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Satre DD, Anderson AN, Leibowitz AS, Levine-Hall T, Slome S, Flamm J, Hare CB, McNeely J, Weisner CM, Horberg MA, Volberding P, Silverberg MJ. Implementing electronic substance use disorder and depression and anxiety screening and behavioral interventions in primary care clinics serving people with HIV: Protocol for the Promoting Access to Care Engagement (PACE) trial. Contemp Clin Trials 2019; 84:105833. [PMID: 31446142 PMCID: PMC6760257 DOI: 10.1016/j.cct.2019.105833] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) and psychiatric disorders are common among people with HIV (PWH) and lead to poor outcomes. Yet these conditions often go unrecognized and untreated in primary care. METHODS The Promoting Access to Care Engagement (PACE) trial currently in process examines the impact of self-administered electronic screening for SUD risk, depression and anxiety in three large Kaiser Permanente Northern California primary care clinics serving over 5000 PWH. Screening uses validated measures (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]; and the Adult Outcomes Questionnaire [AOQ], which includes the Patient Health Questionnaire [PHQ-9] and Generalized Anxiety Disorder [GAD-2]) delivered via three modalities (secure messaging, tablets in waiting rooms, and desktop computers in exam rooms). Results are integrated automatically into the electronic health record. Based on screening results and physician referrals, behavioral health specialists embedded in primary care initiate motivational interviewing- and cognitive behavioral therapy-based brief treatment and link patients to addiction and psychiatry clinics as needed. Analyses examine implementation (screening and treatment rates) and effectiveness (SUD, depression and anxiety symptoms; HIV viral control) outcomes using a stepped-wedge design, with a 12-month intervention phase implemented sequentially in the clinics, and a 24-month usual care period prior to implementation in each clinic functioning as sequential observational phases for comparison. We also evaluate screening and treatment costs and implementation barriers and facilitators. DISCUSSION The study examines innovative, technology-facilitated strategies for improving assessment and treatment in primary care. Results may help to inform substance use, mental health, and HIV services. TRIAL REGISTRATION NCT03217058.
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Affiliation(s)
- Derek D Satre
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America.
| | - Alexandra N Anderson
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Amy S Leibowitz
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Sally Slome
- Kasier Permanente Oakland Medical Center, 3801 Howe St, Oakland, CA 94611, United States of America
| | - Jason Flamm
- Kaiser Permanente Sacramento Medical Center, 2025 Morse Ave, Sacramento, CA 95825, United States of America
| | - C Bradley Hare
- Kaiser Permanente San Francisco Medical Center, 2238 Geary Blvd, San Francisco, CA 94115, United States of America
| | - Jennifer McNeely
- New York University School of Medicine, 550 1st Ave., New York, NY 10016, United States of America
| | - Constance M Weisner
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, 2101 East Jefferson, Rockville, MD 20852, United States of America
| | - Paul Volberding
- AIDS Research Institute, University of California San Francisco, San Francisco, CA, 94158, United States of America
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
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Kopycka-Kedzierawski DT, Cacciato R, Hennessey R, Meyerowitz C, Litaker MS, Heft MW, Johnson KS, Reyes SC, Johnson JD, Baltuck CT, Gilbert GH. Electronic and paper mode of data capture when assessing patient-reported outcomes in the National Dental Practice-Based Research Network. ACTA ACUST UNITED AC 2019; 10:e12427. [PMID: 31155859 DOI: 10.1111/jicd.12427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/11/2019] [Indexed: 11/27/2022]
Abstract
AIM Our objectives were to describe the approach used in the National Dental Practice-Based Research Network to capture patient-reported outcomes and to compare electronic and paper modes of data capture in a specific network study. METHODS This was a prospective, multicenter cohort study of 1862 patients with dentin hypersensitivity. Patient-reported outcomes were assessed based on patients' perception of pain using Visual Analog Scales and Labeled Magnitude scales at baseline and at 1, 4 and 8 weeks post-baseline. RESULTS Eighty-five percent of study patients chose to complete follow-up assessments via an electronic mode; 15% completed them via a paper mode. There was not a significant difference in the proportions of patients who completed the 8-week assessment when comparing the electronic mode to the paper mode (92% vs. 90.8%, P = 0.31, Rao-Scott clustered χ2 -test). CONCLUSION The electronic mode of data capture was as operational as the traditional paper mode, while also providing the advantage of eliminating data entry errors, not involving site research coordinators in measuring the patient-reported outcomes, and not incurring cost and potential delays due to mailing study forms. Electronic data capture of patient reported outcomes could be successfully implemented in the community dental practice setting.
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Affiliation(s)
| | - Rita Cacciato
- Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | | | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | - Mark S Litaker
- School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marc W Heft
- College of Dentistry, University of Florida, Gainesville, Florida
| | | | - Stephanie C Reyes
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - James D Johnson
- College of Dentistry, University of Florida, Gainesville, Florida
| | | | - Gregg H Gilbert
- School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
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Jones G, Brennan V, Jacques R, Wood H, Dixon S, Radley S. Evaluating the impact of a 'virtual clinic' on patient experience, personal and provider costs of care in urinary incontinence: A randomised controlled trial. PLoS One 2018; 13:e0189174. [PMID: 29346378 PMCID: PMC5773012 DOI: 10.1371/journal.pone.0189174] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/15/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the impact of using a 'virtual clinic' on patient experience and cost in the care of women with urinary incontinence. MATERIALS AND METHODS Women, aged > 18 years referred to a urogynaecology unit were randomised to either (1) A Standard Clinic or (2) A Virtual Clinic. Both groups completed a validated, web-based interactive, patient-reported outome measure (ePAQ-Pelvic Floor), in advance of their appointment followed by either a telephone consultation (Virtual Clinic) or face-to-face consultation (Standard Care). The primary outcome was the mean 'short-term outcome scale' score on the Patient Experience Questionnaire (PEQ). Secondary Outcome Measures included the other domains of the PEQ (Communications, Emotions and Barriers), Client Satisfaction Questionnaire (CSQ), Short-Form 12 (SF-12), personal, societal and NHS costs. RESULTS 195 women were randomised: 98 received the intervention and 97 received standard care. The primary outcome showed a non-significant difference between the two study arms. No significant differences were also observed on the CSQ and SF-12. However, the intervention group showed significantly higher PEQ domain scores for Communications, Emotions and Barriers (including following adjustment for age and parity). Whilst standard care was overall more cost-effective, this was minimal (£38.04). The virtual clinic also significantly reduced consultation time (10.94 minutes, compared with a mean duration of 25.9 minutes respectively) and consultation costs compared to usual care (£31.75 versus £72.17 respectively), thus presenting potential cost-savings in out-patient management. CONCLUSIONS The virtual clinical had no impact on the short-term dimension of the PEQ and overall was not as cost-effective as standard care, due to greater clinic re-attendances in this group. In the virtual clinic group, consultation times were briefer, communication experience was enhanced and personal costs lower. For medical conditions of a sensitive or intimate nature, a virtual clinic has potential to support patients to communicate with health professionals about their condition.
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Affiliation(s)
- Georgina Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
- * E-mail:
| | - Victoria Brennan
- Health Economics and Decision Science, School of Health & Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Richard Jacques
- Design, Trials and Statistics, School of Health & Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Hilary Wood
- Health Economics and Decision Science, School of Health & Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Simon Dixon
- Health Economics and Decision Science, School of Health & Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Stephen Radley
- Urogynaecology Unit, Jessop Wing, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
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Smith MJ, Reiter MJ, Crist BD, Schultz LG, Choma TJ. Improving Patient Satisfaction Through Computer-Based Questionnaires. Orthopedics 2016; 39:e31-5. [PMID: 26709557 DOI: 10.3928/01477447-20151218-07] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/20/2015] [Indexed: 02/03/2023]
Abstract
Patient-reported outcome measures are helping clinicians to use evidence-based medicine in decision making. The use of computer-based questionnaires to gather such data may offer advantages over traditional paper-based methods. These advantages include consistent presentation, prompts for missed questions, reliable scoring, and simple and accurate transfer of information into databases without manual data entry. The authors enrolled 308 patients over a 16-month period from 3 orthopedic clinics: spine, upper extremity, and trauma. Patients were randomized to complete either electronic or paper validated outcome forms during their first visit, and they completed the opposite modality at their second visit, which was approximately 7 weeks later. For patients with upper-extremity injuries, the Penn Shoulder Score (PSS) was used. For patients with lower-extremity injuries, the Foot Function Index (FFI) was used. For patients with lumbar spine symptoms, the Oswestry Disability Index (ODI) was used. All patients also were asked to complete the 36-Item Short Form Health Survey (SF-36) Health Status Survey, version 1. The authors assessed patient satisfaction with each survey modality and determined potential advantages and disadvantages for each. No statistically significant differences were found between the paper and electronic versions for patient-reported outcome data. However, patients strongly preferred the electronic surveys. Additionally, the paper forms had significantly more missed questions for the FFI (P<.0001), ODI (P<.0001), and PSS (P=.008), and patents were significantly less likely to complete these forms (P<.0001). Future research should focus on limiting the burden on responders, individualizing forms and questions as much as possible, and offering alternative environments for completion (home or mobile platforms).
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Abstract
Medication adherence plays an important role in optimizing the outcomes of many treatment and preventive regimens in chronic illness. Self-report is the most common method for assessing adherence behavior in research and clinical care, but there are questions about its validity and precision. The NIH Adherence Network assembled a panel of adherence research experts working across various chronic illnesses to review self-report medication adherence measures and research on their validity. Self-report medication adherence measures vary substantially in their question phrasing, recall periods, and response items. Self-reports tend to overestimate adherence behavior compared with other assessment methods and generally have high specificity but low sensitivity. Most evidence indicates that self-report adherence measures show moderate correspondence to other adherence measures and can significantly predict clinical outcomes. The quality of self-report adherence measures may be enhanced through efforts to use validated scales, assess the proper construct, improve estimation, facilitate recall, reduce social desirability bias, and employ technologic delivery. Self-report medication adherence measures can provide actionable information despite their limitations. They are preferred when speed, efficiency, and low-cost measures are required, as is often the case in clinical care.
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van Cranenburgh O, Prinsen C, Sprangers M, Spuls P, de Korte J. Health-Related Quality-of-Life Assessment in Dermatologic Practice: Relevance and Application. Dermatol Clin 2012; 30:323-32, x. [DOI: 10.1016/j.det.2011.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Iskedjian M, Tinmouth AT, Arnold DM, Deuson R, Isitt JJ, Mikhael J. Elicitation of utility scores in Canada for immune thrombocytopenia treated with romiplostim or watch and rescue. J Med Econ 2012; 15:313-31. [PMID: 22136485 DOI: 10.3111/13696998.2011.646045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The objective of this study was to obtain utilities, or preference-based quality-of-life values, from the Canadian general public, for potential health states experienced by immune thrombocytopenia (ITP) patients receiving either romiplostim (a new thrombopoietin mimetic agent) or 'watch and rescue' therapy. Utilities are needed to conduct a cost-utility analysis of romiplostim for formulary and reimbursement decisions. METHODS An electronic Time Trade-off (TTO) survey was developed and administered to a sample of the general public in Canada, with 12 distinct health states derived from two randomized clinical trials of romiplostim vs watch and rescue treatment. Two pilot tests assessed interpretability and respondent burden. In the final survey, each subject was administered the TTO for four randomly-selected health states. Descriptive statistics were computed for utility scores, and differences between health states were evaluated with an analysis of variance model. RESULTS Eight hundred and twenty-one adults completed the TTO survey. Mean age was 36.4 (SD = 15) years; 63% were female. Mean (SD) utility scores ranged from 0.476 (0.271) for the most severe health state (significant bleeding) to 0.633 (0.282) for the least severe health state depicting successful treatment with romiplostim. Statistical significance was found on the mean difference between the most severe health state and five other health states (p < 0.05). After adjusting utilities for matching Canadian demographic parameters, no substantial difference was found between original utility scores and adjusted scores. CONCLUSIONS This study provides evidence of the Canadian general public's preference for 12 ITP health states pertaining to romiplostim treatment or watch and rescue. This study had a number of limitations, the main ones being the lack of perfect match in demographics between this sample and the Canadian population, as well as the fact that the scenario descriptions were based on both published literature and expert opinion. Despite those limitations, the obtained utility scores may be used in cost-utility models of romiplostim as a treatment for ITP patients in Canada.
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Affiliation(s)
- M Iskedjian
- PharmIdeas Research and Consulting Inc, Oakville, Ontario, Canada.
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Belazi D, Goldfarb NI, He H. Measuring health-related quality of life in the clinical setting. Expert Rev Pharmacoecon Outcomes Res 2010; 2:109-17. [PMID: 19807323 DOI: 10.1586/14737167.2.2.109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Quality of life is recognized as an important health outcome and several measures of quality of life have been well validated for use in clinical trials and outcomes research. These measures could play an important role in routine clinical care, providing valuable information on physical functioning, emotional health and other outcomes of interest to patients and providers alike. The literature to date largely reports on how these measures might be used in clinical practice, with few published studies on actual experiences with their implementation. Barriers to the use of quality of life measures, such as cost and time of administration, may decrease thanks to a new generation of measurement methodologies and tools.
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Affiliation(s)
- Dea Belazi
- Office of Health Policy & Clinical Outcomes, Thomas Jefferson University, Philadelphia, PA, USA.
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Gutteling JJ, Busschbach JJV, de Man RA, Darlington ASE. Logistic feasibility of health related quality of life measurement in clinical practice: results of a prospective study in a large population of chronic liver patients. Health Qual Life Outcomes 2008; 6:97. [PMID: 19000316 PMCID: PMC2621146 DOI: 10.1186/1477-7525-6-97] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Accepted: 11/10/2008] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The objective of the present study was to provide a complete and detailed report of technical and logistical feasibility problems with the implementation of routine computerized HRQoL measurement at a busy outpatient department of Hepatology that can serve as a tool for future researchers interested in the procedure. METHODS Practical feasibility was assessed by observing problems encountered during the development of the computer program, observing patients' ability to complete the HRQoL questionnaires, monitoring the number of times that patients completed the HRQoL questionnaires and observing logistics at the outpatient department. Patients' reasons for not completing the HRQoL questionnaires were assessed retrospectively by means of a mailed questionnaire. Physicians' attitudes towards the availability of computerized HRQoL information about their patients were assessed by means semi-structured interviews and by means of checklists administered after each consultation with s study participant. RESULTS All physicians (n = 11) and 587 patients agreed to participate in the study. Practical feasibility problems concerned complicated technical aspects of developing a user-friendly computer program and safe data transmission over the Internet, patients' lack of basic computer skills and patients' lack of compliance (completion of questionnaires on only 43% of the occasions). The main reason given for non-compliance was simply forgetting, which seemed to be related to reception employees' passive attitude towards sending patients to the computer. Physicians were generally positive about the instant computerized availability of HRQoL information. They requested the information in 92% of the consultations and found the information useful in 45% of the consultations, especially when it provided them with new information. CONCLUSION This study was among the first to implement the complete procedure of routine computerized HRQoL measurements in clinical practice and to subsequently describe the feasibility issues encountered. It was shown that the attitudes of physicians were generally positive. Several barriers towards successful implementation of such a procedure were encountered, and subsequently solutions were provided. Most importantly, when implementing routine computerized HRQoL measurements in clinical practice, assistance of an IT professional for the development of a tailor-made computer program, availability of questionnaires in multiple languages and the use of touch-screen computers to optimise patient participation are essential. Also, all staff of the department concerned should approve of the intervention and consider it as part of standard clinical routine if successful implementation is to be obtained.
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Affiliation(s)
- Jolie J Gutteling
- Department of Gastroenterology and Hepatology, Erasmus MC, 's Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands
- Department of Medical Psychology and Psychotherapy, Erasmus MC, Dr. Molewaterplein 50, 3015 GE Rotterdam, the Netherlands
| | - Jan JV Busschbach
- Department of Medical Psychology and Psychotherapy, Erasmus MC, Dr. Molewaterplein 50, 3015 GE Rotterdam, the Netherlands
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus MC, 's Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands
| | - Anne-Sophie E Darlington
- Department of Medical Psychology and Psychotherapy, Erasmus MC, Dr. Molewaterplein 50, 3015 GE Rotterdam, the Netherlands
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Radley SC, Jones GL, Tanguy EA, Stevens VG, Nelson C, Mathers NJ. Computer interviewing in urogynaecology: concept, development and psychometric testing of an electronic pelvic floor assessment questionnaire in primary and secondary care. BJOG 2006; 113:231-8. [PMID: 16412003 DOI: 10.1111/j.1471-0528.2005.00820.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop and evaluate a Web-based, electronic pelvic floor symptoms assessment questionnaire (e-PAQ)1 for women. DESIGN A cross-sectional study in primary and secondary care. SETTING Two general practices, two community health clinics and a secondary care urogynaecology clinic. SAMPLE A total of 432 women (204 in primary care and 228 in secondary care) were recruited between June 2003 and January 2004. METHODS The e-PAQ was located on a workstation (computer, touchscreen and printer). Women completed the e-PAQ prior to their appointment. Untreated women in primary care were asked to return seven days later to complete the e-PAQ a second time (test-retest). MAIN OUTCOME MEASURES Factor analysis, reliability, validity, patient satisfaction, completion times and system costs. RESULTS In secondary care, factor analysis identified 14 domains within the four dimensions (urinary, bowel, vaginal and sexual symptoms) with internal consistency (Cronbach's alpha)>or=0.7 in 11 of these. In primary care, alpha values were all>or=0.7 and test-retest analysis found acceptable intraclass correlations of 0.50-0.95 (P<0.001) for all domains. A measure of face validity and utility was gained using a nine-item questionnaire, which yielded strongly positive patient views on relevance and acceptability. CONCLUSIONS The e-PAQ offers a user-friendly clinical tool, which provides valid and reliable data. The system offers comprehensive symptoms and quality of life evaluation and may enhance the clinical episode as well as the quality of care for women with pelvic floor disorders.
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Affiliation(s)
- S C Radley
- Department of Obstetrics and Gynaecology, Royal Hallamshire Hospital, Sheffield, and Statistical Sciences Department, Leicester University, UK
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Aiello EJ, Taplin S, Reid R, Hobbs M, Seger D, Kamel H, Tufano J, Ballard-Barbash R. In a randomized controlled trial, patients preferred electronic data collection of breast cancer risk-factor information in a mammography setting. J Clin Epidemiol 2005; 59:77-81. [PMID: 16360564 DOI: 10.1016/j.jclinepi.2005.07.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2004] [Revised: 05/24/2005] [Accepted: 07/18/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE We evaluated patient acceptance of an electronic questionnaire to collect breast cancer risk-factor data in a mammography setting. METHODS We developed an electronic questionnaire on a tablet computer incorporating prefilled answers and skip patterns. Using a randomized controlled study design, we tested the survey in a mammography clinic that administers a paper risk-factor questionnaire to every woman at her screening mammogram. We randomized 160 women to use the electronic survey (experimental group, n = 86) or paper survey (control group, n = 74). We evaluated patient acceptance and data completeness. RESULTS Overall, 70.4% of the experimental group women thought the survey was very easy to use, compared to 55.6% of women in the control group. Ninety percent of experimental group women preferred using the tablet, compared to the paper questionnaire. Preference for the tablet did not differ by age; however, women > or = 60 years did not find the tablet as easy to use as did women < 60 years. The proportion of missing data was significantly lower on the tablet compared to the paper questionnaire (4.6% vs. 6.2%, P = .04). CONCLUSION Electronic questionnaires are feasible to use in a mammography setting, can improve data quality, and are preferred by women regardless of age.
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Affiliation(s)
- Erin J Aiello
- Group Health Cooperative, Center for Health Studies, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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Abstract
Clinicians are constantly being challenged to improve services and the care provided for individual patients. This article looks at the current approach to the management of uterovaginal prolapse in women and explores new developments in the assessment of prolapse and related pelvic floor disorders.
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Affiliation(s)
- Stephen Radley
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield S10 2SF
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Schmier JK, Kane DW, Halpern MT. Practical applications of usability theory to electronic data collection for clinical trials. Contemp Clin Trials 2005; 26:376-85. [PMID: 15911471 DOI: 10.1016/j.cct.2005.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2004] [Revised: 01/12/2005] [Accepted: 01/27/2005] [Indexed: 11/19/2022]
Abstract
Pharmaceutical and device companies are more frequently considering and using electronic data collection (EDC) to collect patient-reported outcomes such as satisfaction and quality of life for clinical trials. The transition from paper-and-pencil data collection to EDC is not without risks. The unique context of clinical trials presents challenges that, if not addressed, can lead to expensive mistakes. The advantages inherent to EDC can easily be cancelled out without careful attention to the characteristics of the clinical setting. This paper provides an overview of EDC issues specific to clinical trials and health care settings. In particular, it evaluates usability issues associated with methods of EDC and suggests strategies to minimize potential problems. Lessons learned from usability testing in the unique setting of the clinical trial can be applied to other projects to decrease costs, enhance the quality of the data, and minimize time to analysis.
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Affiliation(s)
- Jordana K Schmier
- Exponent, 1800 Diagonal Road, Suite 300, Alexandria, VA 22314, United States.
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Affiliation(s)
- S C Radley
- Department of Obstetrics and Gynaecology, Royal Hallamshire Hospital, Sheffield, UK
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Ernst ME, Iyer SS, Doucette WR. Drug-related problems and quality of life in arthritis and low back pain sufferers. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2003; 6:51-58. [PMID: 12535238 DOI: 10.1046/j.1524-4733.2003.00202.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The objective of this study was to determine the relationship between drug-related problems (DRPs) and health-related quality-of-life (HRQoL) in ambulatory, community-dwelling patients with musculoskeletal disorders. METHODS A 12-month, prospective, observational study was conducted in 12 independent community pharmacies in eastern Iowa. Ambulatory patients with self-reported diagnoses of osteoarthritis, rheumatoid arthritis, or low back pain were invited to participate. During quarterly visits to the pharmacy, patients used touch-screen computers to fill out the Short Form-36 (SF-36) general health survey. Using the results of these point-of-service health status assessments, community pharmacists interviewed patients to assess for DRPs. To examine the influences of different DRP characteristics on HRQoL and controlling for potential confounders, both univariate and multivariate analyses were performed using the change in physical component summary (PCS) score and mental component summary (MCS) score of the SF-36 from baseline to 12 months as the dependent variables. In each regression, the independent variables were those significant variables from the univariate analyses, as well as the types of DRPs and their outcomes. RESULTS A total of 461 patients were enrolled in the study. Through 12 months, 926 cumulative DRPs were identified. Overall regression models were significant for the PCS and MCS scores, respectively. Two types of DRPs showed significant negative associations with change in PCS: wrong drug and needs additional drug therapy. One type of DRP showed significant negative association with change in MCS: needs additional drug therapy. Resolution or improvement in DRPs showed a significant positive correlation with change in MCS but not PCS. CONCLUSIONS Two DRPs, needs additional drug therapy and wrong drug, are associated with reduced self-reported physical health in arthritis and low back pain, while the DRP needs additional drug therapy is also associated with reduced self-reported mental health. Resolution of DRPs is associated with improvement in mental health in this cohort.
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Affiliation(s)
- Michael E Ernst
- Division of Clinical and Administrative Pharmacy, College of Pharmacy, and Department of Family Medicine, College of Medicine, The University of Iowa, Iowa City 52242, USA.
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Saleh KJ, Radosevich DM, Kassim RA, Moussa M, Dykes D, Bottolfson H, Gioe TJ, Robinson H. Comparison of commonly used orthopaedic outcome measures using palm-top computers and paper surveys. J Orthop Res 2002; 20:1146-51. [PMID: 12472221 DOI: 10.1016/s0736-0266(02)00059-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Measuring patient-perceived outcomes following orthopaedic procedures have become an important component of clinical research and patient care. General and disease-specific outcomes measures have been developed and applied in orthopaedics to assess the patients' perceived health status. Unfortunately, paper-based, self-administered instruments remain inefficient for collecting data because of: (a) missing data (b) respondent error, and (c) the costs to administer and enter data. OBJECTIVE To study the comparability of palm-top computer devices and paper-pencil self-administered questionnaires in the collection of health-related quality of life (HRQL) information from patients. METHODS The comparability of administering HRQL questionnaires using palm-top computer and traditional paper-based forms was tested in a sample of 96 patients with complaints of hip and/or knee pain. Each patient completed mailed versions of the Medical Outcomes Study (MOS), 36-item Health Survey (SF-36), and Western Ontario and McMasters University Arthritis Index (WOMAC) three weeks prior to presenting to clinic. At the clinic they were asked to complete the same outcomes measures using the palm-top computer or a paper-and-pencil version. ANALYSIS In the analysis, scale distributions, floor and ceiling effects, internal consistency and retest reliability of scales were compared across the two data collection methods. Because the baseline characteristics of the groups were not strictly comparable according to age, the data were analyzed for the entire sample and stratified according to age. RESULTS Few statistically significant differences were found for the means, variances and intra-class correlation coefficients between the methods of administration. While the scale distribution between the two methods was comparable, the internal consistency of the scales was dissimilar. CONCLUSIONS Administration of HRQL questionnaires using portable palm-top computer devices has the potential advantage of decreased cost and convenience. These data lend some support for the comparability of palm-top computers and paper surveys for outcomes measures widely used in the field of orthopaedic surgery. The present study identified the lack of reliability across modes of administration that requires further study in a randomized comparability trial. These mode effects are important for orthopaedic surgeons to appreciate before implementing innovative data-capture technologies in their practices.
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Affiliation(s)
- Khaled J Saleh
- Department of Orthopaedic Surgery, School of Medicine, University of Minnesota, 492-420 Delaware Street SE, P.O. Box 492, Minneapolis, MN 55455, USA.
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McHorney CA, Earl Bricker D. A qualitative study of patients' and physicians' views about practice-based functional health assessment. Med Care 2002; 40:1113-25. [PMID: 12409856 DOI: 10.1097/00005650-200211000-00012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interest has increased in using patient-based measures of health status in everyday clinical practice. Patient reports of functioning and well-being have been most commonly used in clinical-practice settings at the group-level for research rather than at the individual-patient level for clinical decision-making. OBJECTIVES Little is known about patients' and physicians' preferences for practice-based functional health assessment. Qualitative methods were used to discover patient and physician attitudes about the use of functional health assessment tools in everyday clinical practice. RESEARCH DESIGN Six focus groups were conducted with 39 asthma patients who had been invited to participate in practice-based functional health assessment (FHA). Thirty in-depth, semistructured interviews were conducted with physicians in a single health maintenance organization to discover their attitudes about practice-based FHA. SETTING A large group-model health maintenance organization in Southeastern Wisconsin that consists of 200,000 members and 315 providers across 22 locations. Patients were selected from the Asthma Clinic and physicians were selected among all MD providers. RESULTS Patients identified numerous practical implementation problems with practice-based FHA, including the site of data collection, feedback on their responses, and who would have access to the data. Patients also identified several barriers and benefits of practice-based FHA. Before they would commit financial and human capital resources and time, clinicians wanted information about the effectiveness and value of practice-based FHA. CONCLUSIONS Several barriers to practice-based FHA were identified by patients and physicians. The evidence-based barrier identified by physicians needs to be overcome with additional intervention studies that push the envelope on several fronts including: (1) the type of tool; (2) the type of patient; (3) the type of setting; and (4) the recipients of the information. Interpretation guides and assessment linkage steps need to be developed and tested.
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Affiliation(s)
- Colleen A McHorney
- Department of Medicine, Indiana University School of Medicine, Regenstrief Institute for Health Care, Indiana University Center for Aging Research, and Roudebush Veterans Administration Medical Center, Indianapolis 46202, USA.
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Affiliation(s)
- Colleen A McHorney
- Department of Medicine, Indiana University School of Medicine, Indianapolis 46202, USA.
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Ernst ME, Doucette WR, Dedhiya SD, Osterhaus MC, Kumbera PA, Osterhaus JT, Townsend RJ. Use of point-of-service health status assessments by community pharmacists to identify and resolve drug-related problems in patients with musculoskeletal disorders. Pharmacotherapy 2001; 21:988-97. [PMID: 11718502 DOI: 10.1592/phco.21.11.988.34525] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To determine whether community pharmacists can use point-of-service health status assessments to identify and resolve drug-related problems (DRPs) in ambulatory patients with selected musculoskeletal (MSK) disorders. DESIGN Twelve-month, prospective, multicenter demonstration project. SETTING Twelve independent community pharmacies in eastern Iowa. PATIENTS Ambulatory patients with self-reported diagnosis of osteoarthritis, rheumatoid arthritis, or low back pain. MEASUREMENTS During quarterly pharmacy visits for 1 year, patients used touch-screen computers to report their health status. Patients answered questions on the Short Form-36 (SF-36) general health survey, as well as questions assessing limitations associated with their MSK condition. Pharmacists used this data in interviewing patients to assess for DRPs. MAIN RESULTS The study enrolled 461 patients, of whom 388 returned for the 12-month visit. During this 1-year period, community pharmacists identified 926 cumulative DRPs. Patients with no DRPs had significantly higher physical component summary scores on the SF-36 (p<0.05) than patients with more than one DRP at baseline (36.2 vs 31.6), 6 months (39.2 vs 33.3), and 12 months (40.1 vs 35.4). At 12 months, actions performed by pharmacists led to resolution or improvement of 70.7% of DRPs. CONCLUSION Drug-related problems are numerous in community-dwelling patients with MSK disorders and correspond to decreased physical health status. Community pharmacists can use patient-reported measures of health status to identify DRPs and initiate processes to resolve them.
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Affiliation(s)
- M E Ernst
- Division of Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa at Iowa City, 52242, USA.
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