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Sadasivam RS, Kamberi A, DeLaughter K, Phillips B, Williams JH, Cutrona SL, Ray MN, Gilbert GH, Houston TK. Secure Asynchronous Communication Between Smokers and Tobacco Treatment Specialists: Secondary Analysis of a Web-Assisted Tobacco Intervention in the QUIT-PRIMO and National Dental PBRN Networks. J Med Internet Res 2020; 22:e13289. [PMID: 32374266 PMCID: PMC7240437 DOI: 10.2196/13289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/24/2019] [Accepted: 01/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Within a web-assisted tobacco intervention, we provided a function for smokers to asynchronously communicate with a trained tobacco treatment specialist (TTS). Previous studies have not attempted to isolate the effect of asynchronous counseling on smoking cessation. OBJECTIVE This study aimed to conduct a semiquantitative analysis of TTS-smoker communication and evaluate its association with smoking cessation. METHODS We conducted a secondary analysis of data on secure asynchronous communication between trained TTSs and a cohort of smokers during a 6-month period. Smokers were able to select their preferred TTS and message them using a secure web-based form. To evaluate whether the TTS used evidence-based practices, we coded messages using the Motivational Interviewing Self-Evaluation Checklist and Smoking Cessation Counseling (SCC) Scale. We assessed the content of messages initiated by the smokers by creating topical content codes. At 6 months, we assessed the association between smoking cessation and the amount of TTS use and created a multivariable model adjusting for demographic characteristics and smoking characteristics at baseline. RESULTS Of the 725 smokers offered asynchronous counseling support, 33.8% (245/725) messaged the TTS at least once. A total of 1082 messages (TTSs: 565; smokers 517) were exchanged between the smokers and TTSs. The majority of motivational interviewing codes were those that supported client strengths (280/517, 54.1%) and promoted engagement (280/517, 54.1%). SCC code analysis showed that the TTS provided assistance to smokers if they were willing to quit (247/517, 47.8%) and helped smokers prepare to quit (206/517, 39.8%) and anticipate barriers (197/517, 38.1%). The majority of smokers' messages discussed motivations to quit (234/565, 41.4%) and current and past treatments (talking about their previous use of nicotine replacement therapy and medications; 201/565, 35.6%). The majority of TTS messages used behavioral strategies (233/517, 45.1%), offered advice on treatments (189/517, 36.5%), and highlighted motivations to quit (171/517, 33.1%). There was no association between the amount of TTS use and cessation. In the multivariable model, after adjusting for gender, age, race, education, readiness at baseline, number of cigarettes smoked per day at baseline, and the selected TTS, smokers messaging the TTS one or two times had a smoking cessation odds ratio (OR) of 0.8 (95% CI 0.4-1.4), and those that messaged the TTS more than two times had a smoking cessation OR of 1.0 (95% CI 0.4-2.3). CONCLUSIONS Our study demonstrated the feasibility of using asynchronous counseling to deliver evidence-based counseling. Low participant engagement or a lack of power could be potential explanations for the nonassociation with smoking cessation. Future trials should explore approaches to increase participant engagement and test asynchronous counseling in combination with other approaches for improving the rates of smoking cessation.
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Affiliation(s)
| | - Ariana Kamberi
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Kathryn DeLaughter
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Barrett Phillips
- Veterans Affairs Central Western Massachusetts Healthcare System, Leeds, MA, United States
| | | | - Sarah L Cutrona
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Midge N Ray
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gregg H Gilbert
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Thomas K Houston
- University of Massachusetts Medical School, Worcester, MA, United States
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Stoops WW, Johnson MF, Strickland JC, Knudsen HK, Gilbert GH, Massingale SD, Ray MN, Studts CR, Atchley L, Reynolds G, Slade E, Studts JL. Feasibility of Collecting Saliva for Biological Verification of Tobacco Use Status in Dental Practices and Patients' Homes: Results from the National Dental PBRN. Community Dent Health 2019; 36:187-189. [PMID: 31436924 DOI: 10.1922/cdh_4474stoops03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the feasibility of collecting and analyzing saliva samples from dental practices and patients' homes for biochemical verification of tobacco use status. BASIC RESEARCH DESIGN Sub-study within single-arm, multi-center, longitudinal clinical study. CLINICAL SETTING Dental practices in the South Central region of the United States National Dental Practice-Based Research Network and patients' homes. PARTICIPANTS Fifty-five patients recruited from 30 dental practices. INTERVENTIONS Participants in the sub-study were instructed on saliva collection for cotinine analysis in dental practices where they enrolled in the primary study. Saliva was collected at the practices and then from patients' homes. MAIN OUTCOME MEASURES Feasibility for dental practice collection was define as 80% of enrolled participants having analyzable samples. For patients' home collection, feasibility was defined as 70%. RESULTS Forty-seven samples (i.e., 86% of those enrolled) collected in dental practices were analyzable. Twenty-one samples (i.e. 38% of those enrolled) collected in patients' homes were analyzable. CONCLUSIONS Collecting saliva samples for cotinine analysis from dental practices, but not from patients' homes, was feasible. Dental practices may provide an advantageous setting for biochemically verifying tobacco use status as part of clinical trials for tobacco cessation.
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Affiliation(s)
- W W Stoops
- Department of Behavioral Science, College of Medicine, University of Kentucky, KY USA.,Department of Psychiatry, College of Medicine, University of Kentucky, KY USA.,Department of Psychology, College of Arts and Sciences, University of Kentucky, KY USA
| | - M F Johnson
- Behavioral and Community-Based Research Shared Resource Facility, University of Kentucky Markey Cancer Center, KY USA
| | - J C Strickland
- Department of Psychology, College of Arts and Sciences, University of Kentucky, KY USA
| | - H K Knudsen
- Department of Behavioral Science, College of Medicine, University of Kentucky, KY USA
| | - G H Gilbert
- Department of Clinical & Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL USA
| | - S D Massingale
- Department of Clinical & Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL USA
| | - M N Ray
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL USA
| | - C R Studts
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY US
| | - L Atchley
- General Dentist, Phenix City, AL USA
| | - G Reynolds
- Health Decision Technologies LLC, Oakland, CA USA
| | - E Slade
- Department of Biostatistics, College of Public Health, University of Kentucky, KY USA
| | - J L Studts
- Department of Behavioral Science, College of Medicine, University of Kentucky, KY USA.,Behavioral and Community-Based Research Shared Resource Facility, University of Kentucky Markey Cancer Center, KY USA.,Cancer Prevention and Control Program, University of Kentucky Markey Cancer Center, KY USA
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Williams JH, DeLaughter K, Volkman JE, Sadasivam RS, Ray MN, Gilbert GH, Houston TK. Exploring Online Asynchronous Counseling With Tobacco Treatment Specialists in the QUIT-PRIMO and National Dental PBRN HI-QUIT Studies: Who Uses It and What Do They Say? Am J Health Promot 2018; 32:1170-1177. [PMID: 29848011 PMCID: PMC5986085 DOI: 10.1177/0890117116670972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the content of messages sent by smokers through asynchronous counseling within a Web-based smoking cessation intervention. DESIGN Qualitative. SETTING National community-based setting of patients who had been engaged by the medical or dental practices at which they attended or via Google advertisements. PARTICIPANTS Adults older than 19 years who were current smokers and interested in quitting. Participants throughout the United States referred to a Web-based cessation intervention by their medical or dental provider or by clicking on a Google advertisement. METHODS We conducted a qualitative review of 742 asynchronous counseling messages sent by 270 Web site users. Messages were reviewed, analyzed, and organized into qualitative themes by the investigative team. RESULTS The asynchronous counseling feature of the intervention was used most frequently by smokers who were white (87%), female (67%), aged 45 to 54 (32%), and who had at least some college-level education (70%). Qualitative analysis yielded 7 basic themes-Talk about the Process of Quitting, Barriers to Quitting, Reasons to Quit, Quit History, Support and Strategies for Quitting, Quitting with Medication, and Quit Progress. The most common theme was Support and Strategies for Quitting with 255 references among all messages. CONCLUSION We found rich communication across the spectrum of the quit process, from persons preparing to quit to those who had successfully quit. Asynchronous smoking cessation counseling provides a promising means of social support for smokers during the quit process.
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Affiliation(s)
- Jessica H Williams
- 1 Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn DeLaughter
- 2 VA eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA, USA
- 3 Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA
- 4 VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford and Boston, MA, USA
| | - Julie E Volkman
- 3 Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA
- 5 Department of Communication, Bryant University, Smithfield, RI, USA
| | - Rajani S Sadasivam
- 2 VA eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA, USA
- 3 Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA
| | - Midge N Ray
- 1 Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gregg H Gilbert
- 6 Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas K Houston
- 2 VA eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA, USA
- 3 Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA
- 4 VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford and Boston, MA, USA
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Cutrona SL, Sadasivam RS, DeLaughter K, Kamberi A, Volkman JE, Cobb N, Gilbert GH, Ray MN, Houston TK. Online tobacco websites and online communities-who uses them and do users quit smoking? The quit-primo and national dental practice-based research network Hi-Quit studies. Transl Behav Med 2016; 6:546-557. [PMID: 27379777 PMCID: PMC5110489 DOI: 10.1007/s13142-015-0373-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Online tobacco cessation communities are beneficial but underused. Our study examined whether, among smokers participating in a web-assisted tobacco intervention (Decide2quit.org), specific characteristics were associated with navigating to BecomeAnEx.org, an online cessation community, and with subsequent quit rates. Among smokers (N = 759) registered with Decide2quit.org, we identified visitors to BecomeAnEx.org, examining associations between smoker characteristics and likelihood of visiting. We then tested for associations between visits and 6-month cessation (point prevalence). We also tested for an interaction between use of other online support-seeking (Decide2quit.org tobacco cessation coaches), visiting, and 6-month cessation. One quarter (26.0 %; n = 197) of the smokers visited BecomeAnEx.org; less than one tenth (7.5 %; n = 57) registered to participate in the online forum. Visitors were more likely to be female (73.0 vs. 62.6 % of non-visitors, P < 0.01) to have visited a cessation website before (33.0 vs. 17.4 %, P < 0.01) and to report quit attempts in the previous year (62.0 vs. 53.0 %, P = 0.03). In analyses of all participants, BecomeAnEx.org visiting was not associated with 6-month quit completion. Among participants who communicated with a coach, BecomeAnEx.org visiting also lacked a significant association with 6 month quit completion, although a non-significant trend toward quit completion in visitors was noted (OR 2.21, 95 % CI 0.81-3.1). Online cessation communities attract smokers with previous cessation website experience and recent quit attempts. Community visiting was not associated with quit rates in our study, but low use may have limited our power to detect differences. Further research should explore whether an additive effect can be achieved by offering community visitors support via online coaches.
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Affiliation(s)
- Sarah L Cutrona
- UMass Medical School, 365 Plantation St, Biotech 1, Suite 100, Worcester, MA, 01605, USA.
| | - Rajani S Sadasivam
- UMass Medical School, 365 Plantation St, Biotech 1, Suite 100, Worcester, MA, 01605, USA
| | - Kathryn DeLaughter
- UMass Medical School, 365 Plantation St, Biotech 1, Suite 100, Worcester, MA, 01605, USA
| | - Ariana Kamberi
- UMass Medical School, 365 Plantation St, Biotech 1, Suite 100, Worcester, MA, 01605, USA
| | - Julie E Volkman
- UMass Medical School, 365 Plantation St, Biotech 1, Suite 100, Worcester, MA, 01605, USA
- VA eHealth QUERI and CHOIR, Bedford, MA, USA
| | - Nathan Cobb
- Division of Pulmonary and Critical Care, Georgetown University Medical Center, Washington, DC, USA
- MeYou Health, Boston, MA, USA
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Midge N Ray
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas K Houston
- UMass Medical School, 365 Plantation St, Biotech 1, Suite 100, Worcester, MA, 01605, USA
- VA eHealth QUERI and CHOIR, Bedford, MA, USA
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Miller MJ, Weech-Maldonado R, Outman RC, Ray MN, Gary LC, Chen L, Cobaugh DJ, Allison JJ, Saag KG. Evaluating the effectiveness of a patient storytelling DVD intervention to encourage physician-patient communication about nonsteroidal anti-inflammatory drug (NSAID) use. Patient Educ Couns 2016; 99:1837-1844. [PMID: 27380647 DOI: 10.1016/j.pec.2016.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/22/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a culturally-sensitive, patient storytelling intervention to enhance physician-patient communication about NSAID risk. METHODS A group randomized trial of 40 medical practices in Alabama was conducted. Patients within intervention practices received a 13-minute DVD that included patient stories related to their experiences with NSAIDs, adverse effects, and importance of communication with their physicians. The proportion of patients who: (1) spoke with their physician about NSAID risk; and (2) used both prescription and over-the-counter (OTC) NSAIDS were primary outcomes. Generalized estimating equations for panel data were used for analysis. RESULTS Intention-to-treat analyses revealed no significant differences between intervention (n=102) and control (n=106) groups for patients speaking with their physician about NSAID risk or concomitant use of prescription/OTC NSAIDs (Odds Ratio [OR]=1.11, p=0.670; OR=0.87, p=0.632, respectively). For 54% of patients who watched the DVD, per-protocol (PP) analyses trended toward increased odds of patients speaking with their physician about prescription NSAID risk compared to the control group [OR=1.37, p=0.354] and lower odds of concomitant prescription/OTC NSAIDs use [OR=0.79, p=0.486]. CONCLUSIONS A patient storytelling intervention in DVD format alone may not increase patient-physician interaction. PRACTICE IMPLICATIONS Strategies that facilitate use of patient educational materials delivered by DVD are needed.
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Affiliation(s)
- Michael J Miller
- University of Oklahoma, School of Community Medicine, Department of Medical Informatics, Tulsa, OK, United States.
| | - Robert Weech-Maldonado
- The University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, AL, United States
| | - Ryan C Outman
- The University of Alabama at Birmingham, School of Medicine, Division of Clinical Immunology and Rheumatology, Birmingham, AL, United States
| | - Midge N Ray
- The University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, AL, United States
| | | | - Lang Chen
- The University of Alabama at Birmingham, School of Medicine, Division of Clinical Immunology and Rheumatology, Birmingham, AL, United States
| | - Daniel J Cobaugh
- American Society of Health-System Pharmacists, Publications and Drug Information Systems Office, Bethesda, MD, United States
| | - Jeroan J Allison
- University of Massachusetts Medical School, Quantitative Health Sciences, Worcester, MA, United States
| | - Kenneth G Saag
- The University of Alabama at Birmingham, School of Medicine, Division of Clinical Immunology and Rheumatology, Birmingham, AL, United States
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Houser SH, Au DW, Miller MJ, Chen L, Outman RC, Ray MN, Saag KG, Weech-Maldonado R. Socio-demographic differences in risk information seeking sources for non-steroidal anti-inflammatory drugs (NSAIDS). Int J Med Inform 2016; 94:222-7. [PMID: 27573330 DOI: 10.1016/j.ijmedinf.2016.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/29/2016] [Accepted: 07/30/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for musculoskeletal pain and inflammatory conditions. A better understanding of patient information seeking behavior can help bridge the gap between patient knowledge and health care resources. This study examines the primary sources of NSAID risk information and the associations with patient socio-demographic factors. METHODS A cross-sectional survey analysis of patients on prescription NSAIDs (n=220) seen by primary care physicians in Alabama. Bivariate and multivariable, multinomial logistic regression analyses were conducted to evaluate the associations among primary NSAID risk information sources used with patient socio-demographic factors. RESULTS The primary patient source of information on NSAID risks was physician (57.3%), followed by internet (16.8%), pharmacist (16.4%), and other sources, such as nurses and family/friends (9.6%). Compared to people who use the internet as a primary source of NSAID risk information, patients who were Black/African-American (p=0.002) and 65 years of age or older (p=0.009) were more likely to use a physician. Older patients were also more likely to use a pharmacist (p=0.008) than the internet. In contrast, females (p=0.032) were less likely to use the pharmacist compared to the internet (p=0.032). CONCLUSIONS Patients obtain information from a variety of sources, but primarily from health care providers. While the internet is a fast growing source of health information, socio-demographic disparities in internet use for seeking information exist. Health care providers should be aware of their patient preferences for information sources on medication risks to meet the age, race, and gender need differences of all patients.
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Affiliation(s)
- Shannon H Houser
- University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, AL, USA.
| | - David W Au
- Valdosta State University, Department of Management and Healthcare Administration, Valdosta, GA, USA
| | - Michael J Miller
- The University of Oklahoma School of Community Medicine, Department of Medical Informatics, Tulsa, OK, USA
| | - Lang Chen
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, USA
| | - Ryan C Outman
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, USA
| | - Midge N Ray
- University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, AL, USA
| | - Kenneth G Saag
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, USA
| | - Robert Weech-Maldonado
- University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, AL, USA
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Yu YF, Hearld LR, Qu H, Ray MN, Kilgore ML. Association of Part D coverage gap with COPD medication adherence. Am J Manag Care 2016; 22:e275-e282. [PMID: 27556829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study assessed the association of the Medicare Part D coverage gap with medication adherence among beneficiaries with chronic obstructive pulmonary disease (COPD). STUDY DESIGN Retrospective observational study based on Medicare claims data. METHODS A 5% random sample of Medicare claims data (2006-2010) was used in this study. Beneficiaries diagnosed with COPD and treated with long-acting bronchodilators (LABDs) were assigned to an exposure cohort (at risk of the coverage gap) or a control cohort (otherwise). The exposure and control cohorts were matched using high-dimensional propensity scores. Adherence was defined as ≥80% of the proportion of days covered by LABDs. Logistic regressions controlling for unbalanced covariates post matching were applied to assess the association of the coverage gap with adherence. RESULTS The final matched exposure and control cohorts each included 4147 patient-year observations with about 42% and 46% of them adherent to LABDs, respectively. About 17% of the exposure cohort hit the coverage gap after October 31. Logistic regression showed that, compared with the control cohort, the beneficiaries in the exposure cohort had a significantly lower likelihood of being adherent if they hit the coverage gap later in the year (odds ratio [OR], 0.603; 95% CI, 0.493-0.738), or had a lower likelihood without statistical significance if otherwise (OR, 0.931; 95% CI, 0.846-1.024). CONCLUSIONS The findings suggest that the Part D coverage gap was associated with lower adherence in patients with COPD, which may serve as evidentiary support for phasing out the coverage gap by 2020.
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Affiliation(s)
- Yanni F Yu
- Boehringer Ingelheim Pharmaceuticals, Inc, 900 Ridgebury Rd, Ridgefield, CT 06877. E-mail:
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Houston TK, Sadasivam RS, Allison JJ, Ash AS, Ray MN, English TM, Hogan TP, Ford DE. Evaluating the QUIT-PRIMO clinical practice ePortal to increase smoker engagement with online cessation interventions: a national hybrid type 2 implementation study. Implement Sci 2015; 10:154. [PMID: 26525410 PMCID: PMC4630887 DOI: 10.1186/s13012-015-0336-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022] Open
Abstract
Background Effective web-assisted tobacco interventions (WATIs) have been underutilized by smokers; moreover, despite practice guideline recommendations, clinical teams do not routinely refer smokers to WATIs. Our goal was to test a clinical practice innovation, an ePortal designed to change practice and patient behavior. Our hypotheses were that the integrated system would result in increased smoker referrals, with an automated follow-up system resulting in more smoker registrations and finally augmentations of the WATI would result in more smokers quitting at 6 months. Methods Practice ePortal Implementation Trial: Practices (n = 174) were randomized to an online practice ePortal with an “e-referral tool” to the WATI (e-referred smokers received automated email reminders from the practice) and with practice feedback reports with patient tracking and practice-to-patient secure messaging versus comparison (a paper “referral prescription”). Implementation success was measured by the number of smokers referred and smokers registering. Clinical Effectiveness Trial: To estimate the effectiveness of the WATI components on 6-month smoking cessation, registered smokers were randomized into three groups: a state-of-the-art tailored WATI control [control], the WATI enhanced with proactive, pushed tailored email motivational messaging (messaging), and the WATI with messaging further enhanced with personal secure messaging with a tobacco treatment specialist and an online support group (personalized). Results Practice ePortal Trial results: A total of 4789 smokers were referred. The mean smokers referred per practice was not statistically different by group (ePortal 24.89 (SD 22.29) versus comparison 30.15 (SD 25.45), p = 0.15). The e-referral portal implementation program resulted in nearly triple the rate of smoker registration (31 % of all smokers referred registered online) versus comparison (11 %, p < 0.001). Clinical Effectiveness Trial results: Active smokers randomized to the personalized group had a 6-month cessation rate of 25.2 %, compared with the messaging group (26.7 %) and the control (17 %). Next, when using an inverse probability weighted selection model to account for attrition, those randomized to the two groups that received motivational messaging (messaging or personalized) were more likely to quit than those in the control (p = 0.04). Conclusions Among all smokers referred, the e-referral resulted in nearly threefold greater registrants (31 %) than paper (11 %). The practice ePortal smokers received multiple reminders (increasing registration opportunities), and the practices could track patient progress. The result was more smokers registering and, thus, more cessation opportunities. Combining the proactive referral and the WATI resulted in higher rates of smoking cessation. Trial Registration Web-delivered Provider Intervention for Tobacco Control (QUIT-PRIMO) - a randomized controlled trial: NCT00797628. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0336-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas K Houston
- VA eHealth Quality Enhancement Research Initiative and Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA. .,Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, MA, USA. .,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Rajani S Sadasivam
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeroan J Allison
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Arlene S Ash
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Midge N Ray
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Thomas M English
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy P Hogan
- VA eHealth Quality Enhancement Research Initiative and Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA.,Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, MA, USA.,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel E Ford
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Berner ES, Burkhardt JH, Panjamapirom A, Ray MN. Cost implications of human and automated follow-up in ambulatory care. Am J Manag Care 2014; 20:SP531-SP540. [PMID: 25811827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To compare the costs of human and automated follow-up processes in ambulatory care. STUDY DESIGN Analysis of costs of nurse-initiated and interactive voice response (IVR) system follow-up interventions. METHODS Using national cost data and data on follow-up processes and outcomes from a previous study, we examined the costs to the healthcare system and providers of developing a follow-up process using nurse-initiated telephone calls compared with calls made by an IVR. RESULTS Whether using nurse-initiated telephone calls or IVR calls, costs over the first 2 years of follow-up for a practice assumed to have 4800 acute care patient visits per year are approximately the same. After 2 years, IVR follow-up is approximately $9000 per year less expensive than nurse follow-up. In addition, overall cost savings are greater with IVR. CONCLUSIONS Follow-up of ambulatory care patients is a way to assess risks of future problems and associated costs and to improve quality of care. An automated follow-up process using IVR is more efficient than one based on nurse-initiated follow-up calls.
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Affiliation(s)
- Eta S Berner
- Center for Health Informatics for Patient Safety/Quality, Dept of Health Services Administration, University of Alabama at Birmingham, 1705 University Blvd, SHPB 590J, Birmingham, AL 35294. E-mail:
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Miller MJ, Allison JJ, Cobaugh DJ, Ray MN, Saag KG. A group-randomized trial of shared decision making for non-steroidal anti-inflammatory drug risk awareness: primary results and lessons learned. J Eval Clin Pract 2014; 20:638-48. [PMID: 24916786 PMCID: PMC6116901 DOI: 10.1111/jep.12193] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2014] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Frequent use and serious adverse effects related to non-steroidal anti-inflammatory drugs (NSAIDs) underscore the need to raise patient awareness about potential risks. Partial success of patient- or provider-based interventions has recently led to interest in combined approaches focusing on both patient and physician. This research tested a shared decision-making intervention for increasing patient-reported awareness of NSAID risk. METHODS A group randomized trial was performed in Alabama from 2005 to 2007. Intervention group doctor practices received continuing medical education (CME) about NSAIDs and patient activation tools promoting risk assessment and communication during visits. Comparison group doctor practices received only CME. Cross-sectional data were collected before and after the intervention. Generalized linear latent and mixed models with logistic link tested relationships among the intervention, study phase, intervention by study phase interaction and patient-reported awareness of risks with either prescription or over-the-counter (OTC) NSAIDs. RESULTS Three hundred and forty-seven patients at baseline and 355 patients at follow-up participated in this study. The intervention [adjusted odds ratio (AOR)=0.74, P=0.248], follow-up study phase (AOR=1.31, P=0.300) and intervention by study phase interaction (AOR=0.98, P=0.942) were not significantly associated with patient-reported awareness of any prescription NSAID risk. Follow-up study phase was associated with increased odds of reporting any OTC NSAID risk awareness (AOR=2.99, P<0.001), but the patient activation intervention and intervention by study phase interaction were not significantly associated with patient-reported awareness of any OTC NSAID risk (AOR=0.98, P=0.929; AOR=0.87, P=0.693, respectively). CONCLUSIONS Our point-of-care intervention encouraging shared decision making did not increase NSAID risk awareness.
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Affiliation(s)
- Michael J Miller
- Department of Pharmacy, Clinical and Administrative Sciences, College of Pharmacy, The University of Oklahoma Health Sciences Center, Tulsa, Oklahoma, USA
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Berner ES, Ray MN, Panjamapirom A, Maisiak RS, Willig JH, English TM, Krawitz M, Nevin CR, Houser S, Cohen MP, Schiff GD. Exploration of an automated approach for receiving patient feedback after outpatient acute care visits. J Gen Intern Med 2014; 29:1105-12. [PMID: 24610308 PMCID: PMC4099452 DOI: 10.1007/s11606-014-2783-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 12/06/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND To improve and learn from patient outcomes, particularly under new care models such as Accountable Care Organizations and Patient-Centered Medical Homes, requires establishing systems for follow-up and feedback. OBJECTIVE To provide post-visit feedback to physicians on patient outcomes following acute care visits. DESIGN A three-phase cross-sectional study [live follow-up call three weeks after acute care visits (baseline), one week post-visit live call, and one week post-visit interactive voice response system (IVRS) call] with three patient cohorts was conducted. A family medicine clinic and an HIV clinic participated in all three phases, and a cerebral palsy clinic participated in the first two phases. Patients answered questions about symptom improvement, medication problems, and interactions with the healthcare system. PATIENTS A total of 616 patients were included: 142 from Phase 1, 352 from Phase 2 and 122 from Phase 3. MAIN MEASURES Primary outcomes included: problem resolution, provider satisfaction with the system, and comparison of IVRS with live calls made by research staff. KEY RESULTS During both live follow-up phases, at least 96% of patients who were reached completed the call compared to only 48% for the IVRS phase. At baseline, 98 of 113 (88%) patients reported improvement, as well as 167 of 196 (85%) in the live one-week follow-up. In the one-week IVRS phase, 25 of 39 (64%) reported improvement. In all phases, the majority of patients in both the improved and unimproved groups had not contacted their provider or another provider. While 63% of providers stated they wanted to receive patient feedback, they varied in the extent to which they used the feedback reports. CONCLUSIONS Many patients who do not improve as expected do not take action to further address unresolved problems. Systematic follow-up/feedback mechanisms can potentially identify and connect such patients to needed care.
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Affiliation(s)
- Eta S Berner
- University of Alabama at Birmingham [UAB], Birmingham, AL, USA,
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Ray MN, Funkhouser E, Williams JH, Sadasivam RS, Gilbert GH, Coley HL, Rindal DB, Houston TK. Smoking-cessation e-referrals: a national dental practice-based research network randomized controlled trial. Am J Prev Med 2014; 46:158-65. [PMID: 24439349 PMCID: PMC4077270 DOI: 10.1016/j.amepre.2013.10.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/30/2013] [Accepted: 10/04/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tobacco use is still the leading preventable cause of death and morbidity in the U.S. Web-assisted tobacco interventions are an effective but underutilized tool in assisting smokers with quitting. The dental visit is an excellent opportunity to assist smokers in quitting by referring them to these tobacco-cessation online programs. PURPOSE The study purpose was to test two patient referral methods-paper referrals (information prescriptions) versus paper plus e-referrals-to a web-assisted smoking-cessation induction system. DESIGN RCT that used implementation research methods. PARTICIPANTS/SETTING A total of 100 community-based dental practices were enrolled and 1814 smokers were referred to the web-assisted tobacco induction system. INTERVENTION The study intervention was a proactive e-referral of smokers to a web-assisted tobacco induction system called Decide2Quit.org, and the control group used paper referrals (information prescriptions) to refer smokers to the Decide2Quit.org. MAIN OUTCOME MEASUREMENTS The outcome measurements were the referral numbers, Decide2Quit registration numbers, and the smokers' quit rate. Data were collected in 2010-2011 and analyses were completed in 2012. RESULTS Although total referrals from intervention practices was lower than control, subsequent proportions of registrations among smokers referred to Decide2Quit.org were nearly fourfold higher (adjusted mean percentages: 29.5% vs 7.6%, p<0.01) in intervention compared with control practices. Subsequent rates of cessation among referred smokers were threefold higher (adjusted mean percentages: 3.0% vs 0.8%, p=0.03) in intervention practices as compared with control. CONCLUSIONS Intervention practices using the e-referral system had higher smoker registration numbers and higher quit smoking rates than the control practices. This study finds that e-referrals are effective in getting smokers to the web-assisted smoking-cessation induction system and in assisting with quitting that more than compensates for any additional effort that e-referrals require on the part of the practitioner. CLINICAL TRIAL REGISTRATION DPBRN Hygienists Internet Quality Improvement in Tobacco Cessation (HiQuit); NCT01108432.
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Affiliation(s)
- Midge N Ray
- Department of Health Services Administration (Ray, Williams), School of Health Professions.
| | | | - Jessica H Williams
- Department of Health Services Administration (Ray, Williams), School of Health Professions
| | - Rajani S Sadasivam
- Division of Health Informatics and Implementation Science (Sadasivam, Houston), Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences (Gilbert), School of Dentistry
| | - Heather L Coley
- Division of Infectious Disease (Coley), School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - D Brad Rindal
- HealthPartners Institute for Education and Research (Rindal), Minneapolis, Minnesota
| | - Thomas K Houston
- Division of Health Informatics and Implementation Science (Sadasivam, Houston), Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester; eHealth Quality Enhancement Research Initiative (Sadasivam, Houston), Bedford VAMC, Bedford, Massachusetts
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Sadasivam RS, Hogan TP, Volkman JE, Smith BM, Coley HL, Williams JH, Delaughter K, Ray MN, Gilbert GH, Ford DE, Allison JJ, Houston TK. Implementing point of care "e-referrals" in 137 clinics to increase access to a quit smoking internet system: the Quit-Primo and National Dental PBRN HI-QUIT Studies. Transl Behav Med 2013; 3:370-8. [PMID: 24294325 DOI: 10.1007/s13142-013-0230-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Integrating electronic referral systems into clinical practices may increase use of web-accessible tobacco interventions. We report on our feasibility evaluation of using theory-driven implementation science techniques to translate an e-referral system (ReferASmoker.org) into the workflow of 137 community-based medical and dental practices, including system use, patient registration, implementation costs, and lessons learned. After 6 months, 2,376 smokers were e-referred (medical, 1,625; dental, 751). Eighty-six percent of the medical practices [75/87, mean referral = 18.7 (SD = 17.9), range 0-105] and dental practices [43/50, mean referral = 15.0 (SD = 10.5), range 0-38] had e-referred. Of those smokers e-referred, 25.3 registered [mean smoker registration rate-medical 4.9 (SD = 7.6, range 0-59), dental 3.6 (SD = 3.0, range 0-10)]. Estimated mean implementation costs are medical practices, US$429.00 (SD = 85.3); and dental practices, US$238.75 (SD = 13.6). High performing practices reported specific strategies to integrate ReferASmoker.org; low performers reported lack of smokers and patient disinterest in the study. Thus, a majority of practices e-referred and 25.3 % of referred smokers registered demonstrating e-referral feasibility. However, further examination of the identified implementation barriers is important as of the estimated 90,000 to 140,000 smokers seen in the 87 medical practices in 6 months, only 1,625 were e-referred.
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Affiliation(s)
- Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, MA 01655-0002 USA ; VA eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA USA
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Ray MN, Allison JJ, Coley HL, Williams JH, Kohler C, Gilbert GH, Richman JS, Kiefe CI, Sadasivam RS, Houston TK. Variations in tobacco control in National Dental PBRN practices: the role of patient and practice factors. Spec Care Dentist 2013; 33:286-93. [PMID: 24164227 PMCID: PMC3812542 DOI: 10.1111/j.1754-4505.2012.00305.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
We engaged dental practices enrolled in The National Dental Practice-Based Research Network to quantify tobacco screening (ASK) and advising (ADVISE); and to identify patient and practice -characteristics associated with tobacco control. Dental practices (N = 190) distributed patient surveys that measured ASK and ADVISE. Twenty-nine percent of patients were ASKED about tobacco use during visit, 20% were identified as tobacco users, and 41% reported being ADVISED. Accounting for clustering of patients within practices, younger age and male gender were positively associated with ASK and ADVISE. Adjusting for patient age and gender, a higher proportion of non-whites in the practice, preventive services and proportion on public assistance were positively associated with ASK. Proportion of tobacco users in the practice and offering other preventive services were more strongly associated with ASK and ADVISE than other practice characteristics. Understanding variations in performance is an important step toward designing strategies for improving tobacco control in dentistry.
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Affiliation(s)
- Midge N. Ray
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
| | - Jeroan J. Allison
- Department of Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Heather L. Coley
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jessica H. Williams
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
| | - Connie Kohler
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joshua S. Richman
- Birmingham VAMC and Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Catarina I. Kiefe
- Department of Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Rajani S. Sadasivam
- Division of Health Informatics and Implementation Science, Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Thomas K. Houston
- Division of Health Informatics and Implementation Science, Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester, MA
- Center for Health Quality, Outcomes and Economic Research, Bedford VAMC, Bedford, MA
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Sadasivam RS, Kinney RL, Delaughter K, Rao SR, Williams JH, Coley HL, Ray MN, Gilbert GH, Allison JJ, Ford DE, Houston TK. Who participates in Web-assisted tobacco interventions? The QUIT-PRIMO and National Dental Practice-Based Research Network Hi-Quit studies. J Med Internet Res 2013; 15:e77. [PMID: 23635417 PMCID: PMC3650921 DOI: 10.2196/jmir.2385] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 02/01/2013] [Accepted: 02/21/2013] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Smoking is the most preventable cause of death. Although effective, Web-assisted tobacco interventions are underutilized and recruitment is challenging. Understanding who participates in Web-assisted tobacco interventions may help in improving recruitment. OBJECTIVES To understand characteristics of smokers participating in a Web-assisted tobacco intervention (Decide2Quit.org). METHODS In addition to the typical Google advertisements, we expanded Decide2Quit.org recruitment to include referrals from medical and dental providers. We assessed how the expanded recruitment of smokers changed the users' characteristics, including comparison with a population-based sample of smokers from the national Behavioral Risk Factors Surveillance Survey (BRFSS). Using a negative binomial regression, we compared demographic and smoking characteristics by recruitment source, in particular readiness to quit and association with subsequent Decide2Quit.org use. RESULTS The Decide2Quit.org cohort included 605 smokers; the 2010 BRFSS dataset included 69,992. Compared to BRFSS smokers, a higher proportion of Decide2Quit.org smokers were female (65.2% vs 45.7%, P=.001), over age 35 (80.8% vs 67.0%, P=.001), and had some college or were college graduates (65.7% vs 45.9%, P=.001). Demographic and smoking characteristics varied by recruitment; for example, a lower proportion of medical- (22.1%) and dental-referred (18.9%) smokers had set a quit date or had already quit than Google smokers (40.1%, P<.001). Medical- and dental-referred smokers were less likely to use Decide2Quit.org functions; in adjusted analysis, Google smokers (predicted count 17.04, 95% CI 14.97-19.11) had higher predicted counts of Web page visits than medical-referred (predicted count 12.73, 95% CI 11.42-14.04) and dental-referred (predicted count 11.97, 95% CI 10.13-13.82) smokers, and were more likely to contact tobacco treatment specialists. CONCLUSIONS Recruitment from clinical practices complimented Google recruitment attracting smokers less motivated to quit and less experienced with Web-assisted tobacco interventions.
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Affiliation(s)
- Rajani Shankar Sadasivam
- Division of Health Informatics & Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA.
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Houston TK, Delaughter KL, Ray MN, Gilbert GH, Allison JJ, Kiefe CI, Volkman JE. Cluster-randomized trial of a web-assisted tobacco quality improvement intervention of subsequent patient tobacco product use: a National Dental PBRN study. BMC Oral Health 2013; 13:13. [PMID: 23438090 PMCID: PMC3623865 DOI: 10.1186/1472-6831-13-13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 02/11/2013] [Indexed: 11/10/2022] Open
Abstract
Background Brief clinician delivered advice helps in tobacco cessation efforts. This study assessed the impact of our intervention on instances of advice given to dental patients during visits on tobacco use quit rates 6 months after the intervention. Methods The intervention was cluster randomized trial at the dental practice level. Intervention dental practices were provided a longitudinal technology-assisted intervention, oralcancerprevention.org that included a series of interactive educational cases and motivational email cues to remind dental provides to complete guideline-concordant brief behavioral counseling at the point of care. In all dental practices, exit cards were given to the first 100 consecutive patients, in which tobacco users provided contact information for a six month follow-up telephone survey. Results A total of 564 tobacco using dental patients completed a six month follow-up survey. Among intervention patients, 55% reported receiving advice to quit tobacco, and 39% of control practice patients reported receiving advice to quit tobacco (p < 0.01). Six-month tobacco use quit rates were not significantly between the Intervention (9%) and Control (13%) groups, (p = 0.088). Conclusion Although we increased rates of cessation advice delivered in dental practices, this study shows no evidence that brief advice by dentist’s increases long-term abstinence in smokers. Trial registration ClinicalTrials.gov NCT00627185
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Houser SH, Ray MN, Maisiak R, Panjamapirom A, Willig J, Schiff GD, English T, Nevin C, Berner ES. Telephone follow-up in primary care: can interactive voice response calls work? Stud Health Technol Inform 2013; 192:112-116. [PMID: 23920526 PMCID: PMC4117224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED Follow-up calls after ambulatory visits are not routinely done, yet they can potentially detect and mitigate unresolved problems. Automated calls via an Interactive Voice Response System (IVRS) are an innovative way to conduct follow-up, but patients' attitudes toward follow-up calls are unknown. This study assessed 1) patient perceptions about follow-up calls after visits; 2) differences in perceptions between human and IVRS calls; and 3) association between follow-up calls and patient satisfaction with care. Post-visit follow-up calls in two ambulatory care setting were done in two phases. Phase 1 used a human caller and phase 2 used IVRS. Patient satisfaction questionnaires were completed after each phase. Results showed that 88% of patients favor the idea of the calls and those receiving them found them helpful. There were no differences in attitudes between patients receiving calls from clinic staff or from an IVRS. Patients receiving calls had higher patient satisfaction scores than those not called. CONCLUSION Patients value follow-up calls and they are associated with patient satisfaction with care. IVRS is an innovative way to conduct post-visit follow-up.
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Affiliation(s)
- Shannon H. Houser
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Midge N. Ray
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - James Willig
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Thomas English
- The University of Massachusetts Medical School, Worcester, MA, USA
| | - Christa Nevin
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eta S. Berner
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL, USA
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Sadasivam RS, Allison JJ, Ray MN, Ford DE, Houston TK. Using a resource effect study pre-pilot to inform a large randomized trial: the Decide2Quit.Org Web-assisted tobacco intervention. AMIA Annu Symp Proc 2012; 2012:789-798. [PMID: 23304353 PMCID: PMC3540477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Resource effect studies can be useful in highlighting areas of improvement in informatics tools. Before a large randomized trial, we tested the functions of the Decide2Quit.org Web-assisted tobacco intervention using smokers (N=204) recruited via Google advertisements. These smokers were given access to Decide2Quit.org for six months and we tracked their usage and assessed their six months cessation using a rigorous follow-up. Multiple, interesting findings were identified: we found the use of tailored emails to dramatically increase participation for a short period. We also found varied effects of the different functions. Functions supporting "seeking social support" (Your Online Community and Family Tools), Healthcare Provider Tools, and the Library had positive effects on quit outcomes. One surprising finding, which needs further investigation, was that writing to our Tobacco Treatment Specialists was negatively associated with quit outcomes.
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Affiliation(s)
- Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Huff-Shack J, Coley HL, Houston TK, Williams JH, Hubbell A, Sadasivam RS, Funkhouser E, Gilbert GH, Ray MN. Dental practice implementation of a point of care electronic referral system for patients who smoke: a dental PBRN study. J Dent Hyg 2012; 86:34. [PMID: 22309931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Sadasivam RS, Delaughter K, Crenshaw K, Sobko HJ, Williams JH, Coley HL, Ray MN, Ford DE, Allison JJ, Houston TK. Development of an interactive, Web-delivered system to increase provider-patient engagement in smoking cessation. J Med Internet Res 2011; 13:e87. [PMID: 22011394 PMCID: PMC3222193 DOI: 10.2196/jmir.1721] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 06/17/2011] [Accepted: 07/05/2011] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Patient self-management interventions for smoking cessation are effective but underused. Health care providers do not routinely refer smokers to these interventions. OBJECTIVE The objective of our study was to uncover barriers and facilitators to the use of an e-referral system that will be evaluated in a community-based randomized trial. The e-referral system will allow providers to refer smokers to an online smoking intervention during routine clinical care. METHODS We devised a four-step development and pilot testing process: (1) system conceptualization using Delphi to identify key functionalities that would overcome barriers in provider referrals for smoking cessation, (2) Web system programming using agile software development and best programming practices with usability refinement using think-aloud testing, (3) implementation planning using the nominal group technique for the effective integration of the system into the workflow of practices, and (4) pilot testing to identify practice recruitment and system-use barriers in real-world settings. RESULTS Our Delphi process (step 1) conceptualized three key e-referral functions: (1) Refer Your Smokers, allowing providers to e-refer patients at the point of care by entering their emails directly into the system, (2) practice reports, providing feedback regarding referrals and impact of smoking-cessation counseling, and (3) secure messaging, facilitating provider-patient communication. Usability testing (step 2) suggested the system was easy to use, but implementation planning (step 3) suggested several important approaches to encourage use (eg, proactive email cues to encourage practices to participate). Pilot testing (step 4) in 5 practices had limited success, with only 2 patients referred; we uncovered important recruitment and system-use barriers (eg, lack of study champion, training, and motivation, registration difficulties, and forgetting to refer). CONCLUSIONS Implementing a system to be used in a clinical setting is complex, as several issues can affect system use. In our ongoing large randomized trial, preliminary analysis with the first 50 practices using the system for 3 months demonstrated that our rigorous preimplementation evaluation helped us successfully identify and overcome these barriers before the main trial. TRIAL Clinicaltrials.gov NCT00797628; http://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/61feCfjCy).
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Affiliation(s)
- Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01545, USA.
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Houston TK, Sadasivam RS, Ford DE, Richman J, Ray MN, Allison JJ. The QUIT-PRIMO provider-patient Internet-delivered smoking cessation referral intervention: a cluster-randomized comparative effectiveness trial: study protocol. Implement Sci 2010; 5:87. [PMID: 21080972 PMCID: PMC2998448 DOI: 10.1186/1748-5908-5-87] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 11/17/2010] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Although screening for tobacco use is increasing with electronic health records and standard protocols, other tobacco-control activities, such as referral of patients to cessation resources, is quite low. In the QUIT-PRIMO study, an online referral portal will allow providers to enter smokers' email addresses into the system. Upon returning home, the smokers will receive automated emails providing education about tobacco cessation and encouragement to use the patient smoking cessation website (with interactive tools, educational resources, motivational email messages, secure messaging with a tobacco treatment specialist, and online support group). METHODS The informatics system will be evaluated in a comparative effectiveness trial of 160 community-based primary care practices, cluster-randomized at the practice level. In the QUIT-PRIMO intervention, patients will be provided a paper information-prescription referral and then "e-referred" to the system. In the comparison group, patients will receive only the paper-based information-prescription referral with the website address. Once patients go to the website, they are subsequently randomized within practices to either a standard patient smoking cessation website or an augmented version with access to a tobacco treatment specialist online, motivational emails, and an online support group. We will compare intervention and control practice participation (referral rates) and patient participation (proportion referred who go to the website). We will then compare the effectiveness of the standard and augmented patient websites. DISCUSSION Our goal is to evaluate an integrated informatics solution to increase access to web-delivered smoking cessation support. We will analyze the impact of this integrated system in terms of process (provider e-referral and patient login) and patient outcomes (six-month smoking cessation). TRIAL REGISTRATION Web-delivered Provider Intervention for Tobacco Control (QUIT-PRIMO) - a randomized controlled trial: NCT00797628.
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Affiliation(s)
- Thomas K Houston
- Division of Health Informatics and Implementation Science, Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
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Miller MJ, Allison JJ, Schmitt MR, Ray MN, Funkhouser EM, Cobaugh DJ, Saag KG, LaCivita C. Using single-item health literacy screening questions to identify patients who read written nonsteroidal anti-inflammatory medicine information provided at pharmacies. J Health Commun 2010; 15:413-427. [PMID: 20574879 DOI: 10.1080/10810731003753091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Our goal was to assess the relationships between single-item health literacy screening questions and reading prescription nonsteroidal anti-inflammatory drug (NSAID) written medicine information (WMI) provided at pharmacies. The health literacy of 382 patients from primary care physician practices in Alabama was estimated using validated health literacy screening questions related to understanding written medical information (SQ1); confidence in completing medical forms alone (SQ2); and need for assistance in reading hospital materials (SQ3). Reading WMI was measured by a "Yes" response to the question, "Often the drug store gives you written information such as pamphlets or handouts along with your prescription. Have you read about the risks of NSAIDs in this written material provided by the drug store?" Relationships were assessed using generalized linear latent and mixed models. Two-thirds (67.6%) of patients read WMI. Higher estimated health literacy was associated with increased odds of reading WMI. Adjusted odds ratios (95% CI) were 2.08 (1.08-4.03); 2.09 (1.12-3.91); and 1.98 (1.04-3.77) using SQ1-SQ3. Current WMI may be unable to meet the needs of those with inadequate health literacy. Health literacy screening questions can be used to triage patients at risk for not reading WMI so they can be assisted with supplemental educational strategies.
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Affiliation(s)
- Michael J Miller
- College of Pharmacy, Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma, Tulsa, Oklahoma, USA
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Miller MJ, Schmitt MR, Allison JJ, Cobaugh DJ, Ray MN, Saag KG. The Role of Health Literacy and Written Medicine Information in Nonsteroidal Antiinflammatory Drug Risk Awareness. Ann Pharmacother 2010; 44:274-84. [DOI: 10.1345/aph.1m479] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Despite widespread use of prescription nonsteroidal antiinflammatory drugs (NSAIDs), patients are commonly unaware of their risks. Pharmacies regularly distribute written medicine information (WMI) describing the risks and benefits of NSAID therapy at the time of dispensing. Objective: To clarify the relationship among common sociodemographic factors, education, health literacy, reading of WMI routinefy distributed at pharmacies, and NSAID risk awareness. Methods: Generalized linear latent and mixed models (GLLAMM) ordered logistic regression and confirmatory path analysis were used to evaluate multivariable relationships in a cross-sectional dataset of 382 patients in the second phase of the Alabama NSAID Patient Safety Study. Results: The majority of the analytical sample was female (72.0%) with 38.7% African American, 38.1% age 65 years or older, and 43.3% reporting at least some college education. Health literacy was positively associated with reading of WMI (p = 0.001) and NSAID risk awareness (p = 0.025), while age was negatively associated with reading WMI (p = 0.001) and NSAID risk awareness (p = 0.005). Medicaid/uninsured status was negatively associated with risk awareness (p = 0.013). Reading of WMI was not associated with NSAID risk awareness (p = 0.659). The final path model demonstrated excellent fit. Conclusions: The lack of relationship between reading of WMI and NSAID risk awareness questions the current strategy of distribution of patient-targeted print education materials at pharmacies. To maximize limited resources, future research should identify more effective strategies to deliver risk information to patients and ensure its retention, especially in high-risk groups such as the elderly, the indigent, and those with inadequate health literacy.
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Affiliation(s)
- Michael J Miller
- Department of Pharmacy: Clinical and Administrative Sciences – Tulsa, College of Pharmacy, The University of Oklahoma, Tulsa, OK
| | - Michael R Schmitt
- Department of Pharmacy: Clinical and Administrative Sciences – Tulsa, College of Pharmacy, The University of Oklahoma
| | - Jeroan J Allison
- Health Disparities, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Daniel J Cobaugh
- Research and Operations, American Society of Health-System Pharmacists Research and Education Foundation, Bethesda, MD
| | - Midge N Ray
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham
| | - Kenneth G Saag
- University of Alabama at Birmingham, Center for Education and Research on Therapeutics of Musculoskeletal Diseases and Center for Outcomes & Effectiveness Research & Education, School of Medicine, University of Alabama at Birmingham
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Houston TK, Coley HL, Sadasivam RS, Ray MN, Williams JH, Allison JJ, Gilbert GH, Kiefe CI, Kohler C. Impact of content-specific email reminders on provider participation in an online intervention: a dental PBRN study. Stud Health Technol Inform 2010; 160:801-805. [PMID: 20841796 PMCID: PMC2967030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Engaging busy healthcare providers in online continuing education interventions is challenging. In an Internet-delivered intervention for dental providers, we tested a series of email-delivered reminders - cues to action. The intervention included case-based education and downloadable practice tools designed to encourage providers to increase delivery of smoking cessation advice to patients. We compared the impact of email reminders focused on 1) general project announcements, 2) intervention related content (smoking cessation), and 3) unrelated content (oral cancer prevention focused content). We found that email reminders dramatically increased participation. The content of the message had little impact on the participation, but day of the week was important - messages sent at the end of the week had less impact, likely due to absence from clinic on the weekend. Email contact, such as day of week an email is sent and notice of new content post-ing, is critical to longitudinal engagement. Further research is needed to understand which messages and how frequently, will maximize participation.
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Affiliation(s)
- Thomas K Houston
- Center for Health Quality, Outcomes & Economic Research, Bedford VAMC, Bedford, MA, USA
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Curtis JR, Taylor AJ, Matthews RS, Ray MN, Becker DJ, Gary LC, Kilgore ML, Morrisey MA, Saag KG, Warriner A, Delzell E. "Pathologic" fractures: should these be included in epidemiologic studies of osteoporotic fractures? Osteoporos Int 2009; 20:1969-72. [PMID: 19184268 PMCID: PMC2766025 DOI: 10.1007/s00198-009-0840-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 11/24/2008] [Indexed: 01/23/2023]
Abstract
UNLABELLED Pathologic fractures are often excluded in epidemiologic studies of osteoporosis. Using Medicare administrative data, we identified persons with vertebral and hip fractures. Among these, 48% (vertebral) and 3% (hip) of the fractures were coded as pathologic. Only 25% and 66% of persons with these pathologic fractures had evidence for malignancy. INTRODUCTION Analyses of osteoporosis-related fractures that use administrative data often exclude pathologic fractures (ICD-9 733.1x) due to concern that these are caused by cancer. We examined "pathologic" fractures of the vertebrae and hip to evaluate their contribution to fracture incidence and assessed the evidence for a malignancy. METHODS We studied US Medicare beneficiaries age > or =65 with new fractures identified using ICD-9 diagnosis codes 733.13 (pathologic vert), 805.0, 805.2, 805.4, 805.8 (nonpathologic vert); and 733.14 (pathologic hip), 820.0, 820.2, 820.8 (nonpathologic hip). We further examined the proportion of cases with a diagnosis of a malignancy proximate to the fracture. RESULTS We identified 44,120 individuals with a vertebral fracture and 60,354 with a hip fracture. Approximately 48% of vertebral fractures and 3% of hip fractures were coded as pathologic. For only approximately 25% of persons with a "pathologic" vertebral fracture ICD-9 code, but 66% of persons with a "pathologic" hip fracture, there was evidence of a possible cancer diagnosis. CONCLUSION Among US Medicare beneficiaries, one fourth of pathologic vertebral fracture and two thirds of pathologic hip fracture cases had evidence for a malignancy. Particularly for vertebral fractures, excluding persons with pathologic fractures in epidemiologic analyses that utilize administrative claims data substantially underestimates the burden of fractures due to osteoporosis.
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Affiliation(s)
- J R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
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LaCivita C, Funkhouser E, Miller MJ, Ray MN, Saag KG, Kiefe CI, Cobaugh DJ, Allison JJ. Patient-reported communications with pharmacy staff at community pharmacies: The Alabama NSAID Patient Safety Study, 2005–2007. J Am Pharm Assoc (2003) 2009; 49:e110-7. [DOI: 10.1331/japha.2009.09005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
The relationship between health and happiness was explored using a cross-sectional survey of 383 community-dwelling older adults. As a function of self-reported health, median happiness was increasing at a decreasing rate; happiness variability was decreasing at a decreasing rate. In multivariable logistic regression, lowest-quartile happiness was associated with poverty, unfavorable subjective health, debilitating pain and urinary incontinence, but not with the comorbidity count or other comorbidities. The results, robust to common method bias, suggest that subjective health measures are better predictors of happiness than objective measures are, except for conditions that disrupt daily functioning or are associated with social stigma.
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Cobaugh DJ, Angner E, Kiefe CI, Ray MN, LaCivita CL, Weissman NW, Saag KG, Allison JJ. Effect of racial differences on ability to afford prescription medications. Am J Health Syst Pharm 2008; 65:2137-43. [DOI: 10.2146/ajhp080062] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Daniel J. Cobaugh
- American Society of Health-System Pharmacists (ASHP) Research and Education Foundation, Bethesda, MD
| | - Erik Angner
- Departments of Philosophy and Finance, University of Alabama at Birmingham (UAB), Birmingham
| | - Catarina I. Kiefe
- Division of Preventive Medicine, School of Medicine, and Founding Director, Center for Outcomes and Effectiveness Research and Education, UAB
| | - Midge N. Ray
- Department of Health Services Administration, School of Health Professions, and Associate Professor, Center for Education and Research on Therapeutics of Musculoskeletal Diseases, UAB
| | | | - Norman W. Weissman
- Department of Health Services Administration, School of Health Professions, UAB
| | - Kenneth G. Saag
- Center for Education and Research on Therapeutics of Musculoskeletal Diseases, and Professor of Medicine, School of Medicine, UAB
| | - Jeroan J. Allison
- Center for Education and Research on Therapeutics of Musculoskeletal Diseases, and Professor of Medicine, School of Medicine, UAB
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Houston TK, Ford DE, Sadasivam RS, Ray MN, Allison JJ, Kohler CL, Ashton CM. Overcoming limits to tobacco control: using the Internet to bridge clinical and public health interventions. AMIA Annu Symp Proc 2008:977. [PMID: 18999091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 06/17/2008] [Indexed: 05/27/2023]
Abstract
Links between clinical and public health interventions are limited. Using the Internet as a delivery method provides the potential to link multiple intervention components, but this potential has not yet been realized. In this poster, we present results of a formative assessment to identify approaches to improving clinical-public health linkages.
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Affiliation(s)
- Thomas K Houston
- University of Alabama at Birmingham School of Medicine; Deep South Center for Effectiveness Research, Birmingham VAMC, USA
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Houston TK, Richman JS, Ray MN, Allison JJ, Gilbert GH, Shewchuk RM, Kohler CL, Kiefe CI. Internet delivered support for tobacco control in dental practice: randomized controlled trial. J Med Internet Res 2008; 10:e38. [PMID: 18984559 PMCID: PMC2630831 DOI: 10.2196/jmir.1095] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 06/30/2008] [Accepted: 07/12/2008] [Indexed: 02/01/2023] Open
Abstract
Background The dental visit is a unique opportunity for tobacco control. Despite evidence of effectiveness in dental settings, brief provider-delivered cessation advice is underutilized. Objective To evaluate an Internet-delivered intervention designed to increase implementation of brief provider advice for tobacco cessation in dental practice settings. Methods Dental practices (N = 190) were randomized to the intervention website or wait-list control. Pre-intervention and after 8 months of follow-up, each practice distributed exit cards (brief patient surveys assessing provider performance, completed immediately after the dental visit) to 100 patients. Based on these exit cards, we assessed: whether patients were asked about tobacco use (ASK) and, among tobacco users, whether they were advised to quit tobacco (ADVISE). All intervention practices with follow-up exit card data were analyzed as randomized regardless of whether they participated in the Internet-delivered intervention. Results Of the 190 practices randomized, 143 (75%) dental practices provided follow-up data. Intervention practices’ mean performance improved post-intervention by 4% on ASK (29% baseline, adjusted odds ratio = 1.29 [95% CI 1.17-1.42]), and by 11% on ADVISE (44% baseline, OR = 1.55 [95% CI 1.28-1.87]). Control practices improved by 3% on ASK (Adj. OR 1.18 [95% CI 1.07-1.29]) and did not significantly improve in ADVISE. A significant group-by-time interaction effect indicated that intervention practices improved more over the study period than control practices for ADVISE (P = 0.042) but not for ASK. Conclusion This low-intensity, easily disseminated intervention was successful in improving provider performance on advice to quit. Trial Registration clinicaltrials.gov NCT00627185; http://clinicaltrials.gov/ct2/show/NCT00627185 (Archived by WebCite at http://www.webcitation.org/5c5Kugvzj)
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Affiliation(s)
- Thomas K Houston
- Surgical and Medical Acute care and Advanced illness Research and Transition sciences (SMAART) Center, VA HSR&D REAP, Birmingham VA Medical Center, Birmingham, AL, USA.
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Fry RB, Ray MN, Cobaugh DJ, Weissman NW, Kiefe CI, Shewchuk RM, Saag KG, Curtis JR, Allison JJ. Racial/ethnic disparities in patient-reported nonsteroidal antiinflammatory drug (NSAID) risk awareness, patient-doctor NSAID risk communication, and NSAID risk behavior. ACTA ACUST UNITED AC 2008; 57:1539-45. [PMID: 18050227 DOI: 10.1002/art.23084] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly used and frequently lead to serious adverse events. Little is known about NSAID-related ethnic/racial disparities. We focused on differences in patient NSAID risk awareness, patient-doctor NSAID risk communication, and NSAID risk-avoidance behavior. METHODS We performed a cross-sectional analysis of survey data from the Alabama NSAID Patient Safety Study. Eligible patients were > or = 65 years old and currently taking prescription NSAIDs (Rx NSAIDS). Generalized linear latent and mixed models accounted for nesting of patients within physicians. RESULTS Of all 404 participants, 32% were African American and 73% were female. The mean +/- SD age was 72.8 +/- 7.5 years, and 64% reported an annual household income <$20,000. African American patients were less likely than white patients to recognize any risk associated with over-the-counter (OTC) NSAIDs (13.3% versus 29.3%; P = 0.001) and Rx NSAIDs (31.3% versus 49.6%; P = 0.001), report that their doctor discussed possible NSAID-related gastrointestinal problems (38.0% versus 52.4%; P = 0.007), and take medications to reduce ulcer risk (30.5% versus 50.2%; P = 0.001). Patients with lower income and education reported significantly less risk awareness for OTC and Rx NSAIDs. Racial/ethnic differences persisted after adjusting for multiple confounders. CONCLUSION In this community-based study of low income elderly individuals receiving NSAIDs, we identified important racial/ethnic differences in risk awareness, communication, and behavior. Additional efforts are needed to promote safe NSAID use and reduce ethnic/racial disparities.
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Affiliation(s)
- Rachel B Fry
- University of Alabama at Birmingham, Birmingham, AL, USA.
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Abstract
OBJECTIVES To assess the patterns of use of handheld clinical decision support tools by internal medicine residents in clinical settings. METHODS Eighty-two internal medicine residents were given personal digital assistants (PDAs) containing a suite of clinical decision support (CDS) programs. A tracking program was used to prospectively track program use during the study period, and a follow-up survey regarding self-reported program use was administered after the study period. Patterns of program use from the tracking data were compared to the data from the self-report survey. RESULTS Sixty-eight residents were followed using the tracking data. Residents used an average of 1.81 CDS programs (SD: 1.57; range, 0-5) per month. Forty-nine residents completed the self-report survey. Residents reported using an average of 3.15 (SD: 1.61) and 3.92 (SD: 1.40) CDS programs during a typical clinic session and inpatient day, respectively. In both inpatient and outpatient settings and for both methods of assessing program use, 2 programs (Epocrates and MedCalc) were used more often than the other programs. No association was observed between age, gender, race, and PGY level with the use of handheld clinical decision support tools for either tracked or self-report data. The self-report data show higher estimates of CDS program use than the tracking data in the clinical setting. CONCLUSIONS The data show that physicians prefer to use certain handheld CDS tools in clinical settings. Drug references and medical calculators have been consistently used more than clinical prediction rules and diagnostic systems. Self-report survey instruments may overestimate recorded use of CDS programs.
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Affiliation(s)
- Feliciano Yu
- UAB Center for Outcomes and Effectiveness Research and Education (COERE), Birmingham, Alabama, USA.
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Ray MN, Houston TK, Yu FB, Menachemi N, Maisiak RS, Allison JJ, Berner ES. Development and testing of a scale to assess physician attitudes about handheld computers with decision support. J Am Med Inform Assoc 2006; 13:567-72. [PMID: 16799120 PMCID: PMC1561800 DOI: 10.1197/jamia.m2096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The authors developed and evaluated a rating scale, the Attitudes toward Handheld Decision Support Software Scale (H-DSS), to assess physician attitudes about handheld decision support systems. DESIGN The authors conducted a prospective assessment of psychometric characteristics of the H-DSS including reliability, validity, and responsiveness. Participants were 82 Internal Medicine residents. A higher score on each of the 14 five-point Likert scale items reflected a more positive attitude about handheld DSS. The H-DSS score is the mean across the fourteen items. Attitudes toward the use of the handheld DSS were assessed prior to and six months after receiving the handheld device. STATISTICS Cronbach's Alpha was used to assess internal consistency reliability. Pearson correlations were used to estimate and detect significant associations between scale scores and other measures (validity). Paired sample t-tests were used to test for changes in the mean attitude scale score (responsiveness) and for differences between groups. RESULTS Internal consistency reliability for the scale was alpha = 0.73. In testing validity, moderate correlations were noted between the attitude scale scores and self-reported Personal Digital Assistant (PDA) usage in the hospital (correlation coefficient = 0.55) and clinic (0.48), p < 0.05 for both. The scale was responsive, in that it detected the expected increase in scores between the two administrations (3.99 (s.d. = 0.35) vs. 4.08, (s.d. = 0.34), p < 0.005). CONCLUSION The authors' evaluation showed that the H-DSS scale was reliable, valid, and responsive. The scale can be used to guide future handheld DSS development and implementation.
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Affiliation(s)
- Midge N Ray
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294-3361, USA.
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Berner ES, Houston TK, Ray MN, Allison JJ, Heudebert GR, Chatham WW, Kennedy JI, Glandon GL, Norton PA, Crawford MA, Maisiak RS. Improving ambulatory prescribing safety with a handheld decision support system: a randomized controlled trial. J Am Med Inform Assoc 2006; 13:171-9. [PMID: 16357350 PMCID: PMC1447547 DOI: 10.1197/jamia.m1961] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Accepted: 11/30/2005] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of a personal digital assistant (PDA)-based clinical decision support system (CDSS) on nonsteroidal anti-inflammatory drug (NSAID) prescribing safety in the outpatient setting. DESIGN The design was a randomized, controlled trial conducted in a university-based resident clinic. Internal medicine residents received a PDA-based CDSS suite. For intervention residents, the CDSS included a prediction rule for NSAID-related gastrointestinal risk assessment and treatment recommendations. Unannounced standardized patients (SPs) trained to portray musculoskeletal symptoms presented to study physicians. Safety outcomes were assessed from the prescriptions given to the SPs. Each prescription was reviewed by a committee of clinicians blinded to participant, intervention group assignment, and baseline or follow-up status. MEASUREMENTS Prescriptions were judged as safe or unsafe. The main outcome measure was the differential change in unsafe prescribing of NSAIDs for the intervention versus the control group. RESULTS At baseline, the mean proportion of cases per physician with unsafe prescriptions for the two groups was similar (0.27 vs. 0.29, p > 0.05). Controlling for baseline performance, intervention participants prescribed more safely than controls after receiving the CDSS (0.23 vs. 0.45 [F = 4.24, p < 0.05]). With the CDSS, intervention participants documented more complete assessment of patient gastrointestinal risk from NSAIDs. CONCLUSION PARTICIPANTS provided with a PDA-based CDSS for NSAID prescribing made fewer unsafe treatment decisions than participants without the CDSS.
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Affiliation(s)
- Eta S Berner
- Department of Health Services Administration, University of Alabama at Birmingham, 1675 University Boulevard, Room 544, Birmingham, AL 35294-3361, USA.
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Wall TC, Mian MAH, Ray MN, Casebeer L, Collins BC, Kiefe CI, Weissman N, Allison JJ. Improving physician performance through Internet-based interventions: who will participate? J Med Internet Res 2005; 7:e48. [PMID: 16236700 PMCID: PMC1550676 DOI: 10.2196/jmir.7.4.e48] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Revised: 07/22/2005] [Accepted: 07/29/2005] [Indexed: 12/03/2022] Open
Abstract
Background The availability of Internet-based continuing medical education is rapidly increasing, but little is known about recruitment of physicians to these interventions. Objective The purpose of this study was to examine predictors of physician participation in an Internet intervention designed to increase screening of young women at risk for chlamydiosis. Methods Eligibility was based on administrative claims data, and eligible physicians received recruitment letters via fax and/or courier. Recruited offices had at least one physician who agreed to participate in the study by providing an email address. After one physician from an office was recruited, intensive recruitment of that office ceased. Email messages reminded individual physicians to participate by logging on to the Internet site. Results Of the eligible offices, 325 (33.2%) were recruited, from which 207 physicians (52.8%) participated. Recruited versus nonrecruited offices had more eligible patients (mean number of eligible patients per office: 44.1 vs 33.6; P < .001), more eligible physicians (mean number of eligible physicians per office: 6.2 vs 4.1; P < .001), and fewer doctors of osteopathy (mean percent of eligible physicians per office who were doctors of osteopathy: 20.5% vs 26.4%; P = .02). Multivariable analysis revealed that the odds of recruiting at least one physician from an office were greater if the office had more eligible patients and more eligible physicians. More participating versus nonparticipating physicians were female (mean percent of female recruited physicians: 39.1% vs 27.0%; P = .01); fewer participating physicians were doctors of osteopathy (mean percent of recruited physicians who were doctors of osteopathy: 15.5% vs 23.9%; P = .04) or international medical graduates (mean percent of recruited physicians who were international graduates: 12.3% vs 23.8%; P = .003). Multivariable analysis revealed that the odds of a physician participating were greater if the physician was older than 55 years (OR = 2.31; 95% CI = 1.09–4.93) and was from an office with a higher Chlamydia screening rate in the upper tertile (OR = 2.26; 95% CI = 1.23–4.16). Conclusions Physician participation in an Internet continuing medical education intervention varied significantly by physician and office characteristics.
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Affiliation(s)
- Terry C Wall
- Department of Pediatrics, University of Alabama, Birmingham, AL, USA.
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Ray MN, Wall T, Casebeer L, Weissman N, Spettell C, Abdolrasulnia M, Mian MAH, Collins B, Kiefe CI, Allison JJ. Chlamydia Screening of At-Risk Young Women in Managed Health Care: Characteristics of Top-Performing Primary Care Offices. Sex Transm Dis 2005; 32:382-6. [PMID: 15912086 DOI: 10.1097/01.olq.0000162367.39209.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Despite effective approaches for managing chlamydial infection, asymptomatic disease remains highly prevalent. We linked administrative data with physician data from the American Medical Association physician survey to identify characteristics of primary care offices associated with best chlamydia screening practices. STUDY Criteria from the National Committee for Quality Assurance provided chlamydia screening rates. We defined top-performing offices as those with rates in the top decile among 978 primary care offices from 26 states. RESULTS Offices screened an average of 16.2% of at-risk, young women, but top-performing offices screened 42.2%. Top-performing offices on average had more black physicians (12.5%, 5.1%, P = 0.001) and were more often located in zip code areas with median income less than $30,000 (22.6%, 5.5%, P = 0.001). CONCLUSIONS Although chlamydia screening rates are alarmingly low overall, there is substantial variation across offices. Understanding predictors of better office performance may lead to effective interventions to promote screening.
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Affiliation(s)
- Midge N Ray
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama 35294-3361, USA.
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Allison JJ, Kiefe CI, Wall T, Casebeer L, Ray MN, Spettell CM, Hook EW, Oh MK, Person SD, Weissman NW. Multicomponent Internet continuing medical education to promote chlamydia screening. Am J Prev Med 2005; 28:285-90. [PMID: 15766617 DOI: 10.1016/j.amepre.2004.12.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Low Chlamydia trachomatis screening rates create an opportunity to test innovative continuing medical education (CME) programs. Few studies of Internet-based physician learning have been evaluated with objective data on practice patterns. DESIGN This randomized controlled trial tested a multicomponent Internet CME (mCME) intervention for increasing chlamydia screening of at-risk women aged 16 to 26 years. SETTING Eligible physician offices had > or =20 patients at risk for chlamydia as defined by the Health Plan Employer Data and Information Set (HEDIS), had at least one primary care physician (internal medicine, family medicine/general practice, pediatrics) with Internet access, and participated in the study managed care organization. The 191 randomized primary care offices represented 20 states. INTERVENTION The intervention, available from February to December 2001, consisted of four case-based learning modules, was tailored in real time to each physician based on theory of behavior change, and included office-level feedback of chlamydia screening rates. MAIN OUTCOME MEASURE HEDIS chlamydia screening rates for the pre-intervention (2000) and post-intervention (2002) periods. RESULTS Pre-intervention screening rates for the intervention and comparison offices were 18.9% and 16.2% (p =0.135). Post-intervention screening rates for the intervention and comparison offices were 15.5% and 12.4%, respectively (p =0.044, adjusting for baseline performance). CONCLUSIONS The substantial decline in chlamydia screening rates observed in the comparison offices was significantly attenuated for the intervention offices. The mCME favorably influenced chlamydia screening by primary care physicians.
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Affiliation(s)
- Jeroan J Allison
- Division of General Internal Medicine, University of Alabama at Birmingham, 720 Faculty Office Tower, 1530 3rd Avenue South, Birmingham, AL 35294-3407, USA.
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Berner ES, Kasiraman RK, Yu F, Ray MN, Houston TK. Data quality in the outpatient setting: impact on clinical decision support systems. AMIA Annu Symp Proc 2005; 2005:41-5. [PMID: 16778998 PMCID: PMC1560426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Clinical decision support system (CDSS) performance may vary with the quality of the input data. We assessed the impact of medical record completeness and accuracy on a CDSS that provides risk assessment for gastrointestinal bleeding and recommends therapy when prescribing NSAIDs. We examined the documentation of six data elements in the medical record and the impact on the performance of the CDSS. We reviewed 178 transcribed clinical encounters from standardized patients with predefined clinical histories. Results showed that the mean completeness score across all encounters was .34. The mean correctness score for those elements present was .94. When the available data was input into the CDSS, the missing data elements resulted in inappropriate and unsafe recommendations in almost 77% of the encounters. The results show that important gaps in the medical record can affect the accuracy of a CDSS designed to improve safe prescribing.
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Abdolrasulnia M, Collins BC, Casebeer L, Wall T, Spettell C, Ray MN, Weissman NW, Allison JJ. Using email reminders to engage physicians in an Internet-based CME intervention. BMC Med Educ 2004; 4:17. [PMID: 15453911 PMCID: PMC521491 DOI: 10.1186/1472-6920-4-17] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Accepted: 09/29/2004] [Indexed: 05/24/2023]
Abstract
BACKGROUND Engaging practicing physicians in educational strategies that reinforce guideline adoption and improve the quality of healthcare may be difficult. Push technologies such as email offer new opportunities to engage physicians in online educational reinforcing strategies. The objectives are to investigate 1) the effectiveness of email announcements in engaging recruited community-based primary care physicians in an online guideline reinforcement strategy designed to promote Chlamydia screening, 2) the characteristics of physicians who respond to email announcements, as well as 3) how quickly and when they respond to email announcements. METHODS Over a 45-week period, 445 recruited physicians received up to 33 email contacts announcing and reminding them of an online women's health guideline reinforcing CME activity. Participation was defined as physician log-on at least once to the website. Data were analyzed to determine participation, to compare characteristics of participants with recruited physicians who did not participate, and to determine at what point and when participants logged on. RESULTS Of 445 recruited physicians with accurate email addresses, 47.2% logged on and completed at least one module. There were no significant differences by age, race, or specialty between participants and non-participants. Female physicians, US medical graduates and MDs had higher participation rates than male physicians, international medical graduates and DOs. Physicians with higher baseline screening rates were significantly more likely to log on to the course. The first 10 emails were the most effective in engaging community-based physicians to complete the intervention. Physicians were more likely to log on in the afternoon and evening and on Monday or Thursday. CONCLUSIONS Email course reminders may enhance recruitment of physicians to interventions designed to reinforce guideline adoption; physicians' response to email reminders may vary by gender, degree, and country of medical training. Repetition of email communications contributes to physician online participation.
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Affiliation(s)
- Maziar Abdolrasulnia
- Division of Continuing Medical Education, University of Alabama at Birmingham, JNWB 406, 1530 3Avenue South, Birmingham, AL 35294-0500, USA
- Center for Outcomes and Effectiveness Research Education, University of Alabama at Birmingham, MT 401, 1530 3Avenue South, Birmingham, AL 35294-1170, USA
| | - Blanche C Collins
- Division of Continuing Medical Education, University of Alabama at Birmingham, JNWB 406, 1530 3Avenue South, Birmingham, AL 35294-0500, USA
| | - Linda Casebeer
- Division of Continuing Medical Education, University of Alabama at Birmingham, JNWB 406, 1530 3Avenue South, Birmingham, AL 35294-0500, USA
- Center for Outcomes and Effectiveness Research Education, University of Alabama at Birmingham, MT 401, 1530 3Avenue South, Birmingham, AL 35294-1170, USA
| | - Terry Wall
- Center for Outcomes and Effectiveness Research Education, University of Alabama at Birmingham, MT 401, 1530 3Avenue South, Birmingham, AL 35294-1170, USA
- Department of Pediatrics, University of Alabama at Birmingham, MTC 201 1600 7Avenue South 35294-0011, USA
| | - Claire Spettell
- Aetna Integrated Informatics, Inc. 151 Farmington Avenue Hartford, CT 06156, USA
| | - Midge N Ray
- Center for Outcomes and Effectiveness Research Education, University of Alabama at Birmingham, MT 401, 1530 3Avenue South, Birmingham, AL 35294-1170, USA
- School of Health Related Professions, University of Alabama at Birmingham, Webb Building 564, 1530 3Avenue South, Birmingham, AL 35294-3361, USA
| | - Norman W Weissman
- Center for Outcomes and Effectiveness Research Education, University of Alabama at Birmingham, MT 401, 1530 3Avenue South, Birmingham, AL 35294-1170, USA
- School of Health Related Professions, University of Alabama at Birmingham, Webb Building 564, 1530 3Avenue South, Birmingham, AL 35294-3361, USA
| | - Jeroan J Allison
- Center for Outcomes and Effectiveness Research Education, University of Alabama at Birmingham, MT 401, 1530 3Avenue South, Birmingham, AL 35294-1170, USA
- Division of General Medicine, University of Alabama at Birmingham, FOT 720D 20Street South, Birmingham, AL 35294-3407, USA
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Berner ES, Savage GT, Houston TK, Williams ES, Crawford MA, Ray MN. Impact of patient feedback on residents' handheld computer use: a multi-site study. Stud Health Technol Inform 2004; 107:582-6. [PMID: 15360879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Handheld computers are being proposed as a resource for ambulatory care, yet physician reluctance to use the devices in the presence of patients is reported to be a barrier to optimal use. This study examined patient attitudes toward the use of handheld computers and the impact of those attitudes on the physicians' use of the handheld computers in the patient care setting. Most patients hold favorable attitudes toward physician use of handheld computers. Providing these data to physicians, however, did not uniformly lead to significant increases in handheld use in the presence of the patient. More understanding of the factors that influence behavior change and methods that will decrease barriers to the use of handhelds is needed
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Affiliation(s)
- Eta S Berner
- University of Alabama at Birmingham, 1675 University Boulevard, Webb 544, Birmingham, AL 35294, USA
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Casebeer LL, Strasser SM, Spettell CM, Wall TC, Weissman N, Ray MN, Allison JJ. Designing tailored Web-based instruction to improve practicing physicians' preventive practices. J Med Internet Res 2003; 5:e20. [PMID: 14517111 PMCID: PMC1550567 DOI: 10.2196/jmir.5.3.e20] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2003] [Accepted: 08/01/2003] [Indexed: 01/24/2023] Open
Abstract
Background The World Wide Web has led to the rapid growth of medical information and continuing medical educational offerings. Ease of access and availability at any time are advantages of the World Wide Web. Existing physician-education sites have often been designed and developed without systematic application of evidence and cognitive-educational theories; little rigorous evaluation has been conducted to determine which design factors are most effective in facilitating improvements in physician performance and patient-health outcomes that might occur as a result of physician participation in Web-based education. Theory and evidence-based Web design principles include the use of: needs assessment, multimodal strategies, interactivity, clinical cases, tailoring, credible evidence-based content, audit and feedback, and patient-education materials. Ease of use and design to support the lowest common technology denominator are also important. Objective Using these principles, design and develop a Web site including multimodal strategies for improving chlamydial-screening rates among primary care physicians. Methods We used office-practice data in needs assessment and as an audit/feedback tool. In the intervention introduced in 4 phases over 11 months, we provided a series of interactive, tailored, case vignettes with feedback on peer answers. We included a quality-improvement toolbox including clinical practice guidelines and printable patient education materials. Results In the formative evaluation of the first 2 chlamydia modules, data regarding the recruitment, enrollment, participation, and reminders have been examined. Preliminary evaluation data from a randomized, controlled trial has tested the effectiveness of this intervention in improving chlamydia screening rates with a significant increase in intervention physicians' chlamydia knowledge, attitude, and skills compared to those of a control group. Conclusions The application of theory in the development and evaluation of a Web-based continuing medical education intervention offers valuable insight into World Wide Web technology's influence on physician performance and the quality of medical care.
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Affiliation(s)
- Linda L Casebeer
- Division of Continuing Medical EducationUniversity of Alabama School of MedicineBirmingham ALUSA
| | - Sheryl M Strasser
- Division of Continuing Medical EducationUniversity of Alabama School of MedicineBirmingham ALUSA
| | | | - Terry C Wall
- University of Alabama School of MedicineDepartment of PediatricsBirmingham ALUSA
| | - Norman Weissman
- University of Alabama School of MedicineDepartment of PediatricsBirmingham ALUSA
| | - Midge N Ray
- University of Alabama at BirminghamSchool of Health Related ProfessionsBirmingham ALUSA
| | - Jeroan J Allison
- University of Alabama School of MedicineDivision of General Internal MedicineBirmingham ALUSA
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Houston TK, Ray MN, Crawford MA, Giddens T, Berner ES. Patient perceptions of physician use of handheld computers. AMIA Annu Symp Proc 2003; 2003:299-303. [PMID: 14728182 PMCID: PMC1480272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Handheld computers have advantages for healthcare providers including portability and integration into office workflow. However, negative patient perceptions of physician use of handheld computers in the examining room might limit integration. OBJECTIVE To survey patients' perceptions of handheld use, and compare those with their providers' perceptions. METHODS A survey of patient attitudes toward handhelds was conducted among patients at a low-income university clinic. Internal Medicine residents providing care were also surveyed. RESULTS Patients (N=93) were mostly female (79%) and ethnic minorities (67%) with average age of 39. Only 10% of patients did not like the idea of a handheld computer in the exam room. Other negative attitudes were also seen in a minority of patients. Some physicians (23%) reported reservations about using the handheld computer with patients. CONCLUSIONS Negative attitudes were rare among patients, but some providers were concerned about using the handheld in the exam room.
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Affiliation(s)
- Thomas K Houston
- School of Medicine, University of Alabama at Birmingham, AL, USA
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