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Jenssen BP, DiFiore G, Powell M, Luberti A, Rapposelli A, Lawton G, Dalembert G, Wood S, Ford CA, Biggs L, Fiks AG. Accelerating Innovation in Primary Care to Support Adolescent Health Discussions. Pediatrics 2024:e2023064285. [PMID: 38836314 DOI: 10.1542/peds.2023-064285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Adolescent strengths and risks are not routinely captured in systematized and actionable ways in pediatric primary care. To address this problem, we developed a comprehensive adolescent health questionnaire (AHQ) integrated within the electronic health record and evaluated the AHQ's impact on collection of information on prioritized health-related domains. METHODS We developed and pilot tested the AHQ. We then scaled and assessed the AHQ's impact on data collection. AHQ development used innovation methods and measured feasibility and acceptability outcomes. Scaling and postscaling outcomes included Reach, Effectiveness, Adoption, Implementation, Maintenance and Sustainability measures: Reach (total questionnaires completed), Effectiveness (capture of key information across health domains pre- vs post-AHQ scaling), Adoption (proportion of practices that adopted the AHQ), Implementation (proportion of eligible adolescents who completed the AHQ), and Maintenance (monthly completion rates). RESULTS AHQ development led to a tool that was feasible and acceptable for use. During scaling (October 2020-December 2021), 22 147 questionnaires were completed by 20 749 unique adolescents aged 13 to 21 years at their preventive visit. Comparing pre- versus post-AHQ scaling data, use of the AHQ increased collection of information across domains, especially for strengths, gun safety, substance use, sexual activity, sexual orientation, and gender identity, from ranges of 0%-25% to 92%-95%. All 31 practices adopted the AHQ with completion at 88.7% of visits (n = 24 968). Two years postscaling, completion rates were >91% per month. CONCLUSIONS We successfully developed, scaled, and maintained an AHQ in a widely-used electronic health record system, a model for improving adolescent care and foundation for developing future interventions.
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Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Possibilities Project
- Department of Biomedical and Health Informatics
| | | | | | - Anthony Luberti
- The Possibilities Project
- Department of Biomedical and Health Informatics
- Digital Health Team
| | | | | | - George Dalembert
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Possibilities Project
| | - Sarah Wood
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Possibilities Project
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carol A Ford
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- The Possibilities Project
- Department of Biomedical and Health Informatics
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2
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Owen A, Owen R, Batz R, Marasco-Wetzel J. Adolescent Perceptions of Adult-Mediated Healthcare Communication. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:400-415. [PMID: 38319709 DOI: 10.1080/19371918.2024.2314022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Adolescence is a time of rapid growth and development and may be accompanied by increased risk-taking behaviors and independence. Youth are particularly at risk for high levels of stress, decreased physical activity, unsafe sexual activity, abuse, depression, and suicide. Considering the unique health risks adolescents face, healthcare service access and utilization can play a pivotal role in promoting positive long term health outcomes throughout adulthood. At the same time, adolescents must often rely on parents/caregivers to mediate their healthcare access. Understanding how adolescents perceive adult interactions within healthcare is important for developing interventions that increase youth access to healthcare. We found that adolescents perceived adult-mediated healthcare experiences as either supportive (Subthemes: Recognition Builds Trust and Validation) or unsupportive (Subthemes: Adult-Focused Communication and Lack of Privacy). Based on our findings, we argue that prevention-focused interventions should include communication-based strategies. We discuss social work and healthcare practice and policy implications of these findings.
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Affiliation(s)
- Aleksa Owen
- School of Social Work, University of Nevada, Reno, NL, USA
| | - Randall Owen
- Special Education, College of Education and Human Development, University of Nevada, Reno, NL, USA
| | - Ruby Batz
- Special Education, College of Education and Human Development, University of Nevada, Reno, NL, USA
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3
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Anan YH, Kahn NF, Garrison MM, McCarty CA, Richardson LP. Associations Between Sleep Duration and Positive Mental Health Screens During Adolescent Preventive Visits in Primary Care. Acad Pediatr 2023; 23:1242-1246. [PMID: 36905952 DOI: 10.1016/j.acap.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE The purpose of this paper was to understand associations between low sleep duration (<8.ßhours) and positive mental health screens among adolescents (ages 13...18) seen for preventive visits in primary care. METHODS Data were from two randomized controlled trials testing the efficacy of an electronic health risk behavior screening and feedback tool for adolescent preventive visits. Participants (n.ß=.ß601) completed screeners at baseline, 3 months, and 6 months which included sleep duration in hours and the Patient Health Questionnaire 9 and Generalized Anxiety Disorder 7 screeners for depression and anxiety, respectively. Main analyses included adjusted logistic regressions testing associations between low sleep duration and positive mental health screens. RESULTS Adjusted models showed that low sleep duration was associated with significantly greater odds of a positive depression screen (OR.ß=.ß1.58, 95% CI: 1.06...2.37) but not with a positive anxiety screen or co-occurring positive depression and anxiety screens. However, follow-up analyses indicated an interaction between sleep duration and anxiety in the association with a positive depression screen, such that the association between low sleep and a positive depression screen was driven by those who did not screen positive for anxiety. CONCLUSIONS As pediatric primary care guidelines for sleep continue to evolve, further research, training, and support for sleep screening are warranted to ensure effective early intervention for sleep and mental health problems during adolescence.
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Affiliation(s)
- Yomna H Anan
- Center for Child Health, Behavior & Development (YH Anan, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Research Institute, Wash.
| | - Nicole F Kahn
- Division of Adolescent Medicine (NF Kahn, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Hospital, Wash
| | - Michelle M Garrison
- Center for Child Health, Behavior & Development (YH Anan, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Research Institute, Wash; Department of Health Systems and Population Health (MM Garrison), University of Washington School of Public Health, Seattle; Division of Child & Adolescent Psychiatry (MM Garrison), Seattle Children...s Hospital, Wash
| | - Carolyn A McCarty
- Center for Child Health, Behavior & Development (YH Anan, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Research Institute, Wash; Division of Adolescent Medicine (NF Kahn, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Hospital, Wash
| | - Laura P Richardson
- Center for Child Health, Behavior & Development (YH Anan, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Research Institute, Wash; Division of Adolescent Medicine (NF Kahn, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Hospital, Wash
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4
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Khetarpal SK, Tiffany-Appleton S, Mickievicz EE, Barral RL, Randell KA, Temple JR, Miller E, Ragavan MI. Sexual Health and Relationship Abuse Interventions in Pediatric Primary Care: A Systematic Review. J Adolesc Health 2023; 72:487-501. [PMID: 36623966 PMCID: PMC10033391 DOI: 10.1016/j.jadohealth.2022.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/23/2022] [Accepted: 11/14/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE Supporting adolescents in developing healthy relationships and promoting sexual and reproductive health (SRH) is an important responsibility of pediatric primary care providers. Less is known about evidence-based interventions in pediatric settings focused on healthy relationships and SRH. METHODS We conducted a systematic review to describe SRH and healthy relationship/adolescent relationship abuse (ARA) interventions for pediatric primary care over the past 20 years. Eligible articles were original research on an SRH-focused or ARA-focused intervention, conducted in-person within pediatric primary care or school-based health centers specifically for middle or high school-aged adolescents. Data abstracted from included articles included intervention description, content, delivery, evaluation design, and effectiveness of primary outcomes. Heterogeneous outcomes and evidence levels made conducting a meta-analysis infeasible. RESULTS Nineteen studies described 17 interventions targeting a variety of SRH and ARA topics (e.g., sexually transmitted infections, contraception, ARA). Interventions largely focused on screening/counseling adolescents (89%). Interventions generally were reported as being effective in changing adolescent health or practice-level outcomes. DISCUSSION This review provides preliminary evidence that SRH and ARA interventions in pediatric primary care settings can be effective in promoting adolescent health. Future work should consider ARA-specific prevention interventions, including parents in interventions, and strategies for implementation, dissemination, and scaling.
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Affiliation(s)
- Susheel Kant Khetarpal
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York.
| | - Sarah Tiffany-Appleton
- Division of General Academic Pediatrics, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erin E Mickievicz
- Division of General Academic Pediatrics, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Romina L Barral
- Division of Adolescent and Young Adult Medicine, Children's Mercy Kansas City, Kansas City, Missouri
| | - Kimberly A Randell
- Division of Emergency Medicine, Children's Mercy Kansas City, Kansas City, Missouri
| | - Jeff R Temple
- Center for Violence Prevention, University of Texas Medical Branch, Galveston, Texas
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maya I Ragavan
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of General Academic Pediatrics, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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5
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Eapen V, Winata T, Gilbert M, Nair R, Khan F, Lucien A, Islam R, Masi A, Lam-Cassettari C, Mendoza Diaz A, Dissanayake C, Karlov L, Descallar J, Eastwood J, Hasan I, Jalaludin B, Kohlhoff J, Liaw ST, Lingam R, Ong N, Tam CWM, Woolfenden S, Barbaro J. Parental experience of an early developmental surveillance programme for autism within Australian general practice: a qualitative study. BMJ Open 2022; 12:e064375. [PMID: 36442896 PMCID: PMC9710335 DOI: 10.1136/bmjopen-2022-064375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Implementing support and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. This study examined parents'/caregivers' experiences and perceptions about a digital developmental surveillance pathway for autism, the autism surveillance pathway (ASP), and usual care, the surveillance as usual (SaU) pathway, in the primary healthcare general practice setting. DESIGN This qualitative study involves using a convenience selection process of the full sample of parents/caregivers that participated in the main programme, 'General Practice Surveillance for Autism', a cluster-randomised controlled trial study. All interviews were audio-recorded, transcribed and coded using NVivo V.12 software. An inductive thematic interpretive approach was adopted and data were analysed thematically. PARTICIPANTS Twelve parents/caregivers of children with or without a developmental condition/autism (who participated in the main programme) in South Western Sydney and Melbourne were interviewed. SETTINGS All interviews were completed over the phone. RESULTS There were seven major themes and 20 subthemes that included positive experiences, such as pre-existing patient-doctor relationships and their perceptions on the importance of knowing and accessing early support/services. Barriers or challenges experienced while using the SaU pathway included long waiting periods, poor communication and lack of action plans, complexity associated with navigating the healthcare system and lack of understanding by general practitioners (GPs). Common suggestions for improvement included greater awareness/education for parents/carers and the availability of accessible resources on child development for parents/caregivers. CONCLUSION The findings support the use of digital screening tools for developmental surveillance, including for autism, using opportunistic contacts in the general practice setting. TRIAL REGISTRATION NUMBER ANZCTR (ACTRN12619001200178).
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Affiliation(s)
- Valsamma Eapen
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Teresa Winata
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Radhika Nair
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Feroza Khan
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Abbie Lucien
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Raisa Islam
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Anne Masi
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Christa Lam-Cassettari
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Antonio Mendoza Diaz
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Saint Lucia, Queensland, Australia
| | - Lisa Karlov
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Joseph Descallar
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - John Eastwood
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Faculty of Medicine and Health, School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Iqbal Hasan
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Bin Jalaludin
- Centre for Research, Evidence Management and Surveillance, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- Faculty of Medicine, School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Jane Kohlhoff
- Faculty of Medicine, Discipline of Psychiatry and Mental Health, UNSW, Sydney, New South Wales, Australia
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, UNSW, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Natalie Ong
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Chun Wah Michael Tam
- Faculty of Medicine, School of Population Health, UNSW, Sydney, New South Wales, Australia
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Susan Woolfenden
- Population Child Health Research Group, Faculty of Medicine, School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism, The University of Queensland, Saint Lucia, Queensland, Australia
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Thomas-Smith S, Klein E, Strelitz B, Jensen J, Parker E, Richardson L, McCarty C, Shafii T. Electronic Screening for Adolescent Risk Behaviors in the Emergency Department: A Randomized Controlled Trial. West J Emerg Med 2022; 23:931-938. [DOI: 10.5811/westjem.2022.7.55755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/19/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: In this study we aimed to assess the impact of an electronic health assessment with individualized feedback for risk behaviors in adolescents seeking care in a pediatric emergency department (ED).
Methods: We conducted a randomized control trial using a tablet-based screening program with a study population of adolescents in a busy pediatric ED. The intervention group received the screening program with individualized feedback. The control group received the screening program without feedback. All participants received one-day and three-month follow-up surveys to assess behaviors and attitudes toward health behaviors.
Results: A total of 296 subjects were enrolled and randomized. There was no difference in changes in risky behaviors between the control and experimental groups. A higher proportion of participants in the intervention groups reported that the screener changed the way they thought about their health at one-day follow-up (27.0%, 36/133) compared to the control group (15.5%, 20/129, P = .02).
Conclusion: This study successfully tested a multivariable electronic health screener in a real-world setting of a busy pediatric ED. The tool did not significantly change risky health behaviors in the adolescent population screened. However, our finding that the intervention changed adolescents’ perceptions of their health opens a door to the continued development of electronic interventions to screen for and target risk behaviors in adolescents in the ED setting.
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Affiliation(s)
- Siobhan Thomas-Smith
- University of Washington, Seattle Children’s Hospital, Department of Pediatrics, Division of Emergency Medicine, Seattle, Washington
| | - Eileen Klein
- University of Washington, Seattle Children’s Hospital, Department of Pediatrics, Division of Emergency Medicine, Seattle, Washington
| | - Bonnie Strelitz
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Jennifer Jensen
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Elizabeth Parker
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Laura Richardson
- University of Washington School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Seattle, Washington
| | - Carolyn McCarty
- University of Washington School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Seattle, Washington
| | - Taraneh Shafii
- University of Washington School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Seattle, Washington
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Al-Shimari F, Kahn NF, McCarty CA, Parker EO, Richardson LP, Shafii T. Provider Use of Time Alone With Adolescents: Differences by Health Concern. J Adolesc Health 2022; 71:508-511. [PMID: 35779999 PMCID: PMC10843781 DOI: 10.1016/j.jadohealth.2022.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE To examine associations between reports of sensitive health behaviors and the provision of time alone by a clinician during adolescent well visits. METHODS Data were collected from 547 adolescents who completed a well visit at one of eight clinics. Adjusted mixed logistic regression was used to examine whether reports of sexual behavior, substance use, disordered eating, mental health concerns, and demographic characteristics were associated with time alone. RESULTS Sexual behavior was found to be significantly associated with time alone, while substance use, disordered eating, a positive depression screen, and suicidal ideation were not. Older adolescents and males were more likely to report time alone, while race/ethnicity had no association with time alone. DISCUSSION Clinicians may be prioritizing time alone for behavioral concerns differently than for other sensitive behaviors.
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Affiliation(s)
- Fatima Al-Shimari
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Nicole F Kahn
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington.
| | - Carolyn A McCarty
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Elizabeth O Parker
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Laura P Richardson
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Taraneh Shafii
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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8
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Xu X, Yu Z, Ge Z, Chow EPF, Bao Y, Ong JJ, Li W, Wu J, Fairley CK, Zhang L. Web-Based Risk Prediction Tool for an Individual's Risk of HIV and Sexually Transmitted Infections Using Machine Learning Algorithms: Development and External Validation Study. J Med Internet Res 2022; 24:e37850. [PMID: 36006685 PMCID: PMC9459839 DOI: 10.2196/37850] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/13/2022] [Accepted: 07/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background HIV and sexually transmitted infections (STIs) are major global public health concerns. Over 1 million curable STIs occur every day among people aged 15 years to 49 years worldwide. Insufficient testing or screening substantially impedes the elimination of HIV and STI transmission. Objective The aim of our study was to develop an HIV and STI risk prediction tool using machine learning algorithms. Methods We used clinic consultations that tested for HIV and STIs at the Melbourne Sexual Health Centre between March 2, 2015, and December 31, 2018, as the development data set (training and testing data set). We also used 2 external validation data sets, including data from 2019 as external “validation data 1” and data from January 2020 and January 2021 as external “validation data 2.” We developed 34 machine learning models to assess the risk of acquiring HIV, syphilis, gonorrhea, and chlamydia. We created an online tool to generate an individual’s risk of HIV or an STI. Results The important predictors for HIV and STI risk were gender, age, men who reported having sex with men, number of casual sexual partners, and condom use. Our machine learning–based risk prediction tool, named MySTIRisk, performed at an acceptable or excellent level on testing data sets (area under the curve [AUC] for HIV=0.78; AUC for syphilis=0.84; AUC for gonorrhea=0.78; AUC for chlamydia=0.70) and had stable performance on both external validation data from 2019 (AUC for HIV=0.79; AUC for syphilis=0.85; AUC for gonorrhea=0.81; AUC for chlamydia=0.69) and data from 2020-2021 (AUC for HIV=0.71; AUC for syphilis=0.84; AUC for gonorrhea=0.79; AUC for chlamydia=0.69). Conclusions Our web-based risk prediction tool could accurately predict the risk of HIV and STIs for clinic attendees using simple self-reported questions. MySTIRisk could serve as an HIV and STI screening tool on clinic websites or digital health platforms to encourage individuals at risk of HIV or an STI to be tested or start HIV pre-exposure prophylaxis. The public can use this tool to assess their risk and then decide if they would attend a clinic for testing. Clinicians or public health workers can use this tool to identify high-risk individuals for further interventions.
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Affiliation(s)
- Xianglong Xu
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,China Australia Joint Research Center for Infectious Diseases, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Zhen Yu
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,China Australia Joint Research Center for Infectious Diseases, Xi'an Jiaotong University Health Science Centre, Xi'an, China.,Monash e-Research Centre, Faculty of Engineering, Airdoc Research, Nvidia AI Technology Research Centre, Monash University, Melbourne, Australia
| | - Zongyuan Ge
- Monash e-Research Centre, Faculty of Engineering, Airdoc Research, Nvidia AI Technology Research Centre, Monash University, Melbourne, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Yining Bao
- China Australia Joint Research Center for Infectious Diseases, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,China Australia Joint Research Center for Infectious Diseases, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Wei Li
- School of Public Health, Southeast University, Nanjing, China
| | - Jinrong Wu
- Research Centre for Data Analytics and Cognition, La Trobe University, Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,China Australia Joint Research Center for Infectious Diseases, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,China Australia Joint Research Center for Infectious Diseases, Xi'an Jiaotong University Health Science Centre, Xi'an, China
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9
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Sutton TL, Koprowski MA, Gold JA, Liu B, Grossblatt-Wait A, Macuiba C, Lehman A, Hedlund S, Rocha FG, Brody JR, Sheppard BC. Disparities in Electronic Screening for Cancer-Related Psychosocial Distress May Promote Systemic Barriers to Quality Oncologic Care. J Natl Compr Canc Netw 2022; 20:765-773.e4. [PMID: 35830889 DOI: 10.6004/jnccn.2022.7015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/25/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Screening for cancer-related psychosocial distress is an integral yet laborious component of quality oncologic care. Automated preappointment screening through online patient portals (Portal, MyChart) is efficient compared with paper-based screening, but unstudied. We hypothesized that patient access to and engagement with EHR-based screening would positively correlate with factors associated with digital literacy (eg, age, socioeconomic status). METHODS Screening-eligible oncology patients seen at our Comprehensive Cancer Center from 2014 through 2019 were identified. Patients with active Portals were offered distress screening. Portal and screening participation were analyzed via multivariable logistic regression. Household income in US dollars and educational attainment were estimated utilizing zip code and census data. RESULTS Of 17,982 patients, 10,279 (57%) had active Portals and were offered distress screening. On multivariable analysis, older age (odds ratio [OR], 0.97/year; P<.001); male gender (OR, 0.89; P<.001); Black (OR, 0.47; P<.001), Hawaiian/Pacific Islander (OR, 1.54; P=.007), and Native American/Alaskan Native race (OR, 0.67; P=.04); Hispanic ethnicity (OR, 0.76; P<.001); and Medicare (OR, 0.59; P<.001), Veteran's Affairs/military (OR, 0.09; P<.01), Medicaid (OR, 0.34; P<.001), or no insurance coverage (OR, 0.57; P<.001) were independently associated with lower odds of being offered distress screening; increasing income (OR, 1.05/$10,000; P<.001) and educational attainment (OR, 1.03/percent likelihood of bachelor's degree or higher; P<.001) were independently associated with higher odds. In patients offered electronic screening, participation rate was 36.6% (n=3,758). Higher educational attainment (OR, 1.01; P=.03) was independently associated with participation, whereas Black race (OR, 0.58; P=.004), Hispanic ethnicity (OR, 0.68; P=.01), non-English primary language (OR, 0.67; P=.03), and Medicaid insurance (OR, 0.78; P<.001) were independently associated with nonparticipation. CONCLUSIONS Electronic portal-based screening for cancer-related psychosocial distress leads to underscreening of vulnerable populations. At institutions using electronic distress screening workflows, supplemental screening for patients unable or unwilling to engage with electronic screening is recommended to ensure efficient yet equal-opportunity distress screening.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Flavio G Rocha
- 4Knight Cancer Institute.,5Division of Surgical Oncology, Department of Surgery, and
| | - Jonathan R Brody
- 1Department of Surgery.,6Brenden-Colson Center for Pancreatic Care, Oregon Health & Science University, Portland, Oregon
| | - Brett C Sheppard
- 1Department of Surgery.,6Brenden-Colson Center for Pancreatic Care, Oregon Health & Science University, Portland, Oregon
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10
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McCarty CA, Parker E, Zhou C, Katzman K, Stout J, Richardson LP. Electronic Screening, Feedback, and Clinician Training in Adolescent Primary Care: A Stepped-Wedge Cluster Randomized Trial. J Adolesc Health 2022; 70:234-240. [PMID: 34404610 DOI: 10.1016/j.jadohealth.2021.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/25/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study is to test the effects of an electronic screening and feedback tool and training for primary care clinicians on care and adolescent health behaviors. METHODS We conducted a stepped-wedge cluster randomized trial with six clinics randomly assigned to sequential crossover from control to intervention periods with clinician training between periods. Adolescents (ages 13-18) with a well visit during the control periods (n = 135) received usual care, while adolescents during the intervention periods (n = 167) received the electronic screening and feedback tool prior to their well visit, with results sent to their clinicians. Adolescents completed surveys at baseline, 1 day, 3 months, 6 months, and 12 months. Linear mixed effects models were used to examine associations between outcomes and treatment, controlling for time as a fixed effect and clinic as a random effect. All analyses employed intent-to-treat analyses and utilized multiple imputations for missing data. RESULTS Adolescents who received the intervention had a higher rate of counseling for their endorsed risk behaviors during the well visit (45% vs. 33%, Wald's T = 2.29, p = .02). There were no significant intervention effects on adolescent satisfaction with the clinician or perception of patient centeredness. The intervention was associated with a small but statistically significant reduction in overall risk score relative to control at 3 months (-.63, 95% confidence interval [-1.07, -.19], Cohen's d = .21), but not at 6 or 12 months. CONCLUSIONS The results suggest that electronic screening and feedback may be associated with small reductions in risk behaviors at 3 months but that changes do not persist at longer term follow-up.
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Affiliation(s)
- Carolyn A McCarty
- Seattle Children's Research Institute, Center for Child Health Behavior, and Development, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington.
| | - Elizabeth Parker
- Seattle Children's Research Institute, Center for Child Health Behavior, and Development, Seattle, Washington
| | - Chuan Zhou
- Seattle Children's Research Institute, Center for Child Health Behavior, and Development, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Katherine Katzman
- Seattle Children's Research Institute, Center for Child Health Behavior, and Development, Seattle, Washington
| | - Jim Stout
- Seattle Children's Research Institute, Center for Child Health Behavior, and Development, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Laura P Richardson
- Seattle Children's Research Institute, Center for Child Health Behavior, and Development, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
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11
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Willis VC, Thomas Craig KJ, Jabbarpour Y, Scheufele EL, Arriaga YE, Ajinkya M, Rhee KB, Bazemore A. Digital Health Interventions to Enhance Prevention in Primary Care: Scoping Review. JMIR Med Inform 2022; 10:e33518. [PMID: 35060909 PMCID: PMC8817213 DOI: 10.2196/33518] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Disease prevention is a central aspect of primary care practice and is comprised of primary (eg, vaccinations), secondary (eg, screenings), tertiary (eg, chronic condition monitoring), and quaternary (eg, prevention of overmedicalization) levels. Despite rapid digital transformation of primary care practices, digital health interventions (DHIs) in preventive care have yet to be systematically evaluated. Objective This review aimed to identify and describe the scope and use of current DHIs for preventive care in primary care settings. Methods A scoping review to identify literature published from 2014 to 2020 was conducted across multiple databases using keywords and Medical Subject Headings terms covering primary care professionals, prevention and care management, and digital health. A subgroup analysis identified relevant studies conducted in US primary care settings, excluding DHIs that use the electronic health record (EHR) as a retrospective data capture tool. Technology descriptions, outcomes (eg, health care performance and implementation science), and study quality as per Oxford levels of evidence were abstracted. Results The search yielded 5274 citations, of which 1060 full-text articles were identified. Following a subgroup analysis, 241 articles met the inclusion criteria. Studies primarily examined DHIs among health information technologies, including EHRs (166/241, 68.9%), clinical decision support (88/241, 36.5%), telehealth (88/241, 36.5%), and multiple technologies (154/241, 63.9%). DHIs were predominantly used for tertiary prevention (131/241, 54.4%). Of the core primary care functions, comprehensiveness was addressed most frequently (213/241, 88.4%). DHI users were providers (205/241, 85.1%), patients (111/241, 46.1%), or multiple types (89/241, 36.9%). Reported outcomes were primarily clinical (179/241, 70.1%), and statistically significant improvements were common (192/241, 79.7%). Results were summarized across the following 5 topics for the most novel/distinct DHIs: population-centered, patient-centered, care access expansion, panel-centered (dashboarding), and application-driven DHIs. The quality of the included studies was moderate to low. Conclusions Preventive DHIs in primary care settings demonstrated meaningful improvements in both clinical and nonclinical outcomes, and across user types; however, adoption and implementation in the US were limited primarily to EHR platforms, and users were mainly clinicians receiving alerts regarding care management for their patients. Evaluations of negative results, effects on health disparities, and many other gaps remain to be explored.
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Affiliation(s)
- Van C Willis
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Kelly Jean Thomas Craig
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yalda Jabbarpour
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Elisabeth L Scheufele
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yull E Arriaga
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Monica Ajinkya
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Kyu B Rhee
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Andrew Bazemore
- The American Board of Family Medicine, Lexington, KY, United States
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12
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Yonek JC, Velez S, Satre DD, Margolis K, Whittle A, Jain S, Tolou-Shams M. Addressing adolescent substance use in an urban pediatric federally qualified health center. J Subst Abuse Treat 2021; 135:108653. [PMID: 34840042 DOI: 10.1016/j.jsat.2021.108653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Screening, brief intervention, and referral to treatment (SBIRT) is a systematic approach to identification and intervention for individuals at risk for substance use disorders. Prior research indicates that SBIRT is underutilized in pediatric primary care. Yet few studies have examined procedures for identifying and addressing substance use in clinics that serve publicly insured adolescents (i.e., federally qualified health centers [FQHC]). This descriptive, multi-method study assessed adolescent substance use frequency and provider perspectives to inform SBIRT implementation in an urban pediatric FQHC in California. METHODS A medical record review assessed substance use frequency and correlates among publicly insured adolescents aged 12-17 years who completed a well-child visit in pediatric primary care between 2014 and 2017 (N = 2252). Data on substance use (i.e., alcohol, illicit drugs, and tobacco) were from a health assessment tool mandated by Medicaid. Semi-structured interviews with 12 providers (i.e., pediatricians, nurse practitioners, behavioral health clinicians) elicited information about the current clinic workflow for adolescent substance use and barriers and facilitators to SBIRT implementation. RESULTS Of 1588 adolescents who completed the assessment (70.5%), 6.8% reported current substance use. Self-reported use was highest among non-Hispanic Black (15.2%) adolescents and those with co-occurring depressive symptoms (14.4%). Provider-reported challenges to implementing SBIRT included a lack of space for confidential screening and a lack of referral options. Providers favored implementing technology-based tools such as tablets for adolescent pre-visit screening and electronic medical record-based decision support to facilitate brief intervention and treatment referrals. CONCLUSIONS This study fills a substantial research gap by examining factors that impede and support SBIRT implementation in pediatric FQHC settings. Successful SBIRT implementation in these settings could significantly reduce the unmet need for substance use treatment among uninsured and publicly insured adolescents. Pediatric primary care and urgent care providers perceived SBIRT to be feasible, and health information and digital technologies may facilitate the integration of SBIRT into clinic workflows. Ensuring confidentiality for screening and expanding referral options for adolescents in need of community-based addiction treatment are also critical to increasing SBIRT uptake.
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Affiliation(s)
- Juliet C Yonek
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Sarah Velez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States.
| | - Kathryn Margolis
- Department of Pediatrics at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 6B, San Francisco, CA 94110, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Amy Whittle
- Department of Pediatrics at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 6B, San Francisco, CA 94110, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Shonul Jain
- Department of Pediatrics at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 6B, San Francisco, CA 94110, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
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13
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Gibbons C, Porter I, Gonçalves-Bradley DC, Stoilov S, Ricci-Cabello I, Tsangaris E, Gangannagaripalli J, Davey A, Gibbons EJ, Kotzeva A, Evans J, van der Wees PJ, Kontopantelis E, Greenhalgh J, Bower P, Alonso J, Valderas JM. Routine provision of feedback from patient-reported outcome measurements to healthcare providers and patients in clinical practice. Cochrane Database Syst Rev 2021; 10:CD011589. [PMID: 34637526 PMCID: PMC8509115 DOI: 10.1002/14651858.cd011589.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patient-reported outcomes measures (PROMs) assess a patient's subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback on PROMs can support decision-making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. OBJECTIVES To assess the effects of PROMs feedback to patients, or healthcare workers, or both on patient-reported health outcomes and processes of care. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, two other databases and two clinical trial registries on 5 October 2020. We searched grey literature and consulted experts in the field. SELECTION CRITERIA Two review authors independently screened and selected studies for inclusion. We included randomised trials directly comparing the effects on outcomes and processes of care of PROMs feedback to healthcare professionals and patients, or both with the impact of not providing such information. DATA COLLECTION AND ANALYSIS Two groups of two authors independently extracted data from the included studies and evaluated study quality. We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. We conducted meta-analyses of the results where possible. MAIN RESULTS We identified 116 randomised trials which assessed the effectiveness of PROMs feedback in improving processes or outcomes of care, or both in a broad range of disciplines including psychiatry, primary care, and oncology. Studies were conducted across diverse ambulatory primary and secondary care settings in North America, Europe and Australasia. A total of 49,785 patients were included across all the studies. The certainty of the evidence varied between very low and moderate. Many of the studies included in the review were at risk of performance and detection bias. The evidence suggests moderate certainty that PROMs feedback probably improves quality of life (standardised mean difference (SMD) 0.15, 95% confidence interval (CI) 0.05 to 0.26; 11 studies; 2687 participants), and leads to an increase in patient-physician communication (SMD 0.36, 95% CI 0.21 to 0.52; 5 studies; 658 participants), diagnosis and notation (risk ratio (RR) 1.73, 95% CI 1.44 to 2.08; 21 studies; 7223 participants), and disease control (RR 1.25, 95% CI 1.10 to 1.41; 14 studies; 2806 participants). The intervention probably makes little or no difference for general health perceptions (SMD 0.04, 95% CI -0.17 to 0.24; 2 studies, 552 participants; low-certainty evidence), social functioning (SMD 0.02, 95% CI -0.06 to 0.09; 15 studies; 2632 participants; moderate-certainty evidence), and pain (SMD 0.00, 95% CI -0.09 to 0.08; 9 studies; 2386 participants; moderate-certainty evidence). We are uncertain about the effect of PROMs feedback on physical functioning (14 studies; 2788 participants) and mental functioning (34 studies; 7782 participants), as well as fatigue (4 studies; 741 participants), as the certainty of the evidence was very low. We did not find studies reporting on adverse effects defined as distress following or related to PROM completion. AUTHORS' CONCLUSIONS PROM feedback probably produces moderate improvements in communication between healthcare professionals and patients as well as in diagnosis and notation, and disease control, and small improvements to quality of life. Our confidence in the effects is limited by the risk of bias, heterogeneity and small number of trials conducted to assess outcomes of interest. It is unclear whether many of these improvements are clinically meaningful or sustainable in the long term. There is a need for more high-quality studies in this area, particularly studies which employ cluster designs and utilise techniques to maintain allocation concealment.
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Affiliation(s)
| | - Ian Porter
- Health Services & Policy Research, University of Exeter Medical School, Exeter, UK
| | - Daniela C Gonçalves-Bradley
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stanimir Stoilov
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain
| | | | | | - Antoinette Davey
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Elizabeth J Gibbons
- PROM Group, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Kotzeva
- Health Technology Assessment Department, Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain
| | - Jonathan Evans
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, Netherlands
| | - Evangelos Kontopantelis
- Centre for Health Informatics, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Jordi Alonso
- CIBER Epidemiologia y Salud Publica (CIBERESP), IMIM-Hospital del mar, Barcelona, Spain
| | - Jose M Valderas
- Health Services & Policy Research, Exeter Collaboration for Academic Primary Care (APEx), NIHR School for Primary Care Research, NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
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Astolfi RC, Leite MA, Papa CHG, Ryngelblum M, Eisner M, Peres MFT. Association between self-control and health risk behaviors: a cross-sectional study with 9th grade adolescents in São Paulo. BMC Public Health 2021; 21:1706. [PMID: 34538245 PMCID: PMC8451098 DOI: 10.1186/s12889-021-11718-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-control (SC) has been consistently found associated with diverse health risk behaviors (HRBs), but little research refers to low- and middle-income countries. Furthermore, there is evidence that some HRBs tend to aggregate, however studies with the specific purpose of addressing the relation between SC and multiple health risk behaviors (MHRBs) are rare. The objective of this study is to analyze these associations and provide evidence to help filling these gaps. METHODS A sample of 2106 9th grade students from the city of São Paulo responded a self-administered questionnaire in 2017. We tested the association of SC measured as an ordinal variable with four levels (higher, high, medium and low) with six HRBs (binge drinking, marijuana use, smoking, high consumption of ultra-processed food, sedentary behavior and bullying perpetration), in both separated and aggregated forms (MHRBs), controlling for potential confounders. Binary logistic regression was used to test the association between exposure (SC) and single outcomes. In order to analyze the association of SC with MHRBs, multinomial logistic regression was employed. RESULTS SC was associated with five of six HRBs investigated and with MHRBs. The effect size of the association of SC and MHRBs increased in a steep pattern with accumulation of more HRBs. CONCLUSION Low self-control is associated with most HRBs investigated and the magnitude of the association increases when more than two or three HRBs are accumulated. There seems to be a group of adolescents in a position of pronounced vulnerability for MHRBs. This should be considered when designing public policy and prevention programs. In contexts of limited or scarce resources and public funds, interventions focusing the most vulnerable groups, instead of universal interventions, should be considered.
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Affiliation(s)
- Roberta Corradi Astolfi
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. Address: Av. Dr. Arnaldo, 455 - 2o. andar - sala 2214, São Paulo, Postal Code: 01246-903, Brazil.
| | - Maria Alvim Leite
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. Address: Av. Dr. Arnaldo, 455 - 2o. andar - sala 2214, São Paulo, Postal Code: 01246-903, Brazil
| | - Cassio Henrique Gomide Papa
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. Address: Av. Dr. Arnaldo, 455 - 2o. andar - sala 2214, São Paulo, Postal Code: 01246-903, Brazil
| | - Marcelo Ryngelblum
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. Address: Av. Dr. Arnaldo, 455 - 2o. andar - sala 2214, São Paulo, Postal Code: 01246-903, Brazil
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge and Professor of Developmental Criminology, Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Maria Fernanda Tourinho Peres
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. Address: Av. Dr. Arnaldo, 455 - 2o. andar - sala 2214, São Paulo, Postal Code: 01246-903, Brazil
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15
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Zippel-Schultz B, Palant A, Eurlings C, F Ski C, Hill L, Thompson DR, Fitzsimons D, Dixon LJ, Brandts J, Schuett KA, de Maesschalck L, Barrett M, Furtado da Luz E, Hoedemakers T, Helms TM, Brunner-La Rocca HP. Determinants of acceptance of patients with heart failure and their informal caregivers regarding an interactive decision-making system: a qualitative study. BMJ Open 2021; 11:e046160. [PMID: 34135043 PMCID: PMC8211061 DOI: 10.1136/bmjopen-2020-046160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Heart failure is a growing challenge to healthcare systems worldwide. Technological solutions have the potential to improve the health of patients and help to reduce costs. Acceptability is a prerequisite for the use and a successful implementation of new disruptive technologies. This qualitative study aimed to explore determinants that influence the acceptance of patients and their informal caregivers regarding a patient-oriented digital decision-making solution-a doctor-at-home system. DESIGN We applied a semistructured design using an interview guide that was based on a theoretical framework influenced by established acceptance theories. The interviews were analysed using a content analysis. SETTING A multicentred study in four European countries. PARTICIPANTS We interviewed 49 patients and 33 of their informal caregivers. Most of the patients were male (76%) and aged between 60 and 69 years (43%). Informal caregivers were mostly female (85%). The majority of patients (55%) suffered from heart failure with mild symptoms. RESULTS Four main categories emerged from the data: needs and expectations, preferences regarding the care process, perceived risk and trust. Participants expressed clear wishes and expectations regarding a doctor-at-home, especially the need for reassurance and support in the management of heart failure. They were receptive to changes to the current healthcare processes. However, trust was identified as an important basis for acceptance and use. Finally, perceived risk for decision-making errors is a crucial topic in need of attention. CONCLUSION Patients and informal caregivers see clear benefits of digitalisation in healthcare. They perceive that an interactive decision-making system for patients could empower and enable effective self-care. Our results provide important insights for development processes of patient-centred decision-making systems by identifying facilitators and barriers for acceptance. Further research is needed, especially regarding the influence and mitigation of patients and informal caregivers' perceived risks.
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Affiliation(s)
| | | | - Casper Eurlings
- Cardiology Department, Laurentius Hospital, Roermond, The Netherlands
| | - Chantal F Ski
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Lana J Dixon
- Belfast Health and Social Care Trust, Belfast, UK
| | - Julia Brandts
- Department of Cardiology, University Hospital Aachen, Aachen, Germany
| | | | | | - Matthew Barrett
- Catherine McAuley Education and Research Centre, University College of Dublin, Dublin, Ireland
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16
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Richardson L, Parker EO, Zhou C, Kientz J, Ozer E, McCarty C. Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial. J Med Internet Res 2021; 23:e24135. [PMID: 33709942 PMCID: PMC7998326 DOI: 10.2196/24135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/30/2020] [Accepted: 01/16/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Health risk behaviors are the most common sources of morbidity among adolescents. Adolescent health guidelines (Guidelines for Preventive Services by the AMA and Bright Futures by the Maternal Child Health Bureau) recommend screening and counseling, but the implementation is inconsistent. OBJECTIVE This study aims to test the efficacy of electronic risk behavior screening with integrated patient-facing feedback on the delivery of adolescent-reported clinician counseling and risk behaviors over time. METHODS This was a randomized controlled trial comparing an electronic tool to usual care in five pediatric clinics in the Pacific Northwest. A total of 300 participants aged 13-18 years who attended a well-care visit between September 30, 2016, and January 12, 2018, were included. Adolescents were randomized after consent by employing a 1:1 balanced age, sex, and clinic stratified schema with 150 adolescents in the intervention group and 150 in the control group. Intervention adolescents received electronic screening with integrated feedback, and the clinicians received a summary report of the results. Control adolescents received usual care. Outcomes, assessed via online survey methods, included adolescent-reported receipt of counseling during the visit (measured a day after the visit) and health risk behavior change (measured at 3 and 6 months after the visit). RESULTS Of the original 300 participants, 94% (n=282), 94.3% (n=283), and 94.6% (n=284) completed follow-up surveys at 1 day, 3 months, and 6 months, respectively, with similar levels of attrition across study arms. The mean risk behavior score at baseline was 2.86 (SD 2.33) for intervention adolescents and 3.10 (SD 2.52) for control adolescents (score potential range 0-21). After adjusting for age, gender, and random effect of the clinic, intervention adolescents were 36% more likely to report having received counseling for endorsed risk behaviors than control adolescents (adjusted rate ratio 1.36, 95% CI 1.04 to 1.78) 1 day after the well-care visit. Both the intervention and control groups reported decreased risk behaviors at the 3- and 6-month follow-up assessments, with no significant group differences in risk behavior scores at either time point (3-month group difference: β=-.15, 95% CI -0.57 to -0.01, P=.05; 6-month group difference: β=-.12, 95% CI -0.29 to 0.52, P=.57). CONCLUSIONS Although electronic health screening with integrated feedback improves the delivery of counseling by clinicians, the impact on risk behaviors is modest and, in this study, not significantly different from usual care. More research is needed to identify effective strategies to reduce risk in the context of well-care. TRIAL REGISTRATION ClinicalTrials.gov NCT02882919; https://clinicaltrials.gov/ct2/show/NCT02882919.
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Affiliation(s)
- Laura Richardson
- Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | | | - Chuan Zhou
- Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Julie Kientz
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, United States
| | - Elizabeth Ozer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States.,Office of Diversity & Outreach, University of California, San Francisco, San Francisco, CA, United States
| | - Carolyn McCarty
- Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
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17
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Previsit Multidomain Psychosocial Screening Tools for Adolescents and Young Adults: A Systematic Review. J Adolesc Health 2021; 68:449-459. [PMID: 33221191 DOI: 10.1016/j.jadohealth.2020.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 11/21/2022]
Abstract
Adolescence and young adulthood constitute a period when exploratory behaviors can evolve into risky behaviors. Most causes of adolescent ill health are preventable; therefore, it is a priority to detect them early before they turn into health problems. Previsit multidomain psychosocial screening tools are used by professionals to detect and prioritize potentially problematic issues. In conjunction with appropriate clinician training, these tools have improved clinician screening rates in several areas of adolescent health. This article reviews existing multidomain previsit psychosocial screening tools developed in the 21st century and describes their characteristics using a systematic methodology. We reviewed 10,623 records to identify 15 different tools in use since 2000 and described their characteristics. Results show that all tools were developed in high-income countries. The tools provide sufficient coverage of many psychosocial domains relevant to young people's health. However, some psychosocial domains such as screen use and strengths are seldomly addressed. Furthermore, the tools rarely focus on young adults as a target population. Future research should assess the effectiveness, acceptability, and psychometric properties of validated psychosocial screening tools and examine how to expand their use in low- and middle-income countries.
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18
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Mehringer JE, Dowshen NL. Opportunities and Challenges for Previsit Screening for Sexual and Gender Identity Among Adolescents in Primary Care. J Adolesc Health 2020; 66:133-134. [PMID: 31952564 DOI: 10.1016/j.jadohealth.2019.11.298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 11/16/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Jamie E Mehringer
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nadia L Dowshen
- Gender and Sexuality Development Clinic, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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