Email Contact Research Articles

Consumer engagement critical to success in an Australian research project: reflections from those involved.

This paper describes the people, activities and methods of consumer engagement in a complex research project, and reflects on the influence this had on the research and people involved, and enablers and challenges of engagement. The 2.5-year Integrating and Deriving Evidence Experiences and Preferences (IN-DEEP) study was conducted to develop online consumer summaries of multiple sclerosis (MS) treatment evidence in partnership with a three-member consumer advisory group. Engagement methods included 6-monthly face-to-face meetings and email contact. Advisory group members were active in planning, conduct and dissemination and translational phases of the research. Engaging consumers in this way improved the quality of the research process and outputs by: being more responsive to, and reflective of, the experiences of Australians with MS; expanding the research reach and depth; and improving the researchers' capacity to manage study challenges. Advisory group members found contributing their expertise to MS research satisfying and empowering, whereas researchers gained confidence in the research direction. Managing the unpredictability of MS was a substantive challenge; the key enabler was the 'brokering role' of the researcher based at an MS organisation. Meaningfully engaging consumers with a range of skills, experiences and networks can make important and unforeseen contributions to research success.

Related Variables of Behavioral and Emotional Problems and Personal Growth of Hospitalized Children's Siblings: Mothers' and Other Main Caregivers' Perspectives.

The psychological well-being of the siblings of hospitalized children is at risk. This study examined the variables related to siblings’ internalizing problems and personal growth during hospitalization from the perspectives of mothers and other main caregivers who temporarily assumed the main caregiver role to the siblings of hospitalized children in place of mothers in the period of children’s hospitalization. A cross-sectional, exploratory survey conducted in Japan examined 113 mothers’ and 90 other main caregivers’ perspectives regarding the psychological state of 2- to 18-year-old siblings of hospitalized children. Mothers and/or other main caregivers of siblings during their brothers’ or sisters’ hospitalization completed the Child Behavior Checklist and the Siblings’ Personal Growth Scale. Multiple linear regression analysis was performed with Child Behavior Checklist internalizing problems and total Siblings’ Personal Growth Scale scores as dependent variables for mothers’ and caregivers’ perspectives. From mothers’ perspectives, environmental factors that change with hospitalization affected siblings. From the perspectives of the other main caregivers, children’s and families’ demographic factors affected siblings’ psychological state. Frequency of e-mail contact between mothers and siblings, explanation of the hospitalized child’s condition, and hospital visitation rules (F = 5.88, P = .001) explained 12.3% of variance in mothers’ Siblings’ Personal Growth Scale scores. Among other main caregivers, 11.6% of variance in the Child Behavior Checklist scores was explained by hospitalized children’s birth order and main caregiver’s prehospitalization residence (F = 5.51, P = .006). Results suggest that the perceived variables related to siblings’ psychological changes differ between mothers and other main caregivers.

On the multiserver retrial queues with negative arrivals.

The paper deals with an M/M/C/K retrial queue with exponential abandonment at which positive and negative customers arrive according to Poisson processes. This model is of practical interest: it can be used for analysing the performance in call centres and e-mail contact systems. For the model under investigation, we find the ergodicity conditions and also the approximate solution by using finite truncation and value extrapolation methods. We present some numerical results to examine the performance of the value extrapolation method as well as the system performance.

Dynamically Managing a Profitable Email Marketing Program

Although email marketing is highly profitable and widely used by marketers, it has received limited attention in the marketing literature. Extant research has focused on either customers’ email responses or the “average” effect of emails on purchases. In this article, the authors use data from a U.S. home improvement retailer to study customers’ email open and purchase behaviors by using a unified hidden Markov and copula framework. Contrary to conventional wisdom, the authors find that email-active customers are not necessarily active in purchases, and vice versa. Furthermore, the number of emails sent by the retailer has a nonlinear effect on both the retailer's short- and long-term profitability. Through a counterfactual study, the authors provide a decision support system to guide retailers in making optimal email contact decisions. This study shows that sending the right number of emails is vital for long-term profitability. For example, sending four (ten) emails instead of the optimal number of seven emails can cause the retailer to lose 32% (16%) of its lifetime profit per customer.

Online Self-Management Support for Family Caregivers to Help Them Manage Behavior Changes in Their Relative With Dementia: Study Protocol for a Randomized Controlled Trial and a Process Evaluation.

BackgroundOnline interventions are potentially effective ways to support family caregivers in the management of behavior changes in their relative with dementia.ObjectiveThe objective of this paper is to present the design of a study evaluating and comparing 3 intervention arms for online self-management support.MethodsA randomized controlled trial (RCT) will be conducted with a total of 81 family caregivers of community-dwelling people with dementia in the Netherlands. Family caregivers will be randomly allocated to one of the following intervention arms: (1) a major self-management support intervention consisting of personal email contacts with a nurse specialized in dementia care, online videos, and electronic bulletins (e-bulletins); (2) a medium self-management support intervention consisting of only online videos and e-bulletins; and (3) a minor self-management support intervention with only e-bulletins. The primary outcome is the self-efficacy of the family caregiver. The secondary outcomes are the behavior problems of the person with dementia as reported by the family caregiver, and positive and negative aspects of the relationship. Background characteristics (eg, type of family relationship) will also be assessed. All data for the RCT will be collected via online questionnaires, administered before the intervention (T0), after 6 weeks (T1), and after 12 weeks (T2). Alongside the RCT, a process evaluation will be conducted, based on a number of evaluation questions and semi-open interviews with family caregivers.ResultsData collection will be completed in August 2017. Study results will be reported in early 2018.ConclusionsThe study will shed more light on the effect of online self-management support interventions and insights will be gained into whether a major intervention, consisting of personal email contacts with specialized nurses, videos, and e-bulletins, has more effect than smaller online interventions. This is relevant in an age with increasing numbers of people with dementia, growing pressure on family caregivers, more and more people using the Internet, and increasing healthcare costs.Trial RegistrationNederlands Trial Registry (NTR): NTR6237; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6237 (Archived by WebCite at http://www.webcitation.org/6v0S4fxTC)

Forced migrants involved in setting the agenda and designing research to reduce impacts of complex emergencies: combining Swarm with patient and public involvement

Plain English summaryThe UK’s National Institute for Health Research (NIHR) Health Protection Research Unit in Emergency Preparedness and Response was asked to undertake research on how to reduce the impact of complex national/international emergencies on public health. How to focus the research and decide on priority topics was challenging, given the nature of complex events. Using a type of structured brain-storming, the researchers identified the ongoing UK, European and international migration crisis as both complex and worthy of deeper research. To further focus the research, two representatives of forced migrant communities were invited to join the project team as patient and public (PPI) representatives. They attended regular project meetings, insightfully contributed to and advised on practical aspects of potential research areas. The representatives identified cultural obstacles and community needs and helped choose the final research study design, which was to interview forced migrants about their strategies to build emotional resilience and prevent mental illness. The representatives also helped design recruitment documents, and undertake recruitment and interviewer training.BackgroundMany events with wide-ranging negative health impacts are notable for complexity: lack of predictability, non-linear feedback mechanisms and unexpected consequences. A multi-disciplinary research team was tasked with reducing the public health impacts from complex events, but without a pre-specified topic area or research design. This report describes using patient and public involvement within an adaptable but structured development process to set research objectives and aspects of implementation.MethodsAn agile adaptive development approach, sometimes described as swarm, was used to identify possible research areas. Swarm is meant to quickly identify strengths and weaknesses of any candidate project, to accelerate early failure before resources are invested. When aspects of the European migration crisis were identified as a potential priority topic area, two representatives of forced migrant communities were recruited to explore possible research ideas. These representatives helped set the specific research objectives and advised on aspects of implementation, still within the swarm framework for project development.ResultsOver ten months, many research ideas were considered by the collaborative working group in a series of six group meetings, supplemented by email contact in between. Up to four possible research ideas were scrutinised at any one meeting, with a focus on identifying practical or desirable aspects of each proposed project. Interest settled on a study to solicit original data about successful strategies that forced migrants use to adapt to life in the UK, with an emphasis on successfully promoting resilience and minimizing emotional distress. “Success in resettlement” was identified to be a more novel theme than “barriers to adaption” research. A success approach encourages participation when individuals may find discussion of mental illness stigmatising. The patient representatives helped with design of patient-facing and interview training materials, interviewer training (mock interviews), and aspects of the recruitment.ConclusionUsing patient and public involvement (PPI) within an early failure development approach that itself arises from theory on complex adaptive systems, we successfully implemented a dynamic development process to determine research topic and study design. The PPI representatives were closely involved in setting research objectives and aspects of implementation.

Correction of: Using New and Emerging Technologies to Identify and Respond to Suicidality Among Help-Seeking Young People: A Cross-Sectional Study.

[This corrects the article DOI: 10.2196/jmir.7897.].

Healthcare utilization in men with poorer sexual and urinary function recovery following robot-assisted radical prostatectomy.

Robotic radical prostatectomy focuses on oncologic cure, urinary continence and sexual function recovery. However, little is known about the effect of declines in urinary continence and sexual function on healthcare utilization. We aim to identify these factors. From March 2011 to September 2013, all men undergoing robotic prostatectomy within our healthcare system were enrolled. Men completed the expanded prostate cancer index composite-26 survey at the time of diagnosis and 90days post-operatively. Patients were stratified according to change in scores in the sexual function and urinary incontinence domains. Patient, treatment and post-op utilization patterns were examined for association with the extent of decline in sexual function and urinary continence. Multivariate linear regression was used to identify factors independently associated with decline in continence and sexual function. A total of 411 men who completed the baseline survey and at 90days postoperatively were included. On multivariate linear regression, younger age (p<0.01), higher preoperative sexual function (<0.01), single marital status (p=0.04) and more post-surgery email contacts (p=0.04) were associated with higher declines in sexual function. For continence, no family history of prostate cancer (p=0.01), higher baseline continence (p<0.01) and more post-surgery physical therapy visits (p<0.01) were associated with higher declines. Patients with the poorest quality of life outcomes at 90days post-operatively were more likely to seek care via email and physical therapy encounters related to sexual function and urinary incontinence, respectively. This suggests that maximizing post-treatment quality of life can potentially reduce healthcare utilization.

Can a Clinician-Scientist Training Program Develop Academic Orthopaedic Surgeons? One Program’s Thirty-Year Experience

Clinician-scientist numbers have been stagnant over the past few decades despite awareness of this trend. Interventions attempting to change this problem have been seemingly ineffective, but research residency positions have shown potential benefit. We sought to evaluate the effectiveness of a clinician-scientist training program (CSTP) in an academic orthopedic residency in improving academic productivity and increasing interest in academic careers. Resident training records were identified and reviewed for all residents who completed training between 1976 and 2014 (n = 329). There were no designated research residents prior to 1984 (pre-CSTP). Between 1984 and 2005, residents self-selected for the program (CSTP-SS). In 2005, residents were selected by program before residency (CSTP-PS). Residents were also grouped by program participation, research vs. clinical residents (RR vs. CR). Data were collected on academic positions and productivity through Internet-based and PubMed search, as well as direct e-mail or phone contact. Variables were then compared based on the time duration and designation. Comparing all RR with CR, RR residents were more likely to enter academic practice after training (RR, 34%; CR, 20%; p = 0.0001) and were 4 times more productive based on median publications (RR, 14; CR, 4; p < 0.0001). Furthermore, 42% of RR are still active in research compared to 29% of CR (p = 0.04), but no statistical difference in postgraduate academic productivity identified. The CSTP increased academic productivity during residency for the residents and the program. However, this program did not lead to a clear increase in academic productivity after residency and did not result in more trainees choosing a career as clinician-scientists.

Urgency of caesarean section, grading, alarm chain and intrauterine resuscitation - a survey of Scandinavian practice.

About 40,000 women have caesarean section in Scandinavia each year. Organizational factors for emergency caesarean section (CS), classification, anaesthetic practice, alarm chain, intrauterine resuscitation has all been investigated in the United Kingdom, but no information from the Scandinavian countries exists. Using publicly available data from the National Board of Health, obstetric anaesthetic departments were identified. The heads of the departments provided e-mail contact details of two anaesthesiologists regularly practicing obstetric anaesthesia who were then surveyed. One hundred and forty-five specialists from 82 departments in Scandinavia replied to our survey. Ninety-five percent of Danish specialists reported a three-grade classification system for urgency CS. Where classification in Denmark was enumerative classification, Norwegians equally reported enumerative and verbal descriptors, whereas Swedish specialists mostly reported verbal descriptors. Local guidelines describing decision-to-delivery interval for emergency CS was reported by 100% of Danish specialists vs. 47% from Norway and 85% from Sweden. Mean benchmark decision-to-delivery interval for emergency CS was 12.7min. General anaesthesia for emergency CS was highly favoured in Norway (95%) and Sweden (97%), compared to Denmark (49%). Twenty specialists reported existence of local guidelines for intrauterine resuscitation. Our survey of Scandinavian specialists indicate emergency CS practise differs from United Kingdom practices in several aspects; general anaesthesia is by the majority of Scandinavian specialists reported as the default choice for emergency CS and benchmark for decision-to-delivery interval is <20min. Nomenclature used for classification showed considerable variance in Norway and Sweden compared to Denmark. No joint Scandinavian guidelines exist.

Medical Students in the United States Reveal Their Ideal Expectations to Help Planners of a New Library

Medical Students in the United States Reveal Their Ideal Expectations to Help Planners of a New Library

School Psychologists’ Experiences with and Training in Suicide Assessment: Challenges in a Rural State

Past research has shown that suicide rates for males and females are higher in rural than in urban areas. Because of the high incidence of suicide attempts and completion of youth in rural areas, it is critical that they receive mental health support within schools. Consequently, the current mixed-methods study surveyed school psychologists in Montana to obtain information about their involvement and training in suicide assessment and the related challenges they have encountered. Thirty-seven school psychologists participated in the study, with 47% serving schools in rural areas. Participants were recruited through the membership listserv of the Montana Association of School Psychologists (response rate of 27%) and through direct e-mail contact (response rate of 16%). Results indicated that only 17% of the participants take the lead in suicide risk assessments and 47% are involved in them less than five times a year, 93% of participants did not have a graduate class exclusively devoted to suicide assessment, and 58% received 10 or more hours of training in suicide assessment post-degree. Furthermore, qualitative thematic analyses, using NVivo software, yielded nine major categories of challenges in suicide assessment identified by school psychologists. Study limitations, future areas for research, and implications for school psychologists are also discussed.

Using New and Emerging Technologies to Identify and Respond to Suicidality Among Help-Seeking Young People: A Cross-Sectional Study.

BackgroundSuicidal thoughts are common among young people presenting to face-to-face and online mental health services. The early detection and rapid response to these suicidal thoughts and other suicidal behaviors is a priority for suicide prevention and early intervention efforts internationally. Establishing how best to use new and emerging technologies to facilitate person-centered systematic assessment and early intervention for suicidality is crucial to these efforts.ObjectiveThe aim of this study was to examine the use of a suicidality escalation protocol to respond to suicidality among help-seeking young people.MethodsA total of 232 young people in the age range of 16-25 years were recruited from either a primary mental health care service or online in the community. Each young person used the Synergy Online System and completed an initial clinical assessment online before their face-to-face or online clinical appointment. A suicidality escalation protocol was used to identify and respond to current and previous suicidal thoughts and behaviors.ResultsA total of 153 young people (66%, 153/232) reported some degree of suicidality and were provided with a real-time alert online. Further levels of escalation (email or phone contact and clinical review) were initiated for the 35 young people (15%, 35/232) reporting high suicidality. Higher levels of psychological distress (P<.001) and a current alcohol or substance use problem (P=.02) predicted any level of suicidality compared with no suicidality. Furthermore, predictors of high suicidality compared with low suicidality were higher levels of psychological distress (P=.01), psychosis-like symptoms in the last 12 months (P=.01), a previous mental health problem (P=.01), and a history of suicide planning or attempts (P=.001).ConclusionsThis study demonstrates the use of new and emerging technologies to facilitate the systematic assessment and detection of help-seeking young people presenting with suicidality. This protocol empowered the young person by suggesting pathways to care that were based on their current needs. The protocol also enabled an appropriate and timely response from service providers for young people reporting high suicidality that was associated with additional comorbid issues, including psychosis-like symptoms, and a history of suicide plans and attempts.

The Effect of Alternative E-mail Contact Timing Strategies on Response Rates in a Self-administered Web Survey

The Federal Employee Viewpoint Survey is an annual survey of over 800,000 permanently employed civilian personnel from 87 agencies. First administered in 2002, the web-based survey measures a broad range of employee perceptions, attitudes, and behaviors, serving as a valuable tool for human resources managers to determine which aspects of an organization are working well and which may require intervention. The data collection protocol begins by sending all sampled individuals an initial invitation to participate. Thereafter, nonrespondents are sent weekly reminder e-mails. These notifications are typically sent on Tuesday mornings. In this article, we present results from an experiment investigating two alternative protocols varying when survey notification and reminder e-mails are sent. Interestingly, the stable Tuesday morning strategy produced a significantly higher response rate than the two alternatives, and we analyze timestamp information from one of the alternatives to help provide insight as to why.

Comparing Two Web/Mail Mixed-mode Contact Protocols to a Unimode Mail Survey

Recent research has shown mixed-mode surveys are advantageous for organizations to use in collecting data. Previous research explored web/mail mode effects for four-contact waves. This study explores the effect of web/mail mixed-mode systems over a series of contacts on the customer satisfaction data from the Florida Cooperative Extension Service during 2012–2013. The experimental design involved a group of clients who provided e-mail and mail contact information randomly assigned to two mixed-mode treatment groups and a mail-only control. Demographic and service utilization data were compared to assess response rates and nonresponse bias. Logistic regression showed the treatment groups had similar response rates and nonresponse bias. The fifth contact was statistically significant in increasing response rates but did not reduce nonresponse bias. Future research should continue exploring optimizing the number of contacts in mixed-mode survey methodology.

Effectiveness of an online SUpport PRogramme (SUPR) for older hearing aid users: study protocol for a cluster randomised controlled trial

BackgroundAn educational SUpport PRogramme called SUPR has been developed for hearing aid users (HAUs) and their communication partners (CPs) offering care beyond hearing aid fitting. SUPR teaches its users communication...

Open science in mental health research

Open science in mental health research

State of global pediatric neurosurgery outreach: survey by the International Education Subcommittee.

OBJECTIVE Neurosurgical services are increasingly recognized as essential components of surgical care worldwide. The degree of interest among neurosurgeons regarding international work, and the barriers to involvement in global neurosurgical outreach, are largely unexplored. The authors distributed a survey to members of the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Joint Section on Pediatric Neurosurgery to assess the state of global outreach among its members and to identify barriers to involvement. METHODS An internet-based questionnaire was developed by the International Education Subcommittee of the AANS/CNS Joint Section on Pediatric Neurosurgery and distributed to pediatric neurosurgeons via the AANS/CNS Joint Section email contact list. Participants were surveyed on their involvement in global neurosurgical outreach, geographic location, nature of the participation, and barriers to further involvement. RESULTS A 35.3% response rate was obtained, with 116 respondents completing the survey. Sixty-one percent have performed or taught neurosurgery in a developing country, and 49% travel at least annually. Africa was the most common region (54%), followed by South America (30%), through 29 separate organizing entities. Hydrocephalus was the most commonly treated condition (88%), followed by spinal dysraphism (74%), and tumor (68%). Most respondents obtained follow-up through communications from local surgeons (77%). Seventy-one percent believed the international experience improved their practice, and 74% were very or extremely interested in working elsewhere. Interference with current practice (61%), cost (44%), and difficulty identifying international partners (43%) were the most commonly cited barriers to participation. CONCLUSIONS Any coordinated effort to expand global neurosurgical capacity begins with appreciation for the current state of outreach efforts. Increasing participation in global outreach will require addressing both real and perceived barriers to involvement. Creation and curation of a centralized online database of ongoing projects to facilitate coordination and involvement may be beneficial.

Nuclear Medicine Technologists' Perception and Current Assessment of Quality: A Society of Nuclear Medicine and Molecular Imaging Technologist Section Survey.

In 2015, the Society of Nuclear Medicine and Molecular Imaging Technologist Section (SNMMI-TS) launched a multiyear quality initiative to help prepare the technologist workforce for an evidence-based health-care delivery system that focuses on quality. To best implement the quality strategy, the SNMMI-TS first surveyed technologists to ascertain their perception of quality and current measurement of quality indicators. Methods: An internet survey was sent to 27,989 e-mail contacts. Questions related to demographic data, perceptions of quality, quality measurement, and opinions on the minimum level of education are discussed in this article. Results: A total of 4,007 (14.3%) responses were received. When asked to list 3 words or phrases that represent quality, there were a plethora of different responses. The top 3 responses were image quality, quality control, and technologist education or competency. Surveying patient satisfaction was the most common quality measure (80.9%), followed by evaluation of image quality (78.2%). Evaluation of image quality (90.3%) and equipment functionality (89.4%) were considered the most effective measures. Technologists' differentiation between quality, quality improvement, quality control, quality assurance, and quality assessment seemed ambiguous. Respondents were confident in their ability to assess and improve quality at their workplace (91.9%) and agreed their colleagues were committed to delivering quality work. Of note, 70.7% of respondents believed that quality is directly related to the technologist's level of education. Correspondingly, respondents felt there should be a minimum level of education (99.5%) and that certification or registry should be required (74.4%). Most respondents (59.6%) felt that a Bachelor's degree should be the minimum level of education, followed by an Associate's degree (40.4%). Conclusion: To best help nuclear medicine technologists provide quality care, the SNMMI-TS queried technologists to discern perceptions of quality in nuclear medicine. The results show that technologists believe image quality and quality control are the most important determinants. Most respondents felt that quality is directly related to the level of education of the technologist acquiring the scan. However, the responses obtained also demonstrated variation in perception of what represents quality. The SNMMI-TS can use the results of the study as a benchmark of current technologists' knowledge and performance of quality measures and target educational programs to improve the quality of nuclear medicine and molecular imaging.

MP69-18 A PATIENT-CENTERED PRACTICE CHANGE: FINDING THE BEST APPROACH FOR PROSTATE CANCER DECISION SUPPORT

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making III1 Apr 2017MP69-18 A PATIENT-CENTERED PRACTICE CHANGE: FINDING THE BEST APPROACH FOR PROSTATE CANCER DECISION SUPPORT Donna Berry, Barbara Halpenny, Meghan Underhill, Martin Sanda, Viraj Master, Christopher Filson, Peter Chang, Gary Chien, and Seth Wolpin Donna BerryDonna Berry More articles by this author , Barbara HalpennyBarbara Halpenny More articles by this author , Meghan UnderhillMeghan Underhill More articles by this author , Martin SandaMartin Sanda More articles by this author , Viraj MasterViraj Master More articles by this author , Christopher FilsonChristopher Filson More articles by this author , Peter ChangPeter Chang More articles by this author , Gary ChienGary Chien More articles by this author , and Seth WolpinSeth Wolpin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2314AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Implementation of evidenced-based patient-centered care is challenging in clinical settings. Success of such practice changes varies. The purpose of our study was to evaluate implementation strategies to deploy a shared decision aid for localized prostate cancer (LPC). METHODS The Personal Patient Profile-Prostate (P3P) is a web-based decision aid with demonstrated efficacy in reducing decisional conflict among men choosing a care plan for LPC. Implementation strategies were co-designed with leaders in six geographically-diverse urology clinics. As part of routine care, men were informed of P3P and offered access via a variety of methods. Physicians received 1-page summaries of P3P patient-generated reports of current symptoms and factors influencing the care decision. Focus groups including physicians, clinic staff and administrators were held at each site to solicit feedback after the implementation period. Access metrics were monitored for up to 6 months. General impressions, common barriers and promoters were identified and synthesized from the focus group data. RESULTS Two sites chose written information only to inform men of P3P, 1 site chose email only, 1 site chose email plus phone contact, 1 site chose MD instruction to use, followed by phone and email follow up and 1 site chose in clinic only. Barriers common to all settings included creating new workflows on top of heavy workloads, and staff and administrator misunderstanding of P3P context and resources. Staff inability to identify men with new LPC (vs follow up visits) hampered access. Promoters to successful implementation included an identified clinical lead, physician engagement and phone combined with email contact. Of all men with LPC seen in the clinics, 51% (range 15-98%) were informed of P3P. The highest rates of P3P access outside of clinic and prior to the consult visit (82, 73%) were observed when 2-3 modes of informing were implemented: physician, email and phone invitations. Clinic sites that chose to only provide written material with instruction to access P3P had the lowest access rates (range 0-14%). Physicians appraised the summaries as useful and helpful. CONCLUSIONS Despite challenges for clinic staff to add strategies to implement P3P to already heavy workloads, success was realized when physicians engaged and when staff provided follow up contacts to encourage P3P access. New practice changes to implement an evidence-based intervention require multi-modal strategies for early success. Future trials evaluating methods to reduce clinical workload may be of value. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e933 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Donna Berry More articles by this author Barbara Halpenny More articles by this author Meghan Underhill More articles by this author Martin Sanda More articles by this author Viraj Master More articles by this author Christopher Filson More articles by this author Peter Chang More articles by this author Gary Chien More articles by this author Seth Wolpin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...