scholarly journals Using Information Technology to Assess Patient Risk Factors in Primary Care Clinics: A Pragmatic Evaluation (Preprint)

2020 ◽  
Author(s):  
Leanne Kosowan ◽  
Alan Katz ◽  
Gayle Halas ◽  
Lisa LaBine ◽  
Alexander Singer
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Information Technology ◽  
Risk Factor ◽  
Primary Prevention ◽  
Primary Care Clinics ◽  
Clinic Staff ◽  
Algorithmic Information ◽  
Prevention Counseling ◽  
Risk Factor Information

BACKGROUND Tobacco use, physical inactivity and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice and support by a primary care provider leads to behaviour change attempts among patients. However, although physicians consider preventative health important the focus on symptoms presentation, acute care and medication review often overshadows primary prevention counseling. OBJECTIVE This study evaluates feasibility, adoption and integration of the tablet-based Risk Factor Identification Tool (RFIT) that uses algorithmic information technology to support obtainment of patient risk factor information in primary care clinics. METHODS This is a pragmatic developmental evaluation. Each clinic developed a site-specific implementation plan adapted to their workflow. RFIT was implemented in two primary care clinics located in Manitoba. Perceptions of 10 clinic staff and 8 primary care clinicians informed this evaluation. RESULTS Clinicians reported a smooth and fast transfer of RFIT responses to an EMR encounter note. Two hundred seven patients used the RFIT with a completion rate of 86%. Clinic staff reported that very few patients declined the use of RFIT or required assistance to use the tablet. Among the patients that used RFIT 12.1% smoked, 21.2% felt their diet could be improved, 9.3% reported high alcohol consumption, 56.4% reported less than 150 minutes of PA a week, and 8.2% lived in poverty. Clinicians suggested that although a wide variety of patients were able to use the tablet-based RFIT, implemented surveys should be tailored to patient subgroups. CONCLUSIONS Clinicians and clinic staff positively reviewed the use of information technology in primary care. Algorithmic information technology can collect, organize and synthesize individual health information to inform and tailor primary care counseling to the patients’ context and readiness to change. RFIT is a user-friendly tool that provides an effective method for obtaining risk factor information from patients. It is particularly useful for subsets of patients lacking continuity in the care they receive. When implemented within a context that can support practical interventions to address identified risk factors, RFIT can inform brief interventions within primary care.

Using Information Technology to Assess Patient Risk Factors in Primary Care Clinics: A Pragmatic Evaluation (Preprint)

2020 ◽  
Author(s):  
Leanne Kosowan ◽  
Alan Katz ◽  
Gayle Halas ◽  
Lisa LaBine ◽  
Alexander Singer
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Information Technology ◽  
Risk Factor ◽  
Primary Prevention ◽  
Patient Risk ◽  
Primary Care Clinics ◽  
Clinic Staff ◽  
Prevention Counseling ◽  
Risk Factor Information

BACKGROUND Tobacco use, physical inactivity and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice and support by a primary care provider leads to behaviour change attempts among patients. However, although physicians consider preventative health important the focus on presentation, acute care and medication review often overshadows primary prevention counseling. OBJECTIVE This study evaluates feasibility, adoption and integration of the tablet-based Risk Factor Identification Tool (RFIT) that uses algorithmic information technology to support obtainment of patient risk factor information in primary care clinics. METHODS This is a pragmatic developmental evaluation. Each clinic developed a site-specific implementation plan adapted to their workflow. RFIT was implemented in two primary care clinics located in Manitoba. Perceptions of 10 clinic staff and 8 primary care clinicians informed this evaluation. RESULTS Clinicians reported a smooth and fast transfer of RFIT responses to an EMR encounter note. There were 207 patients that used the RFIT with a completion rate of 86%. Clinic staff reported that very few patients declined the use of RFIT or required assistance to use the tablet. Among the patients that used RFIT 12.1% smoked, 21.2% felt their diet could be improved, 9.3% reported high alcohol consumption, 56.4% reported less than 150 minutes of PA a week, and 8.2% lived in poverty. Clinicians suggested that although a wide variety of patients were able to use the tablet-based RFIT, implemented surveys should be tailored to patient subgroups. CONCLUSIONS Clinicians and clinic staff positively reviewed the use of information technology in primary care. RFIT is a user-friendly tool that provides an effective method for obtaining risk factor information from patients. It is particularly useful for subsets of patients lacking continuity in the care they receive. When implemented within a context that can support practical interventions to address identified risk factors, RFIT can inform brief interventions within primary care.

scholarly journals Patient perspectives on tablet-based technology to collect risk factor information in primary care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Leanne Kosowan ◽  
Alan Katz ◽  
Gayle Halas ◽  
Alexander Singer
Keyword(s):  
Primary Care ◽  
Information Technology ◽  
Risk Factor ◽  
Risk Behaviours ◽  
Patient Risk ◽  
Self Reflection ◽  
Primary Care Clinics ◽  
User Friendly ◽  
The Impact ◽  
Risk Factor Information

Abstract Background Primary care provides an opportunity to introduce prevention strategies and identify risk behaviours. Algorithmic information technology such as the Risk Factor Identification Tool (RFIT) can support primary care counseling. This study explores the integration of the tablet-based RFIT in primary care clinics to support exploration of patient risk factor information. Methods Qualitative study to explore patients’ perspectives of RFIT. RFIT was implemented in two primary care clinics in Manitoba, Canada. There were 207 patients who completed RFIT, offered to them by eight family physicians. We conducted one-on-one patient interviews with 86 patients to capture the patient’s perspective. Responses were coded and categorized into five common themes. Results RFIT had a completion rate of 86%. Clinic staff reported that very few patients declined the use of RFIT or required assistance to use the tablet. Patients reported that the tablet-based RFIT provided a user-friendly interface that enabled self-reflection while in the waiting room. Patients discussed the impact of RFIT on the patient-provider interaction, utility for the clinician, their concerns and suggested improvements for RFIT. Among the patients who used RFIT 12.1% smoked, 21.2% felt their diet could be improved, 9.3% reported high alcohol consumption, 56.4% reported less than 150 min of PA a week, and 8.2% lived in poverty. Conclusion RFIT is a user-friendly tool for the collection of patient risk behaviour information. RFIT is particularly useful for patients lacking continuity in the care they receive. Information technology can promote self-reflection while providing useful information to the primary care clinician. When combined with practical tools and resources RFIT can assist in the reduction of risk behaviours.

Abstract P720: Primary Stroke Prevention by Primary Care Providers: An Unmet Need

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Raymond Reichwein ◽  
Alicia Richardson ◽  
Cesar Velasco
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Primary Prevention ◽  
Care Setting ◽  
Stroke Risk ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Large Vessel ◽  
Care Providers ◽  
Stroke Risk Factors

Introduction: The majority of patients who present with acute ischemic stroke (AIS) have known stroke risk factors which are not optimally managed. It has been suggested that a CHADS-VASC score can assist with primary prevention by calculating future stroke risk. This however, has not been widely adapted in the primary care setting. Methods: From 2018-2019, 686 AIS patients were included in retrospective analysis. Data elements included: historical stroke risk factors, historical CHADS-VASC score, antiplatelet/anticoagulant use at time of presentation, discharge location, and mRS. Results: Of the 686 AIS patients, 77% were age > 60, and 52% were male. Etiology subtypes were small vessel/lacunar 20%, large vessel 22%, cardioembolic 20%, undetermined 31% (cryptogenic 15%), and other determined 5%. On presentation, the majority of patients had 2 or more stroke risk factors and a calculated historical CHADS-VASC score > 2 (Table 1). Over half of the patients with large vessel or small vessel/lacunar etiology were not on any antiplatelets and 53% of patients with known history of atrial fibrillation weren’t on anticoagulants. Forty-nine percent of patients had a mRS > 3 at discharge. Conclusion: Patients with several stroke risk factors are sub optimally managed by primary care providers. Primary prevention education for PCPs in management of higher stroke risk individuals and additional analysis of the CHADS-VASC tool for this setting is needed. If widely adapted, this tool may prevent strokes by providing adequate risk reduction in the primary care setting.

Abstract 11447: Low Incidence of Appropriate Therapy Following Defibrillator Implantation for Primary Prevention of Sudden Cardiac Death in Hypertrophic Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Amalie C Thavikulwat ◽  
Todd T Tomson ◽  
Bradley P Knight ◽  
Robert O Bonow ◽  
Lubna Choudhury
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hypertrophic Cardiomyopathy ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Secondary Prevention ◽  
Cardiac Death ◽  
Icd Implantation ◽  
Icd Therapy ◽  
Appropriate Therapy

Introduction: Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death (SCD) in young adults. Implantable cardioverter defibrillators (ICD) effectively terminate ventricular tachycardia (VT) and fibrillation (VF) that cause SCD, but the reported prevalence of and patient characteristics leading to appropriate ICD therapy in HCM have been variable. Hypothesis: We hypothesized that some risk factors may be more prevalent than others in patients with HCM who receive appropriate ICD therapy and that the overall incidence of appropriate therapy may be lower than that reported previously. Methods: We retrospectively studied all patients with HCM who were treated with ICDs at our referral center from 2000-2013 to determine the rates of appropriate and inappropriate ICD therapies. Results: Of 1136 patients with HCM, we identified 135 who underwent ICD implantation (125 for primary and 10 for secondary prevention), aged 18-81 years (mean 48±17) at the time of implantation. The mean follow-up time was 5.2±4.5 years. Appropriate ICD intervention occurred in 20 of 135 patients (2.8%/year) by providing a shock or antitachycardia pacing in response to VT or VF. The annual rate of appropriate ICD therapy was 2.4%/year for primary and 7.2%/year for secondary prevention devices. Commonly used risk factors were equally prevalent among patients who received appropriate therapy and those who did not; furthermore, the likelihood of receiving appropriate therapy in the presence of each risk factor was similar (Figure). Inappropriate ICD therapy occurred in 27 patients (3.8%/year). Conclusions: ICDs provide clear benefit to patients who experience life-threatening arrhythmias, particularly those being treated for secondary prevention. However, the appropriate therapy rate for primary prevention was lower than previously reported, and no single risk factor appeared to have stronger association with appropriate ICD therapy than others.

Abstract P052: The Effect of Re-designing Workflow and Introducing Automated Blood Pressure Devices in Community-based Primary Care Clinics

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Romsai T Boonyasai ◽  
Greg P Prokopowicz ◽  
Jeanne Charleston ◽  
Kathryn A Carson ◽  
Gary J Noronha ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Blood Pressure Measurement ◽  
Clinical Inertia ◽  
Intervention Period ◽  
Post Intervention ◽  
Community Based ◽  
Primary Care Clinics ◽  
Clinic Staff ◽  
Measurement Protocol

BACKGROUND: Prior studies report that poor technique and terminal digit preference (TDP) can distort blood pressure (BP) estimates in clinical settings. These limitations may bias population BP estimates, increase clinician workload, and contribute to clinical inertia. HYPOTHESIS: We hypothesized that BP measurement training with an automated blood pressure measurement (aBPM) device would reduce TDP, reduce the number of times clinicians repeat staff-obtained measurements, and reduce average BP estimates within each site. METHODS: We replaced aneroid BP measurement devices in 6 community-based primary care clinics with aBPM devices (Omron HEM-907XL) and trained clinic staff with a standardized BP measurement protocol using 1 hour presentations and follow-up visits. We report mean weekly BP measured in the 8 weeks pre- and 4 weeks post-intervention at the first intervention site. Results are analyzed using chi-squared and paired t-tests. RESULTS: Clinic staff recorded 5796 BP readings in the 8 week pre-intervention period and 2321 readings in the 4 weeks post-intervention period. TDP and clinician workload improved after the intervention. Pre-intervention, 1941 of 4833 (40.2%) of systolic BP and 2199 of 4833 (45.5%) of diastolic BP ended in zero, in contrast to 216 of 2158 (10.0%) of systolic and 219 of 2158 (10.2%) of diastolic readings post-intervention (P<.001 for both SBP and DBP). Clinicians repeated BP obtained by staff in 963 of 5796 (16.6%) of visits pre-intervention but only in 163 of 2321 (7.0%) of visits post-intervention (P<.001). TDP persisted when clinicians repeated staff-obtained BP readings post-intervention: 58 of 163 (35.6%) systolic and 65 of 163 (35.7%) diastolic BP ended in zero (P=.32 for SBP and P=.35 for DBP in comparison with pre-intervention BP readings). Overall, BP estimates changed modestly following the intervention. Post-intervention, mean systolic BP rose 1.4 mmHg (P=.004) and diastolic BP declined 3.1 mmHg (P<.001). Among clinician-repeated BP readings, systolic BP rose 2.4 mmHg (P=.12 for pre/post change) and diastolic BP declined 0.4 mmHg (P=.72 for pre/post change). CONCLUSIONS: A standardized BP measurement protocol used with an aBPM device in community-based primary care settings can reduce TDP and clinician workload but is associated with only modest change in population BP estimates.

Program for Aboriginal and Torres Strait Islander People in the Goulburn-Murray Region: Development and Risk Factor Screening at Indigenous Community Organisations

2007 ◽  
Vol 13 (1) ◽  
pp. 9
Author(s):  
◽  
Ian Anderson ◽  
Vicki Atkinson ◽  
James D Best ◽  
Paul Briggs ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Risk Factor ◽  
Primary Prevention ◽  
Heart Health ◽  
Cvd Risk ◽  
Factor Screening ◽  
Risk Factor Screening ◽  
Diet And Exercise ◽  
Health Project

The Heart Health Project was developed in partnership between Aboriginal health and social organisations in the Goulburn-Murray region and university departments. The aims included screening for cardiovascular disease (CVD) risk factors, and evaluating community-directed interventions. We describe the development of the Heart Health Project and the results of risk factor screening among employees (n=66) of Aboriginal organisations during 2003-04. Screening identified few new cases of overt hypertension, diabetes or hypercholesterolaemia, but did find a large proportion of the survey sample who smoked, had evidence of periodontal disease or who had ?high normal? levels of risk factors at a relatively young age, placing them at risk of developing overt disease. Barriers to diet and exercise behaviours thought to protect against CVD were documented. While appropriate planning made clinical follow-up relatively straightforward, effective referral of at-risk people to primary prevention programs was more difficult. The barriers to making diet and exercise changes need consideration in designing interventions for primary prevention of CVD, as does the importance of promoting heart health in a culturally relevant way. This can be achieved through community direction but long-term support for partnerships and intervention programs is required.

ICARUSS: An effective model for risk factor management in stroke survivors

2019 ◽  
Vol 15 (4) ◽  
pp. 438-453 ◽  
Author(s):  
Jacques Joubert ◽  
Stephen M Davis ◽  
Geoffrey A Donnan ◽  
Christopher Levi ◽  
Graeme Gonzales ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Risk Factor ◽  
Primary Care Physicians ◽  
Best Practice ◽  
Intervention Group ◽  
Control Group ◽  
Stroke Survivors ◽  
Risk Factor Management ◽  
Practice Recommendations

Background and purpose After an initial stroke, the risk of recurrent stroke is high. Models that implement best-practice recommendations for risk factor management in stroke survivors to prevent stroke recurrence remain elusive. We examined a model which focuses on vascular risk factor management to prevent stroke recurrence in survivors returning to their primary care physicians. This model is coordinated from the stroke unit, integrates specialist stroke services with primary care physicians, and directly involves patients and carers in risk factor management. It is underpinned by the shared care principle in which there is joint participation of specialists as well as primary care physicians in a planned, integrated delivery of care with ongoing involvement of patients and carers, a structure which encourages implementation of best-practice recommendations as well as transferability and sustainability. We hypothesized that an integrated, multimodal intervention based on a shared-care model which supports joint participation of stroke specialists and primary care physicians would improve the implementation of best-practice recommendations for risk factor management in stroke survivors returning to the community. Methods We undertook a double-blind randomized controlled trial, testing the model in three Australian cities using stroke survivors admitted to stroke units and discharged from hospital to return to their primary care physicians. The model was a shared care, multifaceted integrated program which included bidirectional feedback between general practitioner and specialist unit, education, and engagement of patient and carer in self-management with ongoing input from a multidisciplinary team. The primary endpoint was improvement or abolition of risk factors such as raised blood pressure, diabetes, hyperlipidemia, the modification of adverse life-style factors such as lack of exercise, smoking and alcohol abuse and adherence to preventive medication at one year. Intermediate measurement points were scheduled at three monthly intervals. Analysis was by intention to treat, evaluated by covariance or a linear model adjusting for confounding factors or variance of base-line risk factors. The study was registered as ACTRN = 1261100026498. Results The study population was as follows: intervention ( n = 112), control ( n = 137). At baseline, there was no statistical difference between the groups for any variable. At the 12-month evaluation, there was a significant decrease in systolic blood pressure from baseline in the intervention group of 5.2 mmHg ( p < 0.01). This change was not observed in the control group ( p = 0.29). Moreover, at 12 months the mean systolic blood pressure in the intervention group was 129.4 mmHg (SD 14.7), a result which was not obtained in controls. Fasting total cholesterol as well as triglycerides was reduced significantly in the intervention group (both p < 0.01) but this was not the case in the control group ( p = 0.11 and p = 0.27, respectively). At 12 months, there was no change in BMI in the intervention group but there was a significant increase in BMI ( p = 0.02) in the control group. At 12 months in the intervention group, the mean distance walked with ease compared to the baseline measurements was increased by a mean distance of 600 m while in the control group the distance walked with ease was reduced compared to that measured at baseline. At 12 months, the Barthel index in the intervention group demonstrated improved function ( p = 0.01), but no change was observed in controls. At 12 months in the intervention group, there was a significant decrease in number of standard alcoholic drinks consumed per week compared to the baseline ( p = 0.04). This was not observed in the control group ( p = 0.34). Conclusion In stroke survivors, the ICARUSS (Integrated Care for the Reduction of Secondary Stroke) model is superior to usual care with respect to best-practice recommendations for traditional risk factors as well as behavioral and functional outcomes.

Measurement and Management of Cardiovascular Risk Factors — is Screening Worthwhile?

1993 ◽  
Vol 38 (6) ◽  
pp. 173-177 ◽  
Author(s):  
S.R. McEwan ◽  
H.T.O. Davies ◽  
E. Allan ◽  
D. Maclean ◽  
C.D. Forbes
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Coronary Heart Disease ◽  
Medical Journal ◽  
Risk Factor ◽  
Coronary Risk Factors ◽  
Coronary Risk ◽  
Class Iii ◽  
Healthy Men ◽  
Journal Paper

Coronary heart disease has been described as Scotland's national disease and ways of reducing its incidence are therefore of paramount importance especially in younger males. A recent British Medical Journal paper1 has indicated that general practitioners can make little impact on patients' lifestyles. This paper shows that a cohort of Scottish men (Social Class III-V) responded well (80%) to offers of screening for risk factors of CHD, continued to attend for review and showed highly significant changes in their risk factor profiles. A committed enthusiastic primary care team have shown the potential for reducing coronary risk factors in so-called healthy men.

Sign in / Sign up

Export Citation Format

Share Document