Primary Care Physicians’ Experience Using Advanced Electronic Medical Record Features to Support Chronic Disease Prevention and Management: Qualitative Study

Background Chronic diseases are the leading cause of death worldwide. In Canada, more than half of all health care spending is used for managing chronic diseases. Although studies have shown that the use of advanced features of electronic medical record (EMR) systems improves the quality of chronic disease prevention and management (CDPM), a 2012 international survey found that Canadian physicians were the least likely to use 2 or more EMR system functions. Some studies show that maturity vis-à-vis clinicians’ EMR use is an important factor when evaluating the use of advanced features of health information systems. The Clinical Adoption Framework (CAF), a common evaluation framework used to assess the success of EMR adoption, does not incorporate the process of maturing. Nevertheless, the CAF and studies that discuss the barriers to and facilitators of the adoption of EMR systems can be the basis for exploring the use of advanced EMR features. Objective This study aimed to explore the factors that primary care physicians in Ontario identified as influencing their use of advanced EMR features to support CDPM and to extend the CAF to include primary care physicians’ perceptions of how their use of EMRs for performing clinical tasks has matured. Methods Guided by the CAF, directed content analysis was used to explore the barriers and facilitating factors encountered by primary care physicians when using EMR features. Participants were primary care physicians in Ontario, Canada, who use EMRs. Data were coded using categories from the CAF. Results A total of 9 face-to-face interviews were conducted from January 2017 to July 2017. Dimensions from the CAF emerged from the data, and one new dimension was derived: physicians’ perception of their maturity of EMR use. Primary care physicians identified the following key factors that impacted their use of advanced EMR features: performance of EMR features, information quality of EMR features, training and technical support, user satisfaction, provider’s productivity, personal characteristics and roles, cost benefits of EMR features, EMR systems infrastructure, funding, and government leadership. Conclusions The CAF was extended to include physicians’ perceptions of how their use of EMR systems had matured. Most participants agreed that their use of EMR systems for performing clinical tasks had evolved since their adoption of the system and that certain system features facilitated their care for patients with chronic diseases. However, several barriers were identified and should be addressed to further enhance primary care physicians’ use of advanced EMR features to support CDPM.

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Primary Care Physicians’ Experience Using Advanced Electronic Medical Record Features to Support Chronic Disease Prevention and Management: Qualitative Study (Preprint)

10.2196/preprints.13318 ◽

2019 ◽

Author(s):

Rana Melissa Rahal ◽

Jay Mercer ◽

Craig Kuziemsky ◽

Sanni Yaya

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Prevention ◽

Medical Record ◽

Chronic Diseases ◽

Electronic Medical Record ◽

Primary Care Physicians ◽

Evaluation Framework ◽

Chronic Disease Prevention

BACKGROUND Chronic diseases are the leading cause of death worldwide. In Canada, more than half of all health care spending is used for managing chronic diseases. Although studies have shown that the use of advanced features of electronic medical record (EMR) systems improves the quality of chronic disease prevention and management (CDPM), a 2012 international survey found that Canadian physicians were the least likely to use 2 or more EMR system functions. Some studies show that maturity vis-à-vis clinicians’ EMR use is an important factor when evaluating the use of advanced features of health information systems. The Clinical Adoption Framework (CAF), a common evaluation framework used to assess the success of EMR adoption, does not incorporate the process of maturing. Nevertheless, the CAF and studies that discuss the barriers to and facilitators of the adoption of EMR systems can be the basis for exploring the use of advanced EMR features. OBJECTIVE This study aimed to explore the factors that primary care physicians in Ontario identified as influencing their use of advanced EMR features to support CDPM and to extend the CAF to include primary care physicians’ perceptions of how their use of EMRs for performing clinical tasks has matured. METHODS Guided by the CAF, directed content analysis was used to explore the barriers and facilitating factors encountered by primary care physicians when using EMR features. Participants were primary care physicians in Ontario, Canada, who use EMRs. Data were coded using categories from the CAF. RESULTS A total of 9 face-to-face interviews were conducted from January 2017 to July 2017. Dimensions from the CAF emerged from the data, and one new dimension was derived: physicians’ perception of their maturity of EMR use. Primary care physicians identified the following key factors that impacted their use of advanced EMR features: performance of EMR features, information quality of EMR features, training and technical support, user satisfaction, provider’s productivity, personal characteristics and roles, cost benefits of EMR features, EMR systems infrastructure, funding, and government leadership. CONCLUSIONS The CAF was extended to include physicians’ perceptions of how their use of EMR systems had matured. Most participants agreed that their use of EMR systems for performing clinical tasks had evolved since their adoption of the system and that certain system features facilitated their care for patients with chronic diseases. However, several barriers were identified and should be addressed to further enhance primary care physicians’ use of advanced EMR features to support CDPM.

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Identifying individuals with multiple sclerosis in an electronic medical record

Multiple Sclerosis Journal ◽

10.1177/1352458514538334 ◽

2014 ◽

Vol 21 (2) ◽

pp. 217-224 ◽

Cited By ~ 20

Author(s):

Kristen M Krysko ◽

Noah M Ivers ◽

Jacqueline Young ◽

Paul O’Connor ◽

Karen Tu

Keyword(s):

Primary Care ◽

Quality Of Care ◽

Medical Record ◽

Electronic Medical Record ◽

Primary Care Physicians ◽

Policy Makers ◽

Patient Profile ◽

Physician Billing ◽

Chart Abstraction

Background: The increasing use of electronic medical records (EMRs) presents an opportunity to efficiently evaluate and improve quality of care for individuals with MS. Objectives: We aimed to establish an algorithm to identify individuals with MS within EMRs. Methods: We used a sample of 73,003 adult patients from 83 primary care physicians in Ontario using the Electronic Medical Record Administrative data Linked Database (EMRALD). A reference standard of 247 individuals with MS was identified through chart abstraction. The accuracy of identifying individuals with MS in an EMR was assessed using information in the cumulative patient profile (CPP), prescriptions and physician billing codes. Results: An algorithm identifying MS in the CPP performed well with 91.5% sensitivity, 100% specificity, 98.7% PPV and 100% NPV. The addition of prescriptions for MS-specific medications and physician billing code 340 used four times within any 12-month timeframe slightly improved the sensitivity to 92.3% with a PPV of 97.9%. Conclusions: Data within an EMR can be used to accurately identify patients with MS. This study has positive implications for clinicians, researchers and policy makers as it provides the potential to identify cohorts of MS patients in the primary care setting to examine quality of care.

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Implementing and evaluating a program to facilitate chronic disease prevention and screening in primary care: a mixed methods program evaluation

Implementation Science ◽

10.1186/s13012-014-0135-7 ◽

2014 ◽

Vol 9 (1) ◽

Cited By ~ 10

Author(s):

Donna Patricia Manca ◽

Kris Aubrey-Bassler ◽

Kami Kandola ◽

Carolina Aguilar ◽

Denise Campbell-Scherer ◽

...

Keyword(s):

Primary Care ◽

Program Evaluation ◽

Mixed Methods ◽

Chronic Disease ◽

Disease Prevention ◽

Chronic Disease Prevention

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A Conceptual Framework for Chronic Disease Prevention Based on Multilevel Approach

Global Journal of Health Science ◽

10.5539/gjhs.v10n5p175 ◽

2018 ◽

Vol 10 (5) ◽

pp. 175

Author(s):

Fadumo Abdi Noor ◽

Gabriel Gulis ◽

Jens Soendergaard

Keyword(s):

Chronic Disease ◽

Disease Prevention ◽

Health System ◽

Conceptual Framework ◽

Chronic Diseases ◽

Chronic Disease Prevention ◽

Structural Level ◽

Grey Zone ◽

Multilevel Approach ◽

Multiple Levels

AIM: The aim of this paper is to present a conceptual framework for the analysis of chronic disease prevention work according to the principles of a multilevel approach to T2DM in Denmark.METHOD: We conducted a review of published papers using PubMed, EMBASE, Web of Science, Google, Google Scholar, NICE Evidence Search, and we extended our search to include grey zone literature. We chose to focus our literature review on the collaboration between the different actors in the health system and the prevention and management of type 2 diabetes. We reviewed abstracts, and our search yielded a final total of 52 papers, of which we retained 18 and eliminated papers which were not related explicitly to the subject.RESULTS: Results showed that prevention and management of type T2DM must address multiple factors at multiple levels (intrapersonal, interpersonal and structural level) and within multiple settings (medical settings, communities/municipalities, regions and government). To analyze chronic disease prevention from a multilevel approach perspective, a conceptual framework was developed, which would guide the analytical process. Interventions should tackle specific risk factors within specific populations and by different actors who need to act in a coordinated manner.CONCLUSION: It is becoming increasingly clear that a multilevel approach is needed to prevent chronic diseases. Working at multiple levels with multiple actors in the health system will hopefully help fight the increasing numbers of chronic diseases.

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Development and evaluation of a brief self-completed family history screening tool for common chronic disease prevention in primary care

British Journal of General Practice ◽

10.3399/bjgp13x668186 ◽

2013 ◽

Vol 63 (611) ◽

pp. e393-e400 ◽

Cited By ~ 13

Author(s):

Fiona M Walter ◽

A Toby Prevost ◽

Linda Birt ◽

Nicola Grehan ◽

Kathy Restarick ◽

...

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Family History ◽

Disease Prevention ◽

Screening Tool ◽

Chronic Disease Prevention ◽

Common Chronic Disease

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Chronic disease prevention in primary care: how and when will genomics impact?

British Journal of General Practice ◽

10.3399/bjgp14x680401 ◽

2014 ◽

Vol 64 (624) ◽

pp. 331-332 ◽

Cited By ~ 4

Author(s):

Fiona M Walter ◽

Jon Emery ◽

Hilary Burton

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Prevention ◽

Chronic Disease Prevention

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Better Health Durham: Community Engagement in a Cluster RCT of a Prevention Practitioner Intervention in Low-Income Neighbourhoods

Journal of Global Oncology ◽

10.1200/jgo.18.53100 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 22s-22s

Author(s):

M.A. O'Brien ◽

A. Lofters ◽

B. Wall ◽

A.D. Pinto ◽

R. Elliott ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

Chronic Disease ◽

Disease Prevention ◽

Community Engagement ◽

Social Services ◽

Low Income ◽

Community Outreach ◽

Chronic Disease Prevention ◽

Cluster Rct

Background: The Building on Existing Tools to Improve Chronic Disease Prevention and Screening (BETTER) intervention has improved uptake of chronic disease prevention and screening activities in primary care. The BETTER intervention consists of 1:1 visits between prevention practitioners (PPs) and patients (40-65 years). It is unknown if an adapted BETTER could be effective in the community with public health nurses as PPs. Aim: The presentation objective is to describe community engagement strategies in a cluster RCT in low income neighborhoods with low cancer screening rates and low uptake of primary care. Methods: Principles of community-based participatory research were used to design the community engagement strategy in Durham region, Ontario. Key elements included close collaboration with public health partners to identify stakeholders and creating a community advisory committee (CAC) and a primary care engagement group to provide advice. Results: We identified 15 community stakeholder groups (∼47 subgroups) including service organizations, faith groups, and charitable organizations representing diverse constituents. Community outreach activities included in-person meetings and information displays at local events. The CAC is comprised of members of the public and representatives from primary care, social services, and community organizations. The CAC and primary care engagement groups have provided advice on trial recruitment strategies and on the design of the PP visit. Conclusion: The partnership between public health, primary care, and the study team has been crucial to connect with community stakeholders. Community engagement is essential in raising awareness about the study and will contribute to successful recruitment. Trial Registration: NCT03052959

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Patients’ perspectives on BETTER 2 prevention and screening: qualitative findings from Newfoundland & Labrador

BJGP Open ◽

10.3399/bjgpopen17x101037 ◽

2017 ◽

Vol 1 (3) ◽

pp. bjgpopen17X101037

Author(s):

Nicolette Sopcak ◽

Carolina Aguilar ◽

Candace I J Nykiforuk ◽

Mary Ann O’Brien ◽

Kris Aubrey-Bassler ◽

...

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Prevention ◽

Primary Care Providers ◽

Chronic Disease Prevention ◽

Qualitative Description ◽

Preventative Care ◽

Care Providers ◽

Rural And Remote ◽

Novel Approach

BackgroundChronic disease prevention and screening (CDPS) has been identified as a top priority in primary care. However, primary care providers often lack time, evidence-based tools, and consistent guidelines to effectively address CDPS. Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER) is a novel approach that introduces a new role, that of the prevention practitioner; the prevention practitioner meets with patients, one on one, to undertake a personalised CDPS visit. Understanding patients’ perspectives is important for clinicians and other stakeholders aiming to address and integrate CDPS.AimTo describe patients’ perspectives regarding visits with a prevention practitioner in BETTER 2, an implementation study that was carried out after the BETTER trial and featured a higher proportion of patients in rural and remote locations.Design & settingQualitative description based on patient feedback surveys, completed by patients in three primary care clinics (urban, rural, and remote) in Newfoundland and Labrador, Canada.MethodPatients’ perspectives were assessed based on responses from 91 feedback forms. In total, 154 patients (aged 40–65 years) received ≥1 prevention visit(s) from a prevention practitioner and were asked to provide written feedback. In addition to demographics, patients were asked what they liked about their visit(s), what they would have liked to be different, and invited to make any other comments. Qualitative description was used to analyse the data.ResultsFour main themes emerged from patients’ feedback: value of visit (patients appreciated the visit with a prevention practitioner); visit characteristics (the visit was personalised, comprehensive, and sufficiently long); prevention practitioners' characteristics (professionalism and interpersonal skills); and patients’ concerns (termination of the programme and access to preventative care).ConclusionPatients appreciated the visits they received with a prevention practitioner and expressed their desire to receive sustained CDPS in primary care.

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