Electronic Reminders Research Articles

Proyecto de mejora en prevención de infecciones del tracto urinario asociadas a sondaje vesical

ObjectiveTo evaluate the impact on the urinary tract infections (UTI) rates of an intervention implemented in the Department of Internal Medicine of the Hospital Universitario Insular de Gran Canaria. Material and methodsInfection control practitioners implemented a three phase project, each lasting two months, focusing on surveillance and feed-back, between 2009 and 2011. During phases 1 and 2, the 2004 Centers for Disease Control and Prevention (CDC)–diagnostic criteria for nosocomial infections were followed, and only rates of infections were calculated. For phase 3, the criteria published in 2009 were used, and rates of infections plus processes rates were obtained. The cumulative incidence of UTI in the three periods was compared using a chi-square for trends test. ResultsThe total number of catheter days, as well as the cumulative incidence of UTI dropped from phase 1 to 3. Nevertheless, in phase 2 the mean urinary catheter days increased. We detected a decrease in the UTI rates and urinary catheter days mean after introducing an electronic reminder in the patient electronic charts. ConclusionsA multidisciplinary approach, including surveillance, reminders, and feed-back, has proved useful in controlling UTI rates in our hospital.

Automated electronic reminders to prevent miscommunication among primary medical, surgical and anaesthesia providers: a root cause analysis

In this case report, the authors present an adverse event possibly caused by miscommunication among three separate medical teams at their hospital. The authors then discuss the hospital's root cause...

The Reliability and Patient Acceptability of the SmartTrack Device: A New Electronic Monitor and Reminder Device for Metered Dose Inhalers

Objective: The SmartTrack (ST) is a new adherence monitoring device for pressurized metered-dose inhalers (pMDI), with remote upload and ringtone reminder capabilities. Our aim was to assess its reliability and patient acceptability. Methods: Baseline Quality Control (QC): Actuation log accuracy and device functionality tests were undertaken. Simulated Patient Use: Salmeterol/fluticasone inhalers with STs were actuated two times twice daily for 48 h. Accuracy of reminders, data logging, and uploads was tested. Patient Field Testing: Devices were quality tested before dispensing. Asthma patients each field-tested one ST for 7 days and recorded actuations in a diary. Uploaded data were compared to pMDI dose counter and patient diaries. Patient-reported ease of use for the ST was recorded. Results: Baseline QC: 9/10 devices had 100% accuracy; one had an electrical circuit failure. Simulated Patient Use: Accuracy was 99% (2/342 actuations duplicated). Patient Field Testing: One device failed pre-dispensing testing (electrical circuit failure). Eight devices were field-tested by asthma patients (mean age 45, 5 females). Mean actuation log accuracy was 97%. Reminders were 100% accurate. All devices successfully uploaded data. Average patient-rated difficulty of use was 6/100 (1 = extremely easy, 100 = extremely difficult). Conclusions: The ST has acceptable reliability and utility comparable to other electronic monitoring devices. Its remote data upload capability, reminder functions for missed doses, and graphical display of medication use for patient- and physician-feedback are useful additional features.

Reminders that make sense: designing multisensory notifications for the home

PurposeThe purpose of this paper is to present a synthesized overview of empirical work carried out in the MultiMemoHome Project in the area of designing multimodal reminders for home care. The paper aims to present an overview of multimodal interaction techniques and how they can be used to deliver messages to the user in a way that is more appropriate to the user's needs, the devices available, and the physical and social environment that the person is in when they receive a message.Design/methodology/approachThe paper argues that electronic reminders or notifications delivered in the home (such as appointments or when to take medication to your phone, computer or TV) should be available in multiple sensory modalities (visual, auditory, tactile and olfactory) in order to increase their usability and acceptability and make them accessible to a wider range of users. This paper supports these arguments by presenting an overview of a series of empirical studies that have been carried out (and reported elsewhere) on the design and evaluation of multimodal reminders for the home.FindingsThe paper provides some guidelines and lessons learned on how to design personalisable multimodal reminder systems for the home.Originality/valueThis paper presents a synthesized overview of a body of existing research on multimodal reminder design for the home. Its contribution is in the argument and presentation of empirical findings that support these arguments. A set of guidelines emerging from the body of work is also presented.

Electronic reminders for cancer prevention: Factors associated with preference for automated voice reminders or text messages

ObjectivePrompting may promote engagement with behavior change interventions. Prompts can be delivered inexpensively via automated voice response (AVR) reminders or short message service (SMS) text messages. We examined the association between participants' characteristics and preferred reminder modality. MethodsHealthy Directions 2 is a cluster randomized controlled trial implemented in Boston, Massachusetts to promote change in multiple behavioral cancer risk factors. At baseline (2009), participants completed a survey assessing socio-demographics, health status, height/weight, and factors associated with technology. One-third of participants randomized to receive the intervention (n=598) were randomized to receive automated reminders, with participants selecting modality. Results28% (167/598) of participants selected SMS reminders. Controlling for clustering by primary care provider, younger participants (OR=0.97, 95% CI=(0.95, 0.99), p<0.01), those most comfortable with computers (very uncomfortable OR=0.54, 95% CI=(0.29, 1.01), p≤0.05: referent group = very comfortable), and those who frequently sent/received text messages (never OR=0.09 CI=(0.04, 0.16) p<0.01; 1–3times/month OR=0.38, 95% CI=(0.15, 0.93) p=0.04: referent group=1–5times/week) were more likely to choose SMS. ConclusionsInterventions should make both modalities available to ensure that more participants can benefit from prompting. Studies examining the effect of automated reminders may have reduced effectiveness or generalizability if they employ only one modality.

Blood pressure control among US veterans: a large multiyear analysis of blood pressure data from the Veterans Administration health data repository.

Hypertension treatment and control remain low worldwide. Strategies to improve blood pressure control have been implemented in the United States and around the world for several years. This study was designed to assess improvement in blood pressure control over a 10-year period in a large cohort of patients in the Department of Veterans Affairs. A cohort of 582 881 hypertensive patients and 260 924 normotensive individuals treated in 15 Department of Veterans Affairs medical centers between 2000 and 2010 were examined. Strategies used system-wide included blood pressure control as a performance measure, automatic notification to healthcare providers, electronic reminders, and a systematic revisit schedule. The main outcome measure was the percentage of hypertensive patients whose hypertension was controlled and the level of blood pressure each month. In the hypertensive cohort (mean age 62.9±13.4 years, 96.0% male), 52.3% of patients were white, 25.1% were black, and 21.1% were Hispanic. Blood pressure control rates improved from 45.7% in September 2000 to 76.3% in August 2010. Improvements were similar across ethnic, racial, age, and sex groups. Average systolic/diastolic blood pressure decreased from 142.6/77.1 mm Hg in 2000 to 131.2/74.8 mm Hg in 2010, a decrease of 11.3/2.3 mm Hg (P<0.0001 for both). Systolic and diastolic blood pressures were lower in summer than in winter, and this trend continued through 2010. On average, control rates increased by 3.0% per year and were 6.8% higher in summer than in winter. High rates of blood pressure control can be achieved in all age and ethnic groups and in both sexes.

Breaking the Bloodstream Infection Connection: Utilizing a Swab containing Chlorhexidine Gluconate (3.15%) and Isopropyl Alcohol (70%), Chlorascrub™

patients, including Hematology/Oncology patients should be a priority. Improved inpatient Influenza vaccination rates at our facility seemed to be linked to improved staff and physician vaccination rates and heightened staff and patient/family awareness, due to the introduction of the new Influenza (H1N1) strain, after the death of a Hematology/Oncology patient and mandatory masking for those staff and physicians declining to receive vaccine. Live attenuated Influenza vaccine seems to be infrequently administered to pediatric inpatients due to staff unfamiliarity with this vaccine and discomfort with using a live product on the inpatient service. Although the number of vaccines administered increased substantially by 2011, this was still a small percentage of inpatients and is unadjusted for patients who had received Influenza vaccine prior to admission. Standing protocols, electronic medical record reminders and linkage to computerized vaccine registries should help in this regard and may further reduce missed opportunities.

Reduction In Duration Of Post-Operative Urinary Catheters Following Implementation Of An Electronic Reminder System

Reduction In Duration Of Post-Operative Urinary Catheters Following Implementation Of An Electronic Reminder System

Electronic prompt to improve outpatient code status documentation for advanced lung cancer.

6048 Background: Rates of documentation of end-of-life care preferences in the medical record remain low, even among patients with incurable malignancies. The goal of this study was to assess the impact of electronic prompts to encourage oncology clinicians to document code status in the outpatient electronic health record (EHR) of patients with advanced lung cancers. Methods: We conducted two clinician focus groups (n=15) at an affiliated academic medical center to determine the appropriate content and timing of the electronic reminders. Based on the focus groups, we developed email reminders that were timed to the start of each new chemotherapy regimen. Between 6/09 and 1/11, 102 eligible patients with advanced lung cancer were approached, and 100 (98%) agreed to participate in the prospective study. Email reminders were sent to oncology clinicians at the patient's next outpatient visit and with each new chemotherapy regimen. Using a pre-post design, we compared study participants to a retrospective cohort of 100 consecutive historical controls who began chemotherapy for advanced lung cancer at least one year prior to the start of this study. The primary outcome measure was the documentation of code status in the EHR. Results: Study participants were similar to historical controls, with no significant differences in age, gender, performance status, histology or initial cancer therapy received. At one year follow-up, 33/98 (34%) of participants had a code status documented in the outpatient EHR compared with 12/83 (15%) of historical controls, p=0.003. Mean time to code status documentation was significantly shorter in study participants (8.6 months [95% CI 7.6-9.5]) compared with controls (10.5 months [95% CI 9.8-11.3]), p=0.004. Conclusions: Email prompts triggered by changes in chemotherapy improved the rate and timing of code status documentation in the EHR.

Commentary: Understanding Risk Behavior Among Adolescent Cancer Survivors--Are They More Like Healthy Adolescents or is Cancer a Teachable Moment? A Commentary on Klosky and Colleagues' Article on Health Behaviors in Survivors of Childhood Cancer and Their Siblings

Commentary: Understanding Risk Behavior Among Adolescent Cancer Survivors--Are They More Like Healthy Adolescents or is Cancer a Teachable Moment? A Commentary on Klosky and Colleagues' Article on Health Behaviors in Survivors of Childhood Cancer and Their Siblings

Nonconformities in Real-World Fatal Crashes— Electronic Stability Control and Seat Belt Reminders

Objective: Many new safety systems are entering the market. Vision Zero is a safety strategy aiming at the elimination of fatalities and impairing injuries by the use of a holistic model for safe traffic to develop a safe system. The aim of this article is to analyze fatalities in modern cars with respect to the Vision Zero model with special respect to electronic stability control (ESC) systems and modern seat belt reminders (SBRs). The model is used to identify and understand cases where cars with ESC systems lost control and where occupants were unbelted in a seat with seat belt reminders under normal driving conditions. Methods: The model for safe traffic was used to analyze in-depth studies of fatal crashes with respect to seat belt use and loss of control. Vehicles from 2003 and later in crashes from January 2004 to mid-2010 were analyzed. The data were analyzed case by case. Cars that were equipped with ESC systems and lost control and occupants not using the seat belt in a seat with a seat belt reminder were considered as nonconformities. A total of 138 fatal crashes involving 152 fatally injured occupants were analyzed. Results: Cars with ESC systems had fewer loss-of-control–relevant cases than cars without ESC systems. Thirteen percent of the ESC-equipped vehicles had loss-of-control–relevant crashes and 36 percent of the cars without ESC systems had loss-of-control–relevant crashes. The analysis indicates that only one car of the 9 equipped with ESC that lost control did it on a road surface with relevant friction when driving within the speed restriction of the road. In seats with seat belt reminders that are in accordance with the European New Car Assessment Programme's (Euro NCAP) protocol, 93 percent of the occupants were using a seat belt. In seats without reminders this number was 74 percent. Conclusions: This study shows that ESC systems result in a very significant reduction in fatal crashes, especially under normal driving conditions. Under extreme driving conditions such as speeding or extremely low friction (snow or on the side of the road), ESC systems can fail in keeping the car under control. Seat belt reminders result in higher seat belt use rates but the level of unbelted occupants is higher than roadside studies have indicated. The holistic Vision Zero approach helped in the analysis by identifying nonconformities and putting these into the safe systems perspective.

Using Handheld Devices to Promote Medication Adherence in Chronic Illness

Medication adherence is a key factor in maintaining optimal health outcomes in chronic illness. Best practices have not yet been identified to measure and increase adherence. The objective was to examine adherence related to the use of handheld devices that delivered electronic medication reminders in a sample of adults experiencing a chronic illness. Health literacy was assessed to reflect patient understanding of the medications prescribed by their health care providers. Study participants were given handheld devices that sounded alarms as medication reminders. The adherence rate was 89.64%, indicating that most participants remembered their medications.

Assessing Ongoing Electronic Resource Purchases: Linking Tools To Synchronize Staff Workflows

Ongoing electronic resource purchases represent a substantial proportion of collections budgets. Recognizing the necessity of systematic ongoing assessment with full selector engagement, Columbia University Libraries appointed an Electronic Resources Assessment Working Group to promote the inclusion of such resources within our current culture of assessment. This article describes the Working Group's implementation of an electronic resource renewal reminder system in Google Calendar, a calendar already in use by selectors for daily scheduling. In discussing this particular solution, this article shows how libraries can link existing systems together to move beyond their limitations and integrate them into existing staff workflows.

A Team-Based Approach to Providing Asthma Action Plans

National guidelines for treatment of asthma include recommendations for providing written asthma action plans (AAPs) to improve outcomes through patient self-management. However, AAP completion rates remain limited in practice. We developed a team-based approach for the delivery of care to asthma patients in a primary care setting that involved integration of an electronic clinical quality management system and provision of written AAPs by registered nurses. The percentage of patients with AAPs increased after implementation of clinical reminders and nurse-led provision of written AAPs. Proper training, use of an electronic clinical reminder system, and enhanced engagement of registered nurses can improve AAP completion rates in a team-based primary care setting.

An electronic medication reminder, supported by a monitoring service, to improve medication compliance for elderly people living independently

We conducted a pilot study of a personal medication reminder unit, supported by a monitoring service. A total of 31 elderly residents were offered the reminder service for a period of eight weeks (1736 person-days of service). A telephone call from the monitoring service was made after four weeks to check that each participant was happy with the service and keen to continue. No one opted out and users of the service found it easy to manage, helpful and acceptable. There was a significant improvement (P = 0.012) in the rate of self-assessed medication compliance, from pre (52%) to post (81%) service introduction. There was a significant improvement in people's perceived ability to look after themselves at home (self-care ability) (P = 0.001). The percentage of participants rating their ability to look after themselves at home as excellent increased from 42% to 68%. Health-related quality of life measures, such as physical and mental health, showed positive improvement, but the changes were not significant. The service has the potential to improve health and well-being outcomes for people on multiple medications living independently in the community.

Improving Human Immunodeficiency Virus Testing Rates with an Electronic Clinical Reminder

Human immunodeficiency virus (HIV) is a major global public health problem. In the United States alone, 1 to 1.18 million people are affected, of whom approximately one quarter are unaware of their diagnosis. In the early stage of the epidemic, when effective therapy was not available, testing for HIV was done primarily to protect the nation’s blood supply. However, with the advent of highly active antiretroviral therapy, HIV is highly treatable, and those infected can live longer. Because more than one third of patients diagnosed with HIV are diagnosed with acquired immunodeficiency syndrome within 1 year after diagnosis, it is likely that many patients are infected for many years before diagnosis. Furthermore, beause approximately 20,000 new infections in the United tates are transmitted by people unaware of their HIV positive tatus, early detection of HIV has the potential to decrease ew infections and prevent complications from advanced disase and has been shown to be cost-effective. The Centers for Disease Control and Prevention recommends offering routine screening for HIV in health care settings for all patients aged 13 to 64 years, unless the prevalence of undiagnosed infection has been documented to be less than 0.1%.

A simple reminder system improves venous thromboembolism prophylaxis rates and reduces thrombotic events for hospitalized patients

Compliance with venous thromboembolism (VTE) prophylaxis is poor. We sought to determine whether a simple electronic reminder applicable to all hospitalized patients would increase prophylaxis rates and reduce VTE rates. An electronic reminder was added to the electronic medical record admission note used by all services in our hospital. Prophylaxis, VTE and bleeding rates before and after implementation were compared. Data were analyzed with sas version 9.1. Among all adult medical and surgical patients admitted to our hospital during the time periods studied, 42.8% (1236/2888) before and 60.0% (1410/2350) after the reminder was added received appropriate prophylaxis as per American College of Chest Physicians (ACCP) guidelines (P < 0.001). The difference reached significance for both medical (51.0% vs. 68.9%; P < 0.001) and surgical (48.0% vs. 61.0%; P < 0.001) services. Fewer patients were diagnosed with VTE after our reminder was added (1.1% vs. 0.3%; P = 0.001), and there was a trend towards fewer bleeds (1.1% vs. 0.6%; P = 0.09). The presence of the reminder was an independent predictor for prophylaxis being given (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.70-2.18; P < 0.001), and was independently associated with a decreased risk for VTE (OR 0.30, 95% CI 0.14-0.64; P = 0.003) after adjustment for other VTE risk factors. Adding an electronic reminder to the admission note improved prophylaxis rates and reduced VTE rates across services. The system is easily reproducible and applicable to other facilities. The improvement obtained was modest, so additional measures will probably be needed to optimize prophylaxis rates.

Increased Documented Brief Alcohol Interventions With a Performance Measure and Electronic Decision Support

Alcohol screening and brief interventions (BIs) are ranked the third highest US prevention priority, but effective methods of implementing BI into routine care have not been described. This study evaluated the prevalence of documented BI among Veterans Affairs (VA) outpatients with alcohol misuse before, during, and after implementation of a national performance measure (PM) linked to incentives and dissemination of an electronic clinical reminder (CR) for BI. VA outpatients were included in this study if they were randomly sampled for national medical record reviews and screened positive for alcohol misuse (Alcohol Use Disorders Identification Test-Consumption score ≥5) between July 2006 and September 2008 (N=6788). Consistent with the PM, BI was defined as documented advice to reduce or abstain from drinking plus feedback linking drinking to health. The prevalence of BI was evaluated among outpatients who screened positive for alcohol misuse during 4 successive phases of BI implementation: baseline year (n=3504), after announcement (n=753) and implementation (n=697) of the PM, and after CR dissemination (n=1834), unadjusted and adjusted for patient characteristics. Among patients with alcohol misuse, the adjusted prevalence of BI increased significantly over successive phases of BI implementation, from 5.5% (95% CI 4.1%-7.5%), 7.6% (5.6%-10.3%), 19.1% (15.4%-23.7%), to 29.0% (25.0%-33.4%) during the baseline year, after PM announcement, PM implementation, and CR dissemination, respectively (test for trend P<0.001). A national PM supported by dissemination of an electronic CR for BI was associated with meaningful increases in the prevalence of documented brief alcohol interventions.

The effect of reminder systems on patients' adherence to treatment.

BackgroundPatient adherence is an important component of the treatment of chronic disease. An understanding of patient adherence and its modulating factors is necessary to correctly interpret treatment efficacy and barriers to therapeutic success.PurposeThis meta-analysis aims to systematically review published randomized controlled trials of reminder interventions to assist patient adherence to prescribed medications.MethodsA Medline search was performed for randomized controlled trials published between 1968 and June 2011, which studied the effect of reminder-based interventions on adherence to self-administered daily medications.ResultsEleven published randomized controlled trials were found between 1999 and 2009 which measured adherence to a daily medication in a group receiving reminder interventions compared to controls receiving no reminders. Medication adherence was measured as the number of doses taken compared to the number prescribed within a set period of time. Meta- analysis showed a statistically significant increase in adherence in groups receiving a reminder intervention compared to controls (66.61% versus 54.71%, 95% CI for mean: 0.8% to 22.4%). Self-reported and electronically monitored adherence rates did not significantly differ (68.04% versus 63.67%, P = 1.0). Eight of eleven studies showed a statistically significant increase in adherence for at least one of the reminder group arms compared to the control groups receiving no reminder intervention.LimitationsThe data are limited by imperfect measures of adherence due to variability in data collection methods. It is also likely that concomitant educational efforts in the study populations, such as instructions regarding proper administration and importance of correct dosing schedules, contributed to improved patient adherence, both in reminder and control arms. The search strategy could have missed relevant studies which were categorized by disease rather than adherence.ConclusionsReminder-based interventions may improve adherence to daily medications. However, the interventions used in these studies, which included reminder phone calls, text messages, pagers, interactive voice response systems, videotelephone calls, and programmed electronic audiovisual reminder devices, are impractical for widespread implementation, and their efficacy may be optimized when combined with alternative adherence-modifying strategies. More practical reminder-based interventions should be assessed to determine their value in improving patient adherence and treatment outcomes.

Development of an electronic medical record based intervention to improve medical care of osteoporosis

Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. An EMR-based intervention (osteoporosis order set) was developed with physician and patient input. There was a trend toward greater calcium supplementation from July 2008 to April 2009 (s = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low. Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. The study population consisted of patients over 50 years of age. Northwestern Memorial Hospital is a tertiary care academic hospital in Chicago. This study was conducted from September 1, 2007 through June 30, 2009. Physicians reported that barriers to care comprised nonacute nature of osteoporosis, belief that osteoporosis should be addressed by the PCP, low awareness of recurrent fractures, and radiographs with terms such as "compression deformity", "wedge deformity", or "vertebral height loss" which in their opinion were not clearly indicative of vertebral fractures. An EMR-based intervention was developed with physician and patient input. Over the evaluation period, 295 fracture cases in individuals over the age of 50 years in the medicine floors were analyzed. Mean age was 72 ± 11 years; 74% were female. Sites of fracture included hip n = 78 (27%), vertebral n = 87 (30%), lower extremity n = 61 (21%), upper extremity n = 43 (15%) and pelvis n = 26 (9%). There was no increase in documentation of osteoporosis in the medical record from pre- to post-EMR implementation (p = 0.89). There was a trend toward greater calcium supplementation from July 2008 to April 2009 (p = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low. An electronic medical record intervention without electronic reminders created with physician input achieves an increase in calcium supplementation but fails to increase diagnosis or treatment for osteoporosis at the time of hospitalization for a fragility fracture.