It's Complicated: Patient and Informal Caregiver Performance of Outpatient Parenteral Antimicrobial Therapy-Related Tasks

Outpatient parenteral antimicrobial therapy (OPAT) requires patients and caregivers to infuse antimicrobials through venous catheters (VCs) in the home. The objective of this study was to perform a patient-centered goal-directed task analysis to identify what is required for successful completion of OPAT. The authors performed 40 semi-structured patient interviews and 20 observations of patients and caregivers performing OPAT-related tasks. Six overall goals were identified: (1) understanding and developing skills in OPAT, (2) receiving supplies, (3) medication administration and VC maintenance, (4) preventing VC harm while performing activities of daily living, (5) managing when hazards lead to failures, and (6) monitoring status. The authors suggest that patients and caregivers use teach-back, take formal OPAT classes, receive visual and verbal instructions, use cognitive aids, learn how to troubleshoot, and receive clear instructions to address areas of uncertainty. Addressing these goals is essential to ensuring the safety of and positive experiences for our patients.

Promoting colorectal cancer screening in public health outreach campaigns

OBJECTIVE

Research on public outreach campaigns is presented.

BACKGROUND

One study examines the effects of instruction design on adherence to cancer self-screening instructions. A second study examines the effect of persuasive announcements on increasing screening campaign participation.

METHOD

The first study examined adherence to screening (operationalized as returning results for evaluation) given standard instructions, or one of three other versions: persuasive, human factored, or a combination of the two.The second study investigated combining persuasion with a campaign announcement to increase participation (operationalized as picking up a test kit).

RESULTS

The first study found that among first-time participants, the persuasive and human-factored instructions evoked higher result return rates than did the standard. The second study found that participation was significantly increased by adding persuasion to the campaign announcement.

CONCLUSION

Enhancing motivation and reducing cognitive barriers increase adherence to test instructions and increase participation.

APPLICATION

These are simple, cost-effective strategies that increase adherence to cancer screening in public outreach campaigns,which may reduce cancer-specific mortality.

A field test of the effects of instruction design on colorectal cancer self-screening accuracy

A field experiment tested whether instruction design improves accurate adherence to instructions for medical do-it-yourself tests like the Fecal Occult Blood Test (FOBT). As part of an outreach campaign, 16,073 participants received FOBTs with instructions that were (i) human factored, (ii) motivational, (iii) human factored/motivational combined, or (iv) the standard used in the past. Among all test results returned (N = 2483), only the human factors instructions reduced errors in filling out result cards. However, after post-validating result cards that had errors, the human-factored, motivational and merged instructions reduced errors. The present findings show that medical instructions designed with human factors and persuasion principles increase accurate adherence. These design principles provide simple and cost-effective ways to increase test taking accuracy and FOBT effectiveness. Better screening instructions can improve the chances of detecting colorectal cancer early, which may help to decrease cancer mortality.

Chronic Disease Management: Improving Continuity of Care with Human Factors Engineering

The management of chronic disease by patients in the home care setting can involve a varied and complex set of tasks. Food allergy, a chronic and potentially life-threatening condition, is used as a case study to explore the role that human factors engineering can play to improve the continuity of care of patients. In order to gain insight into the cognitive demands involved in the management of this chronic disease, a cognitive task analysis was conducted to identify and characterize the critical decision making tasks confronting food allergy patients. This can provide valuable input to the design and development of tools and resources for use by the clinical practitioner and patient alike. Such tools can: assist the clinical practitioner with teaching patients; assist patients in daily tasks involved in managing their condition; and assist patients (or their families) in teaching others who may care for a pediatric patient with food allergy. It is hoped that such an improvement in continuity of care can lead to better disease management by patients.

Transforming Healthcare

The healthcare system is facing several major quality challenges. In 2005, the Institute of Medicine published a report on how systems engineering and improvements in information technology can help address and solve some of these challenges. Systems engineering (SE) and health informatics (HI) have been undergoing advancements over the years. Health systems engineering is an interdisciplinary field that has grown to encompass the design, analysis, and management of complex health systems to improve quality and performance. HI is another interdisciplinary field around collection, storage, retrieval and analysis of data, reporting and enabling use of information, and (re)design and maintenance of systems to do all of these. SE and HI are complementary in their approach to identification of problems and solution procedure for (re)design and improvement. This combination has major implications for care delivery, research, and education to address the challenges.

Improving Medication Knowledge Among Older Adults With Heart Failure: A Patient-Centered Approach to Instruction Design

PURPOSE

We investigated whether patient-centered instructions for chronic heart failure medications increase comprehension and memory for medication information in older adults diagnosed with chronic heart failure.

DESIGN AND METHODS

Patient-centered instructions for familiar and unfamiliar medications were compared with instructions for the same medications from a chain pharmacy (standard pharmacy instructions). Thirty-two adults (age, M = 63.8) read and answered questions about each instruction, recalled medication information (free recall), and then answered questions from memory (cued recall).

RESULTS

Patient-centered instructions were better recalled and understood more quickly than the standard instructions. Instructions for the familiar medications also were better recalled. Patient-centered instructions were understood more accurately for the unfamiliar medications, but standard instructions were understood more accurately for the familiar medications. However, the recall measures showed that the advantage of the standard format for familiar medications was short lived.

IMPLICATIONS

The findings suggest that the patient-centered format may improve printed medication instructions available in many pharmacies, which should help older adults to better understand how to take their medications.