Large Health Center Research Articles

Epidural analgesia associations with depression, PTSD, and bonding at 2 months postpartum

The research aim was to study the possible effect of epidural analgesia, as well as other possible demographic/obstetric variables and subjective birth experience on postpartum depression, PTSD, and impaired bonding. This was a longitudinal study of 254 women who gave birth at the maternity wards of a large tertiary health center and responded to questionnaires at T1 (Childbirth Experience Questionnaire and level of fatigue question; in person, 1–4 days postpartum) and at T2 (Postnatal Depression Scale, Postpartum Bonding Questionnaire, and the City Birth Trauma Scale; online-two months postpartum). Obstetric and demographic data were taken from medical files. Having a previous psychiatric diagnosis and higher levels of fatigue significantly predicted worse outcomes in all measures (level of fatigue was not associated with the City Birth Trauma birth-related symptoms factor). Having higher education, being primiparous, worse birth experience, and longer second stage of birth predicted worse outcomes in some measures. Although epidural administration had no effect on any of the outcome variables, special attention should be devoted to women who had long second-stage births and/or suffering from postpartum fatigue to prevent postpartum psychopathology. In addition, demographic variables, such as primiparity, education, and prior psychopathology diagnosis should be considered to treat women and prevent postpartum psychopathology.

Characterization of Electronic Health Record Use Outside Scheduled Clinic Hours Among Primary Care Pediatricians: Retrospective Descriptive Task Analysis of Electronic Health Record Access Log Data.

BackgroundMany of the benefits of electronic health records (EHRs) have not been achieved at expected levels because of a variety of unintended negative consequences such as documentation burden. Previous studies have characterized EHR use during and outside work hours, with many reporting that physicians spend considerable time on documentation-related tasks. These studies characterized EHR use during and outside work hours using clock time versus actual physician clinic schedules to define the outside work time.ObjectiveThis study aimed to characterize EHR work outside scheduled clinic hours among primary care pediatricians using a retrospective descriptive task analysis of EHR access log data and actual physician clinic schedules to define work time.MethodsWe conducted a retrospective, exploratory, descriptive task analysis of EHR access log data from primary care pediatricians in September 2019 at a large Midwestern pediatric health center to quantify and identify actions completed outside scheduled clinic hours. Mixed-effects statistical modeling was used to investigate the effects of age, sex, clinical full-time equivalent status, and EHR work during scheduled clinic hours on the use of EHRs outside scheduled clinic hours.ResultsPrimary care pediatricians (n=56) in this study generated 1,523,872 access log data points (across 1069 physician workdays) and spent an average of 4.4 (SD 2.0) hours and 0.8 (SD 0.8) hours per physician per workday engaged in EHRs during and outside scheduled clinic hours, respectively. Approximately three-quarters of the time working in EHR during or outside scheduled clinic hours was spent reviewing data and reports. Mixed-effects regression revealed no associations of age, sex, or clinical full-time equivalent status with EHR use during or outside scheduled clinic hours.ConclusionsFor every hour primary care pediatricians spent engaged with the EHR during scheduled clinic hours, they spent approximately 10 minutes interacting with the EHR outside scheduled clinic hours. Most of their time (during and outside scheduled clinic hours) was spent reviewing data, records, and other information in EHR.

Prevalence and risk factors associated with postnatal depression in a South African primary care facility

Background: The prevalence and factors that influence postnatal depression (PND) vary according to context. Objective: To determine the prevalence and factors associated with PND in the postnatal clinic of a large community health centre. Method: In a cross-sectional study, the Edinburg Postnatal Depression Scale (EPDS) was administered on 227 consecutive mothers during postnatal clinic visits. In addition, socio-demographic and clinical information were collected. Analysis included descriptive statistics, chi square test and logistic regression. A score of 13 on the EPDS screened positive for PND. Results: Participants’ mean age was 27 years and most completed grade 12 education (52.4%), was single (55.5%), employed or had a working partner (60%) and no previous PND (97%). Although most of the index pregnancies were unplanned (57.71%), most participants had favourable views of them (63%). The prevalence of PND was 38.8%. In the adjusted logistic regression, completing only primary school education (OR:9.11;95%CI:1.03-80.22;p=0.047), using contraceptive prior to index pregnancy (OR:2.05;95%CI:1.12-3.72;p=0.019) and reporting a thought of self-harm or infanticide (OR:7.08;95%CI:5.79–22.21;p=0.000) significantly increased the risk of PND. In contrast, having a relationship with the father of the index child (OR: 0.42; 95%CI: 0.18-0.94; p=0.037) mitigated this risk. Conclusion: The prevalence of PND is high in the study setting and is concomitant with significant risk of suicide or infanticide. This highlights the need to screen and consider PND as a vital sign during postnatal visits, especially in the face of low educational attainment, failed contraception and poor or no relationship with the father of the index child.

Electronic cigarettes as a harm reduction strategy among patients with COPD: protocol for an open-label two arm randomized controlled pilot trial

BackgroundSmoking cessation is the most effective means of slowing the decline of lung function associated with chronic obstructive pulmonary disease (COPD). While effective smoking cessation treatments are available, they are underutilized and nearly half of people with COPD continue to smoke. By addressing both nicotine and behavioral dependence, electronic cigarettes (EC) could help people with COPD reduce the harm of combustible cigarettes (CC) through reductions in number of Cigarettes per Day (CPD) or quitting CC completely. The purpose of this pilot study is to identify barriers and facilitators to the use of and assess the preliminary effectiveness of EC as a harm reduction strategy among people with COPD.MethodsIn an open-label two-arm randomized controlled trial pilot study, 60 patients identified as smokers with a COPD diagnosis via electronic health records from a large urban health center are randomized in a 1:1 ratio to either standard care [counseling + nicotine replacement therapy (NRT)] or counseling + EC. The NRT arm will receive nicotine patches and nicotine lozenges for 12 weeks. The EC arm will receive EC for 12 weeks. Both cohorts will receive counseling from a licensed mental health counselor. Using ecological momentary assessment, participants will report their use of CC in both arms and EC use in the EC arm daily via text message. Primary outcomes will be feasibility and acceptability of intervention, and secondary outcomes will be reduction in CPD and change in COPD symptoms as measured by COPD Assessment Tool (CAT) score at 12-weeks. EC displacement of CC. To explore attitudes towards the use of EC as a harm-reduction strategy for patients with COPD, interviews will be performed with a sample of participants from both study arms.DiscussionDespite decades of availability of smoking cessation medications, nearly half of people with COPD still smoke. This study aims to address the unmet need for feasible and effective strategies for reducing CC use among those with COPD, which has the potential to significantly improve the health of people with COPD who smoke.Trial Registration ClinicalTrials.gov Identifier: NCT04465318.

Navigating and Negotiating Health and Social Services in the Context of Homelessness: Resistance and Resilience

In this article, we draw upon a case study exploring social inequality and homelessness in homeless-oriented services in a large health and social services centre in Montreal, Quebec, Canada. We take up professionals’ (working in homelessness services) and service users’ (people experiencing homelessness) (N=12) perspectives exploring slippery notions of empowerment/disempowerment using a stigma, resistance, and resilience lens. We mobilize the concepts of navigation and negotiation to better understand participants’ experiences of stigma and the dialogical tensions in empowerment/disempowerment constructs moving beyond simple worker/service user dichotomies of powerful/powerlessness. We explore the more nuanced ways professionals and people who experience homelessness (often described in passive terms) understand these tensions and the dynamics at play within professional relationships, systems, and structural constraints. We unpack professionals’ “silent practices” in their effort to “empower” service users and resist institutional forged by neoliberal pressures. We make the case that systemic and structural constraints manifested in institutional practices push people experiencing homelessness to adopt strategies of resilience.

Diabetes Prevention in a U.S. Healthcare System: A Portrait of Missed Opportunities

Type 2 diabetes is a widespread, preventable illness. The U.S. Preventive Services Task Force (USPSTF) has screening guidelines for diabetes prevention. The aim is to establish the extent to which U.S. Preventive Services Task Force's guidelines for prediabetes screening, diagnosis, and treatment are followed in a large health system and to identify missed opportunities for diabetes prevention. A comprehensive analysis of the electronic health records for the entire patient population of a large health center between August 1, 2019 and October 31, 2020 was analyzed, focusing on 21,448 patients eligible for prediabetes screening according to USPSTF recommendations. Compliance with U.S. Preventive Services Task Force recommendations for screening, diagnosis, and treatment was assessed. Of the 21,448 patients identified as eligible for prediabetes screening, 13,465 (62.8%) were screened in accordance with the USPSTF recommendations. Of those patients screened, 3,430 met the requirements for a prediabetes diagnosis. Only 185 (5.4%) of patients who screened positive for prediabetes received a formal diagnosis of prediabetes, and no patients who received a diagnosis received appropriate treatment for their prediabetes. Women were more likely than men to be screened (p<0.001), and non-Hispanic Whites were less likely than non-Hispanic Blacks and Hispanics to be formally diagnosed even after screening positive (p<0.001). Although a majority of eligible patients receive appropriate screening for prediabetes, diagnosis and treatment of patients who screen positive for prediabetes is not common practice. Future research and policy may benefit from a focus on classifying diabetes prevention as a quality metric and incentivizing behaviors consistent with diabetes prevention.

Prevalence and Predictors of Increased Fall Risk Among Women Presenting to an Outpatient Urogynecology and Pelvic Health Center.

The objective of this study was to determine the prevalence of increased fall risk among women presenting to a large pelvic health center using a screening method compatible with the busy clinic environment and to identify factors associated with increased risk. A retrospective medical records review was conducted on consecutive treatment-seeking women presenting to a Urogynecology & Pelvic Health Center over 6 months. The Centers for Disease Control and Prevention, Stopping Elderly Accidents, Deaths, and Injuries fall risk screening tool was included among the intake questionnaires all patients completed before their scheduled appointments. Relevant sociodemographic and clinical measures were abstracted from the electronic medical record. Three hundred and forty-eight women completed the fall screen. One hundred and twenty-four (36%) screened positive for increased fall risk. Mean age was 58.7 ± 15.8 years. An age threshold of 68 years best discriminated between those who were and were not identified as at risk. There was a gradient of association between number of urinary symptoms and prevalence of increased fall risk. Patients with 3 or more urinary symptoms were most likely to screen positive (1: odds ratio [OR], 1.51 [0.86-2.66]; 2: OR, 1.62 [0.99-2.64]; 3 or more: OR, 1.84 [1.07-3.17]) after adjusting for other know fall risk factors. The prevalence of increased fall risk in this patient population is high and highest in women with multiple urinary symptoms. The Stopping Elderly Accidents, Deaths, and Injuries screening tool was a feasible and nonintrusive screening method for identifying increased fall risk during routine patient care. Fall risk and concern about falling should be taken into consideration when deciding management strategies for urinary problems.

The Effectiveness of the Stepping-On Fall Prevention Program on the Quality of Life, Fear of Fall, and Fall-Preventive Behaviors Among Community-Dwelling Older Adults: A Randomized Clinical Trial

Background: Along with increasing population of the elderly in various countries, the incidence of falls and respective damages has also increased. Objectives: Given the numerous disagreements regarding the effectiveness of different interventions mentioned in various sources, the present study aimed to examine the effectiveness of the Stepping-On fall preventive program on the quality of life, fear of fall, and fall-preventive behaviors among community-dwelling older adults in Shiraz, Iran. Methods: This study is a single-blinded randomized interventional or clinical trial study conducted on 90 elderly people under the coverage of two large health centers during 2019 - 2020 in Shiraz, Iran. Multi-stage randomized sampling was used to select the participants who were randomly allocated to either of the intervention (n = 45) or control groups (n = 45). Data collection tools were the Fall Efficiency Scale, fall prevention behaviors, and Lipad quality of life questionnaires. The intervention group participated in a 7-session Stepping-On program, while the control group received the same routine care. Collected data were analyzed with SPSS software version 22. Results: The findings indicated that the Stepping-On program was effective on the fear of falling scores (P = 0.008) and the quality of life of the elderly under study (P = 0.019) at follow-up time. However, there was no significant difference immediately after the intervention (P &gt; 0.05). However, the mean score of fall-preventing behaviors increased during the course of the study and reached a significant level immediately after the study was conducted (P = 0.046) and the other two months later (P = 0.028). Conclusions: The Stepping-On program may apparently affect the study variables. Therefore, further research is suggested to confirm the effectiveness of this program so that it can be used across all healthcare centers for the elderly.

Machine Learning to Predict the Progression of Bone Mass Loss Associated with Personal Characteristics and a Metabolic Syndrome Scoring Index.

A relationship exists between metabolic syndrome (MetS) and human bone health; however, whether the combination of demographic, lifestyle, and socioeconomic factors that are associated with MetS development also simultaneously affects bone density remains unclear. Using a machine learning approach, the current study aimed to estimate the usefulness of predicting bone mass loss using these potentially related factors. The present study included a sample of 23,497 adults who routinely visited a health screening center at a large health center at least once during each of three 3-year stages (i.e., 2006–2008, 2009–2011, and 2012–2014). The demographic, socioeconomic, lifestyle characteristics, body mass index (BMI), and MetS scoring index recorded during the first 3-year stage were used to predict the subsequent occurrence of osteopenia using a non-concurrence design. A concurrent prediction was also performed using the features recorded from the same 3-year stage as the predicted outcome. Machine learning algorithms, including logistic regression (LR), support vector machine (SVM), random forest (RF), and extreme gradient boosting (XGBoost), were applied to build predictive models using a unique feature set. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, and F1 score were used to evaluate the predictive performances of the models. The XGBoost model presented the best predictive performance among the non-concurrence models. This study suggests that the ensemble learning model with a MetS severity score can be used to predict the progression of osteopenia. The inclusion of an individual’s features into a predictive model over time is suggested for future studies.

Prevalence of candidiasis and oral candidiasis in COVID-19 patients: a cross-sectional pilot study from the patients' registry in a large health center.

Candida albicans in considered to be a marker of immunosuppression in serious chronic condition such as HIV and cancer patients on immunosuppresion medications. The new COVID-19 pandemic has caused acute respiratory distress syndrome in many patients, which poses a risk of super-infections including Candida strains causing oral candidiasis as well as invasive fungal infections. The aim of the study was to examine the association between COVID-19 and oral and general candidiasis. The i2b2 data repository platform was used to analyze the interrelations between COVID-19, oral candidiasis, and total candidiasis in a hospital population. ICD diagnoses codes were used to generate queries on total numbers and demographic data on COVID-19, oral candidasis, total candidasis, and COVID-19 with each form of candidasis. From the 889 patients diagnosed with COVID-19, 106 (12%) were diagnosed with candidiasis at large and 14 (1.6%) had oral candidiasis. The odds ratio (OR) for COVID-19 in the presence of oral candidiasis was 2.01 (95% CI 1.1870 to 3.4143, P = .094) and the OR for COVID-19 in the presence of candidiasis was 3.73 (95% CI 3.0419 to 4.5847, P < .0001 ). African American were disproportionally affected and comprised about 40% of the COVID-19/candidiasis groups. Total candidiasis was significantly associated with increased risk for COVID-19, whereas oral candidiasis showed an insignificant trend. The dental practitioner should be aware of the importance of unexplained oral and systemic candidiasis as a potential harbinger of T and B cell immunosuppression associated with viral in-fections. COVID-19 may be a risk factor for total candidiasis.

Anxious Attachment Mediates the Associations Between Early Recollections of Mother's Own Parental Bonding and Mother-Infant Bonding: A 2-Month Path Analysis Model.

Parental bonding (recollection of own parents' parenting), adult attachment, and mother–infant bonding are all closely related yet distinct concepts of the parent–child relationship, sometimes used interchangeably in the literature. This study aimed to examine the associations between these concepts in a longitudinal path analysis design. A total of 262 postpartum women who gave birth at the maternity ward of a large tertiary health center in Israel completed a demographic questionnaire, the Experiences in Close Relationships Scale (ECR), the Parental Bonding Instrument (PBI) at 1–4 days postpartum, and the Postpartum Bonding Questionnaire (PBQ) at 2 months postpartum. Parental care factor (PBI) was found to be associated with mother–infant bonding (PBQ), directly and indirectly through insecure anxious attachment (ECR). Denial of autonomy factor (PBI) was found to be associated with mother–infant bonding (PBQ) only through insecure anxious attachment (ECR). Encouragement of behavioral freedom factor (PBI) was found to be associated with mother–infant bonding (PBQ) in a simple correlation but not in the complete model. The results highlight the intergenerational aspects of parenting and suggest that early childhood interventions with parents may have a long-term impact on child-rearing though generations, and by that on children's development.

Changes in cannabis, tobacco, and alcohol use among sexually active female adolescents and young adults over a twelve-year period ending in 2019

BackgroundThe United States has experienced an increasing divergence in cannabis, tobacco, and alcohol use among adolescents and young adults (AYA). We assessed the changes in cannabis, tobacco and alcohol use in an inner-city population of predominantly minority AYA females attending a large adolescent-specific health center in New York City. MethodsThis was a longitudinal study of AYA women recruited and followed over a twelve-year period between 2007 and 2019. Lifetime and past 30-day use were assessed by self-administered questionnaire every six months. In addition, we assessed associations with race, ethnicity, sexual behaviors, receipt of social services, living situation at home (e.g., with or without parents), and use of other drugs. ResultsParticipants included 1549 AYA females aged 13–21 at baseline, 95% of whom were youth of color. Use of cannabis increased significantly over the twelve-year period, with frequent cannabis use (≥20 times in 30-days) increasing almost 18% per year (OR = 1.18; 95%CI:1.13–1.23). In contrast, past 30-day tobacco use declined over the same period (OR = 0.86; 95%CI:0.83–0.89). Past 30-day cannabis use was more likely among African Americans (OR = 1.33; 95%CI:1.08–1.63), women who had sex with both men and women compared to with men only (OR = 1.44; 95%CI:1.18–1.75), recent users of tobacco (OR = 2.20; 95%CI:1.92–2.52) and alcohol (OR = 2.84; 95%CI:2.52–3.20), and ever users of other drugs (OR = 1.69; 95%CI:1.44–1.99), independent of age, time and living situation. ConclusionsIncreasing rates of cannabis use and the association with concurrent tobacco and alcohol use in AYA females underscore the need to screen for unhealthy cannabis use, in addition to tobacco and alcohol, especially among inner-city AYA.

"Even when people live just across the road…they won't go": Community health worker perspectives on incentivized delays to under-five care-seeking in urban slums of Kampala, Uganda.

BackgroundAlthough under-five (U5) mortality in Uganda has dropped over the past two decades, rates in urban slum neighborhoods remain high. As part of a broader verbal and social autopsy study of U5 deaths, this study explored the perspectives of volunteer community health workers, called Village Health Teams (VHTs), on why children under five in Kampala’s informal settlements are still dying despite living in close proximity to nearby health facilities.MethodsThis exploratory, qualitative study took place between January and March 2020 in the Rubaga division of Kampala, Uganda. VHTs from the slums of Kawaala and Nankulabye parishes, both located near a large government health center, were interviewed by a trained local interviewer to determine their perceptions of barriers to care-seeking and attribution for U5 childhood deaths. All interviews were audiotaped, transcribed into English, imported into NVivo V 12.0 and thematically analyzed using the Attride-Stirling framework.Results20 VHTs were interviewed, yielding two global themes, the first focusing on VHTs perceptions of their role in the community to promote positive health outcomes, and the second focusing on VHTs’ perceptions of how prompt care-seeking is disincentivized. Within the latter theme, three inter-related sub-themes emerged: disincentives for care-seeking at the health system level, which can drive negative beliefs held by families about the health system, and in turn, drive incentives for alternative health behaviors, which manifest as “incentivized delays” to care-seeking.DiscussionThis study illustrates VHT perspectives on the complex interactions between health system disincentives and the attitudes and behaviors of families with a sick child, as well as the reinforcing nature of these factors. Findings suggest a need for multi-pronged approaches that sensitize community members, engage community and health system leadership, and hold providers accountable for providing high-quality care. VHTs have enormous potential to foster improvement if given adequate resources, training, and support.

Sports participation patterns of pupils in Azerbaijan: on the willingness to participate in an extra-curricular sport even

The main purpose of sports is to create conditions and opportunities for all segments of the population, regardless of their physical, mental and material capabilities, especially for schoolchildren to realize their knowledge and skills, thereby achieving comprehensive development in areas that will positively affect their lives, including education and health. . There is a special care for sports in our country. Over the past 10 years, many sports complexes, facilities, halls have been built, playgrounds have been built, and large sports and health centers have been established for the development of sports. In addition, sports infrastructure has begun to develop in schools. However, in addition to infrastructure, it is very important to hold special sports classes and develop extracurricular activities to increase participation in sports in schools. In order to increase participation in sports in schools and educational centers, it is necessary to find out what kind of sport students are interested in and their talent, and to direct them in this direction. If we increase the interest of students in sports from the lower grades and make sports their way of life, we will see a stronger and more educated generation.

PROFESIONALNI STRES KOD MEDICINSKOG OSOBLJA

Istraživanje je sprovedeno sa ciljem da se utvrdi nivo profesionalnog stresa na uzorku od 220 zdravstvenih radnika koji su pohađali akreditovan kurs „Dobra komunikacija sa pacijentima“ koji je tokom 2018. i 2019. godine održan u Novom Sadu, Kragujevcu, Nišu i Beogradu. Preko 70% ispitanih zdravstvenih radnika je iz primarnog nivoa zdravstvene zaštite (domovi zdravlja i manje ambulante pri većim domovima zdravlja). Po završetku кursa, uz popunjavanje evaluacije i testova znanja učesnici su zamoljeni da anonimno popune i skalu profesionalnog stresa sa ciljem da se proceni nivo profesionalnog stresa. Rezultati su pokazali da je nivo profesionalnog stresa za ceo ispitani uzorak umeren (M = 64.40; SD = 12.43). Jedina dobijena značajna razlika je prema polu, odnosno pokazalo se da žene zdravstveni radnici imaju viši nivo stresa u poređenju sa muškarcima. Očekivane pretpostavke koje su se odnosile na postojanje razlika u nivou profesionalnog stresa u odnosu na bračno stanje, godine starosti, radni staž i radno mesto nisu dobijene. Sagledavanje nivoa stresa zdravstvenih radnika je od značaja za organizovanje tematskih edukacija, kurseva i preventivnog rada sa ciljem da se na vreme prepoznaju i spreče štetni uticaji profesionalnog stresa na fizičko i mentalno zdravlje medicinskog osoblja.

Determinan Quality of life Pada Pasien TB Paru di Kota Surabaya

Tuberkulosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, which can attack various organs, especially the lungs. The infectius disease untreated or treatment is not complete can causing complications dangerous until death. TB estimated to have existed in the world since 5000 BC, but advances in the discovery and control of new TB disease occurred in 2 of the last century. This study aimed determinant of quality of life in patients with pulmonary TB in Surabaya&#x0D; Type a descriptive research with survey approach on three large health centers with a total population sample of 150 respondents. The variable determinant of quality of life includes the respondents perception of the disease, health care search is done, the meaning of life for the respondents, satisfaction with family and health care. Data were collected through questionnaires, through purpusive sampling techniques, then performed the frequency distribution and crostabulasi.&#x0D; The results showed that the respondents' perceptions of the disease is mostly 78.4% said the illness as a result of the process of transmission of TB bacteria mycobaterium, the search for health services 95.7% went to the clinic, the meaning of life for themselves 78.6% said there was no hope for healed, satisfaction with family 67.5% are satisfied with the spirit given by family members and satisfaction of health workers say 85.3% are satisfied with the services provided by a health worker.&#x0D; The conclusion shows that detrminan quality of life in patients with pulmonary tuberculosis have searched for health services to the health service, satisfied with the health workers, but there is no hope of life to recover. Suggestions for further research to dig deeper into the life expectancy of the respondents

Randomized Controlled Trial of Advance Notification Phone Calls vs Text Messages Prior to Mailed Fecal Test Outreach

BACKGROUND & AIMS:Mailing fecal immunochemical test (FITs) to individuals who are due for screening (mailed FIT outreach) increases colorectal cancer (CRC) screening. Little is known about how phone-based advance notifications (primers) affect the effectiveness of mailed FIT outreach programs.METHODS:We performed a prospective study of patients at a large urban health center, 50–75 years old and due for screening, with no record of a prior FIT. Participants were randomly assigned to groups that received a live phone call primer (n = 1203) or a text message primer (n = 1622), from June through December 2018. The participants were then mailed a FIT kit, followed by 2 automated calls, and live reminder calls delivered by the care team. The main outcome was completion of FIT within 3 months of assignment to the live phone call or text message group.RESULTS:Participants had a FIT completion rate of 16.8%, a mean age of 58 years, and 80% were Latino. In adjusted intention to treat analyses (n = 2825), FIT completion rates were higher in the patients assigned to receive a live phone call vs text message primer (percentage point difference, 3.3%; 95% CI, 0.4%–6.2%). Between-group differences increased to 7.3% points (95% CI, 3.6%–11.0%) in the per-protocol analysis of 2144 participants reached by the text message (1320/1622, 81%), live call (438/1203, 36%), or voice message (386/1203, 32%). This rate increased to 14.9% points (95% CI; 9.6%–20.1%) in the per-protocol analysis of 1758 participants reached by the text message or reached by the live call.CONCLUSIONS:In a randomized trial, advance notification live phone calls outperformed text messages in prompting health center patients who had not previously completed a FIT to complete a mailed FIT. Clinicaltrials.gov no: NCT03167125

The Need And Benefit of Implementing Telemedicine in Clinical Practice

The Need And Benefit of Implementing Telemedicine in Clinical Practice

Towards an Architecture for the Interoperability of Hospital Information Systems in Burkina Faso.

The successful introduction of ICTs into medical practice is a key factor in improving the performance of any health system for both patients and healthcare professionals. In Burkina Faso, many hospital information systems (HIS) have been developed and are already widely used in large health centers with proven efficiency. To improve the quality of patient care, these hospital information systems should exchange information. Interoperability is one of the privileged ways to improve the integration of different systems because nowadays a HIS is no longer just a single monolithic software system, which is run on a single machine. This paper presents a semantic interoperability architecture, which is based on a mediation approach. The mediator implements local domain ontologies for each HIS, a knowledge base, and a referential ontology which is used as a semantic repository and web services.

Implementation and adoption of a health insurance support tool in the electronic health record: a mixed methods analysis within a randomized trial

BackgroundIn addition to delivering vital health care to millions of patients in the United States, community health centers (CHCs) provide needed health insurance outreach and enrollment support to their communities. We developed a health insurance enrollment tracking tool integrated within the electronic health record (EHR) and conducted a hybrid implementation-effectiveness trial in a CHC-based research network to assess tool adoption using two implementation strategies.MethodsCHCs were recruited from the OCHIN practice-based research network. Seven health center systems (23 CHC clinic sites) were recruited and randomized to receive basic educational materials alone (Arm 1), or these materials plus facilitation (Arm 2) during the 18-month study period, September 2016–April 2018. Facilitation consisted of monthly contacts with clinic staff and utilized audit and feedback and guided improvement cycles. We measured total and monthly tool utilization from the EHR. We conducted structured interviews of CHC staff to assess factors associated with tool utilization. Qualitative data were analyzed using an immersion-crystallization approach with barriers and facilitators identified using the Consolidated Framework for Implementation Research.ResultsThe majority of CHCs in both study arms adopted the enrollment tool. The rate of tool utilization was, on average, higher in Arm 2 compared to Arm 1 (20.0% versus 4.7%, p < 0.01). However, by the end of the study period, the rate of tool utilization was similar in both arms; and observed between-arm differences in tool utilization were largely driven by a single, large health center in Arm 2. Perceived relative advantage of the tool was the key factor identified by clinic staff as driving tool utilization. Implementation climate and leadership engagement were also associated with tool utilization.ConclusionsUsing basic education materials and low-intensity facilitation, CHCs quickly adopted an EHR-based tool to support critical outreach and enrollment activities aimed at improving access to health insurance in their communities. Though facilitation carried some benefit, a CHC’s perceived relative advantage of the tool was the primary driver of decisions to implement the tool.Trial registrationClinicalTrials.gov: NCT02355262, Posted February 4, 2015.