scholarly journals Improving Patient-Centered Communication about Sudden Unexpected Death in Epilepsy through Computerized Clinical Decision Support

2021 ◽  
Vol 12 (01) ◽  
pp. 090-099
Author(s):  
Randall W. Grout ◽  
Jeffrey Buchhalter ◽  
Anup D. Patel ◽  
Amy Brin ◽  
Ann A. Clark ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Sudden Unexpected Death ◽  
Pediatric Primary Care ◽  
Health Improvement ◽  
Unexpected Death ◽  
Patient Centered ◽  
Computerized Decision Support ◽  
Primary Care Clinics ◽  
Before And After

Abstract Background Sudden unexpected death in epilepsy (SUDEP) is a rare but fatal risk that patients, parents, and professional societies clearly recommend discussing with patients and families. However, this conversation does not routinely happen. Objectives This pilot study aimed to demonstrate whether computerized decision support could increase patient communication about SUDEP. Methods A prospective before-and-after study of the effect of computerized decision support on delivery of SUDEP counseling. The intervention was a screening, alerting, education, and follow-up SUDEP module for an existing computerized decision support system (the Child Health Improvement through Computer Automation [CHICA]) in five urban pediatric primary care clinics. Families of children with epilepsy were contacted by telephone before and after implementation to assess if the clinician discussed SUDEP at their respective encounters. Results The CHICA–SUDEP module screened 7,154 children age 0 to 21 years for seizures over 7 months; 108 (1.5%) reported epilepsy. We interviewed 101 families after primary care encounters (75 before and 26 after implementation) over 9 months. After starting CHICA–SUDEP, the number of caregivers who reported discussing SUDEP with their child's clinician more than doubled from 21% (16/75) to 46% (12/26; p = 0.03), and when the parent recalled who brought up the topic, 80% of the time it was the clinician. The differences between timing and sampling methodologies of before and after intervention cohorts could have led to potential sampling and recall bias. Conclusion Clinician–family discussions about SUDEP significantly increased in pediatric primary care clinics after introducing a systematic, computerized screening and decision support module. These tools demonstrate potential for increasing patient-centered education about SUDEP, as well as incorporating other guideline-recommended algorithms into primary and subspecialty cares. Clinical Trial Registration clinicaltrials.gov, NCT03502759.

scholarly journals Inappropriate Azithromycin Use in Nine Primary-Care Clinics Before and After Implementation of Provider Guidance in the EMR

2020 ◽  
Vol 41 (S1) ◽  
pp. s292-s293
Author(s):  
Alexandria May ◽  
Allison Hester ◽  
Kristi Quairoli ◽  
Sheetal Kandiah
Keyword(s):  
Primary Care ◽  
Retrospective Chart Review ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
National Guidelines ◽  
Targeted Interventions ◽  
Primary Care Clinics ◽  
Before And After ◽  
Upper Respiratory ◽  
Tract Infections

Background: According to the CDC Core Elements of Outpatient Stewardship, the first step in optimizing outpatient antibiotic use the identification of high-priority conditions in which antibiotics are commonly used inappropriately. Azithromycin is a broad-spectrum antimicrobial commonly used inappropriately in clinical practice for nonspecific upper respiratory infections (URIs). In 2017, a medication use evaluation at Grady Health System (GHS) revealed that 81.4% of outpatient azithromycin prescriptions were inappropriate. In an attempt to optimize outpatient azithromycin prescribing at GHS, a tool was designed to direct the prescriber toward evidence-based therapy; it was implemented in the electronic medical record (EMR) in January 2019. Objective: We evaluated the effect of this tool on the rate of inappropriate azithromycin prescribing, with the goal of identifying where interventions to improve prescribing are most needed and to measure progress. Methods: This retrospective chart review of adult patients prescribed oral azithromycin was conducted in 9 primary care clinics at GHS between February 1, 2019, and April 30, 2019, to compare data with that already collected over a 6-month period in 2017 before implementation of the antibiotic prescribing guidance tool. The primary outcome of this study was the change in the rate of inappropriate azithromycin prescribing before and after guidance tool implementation. Appropriateness was based on GHS internal guidelines and national guidelines. Inappropriate prescriptions were classified as inappropriate indication, unnecessary prescription, excessive or insufficient treatment duration, and/or incorrect drug. Results: Of the 560 azithromycin prescriptions identified during the study period, 263 prescriptions were included in the analysis. Overall, 181 (68.8%) of azithromycin prescriptions were considered inappropriate, representing a 12.4% reduction in the primary composite outcome of inappropriate azithromycin prescriptions. Bronchitis and unspecified upper respiratory tract infections (URI) were the most common indications where azithromycin was considered inappropriate. Attending physicians prescribed more inappropriate azithromycin prescriptions (78.1%) than resident physicians (37.0%) or midlevel providers (37.0%). Also, 76% of azithromycin prescriptions from nonacademic clinics were considered inappropriate, compared with 46% from academic clinics. Conclusions: Implementation of a provider guidance tool in the EMR lead to a reduction in the percentage of inappropriate outpatient azithromycin prescriptions. Future targeted interventions and stewardship initiatives are needed to achieve the stewardship program’s goal of reducing inappropriate outpatient azithromycin prescriptions by 20% by 1 year after implementation.Funding: NoneDisclosures: None

Opportunities for and Barriers to Using Smartphones for Health Education Among Families at an Urban Primary Care Clinic

2018 ◽  
Vol 57 (11) ◽  
pp. 1281-1285 ◽  
Author(s):  
Francis J. Real ◽  
Dominick DeBlasio ◽  
Cesarina Rounce ◽  
Adrienne W. Henize ◽  
Andrew F. Beck ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Education ◽  
Mobile Devices ◽  
Mobile Technology ◽  
Primary Care Clinic ◽  
Pediatric Primary Care ◽  
Care Clinic ◽  
Primary Care Clinics ◽  
Survey Questions

Mobile technology is omnipresent in society. Though studies suggest increased rates of smartphone accessibility, current access and barriers to smartphone usage at urban primary care clinics remains unclear. A self-administered survey was distributed to families presenting to an urban, underserved pediatric primary care clinic in spring 2017. Survey questions related to smartphone ownership and barriers to usage. A total of 273 parents completed the survey. Ninety-five percent of participants owned a smartphone. Fifty-eight percent of participants identified no barriers to smartphone usage. Among those who identified one or more barriers (n = 108), difficulties were primarily related to Wi-Fi access (46%), available phone memory (45%), existing phone data (28%), and discomfort with technology (11%). The majority of parents (59%) were interested in using a smartphone to learn about their child’s health. In conclusion, there is opportunity to transform health education utilizing mobile devices, though disparities to usage should be considered.

A computerized decision support system (CDSS) for antibiotic prescription in primary care—Antibioclic: implementation, adoption and sustainable use in the era of extended antimicrobial resistance

2020 ◽  
Author(s):  
Tristan Delory ◽  
Pauline Jeanmougin ◽  
Sylvie Lariven ◽  
Jean-Pierre Aubert ◽  
Nathan Peiffer-Smadja ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Decision Support System ◽  
Support System ◽  
Antibiotic Prescription ◽  
Sustainable Use ◽  
Acute Otitis Media ◽  
Community Acquired Pneumonia ◽  
Computerized Decision Support ◽  
Cross Sectional

Abstract Objectives To describe the implementation and use of a computerized decision support system (CDSS) for antibiotic prescription in primary care in France (Antibioclic). The CDSS targets 37 infectious diseases and has been freely available on a website since 2011. Methods Description and implementation of the architecture of a CDSS for antibiotic prescription in general practice. Analysis of the queries made between 2012 and 2018 on the CDSS by GPs. Analysis of two cross-sectional studies of users in 2014 and 2019. Results The number of queries increased from a median of 796/day [IQR, 578–989] in 2012 to 11 125/day [5592–12 505] in 2018. Unique users increased from 414/day [245–494] in 2012 to 5365/day [2891–5769] in 2018. Time taken to make a query was 2 min [1.9–2.1]. Among 3 542 347 queries in 2018, 78% were for adults. Six situations accounted for ≥50% of queries: cystitis; acute otitis media; acute sinusitis; community-acquired pneumonia; sore throat; and pyelonephritis. Queries concerned pathologies for which antibiotic prescription was necessary (64%), was conditional on additional clinical steps (34%) or was not recommended (2%). Most users (81%) were GPs, with median age of 38 years [31–52] and 58% were female. Among the 4016 GPs who responded to the surveys, the vast majority (96%) reported using the CDSS during the consultation, with 24% systematically using Antibioclic to initiate an antibiotic course and 93% having followed the CDSS recommendation for the latest prescription. Most GPs were comfortable using the CDSS in front of a patient. Conclusions Antibioclic has been adopted and is widely used in primary care in France. Its interoperability could allow its adaptation and implementation in other countries.

Organizational Factors Associated With Self-management Behaviors in Diabetes Primary Care Clinics

2009 ◽  
Vol 35 (5) ◽  
pp. 843-850 ◽  
Author(s):  
Amer A. Kaissi ◽  
Michael Parchman
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Medication Adherence ◽  
Support System ◽  
Clinical Information ◽  
Organizational Characteristics ◽  
Self Management ◽  
Management Support ◽  
Primary Care Clinics ◽  
Management Behaviors

Purpose The purpose of this article is to examine the relationship between organizational characteristics as measured by the Chronic Care Model (CCM) and patient self-management behaviors among patients with type 2 diabetes. Methods The study design was cross-sectional. The study setting included 20 primary care clinics from South Texas. The sample included approximately 30 consecutive patients that were enrolled from each clinic for a sample of 617 patients. For the data collection procedures, the CCM survey was completed by caregivers in the clinic. Self-management behaviors were obtained from patient exit surveys. For measures, the CCM consisted of 6 structural dimensions: (1) organization support, (2) community linkages, (3) self-management support, (4) decision support system, (5) delivery system design, and (6) clinical information systems. Patient self-management behavior included whether the patient reported always doing all 4 of the following behaviors as they were instructed: (1) checking blood sugars, (2) following diabetes diet, (3) exercising, and (4) taking medications. For data analyses, to account for clustering of patients within clinics, hierarchical logistic regression models were used. Results Self-management support was positively associated with medication adherence, while decision support system was positively associated with exercise and all 4 self-management behaviors. Surprisingly, community linkages were negatively associated with medication adherence, while clinical information system was negatively associated with diet and all 4 behaviors. A total score, including all dimensions, was positively associated with only exercise. Conclusions Health care providers and diabetes educators in primary care clinics should consider how organizational characteristics of the clinic might influence self-management behaviors of patients. The focus should be on better access to evidence-based information at the point of care and self-management needs and activities.

scholarly journals Scratching the Surface: Detecting the Presence of Viral Pathogens in Pediatric Primary Care Clinics

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S161-S161
Author(s):  
Folasade Odeniyi ◽  
Jasmine Santos ◽  
Samantha Hanley ◽  
Jennifer Faerber ◽  
Russell Localio ◽  
...  
Keyword(s):  
Primary Care ◽  
Pediatric Primary Care ◽  
Viral Pathogens ◽  
Primary Care Clinics

An Education Model for Otitis Media Care Field-Tested in Latin America

1993 ◽  
Vol 109 (5) ◽  
pp. 895-898 ◽  
Author(s):  
Roland D. Eavey ◽  
Jose Ignacio Santos ◽  
Moises A. Arriaga ◽  
Richard Gliklich ◽  
Carla Odio ◽  
...  
Keyword(s):  
Primary Care ◽  
Otitis Media ◽  
Primary Care Providers ◽  
World Health ◽  
Pediatric Primary Care ◽  
Care Providers ◽  
Media Management ◽  
Before And After ◽  
Health Organization ◽  
Long Term Impact

The World Health Organization has designated the teaching of otitis media management skills a “priority” status. Effective treatment of ear disease requires that the physician be both informationally educated as well as physically trained to use otoscopy. Little is known about how well this education can be provided in a short time and in a foreign country. To more objectively assess teaching effect, results of an education session for rural Mexican pediatric primary-care providers who were given an intensive otitis media lecture and otoscopy skills workshop in 1990 were evaluated. To test immediate cognitive impact, an anonymous written examination was given both before and after the teaching session. Average test scores after the educational sessions improved 24% ( p > 0.001) over baseline scores before the sessions. To evaluate long-term impact on clinical practice, a follow-up telephone survey 2 years later was conducted. The use of an otoscope to diagnose otitis media had increased from 40% to 93% of respondents. We conclude that pediatric primary-care providers In rural Mexico possess a baseline level of knowledge about otitis media that can be significantly enhanced with one educational session. Further, this teaching effort produces an impact on practice pattern that lasts at least 2 years.

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