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Huang L, Zhang L, Huang H, Cai R, Yu H, Li J, Li M, Yu T, Cheng S, Xiao J. Optimizing medication guidance support for patients with cancer pain: development and evaluation of a pharmaceutical care system for healthcare professionals. Support Care Cancer 2024; 32:533. [PMID: 39037493 DOI: 10.1007/s00520-024-08738-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 07/12/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Effective management of cancer pain critically depends on timely medication administration and adherence to precise medication guidelines. In the context of limited time and a busy healthcare environment, tailoring the optimal medication schedule for each patient with cancer pain presents a significant challenge for physicians and clinical pharmacists. METHODS To address this challenge, we conducted a comprehensive analysis of healthcare professionals' needs in guiding cancer pain medication. By developing core features based on key user needs and continuously updating them, we have created the Universal Medication Schedule System (UMSS). We invited 20 physicians and pharmacists specializing in oncology or cancer pain to trial the system and assessed UMSS usage through distributed questionnaires. RESULTS We identified five key needs of healthcare professionals in cancer pain medication guidance. Based on these needs, we (1) constructed a comprehensive drug information database, including basic information for 1135 drugs, 130,590 drug interaction data entries, and 1409 individual medication timing constraints, and (2) developed a web-based system that provides essential reference information such as drug interactions and dietary restrictions. It can create medication schedules and provide medication education tailored to the patient's daily routine. Participating evaluators unanimously agreed (100%) that the system aids in accurately assessing the risks of polypharmacy and quickly scheduling medication regimens. CONCLUSION UMSS, by offering personalized medication schedule support, assists healthcare professionals in better managing patients' medication treatment plans. However, further improvements are needed in the automation of database updates and maintenance, as well as in integrating it with electronic health records.
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Affiliation(s)
- Ling Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, Hunan, China
| | - Lu Zhang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, Hunan, China
| | - Hangxing Huang
- School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Ruwen Cai
- Dali University, Dali, Yunnan, China
| | - Huimin Yu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, Hunan, China
| | - Jingyang Li
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, Hunan, China
| | | | - Ting Yu
- Dali University, Dali, Yunnan, China
| | - Shuqiao Cheng
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, Hunan, China.
| | - Jian Xiao
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, Hunan, China.
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Haji Mukhti MI, Ibrahim MI, Tengku Ismail TA, Nadal IP, Kamalakannan S, Kinra S, Abdullah JM, Musa KI. Exploring the Need for Mobile Application in Stroke Management by Informal Caregivers: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12959. [PMID: 36232257 PMCID: PMC9566614 DOI: 10.3390/ijerph191912959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mobile health (mHealth) has been considered as a prominent concept in digital health and is widely used and easily accessible. Periodic follow-up visits, previously planned procedures, and rehabilitation services for stroke survivors have been cut down during the recent COVID-19 pandemic. Therefore, in this qualitative study we aimed to explore the need for a mobile application in stroke management by informal caregivers. METHODS A phenomenological qualitative study was conducted from November 2020 to June 2021. Thirteen respondents were recruited from two public rehabilitation centers in Kota Bharu, Kelantan, Malaysia. In-depth interviews were conducted. A comprehensive representation of perspectives from the respondents was achieved through purposive sampling. The interviews were conducted in the Kelantanese dialect, recorded, transcribed, and analyzed by using thematic analysis. RESULTS Thirteen participants were involved in the interviews. All of them agreed with the need for a mobile application in stroke management. They believed the future stroke application will help them to seek information, continuous stroke home care, and help in the welfare of caregivers and stroke patients. CONCLUSIONS The current study revealed two themes with respective subthemes that were identified, namely, self-seeking for information and reasons for using a stroke mobile application in the future. This application helps in reducing healthcare costs, enhancing the rehabilitation process, facilitating patient engagement in decision making, and the continuous monitoring of patient health.
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Affiliation(s)
- Muhammad Iqbal Haji Mukhti
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Tengku Alina Tengku Ismail
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | | | - Sureshkumar Kamalakannan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population Health, Keppel Street, London WC1E 7HT, UK
- Department of Social Work, Education and Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle NE7 7XA, UK
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population Health, Keppel Street, London WC1E 7HT, UK
| | - Jafri Malin Abdullah
- Department of Neurosciences, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Department of Neurosciences & Brain and Behaviour Cluster, Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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Kling SMR, Saliba-Gustafsson EA, Winget M, Aleshin MA, Garvert DW, Amano A, Brown-Johnson CG, Kwong BY, Calugar A, El-Banna G, Shaw JG, Asch SM, Ko JM. Teledermatology to Facilitate Patient Care Transitions from Inpatient to Outpatient Dermatology: a Mixed Methods Evaluation (Preprint). J Med Internet Res 2022; 24:e38792. [PMID: 35921146 PMCID: PMC9386584 DOI: 10.2196/38792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 01/26/2023] Open
Abstract
Background Both clinicians and patients have increasingly turned to telemedicine to improve care access, even in physical examination–dependent specialties such as dermatology. However, little is known about whether teledermatology supports effective and timely transitions from inpatient to outpatient care, which is a common care coordination gap. Objective Using mixed methods, this study sought to retrospectively evaluate how teledermatology affected clinic capacity, scheduling efficiency, and timeliness of follow-up care for patients transitioning from inpatient to outpatient dermatology care. Methods Patient-level encounter scheduling data were used to compare the number and proportion of patients who were scheduled and received in-clinic or video dermatology follow-ups within 14 and 90 days after discharge across 3 phases: June to September 2019 (before teledermatology), June to September 2020 (early teledermatology), and February to May 2021 (sustained teledermatology). The time from discharge to scheduling and completion of patient follow-up visits for each care modality was also compared. Dermatology clinicians and schedulers were also interviewed between April and May 2021 to assess their perceptions of teledermatology for postdischarge patients. Results More patients completed follow-up within 90 days after discharge during early (n=101) and sustained (n=100) teledermatology use than at baseline (n=74). Thus, the clinic’s capacity to provide follow-up to patients transitioning from inpatient increased from baseline by 36% in the early (101 from 74) and sustained (100 from 74) teledermatology periods. During early teledermatology use, 61.4% (62/101) of the follow-ups were conducted via video. This decreased significantly to 47% (47/100) in the following year, when COVID-19–related restrictions started to lift (P=.04), indicating more targeted but still substantial use. The proportion of patients who were followed up within the recommended 14 days after discharge did not differ significantly between video and in-clinic visits during the early (33/62, 53% vs 15/39, 38%; P=.15) or sustained (26/53, 60% vs 28/47, 49%; P=.29) teledermatology periods. Interviewees agreed that teledermatology would continue to be offered. Most considered postdischarge follow-up patients to be ideal candidates for teledermatology as they had undergone a recent in-person assessment and might have difficulty attending in-clinic visits because of competing health priorities. Some reported patients needing technological support. Ultimately, most agreed that the choice of follow-up care modality should be the patient’s own. Conclusions Teledermatology could be an important tool for maintaining accessible, flexible, and convenient care for recently discharged patients needing follow-up care. Teledermatology increased clinic capacity, even during the pandemic, although the timeliness of care transitions did not improve. Ultimately, the care modality should be determined through communication with patients to incorporate their and their caregivers’ preferences.
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Affiliation(s)
- Samantha M R Kling
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Erika A Saliba-Gustafsson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Marcy Winget
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Maria A Aleshin
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Donn W Garvert
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Alexis Amano
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Cati G Brown-Johnson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Ana Calugar
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Ghida El-Banna
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Steven M Asch
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Heath Care System, Menlo Park, CA, United States
| | - Justin M Ko
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
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Butler JM, Gibson B, Patterson OV, Damschroder LJ, Halls CH, Denhalter DW, Samore MH, Li H, Zhang Y, DuVall SL. Clinician documentation of patient centered care in the electronic health record. BMC Med Inform Decis Mak 2022; 22:65. [PMID: 35279157 PMCID: PMC8917709 DOI: 10.1186/s12911-022-01794-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background In this study we sought to explore the possibility of using patient centered care (PCC) documentation as a measure of the delivery of PCC in a health system. Methods We first selected 6 VA medical centers based on their scores for a measure of support for self-management subscale from a national patient satisfaction survey (the Survey for Healthcare Experience-Patients). We accessed clinical notes related to either smoking cessation or weight management consults. We then annotated this dataset of notes for documentation of PCC concepts including: patient goals, provider support for goal progress, social context, shared decision making, mention of caregivers, and use of the patient's voice. We examined the association of documentation of PCC with patients’ perception of support for self-management with regression analyses. Results Two health centers had < 50 notes related to either tobacco cessation or weight management consults and were removed from further analysis. The resulting dataset includes 477 notes related to 311 patients total from 4 medical centers. For a majority of patients (201 out of 311; 64.8%) at least one PCC concept was present in their clinical notes. The most common PCC concepts documented were patient goals (patients n = 126; 63% clinical notes n = 302; 63%), patient voice (patients n = 165, 82%; clinical notes n = 323, 68%), social context (patients n = 105, 52%; clinical notes n = 181, 38%), and provider support for goal progress (patients n = 124, 62%; clinical notes n = 191, 40%). Documentation of goals for weight loss notes was greater at health centers with higher satisfaction scores compared to low. No such relationship was found for notes related to tobacco cessation. Conclusion Providers document PCC concepts in their clinical notes. In this pilot study we explored the feasibility of using this data as a means to measure the degree to which care in a health center is patient centered. Practice Implications: clinical EHR notes are a rich source of information about PCC that could potentially be used to assess PCC over time and across systems with scalable technologies such as natural language processing.
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Gloster P, Mash R, Swartz S. Investigating the effect of the Vula Mobile app on coordination of care and capacity building in district health services, Cape Town: Convergent mixed methods study. S Afr Fam Pract (2004) 2021; 63:e1-e13. [PMID: 34636590 PMCID: PMC8517757 DOI: 10.4102/safp.v63i1.5251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 06/07/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Coordinating care is a defining characteristic of high quality primary care. Currently, very little is known about coordination of care in South Africa's primary care setting. The Vula Mobile app was introduced in 2018 to assist with referring patients from primary care facilities to the Eerste River District Hospital (ERDH) emergency centre. The aim of this study was to evaluate the use of the app and its effect on coordination of care and capacity building of staff. METHODS Convergent mixed methods were used with quantitative data collected from hospital records and the Vula Mobile database, and with qualitative data collected from health professionals in primary care and the district hospital. RESULTS Out of 13 321 patients seen in the emergency centre of the district hospital over the 6-month study period, only 1932 (14.5%) of the patients were referred with Vula. Most of these referrals were accepted (85.5%). Sometimes, advice was given to (35.0%) or additional information was requested (27.4%) from the referring doctor. There was little use of Vula in providing other feedback (0.6%). The introduction of the Vula app led to a decrease in the number of inappropriately referred patients (6.7% to 4.2%, p = 0.004). Doctors using the Vula app perceived that it improved care coordination and had the potential for useful feedback. CONCLUSION Vula improved coordination of patients referred from primary care facilities in the Metro Health Services to the district hospital, but missed the opportunity to support continuing professional development and learning. Utilisation of the Vula app should be increased and its potential to provide feedback should be enhanced. Attention should be given to reducing the number of patients self-referred or referred without using the Vula app.
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Affiliation(s)
- Patrick Gloster
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Chaudhry AP, Hankey RA, Kaggal VC, Bhopalwala H, Liedl DA, Wennberg PW, Rooke TW, Scott CG, Disdier Moulder MP, Hendricks AK, Casanegra AI, McBane RD, Shellum JL, Kullo IJ, Nishimura RA, Chaudhry R, Arruda-Olson AM. Usability of a Digital Registry to Promote Secondary Prevention for Peripheral Artery Disease Patients. Mayo Clin Proc Innov Qual Outcomes 2021; 5:94-102. [PMID: 33718788 PMCID: PMC7930799 DOI: 10.1016/j.mayocpiqo.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate usability of a quality improvement tool that promotes guideline-based care for patients with peripheral arterial disease (PAD). Patients and Methods The study was conducted from July 19, 2018, to August 21, 2019. We compared the usability of a PAD cohort knowledge solution (CKS) with standard management supported by an electronic health record (EHR). Two scenarios were developed for usability evaluation; the first for the PAD-CKS while the second evaluated standard EHR workflow. Providers were asked to provide opinions about the PAD-CKS tool and to generate a System Usability Scale (SUS) score. Metrics analyzed included time required, number of mouse clicks, and number of keystrokes. Results Usability evaluations were completed by 11 providers. SUS for the PAD-CKS was excellent at 89.6. Time required to complete 21 tasks in the CKS was 4 minutes compared with 12 minutes for standard EHR workflow (median, P = .002). Completion of CKS tasks required 34 clicks compared with 148 clicks for the EHR (median, P = .002). Keystrokes for CKS task completion was 8 compared with 72 for EHR (median, P = .004). Providers indicated that overall they found the tool easy to use and the PAD mortality risk score useful. Conclusions Usability evaluation of the PAD-CKS tool demonstrated time savings, a high SUS score, and a reduction of mouse clicks and keystrokes for task completion compared to standard workflow using the EHR. Provider feedback regarding the strengths and weaknesses also created opportunities for iterative improvement of the PAD-CKS tool.
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Affiliation(s)
- Alisha P. Chaudhry
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Ronald A. Hankey
- Information Technology, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Vinod C. Kaggal
- Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Huzefa Bhopalwala
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - David A. Liedl
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Paul W. Wennberg
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Thom W. Rooke
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Christopher G. Scott
- Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, MN
| | | | - Abby K. Hendricks
- Department of Pharmacy, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Ana I. Casanegra
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Robert D. McBane
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Jane L. Shellum
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Iftikhar J. Kullo
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Rick A. Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Rajeev Chaudhry
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic and Mayo Foundation, Rochester, MN
- Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Adelaide M. Arruda-Olson
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN
- Correspondence: Adelaide M. Arruda-Olson, MD, PhD, 200 First Street SW, Rochester, MN 55905
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Roberts S, Chaboyer W, Hopper Z, Marshall AP. Using Technology to Promote Patient Engagement in Nutrition Care: A Feasibility Study. Nutrients 2021; 13:nu13020314. [PMID: 33499271 PMCID: PMC7910973 DOI: 10.3390/nu13020314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 11/24/2022] Open
Abstract
Empowering patients to participate in nutrition care during hospitalisation may improve their dietary intakes and associated outcomes. This study tested the acceptability and feasibility of a technology-based intervention to engage hospital patients in nutrition care at a tertiary teaching hospital in Australia. The hospital used an electronic foodservice system (EFS), by which patients ordered meals via bedside computers. Adults at nutritional risk received the nutrition technology (NUTRI-TEC) intervention, involving nutrition assessment, education on nutrition requirements and training on using the EFS to enter food intakes and monitor nutrition goals. Acceptability was assessed using patient satisfaction and engagement surveys. Feasibility was assessed by evaluating the intervention delivery/fidelity and patient recruitment/retention. Patients’ dietary intakes were observed daily to indicate the intervention’s effects and assess the accuracy of the patient-recorded intakes. Descriptive and inferential statistics were used to analyse the data. Of the 71 patients recruited, 49 completed the study (55% male; median (IQR) age 71 (65–78) years; length of stay 10 (7–14) days). Patient satisfaction with NUTRI-TEC was high. Intervention delivery and fidelity targets were met but recruitment (≥50%) and retention (≥75%) targets were not; only 31% of patients agreed to participate and 69% completed the study (mostly due to unexpected/early discharge). Patient- and researcher-recorded dietary intakes correlated strongly, indicating patients can record food intakes accurately using technology. This study highlights the important role technology is likely to play in facilitating patient engagement and improving care during hospitalisation.
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Affiliation(s)
- Shelley Roberts
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD 4222, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; (W.C.); (A.P.M.)
- Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia;
- Correspondence: ; Tel.: +61-7-5552-9557
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; (W.C.); (A.P.M.)
- School of Nursing and Midwifery, Griffith University, Gold Coast, QLD 4222, Australia
| | - Zane Hopper
- Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia;
| | - Andrea P. Marshall
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; (W.C.); (A.P.M.)
- Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia;
- School of Nursing and Midwifery, Griffith University, Gold Coast, QLD 4222, Australia
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Butler JM, Gibson B, Lewis L, Reiber G, Kramer H, Rupper R, Herout J, Long B, Massaro D, Nebeker J. Patient-centered care and the electronic health record: exploring functionality and gaps. JAMIA Open 2020; 3:360-368. [PMID: 33215071 PMCID: PMC7660957 DOI: 10.1093/jamiaopen/ooaa044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/21/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Healthcare systems have adopted electronic health records (EHRs) to support clinical care. Providing patient-centered care (PCC) is a goal of many healthcare systems. In this study, we sought to explore how existing EHR systems support PCC; defined as understanding the patient as a whole person, building relational connections between the clinician and patient, and supporting patients in health self-management. MATERIALS AND METHODS We assessed availability of EHR functions consistent with providing PCC including patient goals and preferences, integrated care plans, and contextual and patient-generated data. We surveyed and then interviewed technical representatives and expert clinical users of 6 leading EHR systems. Questions focused on the availability of specific data and functions related to PCC (for technical representatives) and the clinical usefulness of PCC functions (for clinicians) in their EHR. RESULTS Technical representatives (n = 6) reported that patient communication preferences, personalized indications for medications, and end of life preferences were functions implemented across 6 systems. Clinician users (n = 10) reported moderate usefulness of PCC functions (medians of 2-4 on a 5-pointy -35t scale), suggesting the potential for improvement across systems. Interviews revealed that clinicians do not have a shared conception of PCC. In many cases, data needed to deliver PCC was available in the EHR only in unstructured form. Data systems and functionality to support PCC are under development in these EHRs. DISCUSSION AND CONCLUSION There are current gaps in PCC functionality in EHRs and opportunities to support the practice of PCC through EHR redesign.
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Affiliation(s)
- Jorie M Butler
- Geriatric Research and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Lacey Lewis
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Gayle Reiber
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Heidi Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Rand Rupper
- Geriatric Research and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer Herout
- Department of Veterans Affairs Office of Health Informatics, Washington, District of Columbia, USA
| | - Brenna Long
- Department of Veterans Affairs Office of Health Informatics, Washington, District of Columbia, USA
| | - David Massaro
- Department of Veterans Affairs Office of Health Informatics, Washington, District of Columbia, USA
| | - Jonathan Nebeker
- Geriatric Research and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Veterans Affairs Office of Health Informatics, Washington, District of Columbia, USA
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Pain Management and Its Possible Implementation Research in North Ethiopia: A before and after Study. Adv Med 2020; 2020:5317352. [PMID: 32566691 PMCID: PMC7288047 DOI: 10.1155/2020/5317352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/22/2020] [Accepted: 05/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Though there is an effective intervention, pain after surgical intervention is undermanaged worldwide. A systematic implementation is required to increase the utilization of available evidence-based intervention to manage the inevitable pain after surgery. The aim of this research project is to develop a scalable model for managing pain after cesarean section by implementing the World Health Organization's (WHO) pain management guidelines through a combination of implementation research and quality improvement methods. METHODS We implemented the World Health Organization (WHO) pain management guidelines using effective implementation strategies. First, we conducted a formative qualitative exploration to identify enablers and obstacles. In addition, we took base-line assessment on pain management implementation process and outcome using a checklist prepared from the guideline and an adapted American Pain Outcome assessment tool version 2010, respectively. Then, we integrated the guidelines into the existing practice by using collaborative iterative learning strategy. We analyzed the data by Statistical Packages for Social Sciences (SPSS) version 21. We compared the before and after data using chi-squared and Fischer's exact test. A change in any measurement was considered as significant at p value 0.05. RESULT We collected data from 106 mothers before and 110 mothers after intervention implementation. We successfully integrated pain as a fifth vital sign in more than 87% (p value <0.001) of patient, and fidelity was approximately 59% (p value <0.001). In addition, we significantly improved pain outcome measures after the implementation of the intervention. Conclusion and Recommendations. A systematic approach to implement pain management guidelines was successful. We recommend the ward sustain these gains and that hospital, the region, and the nation to replicate the success.
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Seale DE, LeRouge CM, Ohs JE, Tao D, Lach HW, Jupka K, Wray R. Exploring Early Adopter Baby Boomers' Approach to Managing Their Health and Healthcare. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2019. [DOI: 10.4018/ijehmc.2019010106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Patient 3.0 Profile is used to explore to the patient engagement strategies of early adopter baby boomers' in three domains: 1) patient relationships, 2) health information use and 3) consumer health technology (CHT) use. Findings from six focus groups with early adopter boomers challenge prior notions about older adults' passive approach to patient engagement. Baby boomers want to make final healthcare decisions with input from providers. While adept at finding and critically assessing online health information for self-education and self-management, boomers want providers to curate relevant and trustworthy information. Boomers embrace CHTs offered through providers (i.e., patient portals, email and text messaging) and sponsored by wellness programs (i.e., diet and activity devices and apps). However, there is no indication they add information to their online medical records or use CHT for diagnosis, treatment or disease management. Additional resources are needed to encourage widespread adoption, support patient effectiveness, and confirm cost-benefit.
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Affiliation(s)
| | | | | | | | - Helen W. Lach
- Saint Louis University, School of Nursing, Saint Louis, USA
| | - Keri Jupka
- National Center for Parents as Teachers, Saint Louis, USA
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Sheaff R. Achieving Integrated Care for Older People: What Kind of Ship? Comment on "Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight for the Future?". Int J Health Policy Manag 2018; 7:870-873. [PMID: 30316236 PMCID: PMC6186479 DOI: 10.15171/ijhpm.2018.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/28/2018] [Indexed: 11/09/2022] Open
Abstract
This paper considers an implication of the idea that proposals for integrated care for older people should start from a focus on the patient, consider co-production solutions to the problems of care fragmentation, and be at a system-wide, cross-organisational level. It follows that the analysis, design and therefore evaluation of integrated care projects should be based upon the journeys which older patients with multiple chronic conditions usually have to make from professional to professional and service to service. A systematic realistic review of recent research on integrated care projects identified a number of key mechanisms for care integration, including multidisciplinary care teams, care planning, suitable IT support and changes to organisational culture, besides other activities and contexts which assist care 'integration.' Those findings suggest that bringing the diverse services that older people with multiple chronic conditions need into a single organisation would remove many of the inter-organisational boundaries that impede care 'integration' and make it easier to address the interprofessional and inter-service boundaries.
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Sheaff R, Brand SL, Lloyd H, Wanner A, Fornasiero M, Briscoe S, Valderas JM, Byng R, Pearson M. From programme theory to logic models for multispecialty community providers: a realist evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The NHS policy of constructing multispecialty community providers (MCPs) rests on a complex set of assumptions about how health systems can replace hospital use with enhanced primary care for people with complex, chronic or multiple health problems, while contributing savings to health-care budgets.
Objectives
To use policy-makers’ assumptions to elicit an initial programme theory (IPT) of how MCPs can achieve their outcomes and to compare this with published secondary evidence and revise the programme theory accordingly.
Design
Realist synthesis with a three-stage method: (1) for policy documents, elicit the IPT underlying the MCP policy, (2) review and synthesise secondary evidence relevant to those assumptions and (3) compare the programme theory with the secondary evidence and, when necessary, reformulate the programme theory in a more evidence-based way.
Data sources
Systematic searches and data extraction using (1) the Health Management Information Consortium (HMIC) database for policy statements and (2) topically appropriate databases, including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA). A total of 1319 titles and abstracts were reviewed in two rounds and 116 were selected for full-text data extraction. We extracted data using a formal data extraction tool and synthesised them using a framework reflecting the main policy assumptions.
Results
The IPT of MCPs contained 28 interconnected context–mechanism–outcome relationships. Few policy statements specified what contexts the policy mechanisms required. We found strong evidence supporting the IPT assumptions concerning organisational culture, interorganisational network management, multidisciplinary teams (MDTs), the uses and effects of health information technology (HIT) in MCP-like settings, planned referral networks, care planning for individual patients and the diversion of patients from inpatient to primary care. The evidence was weaker, or mixed (supporting some of the constituent assumptions but not others), concerning voluntary sector involvement, the effects of preventative care on hospital admissions and patient experience, planned referral networks and demand management systems. The evidence about the effects of referral reductions on costs was equivocal. We found no studies confirming that the development of preventative care would reduce demands on inpatient services. The IPT had overlooked certain mechanisms relevant to MCPs, mostly concerning MDTs and the uses of HITs.
Limitations
The studies reviewed were limited to Organisation for Economic Co-operation and Development countries and, because of the large amount of published material, the period 2014–16, assuming that later studies, especially systematic reviews, already include important earlier findings. No empirical studies of MCPs yet existed.
Conclusions
Multidisciplinary teams are a central mechanism by which MCPs (and equivalent networks and organisations) work, provided that the teams include the relevant professions (hence, organisations) and, for care planning, individual patients. Further primary research would be required to test elements of the revised logic model, in particular about (1) how MDTs and enhanced general practice compare and interact, or can be combined, in managing referral networks and (2) under what circumstances diverting patients from in-patient to primary care reduces NHS costs and improves the quality of patient experience.
Study registration
This study is registered as PROSPERO CRD42016038900.
Funding
The National Institute for Health Research (NIHR) Health Services and Delivery Research programme and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
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Affiliation(s)
- Rod Sheaff
- School of Law, Criminology and Government, University of Plymouth, Plymouth, UK
| | - Sarah L Brand
- Y Lab Public Service Innovation Lab for Wales, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Helen Lloyd
- Community and Primary Care Research Group, Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Amanda Wanner
- Community and Primary Care Research Group, Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Mauro Fornasiero
- Community and Primary Care Research Group, Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Simon Briscoe
- NIHR CLAHRC for the South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Jose M Valderas
- NIHR CLAHRC for the South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Richard Byng
- Community and Primary Care Research Group, Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Mark Pearson
- NIHR CLAHRC for the South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Roberts S, Chaboyer W, Gonzalez R, Marshall A. Using technology to engage hospitalised patients in their care: a realist review. BMC Health Serv Res 2017; 17:388. [PMID: 28587640 PMCID: PMC5461760 DOI: 10.1186/s12913-017-2314-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 05/17/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Patient participation in health care is associated with improved outcomes for patients and hospitals. New technologies are creating vast potential for patients to participate in care at the bedside. Several studies have explored patient use, satisfaction and perceptions of health information technology (HIT) interventions in hospital. Understanding what works for whom, under what conditions, is important when considering interventions successfully engaging patients in care. This realist review aimed to determine key features of interventions using bedside technology to engage hospital patients in their care and analyse these in terms of context, mechanisms and outcomes. METHODS A realist review was chosen to explain how and why complex HIT interventions work or fail within certain contexts. The review was guided by Pawson's realist review methodology, involving: clarifying review scope; searching for evidence; data extraction and evidence appraisal; synthesising evidence and drawing conclusions. Author experience and an initial literature scope provided insight and review questions and theories (propositions) around why interventions worked were developed and iteratively refined. A purposive search was conducted to find evidence to support, refute or identify further propositions, which formed an explanatory model. Each study was 'mined' for evidence to further develop the propositions and model. RESULTS Interactive learning was the overarching theme of studies using technology to engage patients in their care. Several propositions underpinned this, which were labelled: information sharing; self-assessment and feedback; tailored education; user-centred design; and support in use of HIT. As studies were mostly feasibility or usability studies, they reported patient-centred outcomes including patient acceptability, satisfaction and actual use of HIT interventions. For each proposition, outcomes were proposed to come about by mechanisms including improved communication, shared decision-making, empowerment and self-efficacy; which acted as facilitators to patient participation in care. Overall, there was a stronger representation of health than IT disciplines in studies reviewed, with a lack of IT input in terms of theoretical underpinning, methodological design and reporting of outcomes. CONCLUSION HIT interventions have great potential for engaging hospitalised patients in their care. However, stronger interdisciplinary collaboration between health and IT researchers is needed for effective design and evaluation of HIT interventions.
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Affiliation(s)
- Shelley Roberts
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD 4222 Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD 4222 Australia
| | - Ruben Gonzalez
- School of Information and Communication Technology, Griffith University, Gold Coast Campus, Gold Coast, QLD 4222 Australia
| | - Andrea Marshall
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD 4222 Australia
- Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Southport, QLD 4215 Australia
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Saillour-Glénisson F, Duhamel S, Fourneyron E, Huiart L, Joseph JP, Langlois E, Pincemail S, Ramel V, Renaud T, Roberts T, Sibé M, Thiessard F, Wittwer J, Salmi LR. Protocole of a controlled before-after evaluation of a national health information technology-based program to improve healthcare coordination and access to information. BMC Health Serv Res 2017; 17:297. [PMID: 28431579 PMCID: PMC5399879 DOI: 10.1186/s12913-017-2199-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improvement of coordination of all health and social care actors in the patient pathways is an important issue in many countries. Health Information (HI) technology has been considered as a potentially effective answer to this issue. The French Health Ministry first funded the development of five TSN ("Territoire de Soins Numérique"/Digital health territories) projects, aiming at improving healthcare coordination and access to information for healthcare providers, patients and the population, and at improving healthcare professionals work organization. The French Health Ministry then launched a call for grant to fund one research project consisting in evaluating the TSN projects implementation and impact and in developing a model for HI technology evaluation. METHODS EvaTSN is mainly based on a controlled before-after study design. Data collection covers three periods: before TSN program implementation, during early TSN program implementation and at late TSN program implementation, in the five TSN projects' territories and in five comparison territories. Three populations will be considered: "TSN-targeted people" (healthcare system users and people having characteristics targeted by the TSN projects), "TSN patient users" (people included in TSN experimentations or using particular services) and "TSN professional users" (healthcare professionals involved in TSN projects). Several samples will be made in each population depending on the objective, axis and stage of the study. Four types of data sources are considered: 1) extractions from the French National Heath Insurance Database (SNIIRAM) and the French Autonomy Personalized Allowance database, 2) Ad hoc surveys collecting information on knowledge of TSN projects, TSN program use, ease of use, satisfaction and understanding, TSN pathway experience and appropriateness of hospital admissions, 3) qualitative analyses using semi-directive interviews and focus groups and document analyses and 4) extractions of TSN implementation indicators from TSN program database. DISCUSSION EvaTSN is a challenging French national project for the production of evidenced-based information on HI technologies impact and on the context and conditions of their effectiveness and efficiency. We will be able to support health care management in order to implement HI technologies. We will also be able to produce an evaluation toolkit for HI technology evaluation. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02837406 , 08/18/2016.
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Affiliation(s)
- Florence Saillour-Glénisson
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- CHU de Bordeaux, Pôle de Santé Publique, Service d’Information Médicale, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Sylvie Duhamel
- Département de Médecine Générale, Université de Bordeaux, 146, rue Léo Saignat 33076, Bordeaux, Cedex France
| | - Emmanuelle Fourneyron
- Institut de Santé Publique d’Epidémiologie et de Développement, Université de Bordeaux, 146, rue Léo Saignat 33076, Cedex F-33000 Bordeaux, France
| | - Laetitia Huiart
- CHU, Unité de Soutien Méthodologique, Saint-Denis, F-97400 France
- Groupe Hospitalier Est Réunion, Route Nationale 3 30, 97470, Saint-Benoît-de-Carmaux, France
| | - Jean Philippe Joseph
- Département de Médecine Générale, Université de Bordeaux, 146, rue Léo Saignat 33076, Bordeaux, Cedex France
| | - Emmanuel Langlois
- University Bordeaux/Sciences Po Bordeaux, Centre Emile Durkheim, F-33000 Bordeaux, France
- Centre Emile Durkheim, Science Politique et Sociologie Comparatives, Université de Bordeaux, 3Ter, Place de la Victoire 33076, Bordeaux, Cedex France
| | - Stephane Pincemail
- Institut de Santé Publique d’Epidémiologie et de Développement, Université de Bordeaux, 146, rue Léo Saignat 33076, Cedex F-33000 Bordeaux, France
| | - Viviane Ramel
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Thomas Renaud
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Tamara Roberts
- Département de Médecine Générale, Université de Bordeaux, 146, rue Léo Saignat 33076, Bordeaux, Cedex France
- University Bordeaux/Sciences Po Bordeaux, Centre Emile Durkheim, F-33000 Bordeaux, France
| | - Matthieu Sibé
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Frantz Thiessard
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Jerome Wittwer
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Louis Rachid Salmi
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- CHU de Bordeaux, Pôle de Santé Publique, Service d’Information Médicale, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - for the EvaTSN Research group
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- CHU de Bordeaux, Pôle de Santé Publique, Service d’Information Médicale, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- Département de Médecine Générale, Université de Bordeaux, 146, rue Léo Saignat 33076, Bordeaux, Cedex France
- Institut de Santé Publique d’Epidémiologie et de Développement, Université de Bordeaux, 146, rue Léo Saignat 33076, Cedex F-33000 Bordeaux, France
- CHU, Unité de Soutien Méthodologique, Saint-Denis, F-97400 France
- University Bordeaux/Sciences Po Bordeaux, Centre Emile Durkheim, F-33000 Bordeaux, France
- Groupe Hospitalier Est Réunion, Route Nationale 3 30, 97470, Saint-Benoît-de-Carmaux, France
- Centre Emile Durkheim, Science Politique et Sociologie Comparatives, Université de Bordeaux, 3Ter, Place de la Victoire 33076, Bordeaux, Cedex France
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