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Villanueva-Blasco VJ, Eslava D, Olave L, Torrens M. Electronic interventions in primary care to address substance use: A systematic review. Addict Behav 2024; 156:108073. [PMID: 38821009 DOI: 10.1016/j.addbeh.2024.108073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/02/2024]
Abstract
The present systematic review aims to identify electronic interventions for addressing substance use and understand their effectiveness in primary care settings. A systematic search was carried out in the Web of Science, PubMed/MEDLINE, Scopus, and Cochrane Library. The search included the keywords "electronic intervention", "substance use", "primary care" and synonyms. To determine the quality and recommendation of the analyzed interventions, the efficacy results reported by the studies were considered, as well as the Mixed Methods Appraisal Tool (MMAT) assessment and the GRADE Evidence Assessment. Twenty-one electronic interventions in Primary Care were identified: internet, mobile or tablet applications, text messages, emails, automated telephone calls, or electronic self-reports. These interventions had diverse components, incorporating theories that have proven effective in face-to-face interventions as their theoretical frameworks. Some of them were complementary to in-person treatment, while others replaced it. Six interventions (28.5 %) displayed high quality: HealthCall, AB-CASI, Quit Genius, eCHECKUP-TOGO, CBI, and TES. Another nine interventions (42.8 %) were found to have moderate-high quality: Alcohol y Salud, IVR-BI, Program of Wallace et al., Let's Talk About Smoking, SMSalud, ESCAPE, AAC-ASPIRE, iQuit, and Programa VIH. One intervention (4.7 %) had moderate-low quality: Vive sin tabaco ¡Decídete! The remaining five interventions (23.8 %) were found to have very low quality: Connection to health, cSBI, Teen Well Check, the program of Helzer et al. (2008), and Down your drink. The programs with the highest recommendation for addressing alcohol-related issues are HealthCall and AB-CASI; for tobacco use, it is Quit Genius; for cannabis use, it is eCHECKUP-TOGO; for addressing both legal and illegal substances, it is CBI and TES. Finally, for specific illicit drug use, the only recommended program is CBI. This last intervention, CBI, is of the highest quality and, therefore, can be considered a model intervention for dissemination in the primary care setting.
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Affiliation(s)
- Víctor J Villanueva-Blasco
- Faculty of Health Sciences, Valencian International University, C/ Pintor Sorolla, 21, 46002, Spain; Research Group on Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, Spain; Research Network in Primary Addiction Care (RIAPAd), Spain.
| | - Dalila Eslava
- Research Network in Primary Addiction Care (RIAPAd), Spain; Faculty of Human Sciences and Education, University of Zaragoza, Spain.
| | - Leticia Olave
- Faculty of Health Sciences, Valencian International University, C/ Pintor Sorolla, 21, 46002, Spain; Research Group on Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, Spain.
| | - Marta Torrens
- Research Network in Primary Addiction Care (RIAPAd), Spain; Addiction Research Group (GRAd), Neuroscience Research Program, Hospital del Mar Research Institute, Spain; School of Medicine, Universitat de Vic-Central de Catalunya (UCC), Spain.
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Rafiq M, Mazzocato P, Guttmann C, Spaak J, Savage C. Predictive analytics support for complex chronic medical conditions: An experience-based co-design study of physician managers' needs and preferences. Int J Med Inform 2024; 187:105447. [PMID: 38598905 DOI: 10.1016/j.ijmedinf.2024.105447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/05/2023] [Accepted: 04/05/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The literature suggests predictive technology applications in health care would benefit from physician and manager input during design and development. The aim was to explore the needs and preferences of physician managers regarding the role of predictive analytics in decision support for patients with the highly complex yet common combination of multiple chronic conditions of cardiovascular (Heart) and kidney (Nephrology) diseases and diabetes (HND). METHODS This qualitative study employed an experience-based co-design model comprised of three data gathering phases: 1. Patient mapping through non-participant observations informed by process mining of electronic health records data, 2. Semi-structured experience-based interviews, and 3. A co-design workshop. Data collection was conducted with physician managers working at or collaborating with the HND center, Danderyd University Hospital (DSAB), in Stockholm, Sweden. HND center is an integrated practice unit offering comprehensive person-centered multidisciplinary care to stabilize disease progression, reduce visits, and develop treatment strategies that enables a transition to primary care. RESULTS Interview and workshop data described a complex challenge due to the interaction of underlying pathophysiologies and the subsequent need for multiple care givers that hindered care continuity. The HND center partly met this challenge by coordinating care through multiple interprofessional and interdisciplinary shared decision-making interfaces. The large patient datasets were difficult to operationalize in daily practice due to data entry and retrieval issues. Predictive analytics was seen as a potentially effective approach to support decision-making, calculate risks, and improve resource utilization, especially in the context of complex chronic care, and the HND center a good place for pilot testing and development. Simplicity of visual interfaces, a better understanding of the algorithms by the health care professionals, and the need to address professional concerns, were identified as key factors to increase adoption and facilitate implementation. CONCLUSIONS The HND center serves as a comprehensive integrated practice unit that integrates different medical disciplinary perspectives in a person-centered care process to address the needs of patients with multiple complex comorbidities. Therefore, piloting predictive technologies at the same time with a high potential for improving care represents an extreme, demanding, and complex case. The study findings show that health care professionals' involvement in the design of predictive technologies right from the outset can facilitate the implementation and adoption of such technologies, as well as enhance their predictive effectiveness and performance. Simplicity in the design of predictive technologies and better understanding of the concept and interpretation of the algorithms may result in implementation of predictive technologies in health care. Institutional efforts are needed to enhance collaboration among the health care professionals and IT professionals for effective development, implementation, and adoption of predictive analytics in health care.
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Affiliation(s)
- Muhammad Rafiq
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, 171 65 Stockholm, Sweden.
| | - Pamela Mazzocato
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, 171 65 Stockholm, Sweden; Södertälje Hospital, Research, Development, Innovation and Education unit, Rosenborgsgatan 6-10, 152 40 Södertälje, Sweden.
| | - Christian Guttmann
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, 171 65 Stockholm, Sweden; Nordic Artificial Intelligence Institute, Garvis Carlssons Gata 4, 16941 Stockholm, Sweden.
| | - Jonas Spaak
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, 171 65 Stockholm, Sweden; Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, 182 88 Stockholm, Sweden.
| | - Carl Savage
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, 171 65 Stockholm, Sweden; School of Health and Welfare, Halmstad University, Halmstad, Sweden.
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Boudreau JH, Moo LR, Kennedy MA, Conti J, Anwar C, Pimentel CB, Nearing KA, Hung WW, Dryden EM. Needs for Successful Engagement in Telemedicine Among Rural Older US Veterans and Their Caregivers: Qualitative Study. JMIR Form Res 2024; 8:e50507. [PMID: 38713503 PMCID: PMC11109863 DOI: 10.2196/50507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Telemedicine is an important option for rural older adults who often must travel far distances to clinics or forgo essential care. In 2014, the Geriatric Research, Education, and Clinical Centers (GRECC) of the US Veterans Health Administration (VA) established a national telemedicine network called GRECC Connect. This network increased access to geriatric specialty care for the 1.4 million rural VA-enrolled veterans aged 65 years or older. The use of telemedicine skyrocketed during the COVID-19 pandemic, which disproportionately impacted older adults, exacerbating disparities in specialty care access as overburdened systems shut down in-person services. This surge presented a unique opportunity to study the supports necessary for those who would forgo telemedicine if in-person care were available. OBJECTIVE In spring 2021, we interviewed veterans and their informal caregivers to (1) elicit their experiences attempting to prepare for a video visit with a GRECC Connect geriatric specialist and (2) explore facilitators and barriers to successful engagement in a telemedicine visit. METHODS We conducted a cross-sectional qualitative evaluation with patients and their caregivers who agreed to participate in at least 1 GRECC Connect telemedicine visit in the previous 3 months. A total of 30 participants from 6 geographically diverse GRECC Connect hub sites agreed to participate. Semistructured interviews were conducted through telephone or the VA's videoconference platform for home telemedicine visits (VA Video Connect) per participant preference. We observed challenges and, when needed, provided real-time technical support to facilitate VA Video Connect use for interviews. All interviews were recorded with permission and professionally transcribed. A team of 5 researchers experienced in qualitative research analyzed interview transcripts using rapid qualitative analysis. RESULTS From 30 participant interviews, we identified the following 4 categories of supports participants described regarding successful engagement in telemedicine, as defined by visit completion, satisfaction, and willingness to engage in telemedicine in the future: (1) caregiver presence to facilitate technology setup and communication; (2) flexibility in visit modality (eg, video from home or a clinic or telephone); (3) technology support (eg, determining device compatibility or providing instruction and on-demand assistance); and (4) assurance of comfort with web-based communication, including orientation to features like closed captioning. Supports were needed at multiple points before the visit, and participants stressed the importance of eliciting the varying needs and preferences of each patient-caregiver dyad. Though many initially agreed to a telemedicine visit because of pandemic-related clinic closures, participants were satisfied with telemedicine and willing to use it for other types of health care visits. CONCLUSIONS To close gaps in telemedicine use among rural older adults, supports must be tailored to individuals, accounting for technology availability and comfort, as well as availability of and need for caregiver involvement. Comprehensive scaffolding of support starts well before the first telemedicine visit.
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Affiliation(s)
- Jacqueline Hannah Boudreau
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
| | - Lauren R Moo
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
- Department of Family Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Jennifer Conti
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
| | - Chitra Anwar
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
| | - Camilla B Pimentel
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Kathryn A Nearing
- Eastern Colorado VA Geriatric Research Education and Clinical Center, Aurora, CO, United States
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - William W Hung
- Bronx Geriatric Research Education and Clinical Center, James J Peters VA Medical Center, Bronx, New York, NY, United States
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, NY, United States
| | - Eileen M Dryden
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, US Department of Veterans Affairs, Bedford, MA, United States
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Domlyn AM, Crowder C, Eisenson H, Pollak KI, Davis JM, Calhoun PS, Wilson SM. Implementation mapping for tobacco cessation in a federally qualified health center. Front Public Health 2022; 10:908646. [PMID: 36117603 PMCID: PMC9478793 DOI: 10.3389/fpubh.2022.908646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/04/2022] [Indexed: 01/22/2023] Open
Abstract
Background Implementation mapping (IM) is a promising five-step method for guiding planning, execution, and maintenance of an innovation. Case examples are valuable for implementation practitioners to understand considerations for applying IM. This pilot study aimed to determine the feasibility of using IM within a federally qualified health center (FQHC) with limited funds and a 1-year timeline. Methods An urban FQHC partnered with an academic team to employ IM for implementing a computerized strategy of tobacco cessation: the 5A's (Ask, Advise, Assess, Assist, Arrange). Each step of IM was supplemented with theory-driven methods and frameworks. Data collection included surveys and interviews with clinic staff, analyzed via rapid data analysis. Results Medical assistants and clinicians were identified as primary implementers of the 5A's intervention. Salient determinants of change included the perceived compatibility and relative priority of 5A's. Performance objectives and change objectives were derived to address these determinants, along with a suite of implementation strategies. Despite indicators of adoptability and acceptability of the 5A's, reductions in willingness to adopt the implementation package occurred over time and the intervention was not adopted by the FQHC within the study timeframe. This is likely due to the strain of the COVID-19 pandemic altering health clinic priorities. Conclusions Administratively, the five IM steps are feasible to conduct with FQHC staff within 1 year. However, this study did not obtain its intended outcomes. Lessons learned include the importance of re-assessing barriers over time and ensuring a longer timeframe to observe implementation outcomes.
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Affiliation(s)
- Ariel M. Domlyn
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, United States
| | | | - Howard Eisenson
- Lincoln Community Health Center, Durham, NC, United States
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, United States
| | - Kathryn I. Pollak
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Duke Cancer Institute, Duke University Health System, Durham, NC, United States
| | - James M. Davis
- Duke Cancer Institute, Duke University Health System, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Patrick S. Calhoun
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, United States
- Duke Cancer Institute, Duke University Health System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Sarah M. Wilson
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Duke Cancer Institute, Duke University Health System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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Bondaronek P, Dicken SJ, Singh Jennings S, Mallion V, Stefanidou C. Barriers to and Facilitators of the Use of Digital Tools in Primary Care to Deliver Physical Activity Advice: Semistructured Interviews and Thematic Analysis. JMIR Hum Factors 2022; 9:e35070. [PMID: 36040764 PMCID: PMC9472053 DOI: 10.2196/35070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/11/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022] Open
Abstract
Background Physical inactivity is a leading risk factor for many health conditions, including cardiovascular disease, diabetes, and cancer; therefore, increasing physical activity (PA) is a public health priority. Health care professionals (HCPs) in primary care are pivotal in addressing physical inactivity; however, few HCPs provide PA advice to patients. There can be obstacles to delivering PA advice, including lack of time, confidence, or knowledge. Digital technology has the potential to overcome obstacles and facilitate delivering PA advice. However, it is unknown if and how digital tools are used to deliver PA advice in primary care consultations and what factors influence their use. Objective We aimed to understand the use of digital tools to support primary care consultations and to identify the barriers to and facilitators of using these systems. Methods Overall, 25 semistructured interviews were conducted with primary care HCPs. Professionals were sampled based on profession (general practitioners, practice nurses, and health care assistants), prevalence of long-term conditions within their practice area, and rural-urban classification. The data were analyzed thematically to identify the influences on the use of digital tools. Themes were categorized using the COM-B (capability, opportunity, and motivation—behavior) model and the Theoretical Domains Framework to identify the barriers to and facilitators of using digital tools to support the delivery of PA advice in primary care consultations. Results The identified themes fell within 8 domains of the Theoretical Domains Framework. The most prominent influence (barrier or facilitator) within psychological capability was having the skills to use digital tools. Training in the use of digital tools was also mentioned several times. The most notable influences within physical opportunity were limited digital tools to prompt/support the provision of PA advice, time constraints, efficiency of digital tools, simplicity and ease of use of digital tools, and integration with existing systems. Other physical opportunity influences included lack of access to digital tools and technical support in the use of digital tools. Within social opportunity, a notable barrier was that digital tools reduce interpersonal communication with patients. Patient preference was also identified. Several important influences were within reflective motivation, including confidence to use digital tools, beliefs about the usefulness of digital tools, the belief that digital tools “are the way forward,” beliefs related to data privacy and security concerns, and perceptions about patient capabilities. About automatic motivation, influences included familiarity and availability regarding digital tools and the fact that digital tools prompt behavior. Conclusions A variety of influences were identified on the use of digital tools to support primary care consultations. These findings provide a foundation for designing a digital tool addressing barriers and leverages the facilitators to support PA advice provision within primary care to elicit patient behavior change and increase PA.
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Affiliation(s)
- Paulina Bondaronek
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom.,Research, Translation & Innovation, Public Health England, London, United Kingdom.,Institute of Health Informatics, University College London, London, United Kingdom
| | - Samuel J Dicken
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom.,Research, Translation & Innovation, Public Health England, London, United Kingdom.,Centre for Obesity Research, University College London, London, United Kingdom
| | - Seth Singh Jennings
- Research, Translation & Innovation, Public Health England, London, United Kingdom
| | - Verity Mallion
- Research, Translation & Innovation, Public Health England, London, United Kingdom
| | - Chryssa Stefanidou
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom.,Research, Translation & Innovation, Public Health England, London, United Kingdom
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Puccinelli-Ortega N, Cromo M, Foley KL, Dignan MB, Dharod A, Snavely AC, Miller DP. Facilitators and Barriers to Implementing a Digital Informed Decision Making Tool in Primary Care: A Qualitative Study. Appl Clin Inform 2022; 13:1-9. [PMID: 34986491 PMCID: PMC8731240 DOI: 10.1055/s-0041-1740481] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Informed decision aids provide information in the context of the patient's values and improve informed decision making (IDM). To overcome barriers that interfere with IDM, our team developed an innovative iPad-based application (aka "app") to help patients make informed decisions about colorectal cancer screening. The app assesses patients' eligibility for screening, educates them about their options, and empowers them to request a test via the interactive decision aid. OBJECTIVE The aim of the study is to explore how informed decision aids can be implemented successfully in primary care clinics, including the facilitators and barriers to implementation; strategies for minimizing barriers; adequacy of draft training materials; and any additional support or training desired by clinics. DESIGN This work deals with a multicenter qualitative study in rural and urban settings. PARTICIPANTS A total of 48 individuals participated including primary care practice managers, clinicians, nurses, and front desk staff. APPROACH Focus groups and semi-structured interviews, with data analysis were guided by thematic analysis. KEY RESULTS Salient emergent themes were time, workflow, patient age, literacy, and electronic health record (EHR) integration. Saving time was important to most participants. Patient flow was a concern for all clinic staff, and they expressed that any slowdown due to patients using the iPad module or perceived additional work to clinic staff would make staff less motivated to use the program. Participants voiced concern about older patients being unwilling or unable to utilize the iPad and patients with low literacy ability being able to read or comprehend the information. CONCLUSION Integrating new IDM apps into the current clinic workflow with minimal disruptions would increase the probability of long-term adoption and ultimate sustainability. NIH TRIAL REGISTRY NUMBER R01CA218416-A1.
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Affiliation(s)
- Nicole Puccinelli-Ortega
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States,Address for correspondence Nicole Puccinelli-Ortega, MS Department of Internal Medicine, Medical Center BoulevardWinston-Salem, NC 27157-1063United States
| | - Mark Cromo
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, United States
| | - Kristie L. Foley
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States
| | - Mark B. Dignan
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, United States
| | - Ajay Dharod
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States
| | - Anna C. Snavely
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States
| | - David P. Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, United States
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Nascimento LCD, Campos AM, Figueiredo SB, Nitschke RG, Moncada MJA, Viegas SMDF. TECHNOSOCIALITY AND HEALTH PROMOTION IN THE DAILY LIVES OF PRIMARY CARE USERS: A SCOPING REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to map available evidence on the use of technologies by Primary Health Care users in the context of health promotion. Method: this is a scoping review according to Joanna Briggs Institute, and the recommendations of the international guide Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were followed. The PCC strategy (participants, concept and context) was used. The search in the databases was carried out from January to April 2020. Results: a total of 5,267 studies were retrieved and 28 articles were selected for review. The article origin was diverse, with the largest number being from the United States of America (7), the predominant language is English, the year was 2018 and the level of evidence 2. Studies show that users obtain benefits in health care through the use of technologies. Conclusion: health interventions, using technology, positively impact people’s behavior and lifestyle, focusing on the prevention and control of chronic diseases. It is noteworthy that technologies used in isolation cannot overcome behavioral barriers and their use does not replace one-to-one care and monitoring.
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Kim B, Wilson SM, Mosher TM, Breland JY. Systematic Decision-Making for Using Technological Strategies to Implement Evidence-Based Interventions: An Illustrated Case Study. Front Psychiatry 2021; 12:640240. [PMID: 34079479 PMCID: PMC8166223 DOI: 10.3389/fpsyt.2021.640240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/14/2021] [Indexed: 12/24/2022] Open
Abstract
Technology can improve implementation strategies' efficiency, simplifying progress tracking and removing distance-related barriers. However, incorporating technology is meaningful only if the resulting strategy is usable and useful. Hence, we must systematically assess technological strategies' usability and usefulness before employing them. Our objective was therefore to adapt the effort-vs-impact assessment (commonly used in systems science and operations planning) to decision-making for technological implementation strategies. The approach includes three components - assessing the effort needed to make a technological implementation strategy usable, assessing its impact (i.e., usefulness regarding performance/efficiency/quality), and deciding whether/how to use it. The approach generates a two-by-two effort-vs-impact chart that categorizes the strategy by effort (little/much) and impact (small/large), which serves as a guide for deciding whether/how to use the strategy. We provide a case study of applying this approach to design a package of technological strategies for implementing a 5 A's tobacco cessation intervention at a Federally Qualified Health Center. The effort-vs-impact chart guides stakeholder-involved decision-making around considered technologies. Specification of less technological alternatives helps tailor each technological strategy within the package (minimizing the effort needed to make the strategy usable while maximizing its usefulness), aligning to organizational priorities and clinical tasks. Our three-component approach enables methodical and documentable assessments of whether/how to use a technological implementation strategy, building on stakeholder-involved perceptions of its usability and usefulness. As technology advances, results of effort-vs-impact assessments will likely also change. Thus, even for a single technological implementation strategy, the three-component approach can be repeatedly applied to guide implementation in dynamic contexts.
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Affiliation(s)
- Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Sarah M Wilson
- Center of Innovation for Accelerating Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, United States.,Duke University School of Medicine, Durham, NC, United States
| | | | - Jessica Y Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, United States
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Cordova D, Mendoza Lua F, Muñoz-Velázquez J, Street K, Bauermeister JA, Fessler K, Adelman N, Neilands TB, Boyer CB. A multilevel mHealth drug abuse and STI/HIV preventive intervention for clinic settings in the United States: A feasibility and acceptability study. PLoS One 2019; 14:e0221508. [PMID: 31437240 PMCID: PMC6705861 DOI: 10.1371/journal.pone.0221508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 08/08/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Drug abuse and sexually transmitted infections (STIs), including the human immunodeficiency virus (HIV), remain significant public health concerns in the United States. Youth are at disproportionate risk of drug use and STIs/HIV, yet interventions aimed at improving STI and HIV testing and reducing STI/HIV risk behaviors through technology-based engagement in clinic settings are limited. The purpose of this study was to examine the feasibility and acceptability of Storytelling 4 Empowerment (S4E), a multilevel mobile-health drug abuse and STI/HIV preventive application (app) for clinic settings. We also explored uptake of STI/HIV testing among youth immediately post-intervention. METHOD Employing community-based participatory research principles and a multi-method research design, we developed a clinician-facing app, and examined the feasibility and acceptability of S4E among clinicians (n = 6) and youth (n = 20) in an urban youth-centered community health clinic. S4E aimed to improve clinician-youth risk communication and youths' drug use and STI/HIV knowledge, self-efficacy, and refusal skills. We also explored youths' uptake of STI and HIV testing. Quantitative data were analyzed by computing mean scores and proportions, and qualitative analyses followed the tenets of content analysis. RESULTS Among eligible participants, 86.9% of youth and 85.7% of clinicians enrolled in the study, suggesting the feasibility of recruiting participants from the targeted clinic. Most clinicians identified as non-Hispanic white (83%) and female (66.7%). Among the youth, 70% identified as non-Hispanic white, followed by 30% African American, and 50% identified as female with a mean age of 19.6 (SD = 1.5, Range = 16-21). The quantitative findings suggest that the acceptability of S4E is high, as indicated by the Client Satisfaction Questionnaire (mean score = 25.2, SD: 4.8). Immediately post-intervention, all youth who reported past 90-day condomless sex or having never been tested for STIs or HIV in their lifetime, were tested for both STIs and HIV. Qualitative themes revealed four overarching themes, including S4E: (1) faciliated timely, targeted, and tailored prevention and risk reduction strategies; (2) shaped clinician and youth communication and interaction during the clinic visit; (3) may have improved uptake of STI/HIV testing and increased STI/HIV knowledge and self-efficacy; and (4) had high feasibiliy and acceptability among youth and clninicans. CONCLUSIONS Findings suggest the feasibility and acceptability of S4E in an urban community-based health clinic setting. A next important step is to examine the efficacy of S4E in a randomized controlled trial design.
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Affiliation(s)
- David Cordova
- University of Michigan School of Social Work, Ann Arbor, Michigan, United States of America
| | - Frania Mendoza Lua
- University of Chicago School of Social Service Administration, Chicago, Illinois, United States of America
| | - Jaime Muñoz-Velázquez
- University of Michigan School of Social Work, Ann Arbor, Michigan, United States of America
| | - Katie Street
- University of Michigan School of Social Work, Ann Arbor, Michigan, United States of America
| | - Jose A. Bauermeister
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America
| | - Kathryn Fessler
- The Corner Health Center, Ypsilanti, Michigan, United States of America
| | - Nicole Adelman
- The Corner Health Center, Ypsilanti, Michigan, United States of America
| | | | - Torsten B. Neilands
- University of California, San Francisco, California, United States of America
| | - Cherrie B. Boyer
- University of California, San Francisco, California, United States of America
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10
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Theis RP, Malik AM, Thompson LA, Shenkman EA, Pbert L, Salloum RG. Considerations of Privacy and Confidentiality in Developing a Clinical Support Tool for Adolescent Tobacco Prevention: Qualitative Study. JMIR Form Res 2019; 3:e12406. [PMID: 31066687 PMCID: PMC6528437 DOI: 10.2196/12406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/24/2019] [Indexed: 11/26/2022] Open
Abstract
Background Electronic clinical support tools show promise for facilitating tobacco screening and counseling in adolescent well-care. However, the application of support tools in pediatric settings has not been thoroughly studied. Successfully implementing support tools in local settings requires an understanding of barriers and facilitators from the perspective of both patients and providers. Objective This paper aimed to present the findings of a qualitative study conducted to inform the development and implementation of a support tool for adolescent tobacco screening and counseling in 3 pediatric clinics in North Florida. The primary objective of the study was to test and collect information needed to refine a tablet-based support tool with input from patients and providers in the study clinics. Methods A tablet prototype was designed to collect information from adolescents on tobacco susceptibility and use before their well-care visit and to present tobacco prevention videos based on their responses. Information collected from adolescents by the support tool would be available to providers during the visit to facilitate and streamline tobacco use assessment and counseling components of well-care. Focus groups with providers and staff from 3 pediatric clinics (n=24) identified barriers and facilitators to implementation of the support tool. In-depth interviews with racially and ethnically diverse adolescent patients who screened as susceptible to tobacco use (n=16) focused on acceptability and usability of the tool. All focus groups and interviews were audio-recorded and transcribed for team-based coding using thematic analysis. Results Privacy and confidentiality of information was a salient theme. Both groups expressed concerns that the tool’s audio and visual components would impede privacy and that parents may read their child’s responses or exert control over the process. Nearly all adolescents stated they would be comfortable with the option to complete the tool at home via a Web portal. Most adolescents stated they would feel comfortable discussing tobacco with their doctor. Adolescent interviews elicited 3 emergent themes that added context to perspectives on confidentiality and had practical implications for implementation: (1) purity: an expressed lack of concern for confidentiality among adolescents with no reported history of tobacco use; (2) steadfast honesty: a commitment to being honest with parents and providers about tobacco use, regardless of the situation; and (3) indifference: a perceived lack of relevance of confidentiality, based on the premise that others will “find out anyway” if adolescents are using tobacco. Conclusions This study informed several modifications to the intervention to address confidentiality and introduce efficiency to well-care visits. The support tool was integrated into the electronic health record system used by the study clinics and modified to offer videos to all adolescents regardless of their tobacco use or susceptibility. Future studies will further test the acceptability of the intervention in practice.
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Affiliation(s)
- Ryan P Theis
- Institute for Child Health Policy, Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Ali M Malik
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Lindsay A Thompson
- Institute for Child Health Policy, Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States.,Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Elizabeth A Shenkman
- Institute for Child Health Policy, Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Ramzi G Salloum
- Institute for Child Health Policy, Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
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11
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Wong JC, Izadi Z, Schroeder S, Nader M, Min J, Neinstein AB, Adi S. A Pilot Study of Use of a Software Platform for the Collection, Integration, and Visualization of Diabetes Device Data by Health Care Providers in a Multidisciplinary Pediatric Setting. Diabetes Technol Ther 2018; 20:806-816. [PMID: 30461307 PMCID: PMC6299845 DOI: 10.1089/dia.2018.0251] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Diabetes devices provide data for health care providers (HCPs) and people with type 1 diabetes to make management decisions. Extracting and viewing the data require separate, proprietary software applications for each device. In this pilot study, we examined the feasibility of using a single software platform (Tidepool) that integrates data from multiple devices. MATERIALS AND METHODS Participating HCPs (n = 15) used the software with compatible devices in all patient visits for 6 months. Samples of registration desk activity and office visits were observed before and after introducing the software, and HCPs provided feedback by survey and focus groups. RESULTS The time required to upload data and the length of the office visit did not change. However, the number of times the HCP referred to the device data with patients increased from a mean of 2.8 (±1.2) to 6.1 (±3.1) times per visit (P = 0.0002). A significantly larger proportion of children looked at the device data with the new application (baseline: 61% vs. study end: 94%, P = 0.015). HCPs liked the web-based user interface, integration of the data from multiple devices, the ability to remotely access data, and use of the application to initiate patient education. Challenges included the need for automated data upload and integration with electronic medical records. CONCLUSIONS The software did not add to the time needed to upload data or the length of clinic visits and promoted discussions with patients about data. Future studies of HCP use of the application will evaluate clinical outcomes and effects on patient engagement and self-management.
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Affiliation(s)
- Jenise C. Wong
- Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, San Francisco, California
- Address correspondence to: Jenise C. Wong, MD, PhD, Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, 1500 Owens Street, Suite 300, San Francisco, CA 94158
| | - Zara Izadi
- Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, San Francisco, California
| | - Shannon Schroeder
- Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, San Francisco, California
| | - Marie Nader
- Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, San Francisco, California
| | - Jennifer Min
- Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, San Francisco, California
| | - Aaron B. Neinstein
- Division of Endocrinology and Metabolism, Department of Medicine, Center for Digital Health Innovation, University of California San Francisco, San Francisco, California
| | - Saleh Adi
- Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, San Francisco, California
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12
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Satterfield JM, Gregorich SE, Kalkhoran S, Lum PJ, Bloome J, Alvarado N, Muñoz RF, Vijayaraghavan M. Computer-Facilitated 5A's for Smoking Cessation: A Randomized Trial of Technology to Promote Provider Adherence. Am J Prev Med 2018; 55:35-43. [PMID: 29929682 PMCID: PMC6020838 DOI: 10.1016/j.amepre.2018.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 03/07/2018] [Accepted: 04/02/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Although evidence-based, the 5A's (Ask, Advise, Assess, Assist, and Arrange) for smoking cessation are often incompletely delivered by primary care providers. This study examines whether a computer tablet 5A's intervention improves primary care provider adherence to the 5A's. STUDY DESIGN Cluster RCT. SETTING/PARTICIPANTS All primary care providers in three urban, adult primary care clinics were randomized for participation. Any English- or Spanish-speaking patient with a primary care appointment who had smoked >100 lifetime cigarettes and at least one cigarette in the past week was eligible. INTERVENTION A cluster RCT comparing computer-facilitated 5A's with usual care assessed effects on provider adherence to each of the 5A's as determined by patient report. Intervention subjects used a computer tablet to complete the 5A's immediately before a primary care appointment. A tailored, patient handout and a structured, clinician guide were generated. Data were collected in 2014-2015 and analyzed in 2016-2017. MAIN OUTCOME MEASURES Provider adherence to the 5A's. RESULTS Providers (N=221) saw 961 patients (n=412 intervention, n=549 control) for a total of n=1,340 encounters with n=1,011 completed post-visit interviews (75.4% completion). Intervention providers had significantly higher odds of completing Assess (AOR=1.32, 95% CI=1.02, 1.73) and Assist (AOR=1.45, 95% CI=1.08, 1.94). When looking at first study visits only, intervention providers had higher odds for Arrange (AOR=1.72, 95% CI=1.23, 2.40) and all 5A's (AOR=2.04, 95% CI=1.35, 3.07) but study visit did not influence receipt of the other 5A's. CONCLUSIONS A computer-facilitated 5A's delivery model was effective in improving the fidelity of provider-delivered 5A's to diverse primary care patients. This relatively low-cost, time-saving intervention has great potential for smoking cessation and other health behaviors. Future studies should identify ways to promote and sustain technology implementation. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02046408.
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Affiliation(s)
- Jason M Satterfield
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California.
| | - Steven E Gregorich
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California
| | - Sara Kalkhoran
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paula J Lum
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, California
| | - Jessica Bloome
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, California
| | - Nicholas Alvarado
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California
| | - Ricardo F Muñoz
- Department of Psychiatry, University of California San Francisco, San Francisco, California; Institute for International Internet Interventions for Health, Palo Alto University, Palo Alto, California
| | - Maya Vijayaraghavan
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California
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13
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Evaluation and refinement of a handheld health information technology tool to support the timely update of bedside visual cues to prevent falls in hospitals. INT J EVID-BASED HEA 2018; 16:90-100. [DOI: 10.1097/xeb.0000000000000129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Bailey SR, Stevens VJ, Fortmann SP, Kurtz SE, McBurnie MA, Priest E, Puro J, Solberg LI, Schweitzer R, Masica AL, Hazlehurst B. Long-Term Outcomes From Repeated Smoking Cessation Assistance in Routine Primary Care. Am J Health Promot 2018. [PMID: 29534598 DOI: 10.1177/0890117118761886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To test the association between repeated clinical smoking cessation support and long-term cessation. DESIGN Retrospective, observational cohort study using structured and free-text data from electronic health records. SETTING Six diverse health systems in the United States. PARTICIPANTS Patients aged ≥18 years who were smokers in 2007 and had ≥1 primary care visit in each of the following 4 years (N = 33 691). MEASURES Primary exposure was a composite categorical variable (comprised of documentation of smoking cessation medication, counseling, or referral) classifying the proportions of visits for which patients received any cessation assistance (<25% (reference), 25%-49%, 50%-74%, and ≥75% of visits). The dependent variable was long-term quit (LTQ; yes/no), defined as no indication of being a current smoker for ≥365 days following a visit where nonsmoker or former smoker was indicated. ANALYSIS Mixed effects logistic regression analysis adjusted for age, sex, race, and comorbidities, with robust standard error estimation to account for within site correlation. RESULTS Overall, 20% of the cohort achieved LTQ status. Patients with ≥75% of visits with any assistance had almost 3 times the odds of achieving LTQ status compared to those with <25% visits with assistance (odds ratio = 2.84; 95% confidence interval: 1.50-5.37). Results were similar for specific assistance types. CONCLUSIONS These findings provide support for the importance of repeated assistance at primary care visits to increase long-term smoking cessation.
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Affiliation(s)
- Steffani R Bailey
- 1 Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Victor J Stevens
- 2 Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Stephen E Kurtz
- 2 Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | | | | | | | - Rebecca Schweitzer
- 6 Department is Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI, USA
| | | | - Brian Hazlehurst
- 2 Kaiser Permanente Center for Health Research, Portland, OR, USA
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15
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Satterfield JM. Thinking Outside the Visit: Digitally Extending the Reach of Behavioral Health. J Gen Intern Med 2016; 31:982-4. [PMID: 27177912 PMCID: PMC4978683 DOI: 10.1007/s11606-016-3736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jason M Satterfield
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.
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