Electronic Reminders Research Articles

Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care.

To analyze the literature on advance care planning (ACP) in primary care through the lens of implementation science, with a focus on implications for rural settings. Scoping review of the literature. The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PsycINFO, and the Psychology and Behavioral Sciences Collection databases were searched for studies related to ACP adoption and implementation in primary care. The Theoretical Domains Framework was used to map the literature to 14 determinants that serve as barriers or facilitators to ACP. The Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors was used to analyze the stage of implementation for each of the included studies. Four steps to ACP were specified: identification, conversation, documentation, and follow-up. Determinants were identified for each step, but studies largely focused on the conversation step. Professional role and identity, environmental context and resources, and emotion were the most frequently cited determinants in initiating conversations. The identification step was largely determined by behavioral regulation. For documenting ACP, environmental context and resource determinants were most prevalent. In the few studies that addressed follow-up, providers expressed a desire for electronic reminders as a behavioral regulator to follow-up. While ACP has been shown to have patient, family, and societal benefits, its uptake in primary care has been minimal. Because ACP is a complex process that is highly context dependent, implementation science is critical to inform its successful adoption and implementation. Smaller healthcare networks, adaptable professional roles, trusted relationships, and tight-knit community might be important facilitators of ACP in rural primary care. Findings from this study can be used to accelerate ACP implementation in rural primary care.

Development, Implementation and Preliminary Results of an Electronic Reminder for HIV Screening Using a Service Oriented Architecture.

30% of the Argentinian population and 58% of Plan de Salud HIBA patients are unaware of their HIV status. The Ministry of Health and US Preventive Service Task recommends physicians to assess HIV infection in persons aged 15 to 65. An HIV screening reminder integrated in an electronic health record (EHR) was created using FHIR to represent clinical information and CDS-Hooks to represent the exchange of information with a CDS service. The tool had a 1% intervention rate, and 67.4% acceptance rate. The number of HIV screening tests requested during the weeks after the CDSS implementation and in the same period in 2017 were obtained. 575 orders were requested in the 2017 period and 893 in the 2018. 89 (almost 10%) of these came from the electronic tool. The preliminary results indicate that this non disruptive, action oriented reminder can contribute to increased HIV screening orders.

Telehealth Interventions for Improving Self-Management in Patients With Hemophilia: Scoping Review of Clinical Studies.

BackgroundThe introduction of home therapy for hemophilia has empowered patients and their families to manage the disease more independently. However, self-management of hemophilia is demanding and complex. The uses of innovative interventions delivered by telehealth routes such as social media and Web-based and mobile apps, may help monitor bleeding events and promote the appropriate use of clotting factors among patients with hemophilia.ObjectiveThis scoping review aims to summarize the literature evaluating the effectiveness of telehealth interventions for improving health outcomes in patients with hemophilia and provides direction for future research.MethodsA search was conducted in Ovid MEDLINE, EMBASE, and PubMed databases for studies that (1) focused on patients with hemophilia A or B; (2) tested the use of remote telehealth interventions via the internet, wireless, satellite, telephone, and mobile phone media on patients and caregivers; and (3) reported on at least one of the following patient-/caregiver-focused outcomes related to empowering patients/caregivers to be active decision makers in the emotional, social, and medical management of the illness: quality of life, monitoring of bleeding episodes, joint damage or other measures of functional status, medication adherence, and patients’ knowledge. Implementation outcomes (user metrics, cost saving, and accuracy of electronic records) were also evaluated. Reviews, commentaries, and case reports comprising ≤10 cases were excluded.ResultsSixteen articles fulfilled the inclusion criteria. The majority of the interventions (10/16, 62%) evaluated both implementation outcomes and patient-/caregiver-focused outcomes. User performance and accuracy and comprehensiveness of electronic records were also measured in most studies (4/16, 87%). The components of the interventions were rather homogenous and typically involved electronic logging and reminders for prophylactic infusions, reporting of spontaneous and traumatic bleeding events, monitoring of infusion product usage and home inventory, and real-time communication with health care professionals and hemophilia clinics. Telemedicine-supported education and information interventions seemed to be particularly effective among adolescent and young adult patients. Although the patients reported improvements in their health-related quality of life and perception of illness, telemonitoring devices did not appear to have a significant effect on quantifiable health outcomes such as joint health. Longitudinal studies seemed to suggest that the response and adherence rates to recording decreased over time.ConclusionsPreliminary evidence from this review suggests that telehealth-delivered interventions could feasibly improve patients’ adherence to medication use and promote independence in disease management. Given the complexity and resources involved in developing a mature and established system, support from a dedicated network of hemophilia specialists and data managers will be required to maintain the technology, improve adherence to prophylactic treatment and recording, and validate the electronic data locally.

Inhaled corticosteroids prescriptions increased in the ED for recurrent asthma exacerbations by automated electronic reminders in the ED

Objective: The objective of this study was to evaluate the impact of an electronic alert on the prescription rate of inhaled corticosteroids (ICS) by ED providers for poorly controlled persistent asthmatic children.Methods: Study subjects included asthmatic patients age 4–18 presenting to the ED at Phenix Children’s Hospital between February 9, 2018 and December 4, 2018, with a history of at least two previous ED visits for acute exacerbation of asthma within 365 days, no active ICS prescription within 90 days, and free from developmental delay, bronchopulmonary dysplasia due to prematurity, cystic fibrosis, sickle cell disease, and/or interstitial ling disease. Patients meeting these criteria triggered an electronic alert prompting the medical provider to prescribe ICS or indicate reason for not prescribing. Instruction on the alert was provided to ED attending physicians and residents by email and through several educational sessions held prior to the implementation.Results: Among 62 patients without prior ICS who were discharged home from the ED, ICS was prescribed for 48 (77%). No statistically significant differences were detected in baseline characteristics between patients discharged home from the ED with and without ICS prescription. While ICS was prescribed by a larger proportion of physicians (56%) compared to residents (42%), statistical significance was not reached. For the 14 (33%) patients who were discharged home without ICS, no reason was provided to indicate why ICS were not prescribed.Conclusion: An electronic alert incorporated into the ED workflow to populate a discharge order set is effective to initiate asthma controller medication for poorly controlled pediatric patients. Additional data describing reasons for not prescribing ICS can further refine recommendations for ICS prescriptions, and provide a comprehensive strategy to support clinical decision for pediatric asthma control in acute care settings.

An Interprofessional Approach to Improving Identification and Time to Treatment of Severe Hypertension in Pregnant Women

To develop and implement a protocol to improve the quality of care for women with severe hypertension during pregnancy and reduce adverse outcomes. Severe maternal morbidity associated with preeclampsia and eclampsia occurs in 12%–22% of pregnancies and is a leading cause of maternal death, contributing to 18% of maternal deaths in the United States. Other adverse outcomes include abruption, hemorrhage, disseminated intravascular coagulation, intrauterine growth restriction, intrauterine death, and increased health care costs. Organizational factors that contribute to adverse outcomes include delayed diagnosis and ineffective treatment. In Illinois, the goal is to treat 80% of women within 60 min of identification of severe hypertension. This quality improvement project was conducted in a Level III perinatal center in a community-based hospital with 2,600 births annually. In in March 2016, a multidisciplinary team was created that reviewed baseline data, identified areas for improvement in the care processes, and developed a treatment protocol followed by implementation of a multimodal educational strategy for physicians and nurses. An order set was created in the electronic medical record and visual reminders of the new protocol were posted. Data were collected from Calendar Year 2015 through the first quarter of 2018. Time-to-treatment within 1 hr was 8% in 2015 and 2016 and 90% in 2017; 100% of women were treated within 30 min in 2018. Rates of adverse maternal outcomes were at 17% (2016), 18% (2017), and 7% (2018). Findings support the effectiveness of our strategies to develop and implement a protocol to improve the quality of care for women with severe hypertension during pregnancy and reduce adverse outcomes. It is important to use an interprofessional approach to protocol development and education and to offer intensive initial education as well as ongoing education to sustain practice change. Use of the protocol was critical for empowering nurses to communicate more effectively with physicians about the status of patients and subsequent timely treatment to improve maternal outcomes.

Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials

Objective: The aim of this study was to investigate the effectiveness of interventions aimed at moving research evidence into stroke rehabilitation practice through changing the practice of clinicians. Data sources: EMBASE, CINAHL, Cochrane and MEDLINE databases were searched from 1980 to April 2019. International trial registries and reference lists of included studies completed our search. Review methods: Randomized controlled trials that involved interventions aiming to change the practice of clinicians working in stroke rehabilitation were included. Bias was evaluated using RevMan to generate a risk of bias table. Evidence quality was evaluated using GRADE criteria. Results: A total of 16 trials were included (250 sites, 14,689 patients), evaluating a range of interventions including facilitation, audit and feedback, education and reminders. Of which, 11 studies included multicomponent interventions (using a combination of interventions). Four used educational interventions alone, and one used electronic reminders. Risk of bias was generally low. Overall, the GRADE criteria indicated that this body of literature was of low quality. This review found higher efficacy of trials which targeted fewer outcomes. Subgroup analysis indicated moderate-level GRADE evidence (103 sites, 10,877 patients) that trials which included both site facilitation and tailoring for local factors were effective in changing clinical practice. The effect size of these varied (odds ratio: 1.63–4.9). Education interventions alone were not effective. Conclusion: A large range of interventions are used to facilitate clinical practice change. Education is commonly used, but in isolation is not effective. Multicomponent interventions including facilitation and tailoring to local settings can change clinical practice and are more effective when targeting fewer changes.

Primary care provider perceptions and experiences of implementing hepatitis C virus birth cohort testing: a qualitative formative evaluation

BackgroundIn 2014, the Department of Veterans Affairs (VA) adopted a screening test policy for hepatitis C virus (HCV) in all “Baby Boomers” - those born between 1945 and 1965. About 1 in 12 Veterans were estimated to be infected with HCV yet approximately 34% of the birth cohort remained untested. Early HCV diagnosis and successful antiviral treatment decrease the risk of onward transmission, cirrhosis, hepatocellular carcinoma, liver transplant, and death. Implementing evidence-based HCV screening in primary care has great potential to reduce morbidity and mortality. To inform design and implementation of a quality improvement intervention, we studied primary care provider (PCP) perceptions of and experiences with HCV birth cohort testing.MethodsWe conducted a formative evaluation using qualitative semi-structured interviews guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Twenty-two PCPs in six states across a large integrated US healthcare system were interviewed. Content analysis with a priori and emergent codes was performed on verbatim interview transcripts.ResultsWe identified three themes related to primary care provider HCV testing and linkage practices, as mapped to i-PARIHS constructs: 1) evaluating cues to HCV testing (innovation/evidence), 2) framing HCV testing decisions (recipients), and 3) HCV testing and linkage to care in the new treatment era (context). The most frequently reported HCV testing cue was an electronic clinical reminder alert, followed by clinical markers and the presence of behavioral risk factors. Most PCPs saw testing as routine, but less urgent, leading to some reluctance. Providers largely saw themselves as performing guideline-concordant testing, yet no performance data were available to assess performance. Given the recent availability of new HCV medications, many PCPs were highly motivated to test and link patients to specialty care for treatment.ConclusionsOur results suggest a multi-component intervention around awareness and education, feedback of performance data, clinical reminder updates, and leadership support, would address both a significant need, and be deemed acceptable and feasible to primary care providers.

126 Brief Motivational Interviewing Increases Participation in the Take Charge of Burn Pain Self- Management Program

Burn related pain is a common experience post‐injury impacting physical, psychological and social recovery, and reducing long‐term function and community participation. The Take Charge of Burn Pain online self-management program (www.takechargeofburnpain.org) is a cognitive-behavioral based, 7 session, interactive program that utilizes the principles of self-management to provide knowledge, self-monitoring, pain coping skill development and practice. In the parent RCT study, initial efficacy data indicates program completers have significant benefits. However, there are significant numbers of individuals who initially enroll in the program and do not start or complete the program. This paper reports on the impact of a brief motivational interviewing (MI) intervention to increase program utilization and completion. A matched cohort series design was used. Eligibility criteria are: 18 to 70 years of age, having experienced a burn injury requiring hospitalization at least 6 months prior to enrollment; 2) Reporting a pain severity score on the Brief Pain Inventory of 4 (0‐10) or higher; 3) Reporting pain of at least 3 months duration; 4) English speaking; and 5) Did not log on in within one week of enrollment, or became inactive (no program usage for 21 days). 66 participants in the initial cohort received a series of electronic reminders to re-engage. In the second cohort, 20 individuals in the second cohort who did not respond to the standard reminders, received a single, brief MI- based phone intervention to promote re-engagement. The outcome measures were log on and program completion rates. The 86 participants are 55% female, 60% white, 8% Latino/Hispanic, 55% have more than high school education, and a mean age of 41. The standard reminder cohort had a log on rate of 43%, completed 3 lessons on average and had and program completion rate of 30%. The brief MI- based phone intervention cohort had a log on rate of 53%, completed 4 lessons on average and had and program completion rate of 40%. Standard electronic reminders yield less than optimal utilization of the online pain self-management program. Addition of a single MI-based phone call modestly increased log on rates and program completion rates. Additional research is needed to determine if additional MI-based contacts would further increased utilization and lead to long-term improvements in pain, psychological distress and quality of life. Poor participant engagement undermines the potential benefit of online resources to address the pain and psychosocial sequelae of burn injury. There is a need to identify strategies to increase participant engagement and improve effectiveness of online resources.

Acceptance and Use of Innovative Assistive Technologies among People with Cognitive Impairment and Their Caregivers: A Systematic Review.

Cognitive impairments (CI), associated with the consequences of Alzheimer's disease and other dementias, are increasingly prevalent among older adults, leading to deterioration in self-care, mobility, and interpersonal relationships among them. Innovative Assistive Technologies (IAT) such as electronic reminders and surveillance systems are considered as increasingly important tools to facilitate independence among this population and their caregivers. The aim of this study is to synthesise knowledge on facilitators and barriers related to acceptance of and use of IAT among people with CI and their caregivers. This systematic review includes original papers with quantitative, qualitative, or mixed methods design. Relevant peer-reviewed articles published in English between 2007 and 2017 were retrieved in the following databases: CINAHL; PubMed; Inspec; and PsycINFO. The Mixed Method Appraisal Tool (MMAT) was used for quality assessment. We retrieved thirty studies, including in total 1655 participants from Europe, USA/Canada, Australia, and Asia, enrolled in their homes, care-residences, day-care centres, or Living Labs. Two-thirds of the studies tested technologies integrating home sensors and wearable devices for care and monitoring CI symptoms. Main facilitators for acceptance and adherence to IAT were familiarity with and motivation to use technologies, immediate perception of effectiveness (e.g., increase in safety perceptions), and low technical demands. Barriers identified included older age, low maturity of the IAT, little experience with technologies in general, lack of personalization, and support. More than 2/3 of the studies met 80% of the quality criteria of the MMAT. Low acceptance and use of IAT both independently and with caregivers remains a significant concern. More knowledge on facilitators and barriers to use of IAT among clients of health care and social services is crucial for the successful implementation of innovative programmes aiming to leverage innovative technologies for the independence of older people with CI.

Reducing urinary catheter use using an electronic reminder system in hospitalized patients: A randomized stepped-wedge trial.

To determine the effectiveness and ease of use of an electronic reminder device in reducing urinary catheterization duration. A randomized controlled trial with a cross-sectional anonymous online survey and focus group. Ten wards in an Australian hospital. All hospitalized patients with a urinary catheter. An electronic reminder system, the CATH TAG, applied to urinary catheter bags to prompt removal of urinary catheters. Catheterization duration and perceptions of nurses about the ease of use. A Cox proportional hazards model was used to assess the rate of removal of catheters. A phenomenological approach underpinned data collection and analysis methods associated with the focus group. In total, 1,167 patients with a urinary catheter were included. The mean durations in control and intervention phases were 5.51 days (95% confidence interval [CI], 4.9-6.2) and 5.08 days (95% CI, 4.6-5.6), respectively. For patients who had a CATH TAG applied, the hazard ratio (HR) was 1.02 (95% CI, 0.91-1.14; P = .75). A subgroup analysis excluded patients in an intensive care unit (ICU), and the use of the CATH TAG was associated with a 23% decrease in the mean, from 5.00 days (95% CI, 4.44-5.56) to 3.84 days (95% CI, 3.47-4.21). Overall, 82 nurses completed a survey and 5 nurses participated in a focus group. Responses regarding the device were largely positive, and benefits for patient care were identified. The CATH TAG did not reduce the duration of catheterization, but potential benefits in patients outside the ICU were identified. Electronic reminders may be useful to aid prompt removal of urinary catheters in the non-ICU hospital setting.

Make It Fresh, for Less! A Supermarket Meal Bundling and Electronic Reminder Intervention to Promote Healthy Purchases Among Families With Children

ObjectiveTo evaluate the effects of a supermarket meal bundling and electronic reminder intervention on food choices of families with children. DesignQuasi-experimental (meal bundling) and randomized, controlled trial (electronic reminders). SettingLarge supermarket in Maine during 40-week baseline and 16-week intervention periods in 2015–2016. ParticipantsEnglish-speaking adults living with at least 1 child aged ≤18 years (n = 300) with 25% of households participating in the Supplemental Nutrition Assistance Program. Intervention(s)(1) Four bundles of ingredients needed to make 8 low-cost healthful meals were promoted in the store through displays and point-of-purchase messaging for 4 weeks each; (2) weekly electronic messages based on principles from behavioral psychology were sent to study participants reminding them to look for meal bundles in the store. Main Outcome Measures(1) Difference in storewide sales and individual purchases of bundled items (measured using supermarket loyalty card data) from baseline to intervention in intervention vs control groups. AnalysisRegressions controlling for total food spending and accounting for repeated measures. ResultsThere were no differences in spending on bundled items resulting from the meal bundling intervention or the electronic reminders. Conclusions and ImplicationsOverall, there was little impact of healthful meal bundles and electronic reminders on storewide sales or purchases of promoted items in a large supermarket.

Text and Email Messaging for Increasing Human Papillomavirus Vaccine Completion among Uninsured or Medicaid-insured Adolescents in Rural Eastern North Carolina.

We sought to assess if electronic messaging/reminders could increase human papillomavirus (HPV) vaccine completion among adolescents and HPV knowledge among their parents. The study was conducted in two clinics in eastern North Carolina from March 2014-March 2016. Participants included English-speaking and/or Spanish-speaking, uninsured or Medicaid-insured parents and their children (ages 9-17). Intervention participants received text/email appointment reminders and education messages and controls received standard-of-care. The final sample included 257 parent-child dyads. Most identified as Black (60%) or Hispanic (28%). Completion rates for intervention and control groups were similar for HPV dose 2 (65% vs. 65%) and HPV dose 3 (35% vs. 30%), respectively. Although knowledge change was higher for the intervention group, this difference was not statistically significant. Those who reported provider vaccine recommendation were 1.8 times more likely to complete the series. Electronic reminders to promote vaccine completion were not effective in this population. More research is needed.

Physicians' awareness and practice toward influenza and pneumococcal vaccines for high-risk patients.

Objectives:The aim of the study is to assess the awareness of family medicine residents about influenza and pneumococcal vaccination for high-risk patients and to verify the most significant variables that might affect residents’ knowledge and the tools needed to enhance their practice.Materials and Methods:This cross-sectional study was conducted at four major hospitals in Riyadh, Saudi Arabia, during the period, October through December 2017. A pretested self-administered questionnaire was handed to 180 family residents. Descriptive statistics were used to analyze the study data. The Chi-square test was used to compare categorical variables data. The One-way ANOVA test was used to detect the significant difference.Results:The overall knowledge of physicians about influenza and pneumococcal vaccines was inadequate and was more toward pneumococcal vaccine, in spite their respectable knowledge about the target population. The main reasons for non- prescribing of vaccines were forgetfulness (59.4%), the availability of vaccines (33.9%), and the patients’ refusal (23.3%). The tools that might help for prescribing were the need for the presence of electronic reminder (69.4%) and the patients should follow a regular family physician (47.2%).Conclusion:Knowledge and practice of influenza and pneumococcal vaccination are inadequate. This is mainly because of forgetfulness owing to minimal guideline awareness, lack of vaccine availability, and patients’ refusal. The important recommendations to enhance vaccination practice among physicians are the implementation of electronic reminders, regular follow-up with the same physician in addition to educational programs during residency, and patient education about the importance of vaccinations as a means of disease prevention.

Improved Gout Outcomes in Primary Care Using a Novel Disease Management Program: A Pilot Study.

To pilot a primary care gout management improvement intervention. Two large primary care sites were selected: 1 underwent the intervention, the other, a control, underwent no intervention. The intervention consisted of engagement of intervention-site staff, surveys of provider performance improvement preferences, and onsite live and enduring online education. Electronic health record reminders were constructed. Both the intervention and control sites had 3 quality measures assessed monthly: the percentage of gout patients treated with urate-lowering therapy, the percentage of treated patients monitored with serum urate, and the percentage of treated patients at target serum urate ≤6.0 mg/dl. The intervention-site providers received monthly reports comparing their measures against their peers. By 6 months, the intervention site significantly improved all 3 gout performance measures. The percentage treated increased from 54.4% to 61.1% (odds ratio [OR] 1.19 [95% confidence interval (95% CI) 1.08-1.31]; P < 0.001), the percentage monitored increased from 56.1% to 79.2% (OR 1.52 [95% CI 1.24-1.87]; P < 0.001), and the percentage at goal increased from 26.85% to 43.3% (OR 1.43 [95% CI 1.16-1.77]; P < 0.001). At 6 months after intervention, gout patients at the intervention site were more likely to be monitored (79.2% versus 53.4% [OR 3.54 (95% CI 2.30-5.45)]; P < 0.001) and at goal (43.3% versus 28.3% [OR 1.99 (95% CI 1.33-2.96)]; P < 0.001) than control-site patients. Numbers treated did not significantly improve over the control site. A pilot multifaceted gout management program can significantly improve primary care gout management performance.

Electronic reminders increase hepatitis C screening, referral, treatment and cure.

Electronic reminders increase hepatitis C screening, referral, treatment and cure.

Individual, social, and structural factors affecting antiretroviral therapy adherence among HIV-positive people who inject drugs in Kazakhstan

BackgroundHIV-infected people who inject drugs (PWID) are particularly vulnerable to suboptimal ART adherence. The fastest-growing HIV epidemics globally are driven by injection drug use, but only a small percentage of HIV-positive PWID have achieved viral suppression. Virally suppressed individuals have better HIV-related health outcomes and effectively no risk of transmitting HIV to others. Hence, ART adherence is important for both HIV treatment and HIV prevention. There is a paucity of data on barriers and facilitators of ART adherence among PWID in low and middle income countries, which is problematic given the growing HIV epidemics among PWID in these countries. MethodsUsing the Theory of Triadic Influence, this paper examines individual, interpersonal, and structural barriers and facilitators of ART adherence among HIV-positive PWID in four cities in Kazakhstan. Eight focus groups were conducted (two in each city) with a total of 57 participants. Data were coded and analyzed by three researchers. ResultsWe found a number of barriers and facilitators to ART adherence among PWID at the individual, interpersonal, and structural levels. Individual barriers to ART adherence include misperceptions about ART, forgetfulness due to the effects of illicit drug use, and medication side effects. Interpersonal facilitators of ART adherence include social support and good relationships with healthcare providers. Structural barriers include poverty, legal challenges, disruptions in the ART supply, and stigma and discrimination. ConclusionThe paper highlights important factors related to ART adherence for HIV-positive PWID and identifies potential strategies for intervention efforts, including couple-based interventions, electronic reminders, linkage to drug treatment services, and patient navigation. Effectively enhancing adherence to ART among PWID will likely require multi-level approaches and strategies. Further research should be conducted on potential methods and interventions for improving ART adherence among this vulnerable population.

Reminder Systems for Improving Adherence among HIV-infected Adolescents Attending a Tertiary Facility in Abuja

&#x0D; &#x0D; &#x0D; &#x0D; Background: Adherence to antiretroviral therapy is a key factor in the successful treatment of people living with HIV infection. Use of reminder system has been shown to improve adherence to antiretroviral therapy. This study was conducted to identify the reminder systems used by the HIV-infected adolescents in our health facility and determine the relationships with adherence using self-report and pill count.&#x0D; Study Design: This was a cross sectional study.&#x0D; Place and Duration of Study: The study was done at Paediatric Special Treatment Clinic of the University of Abuja Teaching Hospital, Nigeria. The data collection was over a six month period, September 2015 to February, 2016.&#x0D; Methodology: This was a face-to-face interviewer administered pretested questionnaire-based study. Adherence was measured using three-day recall self report and pill count, with convenience sampling method employed.&#x0D; Results: One-hundred and forty-five adolescents aged 10 years to 19 years participated in the study, 80(55.2%) were males, 78(53.8%)%) were between the ages of 10-13 years, 111(76.6%) were Christians, 91(62.7%) had secondary level of education, and 61(42.1%) were from the middle socio-economic class. The most common reminder systems used were the alarm devices 43(29.7%), timers 34(23.4%) and parents 39(26.9%). Twenty-two (15.2%) participants did not use any form of reminders for their self-care. Use of reminder systems had a statistically significant relationship with gender (P= .031), social class (P = .003) and self-report (P = &lt;0.001).&#x0D; Conclusion: The alarm system was mostly used by adolescents for their medication adherence and was associated with gender, social class and self-reporting. It is hoped that interventional studies will be carried out on the use of types of electronic reminder devices to ARV medications with the aim of its integration into the routine care of HIV-infected adolescents in Nigeria.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

A pilot study using electronic reminders for amblyopia treatment

ABSTRACTTreatment compliance is the most important factor for predicting a successful outcome in amblyopia treatment. Electronic applications have been successfully employed in other medical conditions in an effort to improve compliance.Aim: To determine whether a smartphone medical adherence application (app) (RxmindMe® Prescription/Medicine Reminder and Pill Tracker) may be successfully incorporated into the treatment plan of patients 3–7 years of age who have not previously been treated for amblyopia.Methods: Children 3–7 years of age were randomized to receive electronic reminders (reminders group) or standard instructions (control group). Visual acuity and compliance with treatment was assessed at the first follow-up visit. The child’s adherence with the prescribed treatment was calculated as the reported number of hours of patching performed divided by the number of hours prescribed or compliance percentage. The validated “Amblyopia Treatment Index Parental Questionnaire” was administered to the parent/guardian to assess any differences in the compliance subscale between the two treatment groups. Any difficulties encountered with the use of the reminder app were also recorded at the follow-up visit.Results: Twenty-four participants were enrolled. Twelve participants in the reminder group (eight female, four male; mean age 4.5 ± 1.3) were compared with 12 participants in the control group (five female, seven male; mean 4.8 ± 1.1). No significant differences were found between the two groups in terms of age (p = 0.62), gender (p = 0.22), or degree of amblyopia at the start of treatment (p = 0.99). Eleven of 12 participants in the reminders group were able to incorporate the reminder app into amblyopia treatment. No participant reported malfunction of the alarm portion of the reminder app. There was no significant difference seen in degree of visual acuity improvement, reported percentage compliance or effect on the compliance subscale as assessed by the ATI questionnaire. Several participants reported the app to be “helpful” in initiating treatment.Conclusion: Our findings indicate that use of a smartphone app is feasible in this patient population. Targeting the app to specific patient demographics or when difficulty with compliance is encountered needs to be further investigated.

Mind the Gap: Improving Transitions of Care After Inpatient Endoscopy at an Academic Medical Center

Introduction: Follow-up after inpatient endoscopy is suboptimal in patients discharged from the hospital. To evaluate the gap in care, prior review of 182 consecutive inpatients (3-month period) undergoing endoscopy at our academic center found that when repeat endoscopy was recommended, less than 30% of patients completed it. Possible barriers included poor communication between services, lack of scheduling, and poor patient follow-up. We aimed to increase the rate of completion of follow-up endoscopies after discharge. Methods: Electronic reminders were sent from 9-11/2015 to inpatient GI consult teams to include indication for repeat endoscopy in reports, to message the scheduler, and to assure appointments were included on discharge instructions. A flyer was posted in the workroom and a presentation was given to the fellows regarding the gap in care. We then reviewed the records to determine the rate of completion of recommended follow-up endoscopy and clinic visits for patients who underwent inpatient endoscopy during our quality improvement intervention. Results: 210 consecutive inpatient endoscopies were performed in the quarter of the intervention (Table 1). Prior to intervention, repeat endoscopy was indicated in 54/182 patients and recommended for 38/54. Of these, 11 patients completed the repeat study (28.9%). After the intervention, of 65/210 patients for whom repeat endoscopy was indicated, it was recommended in 49 patients. Of these 49 patients, 30 patients completed the recommended repeat procedure (61.2%) (Figure 1). This represents a significant improvement (Chi square p= 0.003). The indications for repeat endoscopy are outlined in figure 2. Before our intervention, 66/90 patients recommended to follow in GI clinic did so. Since intervention, significantly more patients (52/54, fisher's exact p= 0.0003) followed up as recommended.1071_A Figure 1. Pre and Post-Intervention Patient CharacteristicsConclusion: This study supports that a simple quality improvement initiative of reminders and education doubled follow-up endoscopy after hospitalization. While less than 30% completed recommended studies before, over 60% of patients did so afterwards. Furthermore, while only 73% of patients followed up in clinic before, the rate of follow-up post-intervention increased to 96%. Similar systems can be implemented throughout other centers and increase likelihood of both outpatient endoscopy and office visit follow-up and offer our patients optimal transitions of care.1071_B Figure 2. Significant Endoscopic Findings and Follow Up Outcomes Pre and Post Intervention

Adherence to Preventative Health Care Measures in Inflammatory Bowel Disease Patients Is Low

Introduction: Prior studies have shown that preventative health issues are neglected in patients with inflammatory bowel disease. In 2017, the American College of Gastroenterology (ACG) published comprehensive 14-point guidelines regarding preventive care measures (PCMs) in IBD. The adherence to these guidelines has not been assessed. We aimed to evaluate adherence to PCMs outlined by ACG in IBD patients at our center. Methods: We conducted retrospective quality improvement study including IBD patients who had received care at our gastroenterology outpatient clinics between September, 2017 to October, 2017. Baseline patient characteristics and data regarding adherence to preventative health care measures was noted. Results: A total of 94 patients were included. Mean age was 47.6 years and 34% were males. 49% of the patients had Crohn's disease (CD), while 51% had ulcerative colitis. 58.5% of the patients were on long-term steroids, while 45.7% and 44.6% of the patients were on immunomodulators and biologics respectively. Majority of the patients (88%) had a PCP, and 56.6% of the female patients were established with a gynecologist. Adherence with appropriate PCMs as indicated was: Influenza 58.5%, pneumococcal: 56.3%, herpes zoster 19.5%, varicella zoster 11.6%, meningococcal 100%, Tetanus, Diphtheria and Pertussis (Tdap) 55.3%, HAV: 58.5%, HBV 80.5%, HPV 80%, depression screening: 55.3%, melanoma screening: 30.8%. In women on immunosuppressive therapy, 51.6% underwent annual cervical cancer screening, and 33.3% of patients on immunomodulators had non-melanoma skin cancer screening. Bone mineral density testing was performed 67.2% of patients in whom it was indicated, and smoking cessation was advised to 76.9% of CD patients who used tobacco. Conclusion: Despite comprehensive guidelines, PCMs in IBD patients continue to be neglected. There continues to be debate whether preventative care in IBD is best addressed by PCP or gastroenterologists. Although our sample size is small, our results demonstrate significant room for improvement. There is a trend towards better preventive care in patients with IBD who have a PCP in addition to a gastroenterologist. Our next steps include: feedback to our physicians regarding adherence to PCMs, development of electronic health record reminders, and placing flyers in patient rooms. We plan to collect post-intervention data to assess if our interventions lead to improvement in preventive health care delivery to IBD patients.619_A Figure 1. Adherence to preventive care measures in patients with IBD619_B Figure 2. Comparison between gastroenterology fellow and faculty in regards to adherence to preventive care measures in IBD