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Keret S, Silva RL, Chandra T, Sharma A, Moghadam-Kia S, Oddis CV, Aggarwal R. Patient reported outcome for physical function in idiopathic inflammatory myopathy. Rheumatology (Oxford) 2024:keae091. [PMID: 38321360 DOI: 10.1093/rheumatology/keae091] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/08/2024] [Accepted: 01/28/2024] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVES There is an unmet need to develop patient-reported outcomes (PRO) measures for Idiopathic Inflammatory Myopathies (IIM). To investigate the feasibility, compliance, and psychometric properties of NIH's Patient-Reported Outcomes Measurement Information System (PROMIS) physical function-20 (PF-20) in a large U.S. IIM population. METHODS "Myositis Patient Centered Tele-Research" (My PACER) is a multicentre prospective observational study of IIM patients, competitively recruited through traditional in-person clinic visits (Center-Based Cohort [CBC]), and remotely using smartphone and web-based technology (Tele-Research Cohort [TRC]). The CBC was further randomly divided (1:1 ratio) into a traditional local sub-cohort, and a remote sub-cohort. Data collected included PRO and other patient self-assessments monthly for 6 months. Clinician-reported outcomes were obtained at baseline and 6 months. RESULTS 120 IIM patients were enrolled (82 TRC/38 CBC, mean age 55 ± 13.4, 75% females, 81% Caucasians), with similar demographics and mean PROMIS PF-20 score between cohorts. The PROMIS PF-20 score was not associated with age, sex or race. The compliance and completion rates were similar between TRC and CBC as well as sub-cohorts. PROMIS PF-20 showed strong test-retest reliability at 1 month. PROMIS PF-20 was significantly associated with all core set measures except extra-muscular global and CK, as well as with most of symptoms, function and physical activity measures. PROMIS PF-20 illustrated concordant change with myositis response criteria and patient assessment, with a large effect size. CONCLUSIONS PROMIS PF-20 demonstrates favorable psychometric properties including reliability, validity and responsiveness in a large cohort of myositis patients, with similar adherence in local or remotely enrolled patients.
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Affiliation(s)
- Shiri Keret
- Faculty of Medicine, Rheumatology, Bnai-Zion Medical Center, Israel, Technion, Haifa
| | - Raisa Lomanto Silva
- Internal medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tanya Chandra
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Akanksha Sharma
- Internal medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Siamak Moghadam-Kia
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Venable SR, Al-Hendy A. Uterine Fibroids: A Podcast on Patient and Physician Perspectives on Medical Management and a New Medical Therapy (Relugolix Combination Therapy). Adv Ther 2023; 40:4127-4133. [PMID: 37568061 PMCID: PMC10499739 DOI: 10.1007/s12325-023-02595-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] [Received: 02/15/2023] [Accepted: 06/26/2023] [Indexed: 08/13/2023]
Abstract
Uterine fibroids (UF) are common benign tumors in women and are an important health concern in the US and globally. UF can severely compromise a woman's quality of life, thus making it an important health issue. In this podcast, a professor of Obstetrics and Gynecology, University of Chicago (Dr. Ayman Al-Hendy) and the CEO of the Fibroid Foundation (Sateria Venable) provide their perspectives on the diagnosis and management of UF, including common treatments (e.g., myomectomy or hysterectomy). They also discuss Relugolix combination therapy for UF, noting who could benefit from this treatment and how it works. Podcast audio available for this article.
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Affiliation(s)
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA.
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Abbott T, Ng K, Nobes J, Muehlschlegel P. Small-Cell Carcinoma of the Prostate - Challenges of Diagnosis and Treatment: A Next of Kin and Physician Perspective Piece. Oncol Ther 2023; 11:291-301. [PMID: 37358792 PMCID: PMC10447819 DOI: 10.1007/s40487-023-00238-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/08/2023] [Indexed: 06/27/2023] Open
Abstract
This article was co-authored by a patient's relative describing their experiences of receiving a diagnosis and subsequent clinical management of a rare form of prostate cancer, neuroendocrine prostate cancer (NEPC). The difficulty of receiving this diagnosis, particularly as this was terminal with no options for systemic treatment, and experiences throughout this process are detailed. The relative's questions regarding the care of her partner, NEPC and clinical management are answered. The treating physician's perspective regarding clinical management is enclosed. Prostate cancer remains one of the most common cancer diagnoses, with small-cell carcinoma (SCC) of the prostate representing 0.5-2% of these. Prostatic SCC frequently develops in patients previously treated for prostate adenocarcinoma, more rarely arising de novo. Diagnosis and management present clinical challenges owing to its rarity, frequently aggressive disease course, lack of specific diagnostic and monitoring biomarkers, and treatment limitations. Current pathophysiological understanding of prostatic SCC, genomics and contemporary and evolving treatment options in addition to current guidelines are discussed. Written principally from the patient's relatives and physician experience with discussion of current evidence, diagnostic and treatment options, we hope this piece is informative for both patients and healthcare professionals alike.
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Affiliation(s)
| | - Kenrick Ng
- Department of Medical Oncology, University College London Hospitals, London, UK
| | - Jenny Nobes
- Department of Oncology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - Paula Muehlschlegel
- Department of Medical Oncology, University College London Hospitals, London, UK.
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Koopman I, Verbaan D, Vandertop WP, van der Graaf R, Kompanje EJO, Post R, Coert BA, Ploem MC, Sluis WM, Scheijmans FEV, Rinkel GJE, Vergouwen MDI. Deferred Consent in an Acute Stroke Trial from a Patient, Proxy, and Physician Perspective: A Cross-Sectional Survey. Neurocrit Care 2021. [PMID: 34611811 DOI: 10.1007/s12028-021-01357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/13/2021] [Indexed: 12/03/2022]
Abstract
Background In some acute care trials, immediate informed consent is not possible, but deferred consent is often considered problematic. We investigated the opinions of patients, proxies, and physicians about deferred consent in an acute stroke trial to gain insight into its acceptability and effects. Methods Paper-based surveys were sent to patients who were randomly assigned in the Ultra-early Tranexamic Acid After Subarachnoid Hemorrhage (ULTRA) trial between 2015 and 2018 in two tertiary referral centers and to physicians of centers who agreed or declined to participate. The primary outcome measure was the proportion of respondents who agreed with deferral of consent in the ULTRA trial. Secondary outcomes included respondents’ preferred consent procedure for the ULTRA trial, the effect of deferred consent on trust in physicians and scientific research, and the willingness to participate in future research. Results Eighty-nine of 135 (66%) patients or proxies and 20 of 30 (67%) physicians completed the survey. Of these, 82 of 89 (92%) patients or proxies and 14 of 20 (70%) physicians agreed with deferral of consent in the ULTRA trial. When asked for their preferred consent procedure for the ULTRA trial, 31 of 89 (35%) patients or proxies indicated deferred consent, 15 of 89 (17%) preferred immediate informed consent, and 32 of 89 (36%) had no preference. None of the patients’ or proxies’ trust in physicians or scientific research had decreased because of the deferred consent procedure. Willingness to participate in future studies remained the same or increased in 84 of 89 (94%) patients or proxies. Conclusions A large majority of the surveyed patients and proxies and a somewhat smaller majority of the surveyed physicians agreed with deferred consent in the ULTRA trial. Deferred consent may enable acute care trials in an acceptable manner without decreasing trust in medicine. Future research should investigate factors facilitating the responsible use of deferred consent, such as in-depth interviews, to study the minority of participants who agreed with deferred consent but still preferred immediate informed consent. Supplementary Information The online version contains supplementary material available at 10.1007/s12028-021-01357-3.
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Svider PF. Introduction: Opioid Analgesia: A Patient Perspective. Otolaryngol Clin North Am 2020; 53:709-713. [PMID: 32682529 DOI: 10.1016/j.otc.2020.05.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Many individuals believe that physicians can be difficult when they become patients, as having "just enough" knowledge or attempting to direct one's personal medical care presents problems particularly when dealing with a dynamic issue such as analgesia. Physicians are used to being advocates for their patients, and when they are the patients themselves, there is a certain degree of transition that changes one's perspective and affects how complex medical issues are addressed. There has been an evolution in management of pain concerns in recent decades with growing recognition of the toll of the opioid epidemic on our society.
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Affiliation(s)
- Peter F Svider
- Hackensack University Medical Center, Hackensack, NJ, USA; Bergen Medical Associates, 466 Old Hook Road, Suite 1, Emerson, NJ 07630, USA.
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Navarro-Millán I, Cornelius-Schecter A, O'Beirne RJ, Morris MS, Lui GE, Goodman SM, Cherrington AL, Fraenkel L, Curtis JR, Safford MM. Views of primary care physicians and rheumatologists regarding screening and treatment of hyperlipidemia among patients with rheumatoid arthritis. BMC Rheumatol 2020; 4:14. [PMID: 32159074 PMCID: PMC7057468 DOI: 10.1186/s41927-020-0112-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Despite high risk for cardiovascular disease (CVD) mortality, screening and treatment of hyperlipidemia in patients with rheumatoid arthritis (RA) is suboptimal. We asked primary care physicians (PCPs) and rheumatologists to identify barriers to screening and treatment for hyperlipidemia among patients with RA. Methods We recruited rheumatologists and PCPs nationally to participate in separate moderated structured group teleconference discussions using the nominal group technique. Participants in each group generated lists of barriers to screening and treatment for hyperlipidemia in patients with RA, then each selected the three most important barriers from this list. The resulting barriers were organized into physician-, patient- and system-level barriers, informed by the socioecological framework. Results Twenty-seven rheumatologists participated in a total of 3 groups (group size ranged from 7 to 11) and twenty PCPs participated in a total of 3 groups (group size ranged from 4 to 9). Rheumatologists prioritized physician level barriers (e.g. ‘ownership’ of hyperlipidemia screening and treatment), whereas PCPs prioritized patient-level barriers (e.g. complexity of RA and its treatments). Conclusion Rheumatologists were conflicted about whether treatment of CVD risk among patients with RA should fall within the role of the rheumatologist or the PCP. All participating PCPs agreed that CVD risk reduction was within their role. Factors that influenced PCPs’ decisions for screening and treatment for CVD risk in patients with RA were mainly related to their concern about how treatment for CVD risk could influence RA symptomatology (myalgia from statins) or how inflammation from RA and RA medications influences lipid profiles.
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Affiliation(s)
- Iris Navarro-Millán
- 1Division of General Internal Medicine, Weill Cornell Medicine, 420 E 70th Street, LH-363, New York, NY 10021 USA.,2Division of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - Anna Cornelius-Schecter
- 1Division of General Internal Medicine, Weill Cornell Medicine, 420 E 70th Street, LH-363, New York, NY 10021 USA
| | | | | | - Geyanne E Lui
- 1Division of General Internal Medicine, Weill Cornell Medicine, 420 E 70th Street, LH-363, New York, NY 10021 USA
| | - Susan M Goodman
- 2Division of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | | | - Liana Fraenkel
- 4Yale University, New Haven, CT USA.,5Berkshire Health Systems, Pittsfield, MA USA
| | | | - Monika M Safford
- 1Division of General Internal Medicine, Weill Cornell Medicine, 420 E 70th Street, LH-363, New York, NY 10021 USA
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Tory H, Zurakowski D, Kim S. Patient and physician discordance of global disease assessment in juvenile dermatomyositis: findings from the Childhood Arthritis & Rheumatology Research Alliance Legacy Registry. Pediatr Rheumatol Online J 2020; 18:5. [PMID: 31941511 PMCID: PMC6964044 DOI: 10.1186/s12969-020-0402-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/06/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Global disease activity scores (gVAS) capture patient or family (PF) and physician (MD) assessments of disease. This study sought to measure discordance between PF and MD global activity scores in juvenile dermatomyositis (JDM), and determine factors associated with discordance. METHODS Patients with JDM were included from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry (N = 563). PF and MD gVAS were assessed for discordance, defined as a ≥ 2-point difference. Factors associated with discordant gVAS were compared in univariate analysis. Multivariable regression analysis was used to identify predictors of discordance. RESULTS Almost 40% (N = 219) of PF and MD gVAS were discordant. Among discordant scores, 68% of PF rated gVAS ≥2-points above MD, which was associated with calcinosis and lower quality of life and functional scores (p < 0.01). MD gVAS rated ≥2-points above PF in 32%, which was associated with abnormal laboratory results, weakness, arthritis, rash and other skin changes, and current intravenous steroid treatment (p < 0.01). In multivariate analysis, predictors for higher PF rating included calcinosis, lower quality of life and functional scores, while predictors for higher MD rating included rash, calcinosis, nailfold capillaroscopy changes, and current intravenous steroid treatment. CONCLUSIONS Discordance between PF and MD gVAS was common in this JDM cohort. Overall, higher PF rating was associated with poorer patient reported outcome (PRO) scores, while higher MD rating was associated with poorer objective measures. This suggests PF and MD assessments of gVAS may be measuring different aspects of disease, highlighting the importance of integrating PROs into clinical practice and research.
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Affiliation(s)
- Heather Tory
- Division of Pediatric Rheumatology, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA. .,Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Susan Kim
- Pediatric Rheumatology, Benioff Children’s Hospital and University of San Francisco Medical Center, San Francisco, CA USA
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Jagpal A, O’Beirne R, Morris MS, Johnson B, Willig J, Yun H, Cherrington AL, Fraenkel L, Curtis JR, Safford MM, Navarro-Millán I. Which patient reported outcome domains are important to the rheumatologists while assessing patients with rheumatoid arthritis? BMC Rheumatol 2019; 3:36. [PMID: 31517249 PMCID: PMC6727422 DOI: 10.1186/s41927-019-0087-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 08/25/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) aid in rheumatoid arthritis (RA) management, but it is not well understood which measures would be most relevant to the rheumatologists for making treatment decisions. METHODS We recruited rheumatologists nationally to participate in moderated structured group teleconference discussions using the nominal group technique. Participants in each group generated lists of the elements from patient's history and signs that they use to make treatment recommendations for RA. Each participant then selected the three most important elements from the generated list. The results of each group were then combined and summarized. RESULTS Twenty-five rheumatologists participated in 4 groups (group size ranged from 4 to 8) and 150 available ranking votes across all groups. The statements generated across the 4 groups were categorized into 13 topics (including symptoms, physical function, comorbidities, social aspects, physical findings, response to treatment, treatment adherence, pain management, side effects, tests, access to care, contraception, and organ involvement), 10 of which received ranking votes. Symptoms received the highest ranking (46% of votes), followed by physical function (16%), and physical findings (13%). Among the unranked topics, social aspects had the highest number of statements (8 statements). CONCLUSION Rheumatologists highly valued patient-reported RA symptoms and physical function to inform their treatment decisions, even above objective data such as physical findings and test results. These results can guide the selection of validated PRO measures to assess these domains to inform the clinical care of patients with rheumatoid arthritis.
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Affiliation(s)
| | | | | | | | - James Willig
- University of Alabama at Birmingham, Birmingham, AL USA
| | - Huifeng Yun
- University of Alabama at Birmingham, Birmingham, AL USA
| | | | | | | | - Monika M. Safford
- Division of General Internal Medicine, Weill Cornell Medicine, 420 E 70th St., LH-363, New York, NY 10021 USA
| | - Iris Navarro-Millán
- Division of General Internal Medicine, Weill Cornell Medicine, 420 E 70th St., LH-363, New York, NY 10021 USA
- Division of Rheumatology, Hospital for Special Surgery, 420 E 70th St., LH-363, New York, NY 10021 USA
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Tory HO, Carrasco R, Griffin T, Huber AM, Kahn P, Robinson AB, Zurakowski D, Kim S; CARRA Juvenile Dermatomyositis Quality Measures Workgroup. Comparing the importance of quality measurement themes in juvenile idiopathic inflammatory myositis between patients and families and healthcare professionals. Pediatr Rheumatol Online J 2018; 16:28. [PMID: 29673367 DOI: 10.1186/s12969-018-0248-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/11/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A standardized set of quality measures for juvenile idiopathic inflammatory myopathies (JIIM) is not in use. Discordance has been shown between the importance ascribed to quality measures between patients and families and physicians. The objective of this study was to assess and compare the importance of various aspects of high quality care to patients with JIIM and their families with healthcare providers, to aid in future development of comprehensive quality measures. METHODS Surveys were developed by members of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Juvenile Dermatomyositis Workgroup through a consensus process and administered to patients and families through the CureJM Foundation and to healthcare professionals through CARRA. The survey asked respondents to rate the importance of 19 items related to aspects of high quality care, using a Likert scale. RESULTS Patients and families gave generally higher scores for importance to most of the quality measurement themes compared with healthcare professionals, with ratings of 13 of the 19 measures reaching statistical significance (p < 0.05). Of particular importance, however, was consensus between the groups on the top five most important items: quality of life, timely diagnosis, access to rheumatology, normalization of functioning/strength, and ability for self care. CONCLUSIONS Despite overall differences in the rating of importance of quality indicators between patients and families and healthcare professionals, the groups agreed on the most important aspects of care. Recognizing areas of particular importance to patients and families, and overlapping in importance with providers, will promote the development of standardized quality measures with the greatest potential for improving care and outcomes for children with JIIM.
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Auspitz M, Cleghorn MC, Azin A, Sockalingam S, Quereshy FA, Okrainec A, Jackson TD. Knowledge and Perception of Bariatric Surgery Among Primary Care Physicians: a Survey of Family Doctors in Ontario. Obes Surg 2018; 26:2022-2028. [PMID: 26780362 DOI: 10.1007/s11695-016-2055-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The primary objective of this study was to identify Ontario family physicians' knowledge and perceptions of bariatric surgery. METHODS The study population included all physicians practicing family medicine in Ontario who were listed in the Canadian Medical Directory. A self-administered questionnaire consisting of 28 questions was developed and validated using a focus group of seven primary care physicians. The questionnaire was distributed to 1328 physicians. RESULTS One hundred sixty-five surveys were completed. 8.8 % of physicians did not have any bariatric surgical patients, and 71.3 % had no more than five in their practice. 70.2 % referred no more than 5 % of their morbidly obese patients for surgery. Only 32.1 % had the appropriate equipment and resources to manage obese patients. 92.5 % of physicians would like to receive more education about bariatric surgery. Physicians with no history of referral (n = 21) were earlier into their practices and had less morbidly obese patients than physicians with previous referrals (n = 141). They were also less likely to discuss bariatric surgery with their patients (30 vs. 79.3 %; p < 0.001) and less likely to feel comfortable explaining procedure options (5.6 vs. 33.9 %; p = 0.013) and providing postoperative care (26.7 vs. 64.2 %; p = 0.005). 55.6 % would refer a family member for surgery, compared to 85.4 % of physicians with previous referrals; p = 0.002. CONCLUSION There appears to be a knowledge gap in understanding the role of bariatric surgery in the treatment of obesity. There is an opportunity to improve education and available resources for primary care physicians surrounding patient selection and follow-up care. This may improve access to treatment.
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Affiliation(s)
- Mark Auspitz
- Division of General Surgery, University Health Network-Toronto Western Hospital, 399 Bathurst Street, Room 8MP-322, Toronto, Ontario, M5T 2S8, Canada
| | - Michelle C Cleghorn
- Division of General Surgery, University Health Network-Toronto Western Hospital, 399 Bathurst Street, Room 8MP-322, Toronto, Ontario, M5T 2S8, Canada
| | - Arash Azin
- Division of General Surgery, University Health Network-Toronto Western Hospital, 399 Bathurst Street, Room 8MP-322, Toronto, Ontario, M5T 2S8, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Fayez A Quereshy
- Division of General Surgery, University Health Network-Toronto Western Hospital, 399 Bathurst Street, Room 8MP-322, Toronto, Ontario, M5T 2S8, Canada
| | - Allan Okrainec
- Division of General Surgery, University Health Network-Toronto Western Hospital, 399 Bathurst Street, Room 8MP-322, Toronto, Ontario, M5T 2S8, Canada
| | - Timothy D Jackson
- Division of General Surgery, University Health Network-Toronto Western Hospital, 399 Bathurst Street, Room 8MP-322, Toronto, Ontario, M5T 2S8, Canada.
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Abramson EL, Patel V, Pfoh ER, Kaushal R. How Physician Perspectives on E-Prescribing Evolve over Time. A Case Study Following the Transition between EHRs in an Outpatient Clinic. Appl Clin Inform 2016; 7:994-1006. [PMID: 27786335 PMCID: PMC5228140 DOI: 10.4338/aci-2016-04-ra-0069] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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] [Received: 08/03/2016] [Accepted: 09/17/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Physicians are expending tremendous resources transitioning to new electronic health records (EHRs), with electronic prescribing as a key functionality of most systems. Physician dissatisfaction post-transition can be quite marked, especially initially. However, little is known about how physicians' experiences using new EHRs for e-prescribing evolve over time. We previously published a qualitative case study about the early physician experience transitioning from an older to a newer, more robust EHR, in the outpatient setting, focusing on their perceptions of the electronic prescribing functionality. OBJECTIVE Our current objective was to examine how perceptions about using the new HER evolved over time, again with a focus on electronic prescribing. METHODS We interviewed thirteen internists at an academic medical center-affiliated ambulatory care clinic who transitioned to the new EHR two years prior. We used a grounded theory approach to analyze semi-structured interviews and generate key themes. RESULTS We identified five themes: efficiency and usability, effects on safety, ongoing training requirements, customization, and competing priorities for the EHR. We found that for even experienced e-prescribers, achieving prior levels of perceived prescribing efficiency took nearly two years. Despite the fact that speed in performing prescribing-related tasks was highly important, most were still not utilizing system short cuts or customization features designed to maximize efficiency. Alert fatigue remained common. However, direct transmission of prescriptions to pharmacies was highly valued and its benefits generally outweighed the other features considered poorly designed for physician workflow. CONCLUSIONS Ensuring that physicians are able to do key prescribing tasks efficiently is critical to the perceived value of e-prescribing applications. However, successful transitions may take longer than expected and e-prescribing system features that do not support workflow or require constant upgrades may further prolong the process. Additionally, as system features continually evolve, physicians may need ongoing training and support to maintain efficiency.
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Affiliation(s)
- Erika L Abramson
- Erika Abramson, MD, MS, Departments of Pediatrics and Healthcare Policy and Research, Weill Cornell Medical College, 525 East 68th Street, Rm M 610A, New York, NY 10065, Tel: 212-746-3929, Fax: 212-746-3140,
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Rosenfeld G, Greenup AJ, Round A, Takach O, Halparin L, Saadeddin A, Ho JK, Lee T, Enns R, Bressler B. FOCUS: Future of fecal calprotectin utility study in inflammatory bowel disease. World J Gastroenterol 2016; 22:8211-8218. [PMID: 27688663 PMCID: PMC5037090 DOI: 10.3748/wjg.v22.i36.8211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/24/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the perspective of gastroenterologists regarding the impact of fecal calprotectin (FC) on the management of patients with inflammatory bowel disease (IBD).
METHODS Patients with known IBD or symptoms suggestive of IBD for whom the physician identified that FC would be clinically useful were recruited. Physicians completed an online “pre survey” outlining their rationale for the test. After receipt of the test results, the physicians completed an online “post survey” to portray their perceived impact of the test result on patient management. Clinical outcomes for a subset of patients with follow-up data available beyond the completion of the “post survey” were collected and analyzed.
RESULTS Of 373 test kits distributed, 290 were returned, resulting in 279 fully completed surveys. One hundred and ninety patients were known to have IBD; 147 (77%) with Crohn’s Disease, 43 (21%) Ulcerative Colitis and 5 (2%) IBD unclassified. Indications for FC testing included: 90 (32.2%) to differentiate a new diagnosis of IBD from Irritable Bowel Syndrome (IBS), 85 (30.5%) to distinguish symptoms of IBS from IBD in those known to have IBD and 104 (37.2%) as an objective measure of inflammation. FC levels resulted in a change in management 51.3% (143/279) of the time which included a significant reduction in the number of colonoscopies (118) performed (P < 0.001). Overall, 97.5% (272/279) of the time, the physicians found the test sufficiently useful that they would order it again in similar situations. Follow-up data was available for 172 patients with further support for the clinical utility of FC provided.
CONCLUSION The FC test effected a change in management 51.3% of the time and receipt of the result was associated with a reduction in the number of colonoscopies performed.
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