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COVID-19 Vaccination Telephone Outreach: A Primary Care Clinic Intervention Targeting Health Equity.WMJ : Official Publication of the State... Dec 2023Equitable COVID-19 vaccine access is essential to ending the COVID-19 pandemic. In many instances, COVID-19 vaccination notification and scheduling occurred through...
INTRODUCTION
Equitable COVID-19 vaccine access is essential to ending the COVID-19 pandemic. In many instances, COVID-19 vaccination notification and scheduling occurred through online patient portals, for which socially vulnerable populations have limited access. Our objective was to reduce disparities in COVID-19 vaccine access for the Black and socially vulnerable populations unintentionally excluded by our health system's patient portal-driven vaccine outreach through a telephone outreach initiative.
METHODS
From February 1, 2021, through April 27, 2021, telephone outreach was directed towards patients aged 65 and older without patient portal access at a large urban academic general internal medicine clinic. Univariate and multivariate analyses between those who did and did not receive telephone outreach were completed to assess the odds of vaccination, accounting for outreach status, sex, age, race/ethnicity, payor status, social vulnerability index, and Elixhauser Comorbidity count.
RESULTS
A total of 1466 patients aged 65 and older without active patient portals were eligible to receive the COVID-19 vaccine. Of these patients, 664 received outreach calls; 382 (57.5%) of them got vaccinated compared to 802 patients who did not receive outreach calls, of which 486 (60.6%) got vaccinated ( = 0.2341). Patients who received outreach calls versus those who did not were more likely to be female, younger, non-Hispanic Black, from high social vulnerability index census tracts, and have higher Elixhauser Comorbidity counts. Logistical analysis revealed an odds ratio (OR) with a nonstatistically significant trend favoring higher vaccination likelihood in the no outreach cohort with univariate analysis with no changes when adjustment was made for age, sex, race/ethnicity, payor, social vulnerability index, and Elixhauser Comorbidity count (univariate analysis: OR 0.88 [95% CI, 0.71-1.09]; model 1: OR 0.89 [95% CI, 0.72 - 1.10]; model 2 - 0.89 (0.72 - 1.11); model 3: OR 0.87 (95% CI, 0.70 -1.09)].
CONCLUSIONS
While our telephone outreach initiative was not successful in increasing vaccination rates, lessons learned can help clinicians and health systems as they work to improve health equity. Achieving health equity requires a multifaceted approach engaging not only health systems but also public health and community systems to directly address the pervasive effects of structural racism perpetuating health inequities.
Topics: Humans; Female; Male; COVID-19; COVID-19 Vaccines; Health Equity; Pandemics; Vaccination; Primary Health Care
PubMed: 38180942
DOI: No ID Found -
JMIR Perioperative Medicine Nov 2023Enhanced recovery after surgery (ERAS) protocols are patient-centered, evidence-based guidelines for peri-, intra-, and postoperative management of surgical candidates...
BACKGROUND
Enhanced recovery after surgery (ERAS) protocols are patient-centered, evidence-based guidelines for peri-, intra-, and postoperative management of surgical candidates that aim to decrease operative complications and facilitate recovery after surgery. Anesthesia providers can use these protocols to guide decision-making and standardize aspects of their anesthetic plan in the operating room.
OBJECTIVE
Research across multiple disciplines has demonstrated that clinical decision support systems have the potential to improve protocol adherence by reminding providers about departmental policies and protocols via notifications. There remains a gap in the literature about whether clinical decision support systems can improve patient outcomes by improving anesthesia providers' adherence to protocols. Our hypothesis is that the implementation of an electronic notification system to anesthesia providers the day prior to scheduled breast surgeries will increase the use of the already existing but underused ERAS protocols.
METHODS
This was a single-center prospective cohort study conducted between October 2017 and August 2018 at an urban academic medical center. After obtaining approval from the institutional review board, anesthesia providers assigned to major breast surgery cases were identified. Patient data were collected pre- and postimplementation of an electronic notification system that sent the anesthesia providers an email reminder of the ERAS breast protocol the night before scheduled surgeries. Each patient's record was then reviewed to assess the frequency of adherence to the various ERAS protocol elements.
RESULTS
Implementation of an electronic notification significantly improved overall protocol adherence and several preoperative markers of ERAS protocol adherence. Protocol adherence increased from 16% (n=14) to 44% (n=44; P<.001), preoperative administration of oral gabapentin (600 mg) increased from 13% (n=11) to 43% (n=43; P<.001), and oral celebrex (400 mg) use increased from 16% (n=14) to 35% (n=35; P=.006). There were no statistically significant differences in the use of scopolamine transdermal patch (P=.05), ketamine (P=.35), and oral acetaminophen (P=.31) between the groups. Secondary outcomes such as intraoperative and postoperative morphine equivalent administered, postanesthesia care unit length of stay, postoperative pain scores, and incidence of postoperative nausea and vomiting did not show statistical significance.
CONCLUSIONS
This study examines whether sending automated notifications to anesthesia providers increases the use of ERAS protocols in a single academic medical center. Our analysis exhibited statistically significant increases in overall protocol adherence but failed to show significant differences in secondary outcome measures. Despite the lack of a statistically significant difference in secondary postoperative outcomes, our analysis contributes to the limited literature on the relationship between using push notifications and clinical decision support in guiding perioperative decision-making. A variety of techniques can be implemented, including technological solutions such as automated notifications to providers, to improve awareness and adherence to ERAS protocols.
PubMed: 37921854
DOI: 10.2196/44139 -
Sao Paulo Medical Journal = Revista... 2016Healthcare professionals need to instill the process of prevention, control and treatment of people infected with HIV into care practice. Through maintaining preventive...
CONTEXT AND OBJECTIVE:
Healthcare professionals need to instill the process of prevention, control and treatment of people infected with HIV into care practice. Through maintaining preventive treatment among HIV-infected pregnant women, it has been demonstrated that prophylactic antiretroviral therapy, scheduled cesarean section and the prohibition of breastfeeding significantly reduce vertical HIV transmission. This study aimed to assess the rates of vertical HIV transmission in a specialized service and identify the factors associated with it.
DESIGN AND SETTING:
Cross-sectional study developed at the University Hospital of Santa Maria (RS), Brazil.
METHODS:
A cross-sectional study was conducted on a sample of 198 notification forms and medical records of HIV-positive pregnant women and exposed children.
RESULTS:
The vertical transmission rate was 2.4%, and three children had been infected by vertical HIV transmission. The statistically significant risk factor was the use of injectable drugs. Delayed reporting of pregnancy, absence of antiretroviral therapy during pregnancy, lack of proper prenatal care, incapacity to perform viral load detection tests and CD4+ T cell counts and obstetric and maternal clinical complications were reported.
CONCLUSIONS:
The vertical transmission rate was high and the recommended intervention measures were not adopted in full. Adequate prophylactic measures need to be implemented in HIV-positive pregnant women prenatally and during the antenatal, delivery and postpartum periods.
Topics: Adolescent; Adult; Anti-HIV Agents; Brazil; Breast Feeding; CD4 Lymphocyte Count; Cross-Sectional Studies; Female; HIV Infections; Hospitals, University; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Risk Factors; Time Factors; Viral Load; Young Adult
PubMed: 28076637
DOI: 10.1590/1516-3180.2016.0139140616 -
Journal of Medical Internet Research Nov 2021Universal access to assessment and treatment of mental health and learning disorders remains a significant and unmet need. There are many people without access to care...
BACKGROUND
Universal access to assessment and treatment of mental health and learning disorders remains a significant and unmet need. There are many people without access to care because of economic, geographic, and cultural barriers, as well as the limited availability of clinical experts who could help advance our understanding and treatment of mental health.
OBJECTIVE
This study aims to create an open, configurable software platform to build clinical measures, mobile assessments, tasks, and interventions without programming expertise. Specifically, our primary requirements include an administrator interface for creating and scheduling recurring and customized questionnaires where end users receive and respond to scheduled notifications via an iOS or Android app on a mobile device. Such a platform would help relieve overwhelmed health systems and empower remote and disadvantaged subgroups in need of accurate and effective information, assessment, and care. This platform has the potential to advance scientific research by supporting the collection of data with instruments tailored to specific scientific questions from large, distributed, and diverse populations.
METHODS
We searched for products that satisfy these requirements. We designed and developed a new software platform called MindLogger, which exceeds the requirements. To demonstrate the platform's configurability, we built multiple applets (collections of activities) within the MindLogger mobile app and deployed several of them, including a comprehensive set of assessments underway in a large-scale, longitudinal mental health study.
RESULTS
Of the hundreds of products we researched, we found 10 that met our primary requirements with 4 that support end-to-end encryption, 2 that enable restricted access to individual users' data, 1 that provides open-source software, and none that satisfy all three. We compared features related to information presentation and data capture capabilities; privacy and security; and access to the product, code, and data. We successfully built MindLogger mobile and web applications, as well as web browser-based tools for building and editing new applets and for administering them to end users. MindLogger has end-to-end encryption, enables restricted access, is open source, and supports a variety of data collection features. One applet is currently collecting data from children and adolescents in our mental health study, and other applets are in different stages of testing and deployment for use in clinical and research settings.
CONCLUSIONS
We demonstrated the flexibility and applicability of the MindLogger platform through its deployment in a large-scale, longitudinal, mobile mental health study and by building a variety of other mental health-related applets. With this release, we encourage a broad range of users to apply the MindLogger platform to create and test applets to advance health care and scientific research. We hope that increasing the availability of applets designed to assess and administer interventions will facilitate access to health care in the general population.
Topics: Adolescent; Humans; Mental Health; Mobile Applications; Psychiatry; Surveys and Questionnaires; Telemedicine
PubMed: 34762054
DOI: 10.2196/22369 -
Journal of the American Medical... Jul 2021To assess primary care teams' perceptions of a health information exchange (HIE) event notification intervention for geriatric patients in 2 Veterans Health... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To assess primary care teams' perceptions of a health information exchange (HIE) event notification intervention for geriatric patients in 2 Veterans Health Administration (VHA) medical centers.
MATERIALS AND METHODS
We conducted a qualitative evaluation of an event notification alerting primary care teams to non-VHA hospital admissions and emergency department visits. Data were collected through semistructured interviews (n = 23) of primary care team physicians, nurses and medical assistants. Study design and analysis were guided by the Consolidated Framework for Implementation Research (CFIR).
RESULTS
Team members found the alerts necessary, helpful for filling information gaps, and effective in supporting timely follow-up care, although some expressed concern over scheduling capacity and distinguishing alerts from other VHA notices. Participants also suggested improvements including additional data on patients' diagnosis and discharge instructions, timing alerts to patients' discharge (including clear next steps), including additional team members to ensure alerts were acted upon, and implementing a single sign-on.
DISCUSSION
Primary care team members perceived timely event notification of non-VHA emergency department visits and hospital admissions as potentially improving post-discharge follow-up and patient outcomes. However, they were sometimes unsure of next steps and suggested the alerts and platform could be streamlined for easier use.
CONCLUSIONS
Event notifications may be a valuable tool in coordinating care for high-risk older patients. Future intervention research should explore the optimal amount and types of information and delivery method across sites and test the integration of alerts into broader care coordination efforts.
Topics: Aftercare; Aged; Hospitalization; Humans; Patient Care Team; Patient Discharge; Perception
PubMed: 33997903
DOI: 10.1093/jamia/ocab074 -
Pilot and Feasibility Studies 2018Osteoarthritis (OA) is a leading cause of persistent pain and disability. Traditionally viewed as a slowly progressive disease, the impact of symptom variability on...
BACKGROUND
Osteoarthritis (OA) is a leading cause of persistent pain and disability. Traditionally viewed as a slowly progressive disease, the impact of symptom variability on prognosis remains unclear. 'Acute-on-chronic' episodes are a well-recognised feature of many long-term conditions but only recently formally described in OA. This study aimed to develop a web-based data collection platform and establish key methodological design parameters, to develop a larger community-based study investigating acute flares of knee OA in England.
METHODS
The study is a 9-week feasibility and pilot web-based observational case-crossover study. Adults aged ≥ 40 years registered with two general practices who had consulted their general practitioner for knee pain/OA in the last 2 years were recruited. Participants completed a baseline questionnaire and scheduled (control-period) questionnaires at follow-up weeks 1, 5, and 9. Participants were invited to self-declare via the website on any occasion they experienced a knee pain flare-up lasting ≥ 24 h. Upon notification, an event-driven (case-period) questionnaire comparable to the scheduled questionnaires was completed and daily measurements on the course and consequences were taken until resolution. A sub-study of 10 participants logged daily pain measurements. The analysis estimated key parameters including recruitment (selective non-participation, eligibility, consent), retention, and flare-up capture processes. Questionnaire completeness and website usability were evaluated.
RESULTS
Of 442 patients invited, 14 completed baseline questionnaires. Eligibility rate was 26.9% (95% CI 19.3, 36.2), consent rate 53.6% (35.8, 70.5), and overall recruitment rate 3.2% (1.9, 5.2). Compared to those mailed, baseline responders were more likely to be male and ≥ 65 years, as were those reporting ≥ 1 flare-up. Eleven scheduled questionnaires were completed (mean response 35%). Although seven participants (50%) self-declared 11 flare-ups, only one event-driven questionnaire was completed and three participants contributed daily flare measurement for four flares. Missing data was ≤ 3.7% across completed baseline, scheduled, and event-driven questionnaires. Aspects of website usability require minor refinement.
CONCLUSIONS
Recruitment was not feasible with the current strategy. An evaluation of processes has suggested several substantial changes in design that may enhance recruitment, retention, and data quality in a future full-scale study.
PubMed: 30410785
DOI: 10.1186/s40814-018-0359-4 -
Global Health, Science and Practice Dec 2021Eleven anti-TB drugs were included in the Government of India's Schedule H1 drug regulations in 2014. The National Strategic Plan for TB Elimination in India 2017-2025...
INTRODUCTION
Eleven anti-TB drugs were included in the Government of India's Schedule H1 drug regulations in 2014. The National Strategic Plan for TB Elimination in India 2017-2025 recognized the opportunity to strengthen the TB surveillance system and improve the quality of TB care by implementing the Schedule H1 regulation. However, there were no documented systematic large-scale efforts to use Schedule H1 regulation to support TB surveillance or improve the quality of care. We aimed to document the process of implementation of the Schedule H1 regulation to enhance the quality of TB care and strengthen the TB surveillance system in Kerala, India.
METHODS
We conducted 33 in-depth interviews of the drugs control department enforcement officers, chemist shop owners, private-sector doctors, leaders of professional medical associations, and program managers and key staff of the TB Elimination Program in Kerala. Major themes identified were the process of implementation of Schedule H1 and how the National TB Elimination Program used the information. Findings from the qualitative interviews were corroborated with the quantitative information from the annual program performance reports and anti-TB drug sales data.
RESULTS
The TB Elimination Program of Kerala used the information from the Schedule H1 drug register to identify the missing TB cases and strengthen TB notification, identify providers for engagement and extend support to them for ensuring standards of TB care, and provide feedback to providers regarding prescription practices. Stakeholders felt that implementation of Schedule H1 surveillance has helped to improve TB patient notifications from the private sector, build better public-private partnerships, and improve the quality of TB diagnosis and treatment in Kerala.
CONCLUSION
Pharmacy-based drug sales data collected either through regulatory or non-regulatory methods have immense potential to support TB elimination programs.
Topics: Humans; India; Pharmacies; Pharmacy; Private Sector; Public-Private Sector Partnerships; Tuberculosis
PubMed: 34933980
DOI: 10.9745/GHSP-D-21-00346 -
Online Journal of Public Health... 2019Non-attendance and delay for vaccination schedules remains a big challenge to healthcare workers. Among the frequently mentioned reasons for missed vaccination in...
INTRODUCTION
Non-attendance and delay for vaccination schedules remains a big challenge to healthcare workers. Among the frequently mentioned reasons for missed vaccination in children is forgetfulness of caretakers to show up in vaccination schedules. This necessitates developing an automated reminder system with integration of mobile technologies.
OBJECTIVES
This paper aimed to develop and test an automated mobile text message reminder system in the local context of Ethiopia.
METHODS
This system is developed using iterative development process through phases of requirement analysis, design, development, testing and refinement. Requirement gathering was done before development of the system. Front end application was developed using java technologies while back end applications were developed with oracle database. Finally, pilot testing of the automated reminder system was done on 30 participants.
RESULTS
The automated system has been developed based on requirements. The text message reminder system has two components: 1. Web based application for client registration and automatic reminder scheduling; 2. SMS application for automatic SMS text messaging. In the pilot testing, all the text messages (100%) were dispatched from the automated system to the respective participants. Finally, the system has shown a notification that the text messages have been sent successfully.
CONCLUSION
Text message reminder system has been developed for routine childhood immunization program in Ethiopian context. Text message based mHealth interventions should be carefully designed, developed, tested and refined before actual implementation.
PubMed: 31632609
DOI: 10.5210/ojphi.v11i2.10244 -
Saudi Journal of Gastroenterology :... 2020To study the impact of computer-aided detection (CADe) system on the detection rate of polyps and adenomas in colonoscopy. (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND/AIM
To study the impact of computer-aided detection (CADe) system on the detection rate of polyps and adenomas in colonoscopy.
MATERIALS AND METHODS
A total of 1026 patients were prospectively randomly scheduled for colonoscopy with (the CADe group, CADe) or without (the control group, CON) the aid of the CADe system, together with visual notification and voice alarm, so as to compare the detection rate of polyp.
RESULTS
Compared with group CON, the detection rate of adenomas increased in group CADe, the average number of adenomas increased, the number of small adenomas increased, the number of proliferative polyps increased, and the differences were statistically significant (P < 0.001), but the comparison for the number of larger adenomas showed no significant difference between the groups (P> 0.05).
CONCLUSIONS
The CADe system is feasible for increasing the detection of polyps and adenomas in colonoscopy.
Topics: Adenoma; Adult; Artificial Intelligence; Colonic Polyps; Colonoscopy; Diagnosis, Computer-Assisted; Female; Humans; Male; Middle Aged; Prospective Studies
PubMed: 31898644
DOI: 10.4103/sjg.SJG_377_19