weight, overweight, and obese. Aim To explore the prevalence of depression among underweight, normal weight, overweight, and obese general practice patients. Design and setting A cross-sectional survey was conducted in 12 Australian general practices. Method Patients aged ≥18 years and older who were presenting for general practice care were eligible to participate. Consenting patients completed a touchscreen computer survey assessing self-reported weight and height. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9), with a score of ≥10 used to indicate possible depression. Results Data were obtained from 3361 participants. The prevalence of depression was 24% (95% confidence interval [CI] = 11.86 to 39.28) among underweight participants, 11% (95% CI = 8.5 to 14.0) among normal weight participants, 12% (95% CI = 0.9 to 15.2) among overweight participants, and 23% (95% CI = 17.8 to 29.0) among obese participants. The prevalence of depression was higher for women than for men across all weight categories except underweight. Conclusion Weight and depression demonstrated a U-shaped relationship, with higher prevalence of depression observed among underweight and obese general practice patients. These conditions may act as red flags for opportunistic screening of depression in the general practice setting.
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Paul CL, Carey ML, Russell G, D'Este C, Sanson-Fisher RW, Zwar N. Prevalence of FOB testing in eastern-Australian general practice patients: what has a national bowel cancer screening program delivered? Health Promot J Austr 2015; 26:39-44. [DOI: 10.1071/he14058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 02/08/2015] [Indexed: 01/22/2023] Open
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Bryant J, Carey M, Sanson-Fisher R, Mansfield E, Regan T, Bisquera A. Missed opportunities: general practitioner identification of their patients' smoking status. BMC FAMILY PRACTICE 2015; 16:8. [PMID: 25649312 PMCID: PMC4333157 DOI: 10.1186/s12875-015-0228-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/19/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND In order to provide smoking cessation support to their patients in line with clinical practice guidelines, general practitioners must first ascertain whether their patients' use tobacco. This study examined (i) the sensitivity, specificity, positive predictive value and negative predictive value of general practitioner detection of smoking, and (ii) the general practitioner and patient characteristics associated with detection of tobacco use. METHODS Eligible patients completed a touchscreen computer survey while waiting for an appointment with their general practitioner. Patients self-reported demographic characteristics, medical history, and current smoking status. Following the patient's consultation, their general practitioner was asked to indicate whether the patient was a current smoker (yes/no/unsure/not applicable). Smoking prevalence, sensitivity, specificity, positive predictive value and negative predictive values (with 95% confidence intervals) were calculated using patient self-report of smoking status as the gold standard. Generalised estimating equations were used to examine the general practitioner and patient characteristics associated with detection of tobacco use. RESULTS Fifty-one general practitioners and 1,573 patients in twelve general practices participated. Patient self-report of smoking was 11.3% compared to general practitioner estimated prevalence of 9.5%. Sensitivity of general practitioner assessment was 66% [95% CI 59-73] while specificity was 98% [95% CI 97-98]. Positive predictive value was 78% [95% CI 71-85] and negative predictive value was 96% [95% CI 95-97]. No general practitioner factors were associated with detection of smoking. Patients with a higher level of education or who responded 'Other' were less likely to be detected as smokers than patients who had completed a high school or below level of education. CONCLUSION Despite the important role general practitioners play in providing smoking cessation advice and support, a substantial proportion of general practitioners do not know their patient's smoking status. This represents a significant missed opportunity in the provision of preventive healthcare. Electronic waiting room assessments may assist general practitioners in improving the identification of smokers.
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Affiliation(s)
- Jamie Bryant
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, Australia.
| | - Mariko Carey
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, Australia.
| | - Rob Sanson-Fisher
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, Australia.
| | - Elise Mansfield
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, Australia.
| | - Tim Regan
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, Australia.
| | - Alessandra Bisquera
- Clinical Research Design IT and Statistical Support Unit, Hunter Medical Research Institute, University of Newcastle, HMRI Building, Callaghan, NSW, 2308, Australia.
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Carey M, Jones KA, Yoong SL, D'Este C, Boyes AW, Paul C, Inder KJ, Sanson-Fisher R. Comparison of a single self-assessment item with the PHQ-9 for detecting depression in general practice. Fam Pract 2014; 31:483-489. [PMID: 24839267 DOI: 10.1093/fampra/cmu018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Several factors need to be considered when selecting a screening tool for depression including accuracy, level of burden for patients and for staff to administer and follow-up. OBJECTIVE This study aimed to explore the utility of a single self-assessment item in identifying possible cases of depression in primary care by examining sensitivity and specificity with the nine-item Patient Health Questionnaire (PHQ-9) at different thresholds. DESIGN Cross-sectional survey presented on a touchscreen computer. PARTICIPANTS Adult patients attending 12 urban general practices in Australia completed a health status questionnaire (n = 1004). MAIN MEASURES Depression was assessed by the PHQ-9 and a single self-assessment item. Sensitivity, specificity, and positive and negative predictive values were calculated for the single item using a PHQ-9 score of 10 or more as the criterion value. KEY RESULTS A total of 1004 participants (61% female, 48% aged 55 years or older) completed both the PHQ-9 and a single self-assessment item. When using a threshold of mild depression or greater, the single item had adequate specificity (76%, 95% CI: 71-80%), with 76 out of every 100 people defined as non-depressed by the PHQ-9 also identified as not depressed by the single item. Sensitivity was high (91%, 95% CI: 84-95%), with the single item identifying 91 out of every 100 true cases (as defined by the PHQ-9). CONCLUSIONS The single self-assessment item has high sensitivity and moderate specificity to identify possible cases of depression when used at a threshold of mild depression or greater.
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Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia,
| | - Kimberley A Jones
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Sze Lin Yoong
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia and
| | - Allison W Boyes
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Christine Paul
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Kerry J Inder
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia, NHMRC Centre for Research Excellence in Mental Health and Substance Use, Centre for Translational Neuroscience and Mental Health, University of Newcastle, New South Wales, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, New South Wales, Australia, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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16
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Yoong SL, Carey M, Sanson-Fisher R, D'Este C. Prevalence and correlates of overweight and obesity in adult Australian general practice patients. Aust N Z J Public Health 2014; 37:586. [PMID: 24892158 DOI: 10.1111/1753-6405.12117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Carey M, Jones K, Meadows G, Sanson-Fisher R, D’Este C, Inder K, Yoong SL, Russell G. Accuracy of general practitioner unassisted detection of depression. Aust N Z J Psychiatry 2014; 48:571-8. [PMID: 24413807 PMCID: PMC4230951 DOI: 10.1177/0004867413520047] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Primary care is an important setting for the treatment of depression. The aim of the study was to describe the accuracy of unassisted general practitioner judgements of patients' depression compared to a standardised depression-screening tool delivered via touch-screen computer. METHOD English-speaking patients, aged 18 or older, completed the Patient Health Questionnaire-9 (PHQ-9) when presenting for care to one of 51 general practitioners in Australia. General practitioners were asked whether they thought the patients were clinically depressed. General practitioner judgements of depression status were compared to PHQ-9 results. RESULTS A total of 1558 patients participated. Twenty per cent of patients were identified by the PHQ-9 as being depressed. General practitioners estimated a similar prevalence; however, when compared to the PHQ-9, GP judgement had a sensitivity of 51% (95% CI [32%, 66%]) and a specificity of 87% (95% CI [78%, 93%]). CONCLUSIONS General practitioner unassisted judgements of depression in their patients lacked sensitivity when compared to a standardised psychiatric measure used in general practice.
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Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour, Faculty of Health, University of Newcastle, Callaghan, Australia,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Kim Jones
- Priority Research Centre for Health Behaviour, Faculty of Health, University of Newcastle, Callaghan, Australia,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Graham Meadows
- Faculty of Medicine, Nursing and Health Sciences, School of Psychology and Psychiatry, Monash University, Clayton, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health, University of Newcastle, Callaghan, Australia,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Catherine D’Este
- Hunter Medical Research Institute, New Lambton Heights, Australia,Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, Australia
| | - Kerry Inder
- Hunter Medical Research Institute, New Lambton Heights, Australia,Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, Australia
| | - Sze Lin Yoong
- Priority Research Centre for Health Behaviour, Faculty of Health, University of Newcastle, Callaghan, Australia,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Grant Russell
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, Australia
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18
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Paul C, Yoong SL, Sanson-Fisher R, Carey M, Russell G, Makeham M. Under the radar: a cross-sectional study of the challenge of identifying at-risk alcohol consumption in the general practice setting. BMC FAMILY PRACTICE 2014; 15:74. [PMID: 24766913 PMCID: PMC4004529 DOI: 10.1186/1471-2296-15-74] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 04/22/2014] [Indexed: 02/02/2023]
Abstract
Background Primary care providers are an important source of information regarding appropriate alcohol consumption. As early presentation to a provider for alcohol-related concerns is unlikely, it is important that providers are able to identify at-risk patients in order to provide appropriate advice. This study aimed to report the sensitivity, specificity, positive predictive value and negative predictive value of General Practitioner (GP) assessment of alcohol consumption compared to patient self-report, and explore characteristics associated with GP non-detection of at-risk status. Method GP practices were selected from metropolitan and regional locations in Australia. Eligible patients were adults presenting for general practice care who were able to understand English and provide informed consent. Patients completed a modified AUDIT-C by touchscreen computer as part of an omnibus health survey while waiting for their appointment. GPs completed a checklist for each patient, including whether the patient met current Australian guidelines for at-risk alcohol consumption. Patient self-report and GP assessments were compared for each patient. Results GPs completed the checklist for 1720 patients, yielding 1565 comparisons regarding alcohol consumption. The sensitivity of GPs’ detection of at-risk alcohol consumption was 26.5%, with specificity of 96.1%. Higher patient education was associated with GP non-detection of at-risk status. Conclusions GP awareness of which patients might benefit from advice regarding at-risk alcohol consumption appears low. Given the complexities associated with establishing whether alcohol consumption is ‘at-risk’, computer-based approaches to routine screening of patients are worthy of exploration as a method for prompting the provision of advice in primary care.
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Affiliation(s)
- Christine Paul
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour and Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia.
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19
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Noble NE, Paul CL, Carey ML, Sanson-Fisher RW, Blunden SV, Stewart JM, Conigrave KM. A cross-sectional survey assessing the acceptability and feasibility of self-report electronic data collection about health risks from patients attending an Aboriginal Community Controlled Health Service. BMC Med Inform Decis Mak 2014; 14:34. [PMID: 24739205 PMCID: PMC4005463 DOI: 10.1186/1472-6947-14-34] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 04/11/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Aboriginal Australians experience significantly worse health and a higher burden of chronic disease than non-Aboriginal Australians. Electronic self-report data collection is a systematic means of collecting data about health risk factors which could help to overcome screening barriers and assist in the provision of preventive health care. Yet this approach has not been tested in an Aboriginal health care setting. Therefore, the aim of this study was to examine the acceptability and feasibility of a health risk questionnaire administered on a touch screen laptop computer for patients attending an Aboriginal Community Controlled Health Service (ACCHS). METHODS In 2012, consecutive adult patients attending an ACCHS in rural New South Wales, Australia, were asked to complete a health risk survey on a touch screen computer. Health risk factors assessed in the questionnaire included smoking status, body mass index, and level of physical activity. The questionnaire included visual cues to improve accuracy and minimise literacy barriers and was completed while participants were waiting for their appointment. RESULTS A total of 188 participants completed the questionnaire, with a consent rate of 71%. The mean time taken to complete the questionnaire was less than 12 minutes. Over 90% of participants agreed that: the questionnaire instructions were easy to follow; the touch screen computer was easy to use; they had enough privacy; the questions were easy to understand; they felt comfortable answering all the questions. CONCLUSIONS Results indicate that the use of a touch screen questionnaire to collect information from patients about health risk factors affecting Aboriginal Australians is feasible and acceptable in the ACCHS setting. This approach has potential to improve identification and management of at-risk individuals, therein providing significant opportunities to reduce the burden of disease among Aboriginal Australians.
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Affiliation(s)
- Natasha E Noble
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Christine L Paul
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Mariko L Carey
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Robert W Sanson-Fisher
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | | | - Jessica M Stewart
- National Health Performance Authority, Level 9, Oxford St, Sydney NSW 2001, Australia
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20
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Access to chronic disease care in general practice: the acceptability of implementing systematic waiting-room screening using computer-based patient-reported risk status. Br J Gen Pract 2014; 63:e620-6. [PMID: 23998842 DOI: 10.3399/bjgp13x671605] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Routine screening and advice regarding risky lifestyle behaviours is appropriate in the primary care setting, but often not implemented. Routine electronic collection of patients' self-reported data may streamline the collection of such information. AIM To explore the perceptions of GPs and their attending patients regarding the acceptability of waiting-room touchscreen computers for the collection of health behaviour information. Uptake, ease of operation, and the perceived likelihood of future implementation were studied. DESIGN AND SETTING Cross-sectional health-risk survey. General practices in metropolitan areas in Australia. METHOD Practices were randomly selected by postcode. Consecutive patients who were eligible to take part in the study were approached in the waiting room and invited to do so. Participants completed the touchscreen health survey. A subsample of patients and GPs completed additional items regarding acceptability. RESULTS Twelve general practices participated in the study, with 4058 patients (86%) and 51 of 68 (75%) GPs consenting to complete the health-risk survey, 596 patients and 30 GPs were selected to complete the acceptability survey. A majority of the 30 GPs indicated that the operation of the survey was not disruptive to practice and more than 90% of patients responded positively to all items regarding its operation. More than three-quarters of the patient sample were willing to consider allowing their responses to be kept on file and complete such surveys in the future. CONCLUSION As waiting-room-based collection of this information appears to be both feasible and acceptable, practitioners should consider collecting and incorporating routine patient-reported health behaviours for inclusion in the medical record.
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21
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Yoong SL, Carey ML, Sanson-Fisher RW, D'Este CA, Mackenzie L, Boyes A. A cross-sectional study examining Australian general practitioners' identification of overweight and obese patients. J Gen Intern Med 2014; 29:328-34. [PMID: 24101533 PMCID: PMC3912305 DOI: 10.1007/s11606-013-2637-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 08/23/2013] [Accepted: 09/10/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Overweight and obese patients attempt weight loss when advised to do so by their physicians; however, only a small proportion of these patients report receiving such advice. One reason may be that physicians do not identify their overweight and obese patients. OBJECTIVES We aimed to determine the extent that Australian general practitioners (GP) recognise overweight or obesity in their patients, and to explore patient and GP characteristics associated with non-detection of overweight and obesity. METHODS Consenting adult patients (n = 1,111) reported weight, height, demographics and health conditions using a touchscreen computer. GPs (n = 51) completed hard-copy questionnaires indicating whether their patients were overweight or obese. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for GP detection, using patient self-reported weight and height as the criterion measure for overweight and obesity. For a subsample of patients (n = 107), we did a sensitivity analysis with patient-measured weight and height. We conducted an adjusted, multivariable logistic regression to explore characteristics associated with non-detection, using random effects to adjust for correlation within GPs. RESULTS Sensitivity for GP assessment was 63 % [95 % CI 57-69 %], specificity 89 % [95 % CI 85-92 %], PPV 87 % [95 % CI 83-90 %] and NPV 69 % [95 % CI 65-72 %]. Sensitivity increased by 3 % and specificity was unchanged in the sensitivity analysis. Men (OR: 1.7 [95 % CI 1.1-2.7]), patients without high blood pressure (OR: 1.8 [95 % CI 1.2-2.8]) and without type 2 diabetes (OR: 2.4 [95 % CI 1.2-8.0]) had higher odds of non-detection. Individuals with obesity (OR: 0.1 [95 % CI 0.07-0.2]) or diploma-level education (OR: 0.3 [95%CI 0.1-0.6]) had lower odds of not being identified. No GP characteristics were associated with non-detection of overweight or obesity. CONCLUSIONS GPs missed identifying a substantial proportion of overweight and obese patients. Strategies to support GPs in identifying their overweight or obese patients need to be implemented.
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Affiliation(s)
- Sze Lin Yoong
- Priority Research Centre for Health Behaviour and Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, 2308, Australia,
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Yoong SL, Carey ML, Sanson-Fisher RW, D’Este CA. A cross-sectional study assessing Australian general practice patients' intention, reasons and preferences for assistance with losing weight. BMC FAMILY PRACTICE 2013; 14:187. [PMID: 24321022 PMCID: PMC4029270 DOI: 10.1186/1471-2296-14-187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 12/02/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND The high prevalence of overweight and obesity in the population is concerning, as these conditions increase an individual's risk of various chronic diseases. General practice is an ideal setting to target the reduction of overweight or obesity. Examining general practice patients' intentions to lose weight and preferences for assistance with managing their weight is likely to be useful in informing weight management care provided in this setting. Thus, this study aimed to: 1) identify the proportion and characteristics of patients intending to change weight in the next six months; 2) reasons for intending to change weight and preferences for different modes of weight management assistance in overweight and obese patients. METHODS A cross-sectional study was conducted with 1,306 Australian adult general practice patients. Consenting patients reported via a touchscreen computer questionnaire their demographic characteristics, intention to lose weight in the next six months, reasons for wanting to lose weight, preferred personnel to assist with weight loss and willingness to accept support delivered via telephone, mobile and internet. RESULTS Fifty six percent (n = 731) of patients intended to lose weight in the next six months. Females, younger patients, those with a level of education of trade certificate and above or those with high cholesterol had significantly higher odds of intending to lose weight. "Health" was the top reason for wanting to lose weight in normal weight (38%), overweight (57%) and obese (72%) patients. More than half of overweight (61%) or obese (74%) patients reported that they would like help to lose weight from one of the listed personnel, with the dietitian and general practitioner (GP) being the most frequently endorsed person to help patients with losing weight. Almost 90% of overweight or obese participants indicated being willing to accept support with managing their weight delivered via the telephone. CONCLUSIONS Most overweight or obese general practice patients intended to lose their weight in the next six months for health reasons. Younger females, with higher level of education or had high cholesterol had significantly higher odds of reporting intending to lose weight in the next six months. An opportunity exists for GPs to engage patients in weight loss discussions in the context of improving health. Interventions involving GP and dietitians with weight management support delivered via telephone, should be explored in future studies in this setting.
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Affiliation(s)
- Sze Lin Yoong
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, W4 Hunter Medical Research Institute, University of Newcastle, Newcastle 2308, Callaghan, Australia
| | - Mariko Leanne Carey
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, W4 Hunter Medical Research Institute, University of Newcastle, Newcastle 2308, Callaghan, Australia
| | - Robert William Sanson-Fisher
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, W4 Hunter Medical Research Institute, University of Newcastle, Newcastle 2308, Callaghan, Australia
| | - Catherine Anne D’Este
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, W4 Hunter Medical Research Institute, University of Newcastle, Newcastle 2308, Callaghan, Australia
- Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Hights 2305, Australia
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Prostate specific antigen testing in family practice: a cross sectional survey of self-reported rates of and reasons for testing participation and risk disclosure. BMC FAMILY PRACTICE 2013; 14:186. [PMID: 24321004 PMCID: PMC4029150 DOI: 10.1186/1471-2296-14-186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 12/04/2013] [Indexed: 12/31/2022]
Abstract
Background Despite controversy about the benefits of routine prostate specific antigen (PSA) testing, rates of participation continue to rise. It is important to ensure that men are fully informed about the potential risks associated with this test. Little is known about the processes of shared decision making for PSA testing in the family practice setting. This study aimed to explore men’s experiences of PSA testing participation and risk disclosure for PSA testing. Methods A cross-sectional survey of male family practice attendees aged 40 years or older, with no previous history of prostate cancer, between June 2010 and November 2011. Questions related to whether participants had undertaken PSA testing or discussed this with their doctor over the past 5 years, whether the patient or doctor had initiated the discussion, reasons for undergoing testing, and whether their doctor had discussed particular risks associated with PSA testing. Results Sixty-seven percent (215/320) of men recalled having a PSA test in the past five years. Of the respondents who reported not having a test, 14% had discussed it with their doctor. The main reasons for having a PSA test were doctor recommendation and wanting to keep up to date with health tests. Thirty-eight percent or fewer respondents reported being advised of each potential risk. Conclusions Despite debate over the benefits of routine PSA testing, a high proportion of male family practice attendees report undertaking this test. Risks associated with testing appear to be poorly disclosed by general practitioners. These results suggest the need to improve the quality of informed consent for PSA testing in the family practice setting.
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