Nonphysician Staff Research Articles

Pursuing Excellence: Integrating Clinical Learning Environment Staff and Learners Into the Pursuit of Quality, Safety, Equity, and Value

<i>Pursuing Excellence</i>: Integrating Clinical Learning Environment Staff and Learners Into the Pursuit of Quality, Safety, Equity, and Value

Key Informants' Perspectives on Implementing a Comprehensive Lung Cancer Screening Program in a Safety Net Healthcare System: Leadership, Successes, and Barriers.

Implementing evidence-based practice (EBP) in a safety net healthcare system is challenging. This study examined factors associated with feasibility and potential facilitators and barriers which might affect the implementation of a new evidence-based comprehensive primary care and community health-based program aiming to promote efficient and equitable delivery of Lung Cancer Screening and Tobacco Cessation (LCS-TC). Fifty-three key informants were interviewed. Informants discussed their perceptions of adoption of screening and appropriate referral practices across 15 community health centers. They also identified barriers and facilitators to implementing the LCS-TC program. Interview data were analyzed using inductive thematic analysis. Three major themes representing facilitators and barriers were identified: (1) Allocation of resources and services coverage; (2) need for a collaborative process to engage stakeholders and identify champions; and (3) stakeholders need different types of evidence to support implementation. The top three activities identified as essential for success included provision of sufficient resources for radiologic screening (30%); using non-physician staff for screening (30%); and minimizing the time healthcare providers need to contribute (23%). Conversely, the top three barriers were lack of resources for screening and treatment (60%); insufficient time to address complex patient problems (36%); and perceived lack of patient buy-in (30%). Models for EBP implementation provide stepwise guidance; however, particular contextual factors act as facilitators or barriers to the process. Findings inform EBP implementation efforts regarding resources and key barriers to success around organizational-level supports and promotion of suitable EBP programs.

Medical Error, Adverse Events, and Complications in Interventional Radiology: Liability or Opportunity?

This review suggests that there is a critical need to renew understanding of adverse events and complications within interventional radiology and to redefine a robust commitment to patient safety a...

Exploring the Impact of the Surgical Exploration and Discovery (SEAD) Program on Medical Students’ Perceptions of Gender Biases in Surgery: A Mixed-Method Evaluation

Female representation in surgery is increasing; however, many surgical specialties continue to observe disproportionately fewer females entering their residencies. This study assesses how medical students' gender-based perceptions of surgical careers are impacted by attending the Surgical Exploration and Discovery (SEAD) program, a 2-week, immersive procedural program that offers observerships, mentorship, and workshops across 8 surgical specialties. In this mixed-method prospective cohort study, medical students' awareness, beliefs, and experiences of gender bias in surgery were assessed using a 10-item Gender Bias in Medical Students Assessment-Surgery (GBMSA-S) psychometric survey instrument inspired by the validated Gender Bias in Medical Education Scale (Parker et al., 2016). Undergraduate Medical Education, Faculty of Medicine, at the University of Ottawa in Ottawa, Ontario, Canada. Eighteen first-year medical students in the experimental group (8 male, 10 female) and 18 in the control group (7 male, 11 female). Compared to the control group, SEAD participants had significant changes in agreement with the statements: "surgery is male-dominated," "medical studies are mainly done in males," "gender discrimination is more pronounced in surgery than other medical professions," "consideration of my gender is an important factor in whether or not to pursue surgery as a career," and "I have encountered gender-biased attitudes and/or behaviors among non-physician health care staff" (p < 0.05). Perceptions of gender bias were reduced post-SEAD. Subgroup analysis by gender suggested that the significance of these changing perspectives was due to female participants' responses. SEAD also produced an increase in the level of interest in surgery (p = 0.04). Receptive and authentic dialogue was identified as a critical step toward social inclusivity (n = 11). Early surgical exposure through SEAD produces a statistically significant increase in surgical interest and reduces certain perceptions of gender bias in surgery, particularly among female medical students.

Bridging to value with codes that promote care management.

Transitional care management (TCM) and chronic care management (CCM) fee-for-service billing codes can serve as bridges to help organizations build care management capabilities and effectively transition from volume- to value-based care. TCM codes encourage providers to build capabilities for managing hospital discharge transitions. CCM codes encourage physician and nonphysician staff to build capabilities for longitudinally managing patients with multiple chronic conditions. Implementation challenges include achieving return on investment in health information technology and securing stakeholder commitment and engagement. Nonetheless, policy makers have reinforced their commitment to these codes, offering an encouraging signal for organizations seeking more gradual ways to build competencies and bridge toward value-based payment and care delivery.

Women Surgeons’ Experiences of Interprofessional Workplace Conflict

Gender differences in interprofessional conflict may exist and precipitate differential achievement, wellness, and attrition in medicine. Although substantial attention and research has been directed toward improving gender equity in surgery and addressing overall physician wellness, research on the role of interprofessional conflict has been limited. The objective of this study was to understand scenarios driving interprofessional conflict involving women surgeons, the implications of the conflict on personal, professional, and patient outcomes, and how women surgeons navigate conflict adjudication. A qualitative approach was used to explore the nature, implications, and ways of navigating interprofessional workplace conflict experienced by women surgeons. The setting was a national sample of US women surgeons. Purposive and snowball sampling were used to recruit women surgeons in training or practice from annual surgical society meetings. Participants were eligible if they were currently in a surgical training program or surgical practice. Nearly all participants had experienced at least 1 workplace conflict with a nonphysician staff member resulting in a formal write-up. A workplace conflict was defined as any conflict resulting in the nonphysician staff member taking action such as confronting the woman surgeon, reporting the event to supervisors, or filing a formal report. Interviews were conducted between February 19, 2019, and June 21, 2019. Recordings were transcribed and deidentified. Inductive thematic analysis was used to examine data in relation to the research questions. Thirty US women surgeons (8 [27%] age 25-34 years, 16 [53%] age 35-44 years, 5 [17%] age 45-54 years, and 1 [3%] age 55-64 years) of varying surgical specialties were interviewed. Conflicts were often reported as due to a breakdown in communication or from performance-related disputes. Participants perceived personal and professional implications including self-doubt, depression, frustration, anxiety, loss of sleep, reputational harms, and delays to advancement. Participants also described potential patient safety implications primarily due to decreased communication resulting from some surgeons being hesitant to engage in subsequent interactions. Participants described a variety of navigation strategies including relationship management, rapport building, and social capital. The success of these processes tended to vary by individual circumstances, including the details of the conflict, practice setting, level of support of leadership, and individual personality of the surgeon. This qualitative study highlights women surgeons' experiences with interprofessional workplace conflict. Interprofessional culture building, broader dissemination of implicit bias training, and transparent and equitable adjudication systems are potential strategies for avoiding or mitigating the implications of these conflicts.

The Management Experiences, Priorities, and Challenges of Medical Directors in the Subspecialty of Consultation-Liaison Psychiatry: Results of a Needs Assessment.

Medical directors need management skills, yet few studies describe the specific tasks that directors consider most important, their confidence for these tasks, and how their confidence develops. We studied these questions among directors in the subspecialty of Consultation-Liaison Psychiatry. A needs survey was sent to 48 registrants of a new forum for Consultation-Liaison Psychiatry directors. The survey asked about 6 professional experiences, the relative importance of 14 management tasks, and the directors' confidence in managing these tasks, using 7-point Likert scales. Correlations between experiences, task importance, and task confidence were performed. Twenty-seven directors responded (56% response). The experiences that correlated most with management confidence were years in practice and health care leadership training, yet approximately half of responders were directors for ≤5 years and had received minimal training. Management tasks with the highest importance included demonstrating value of their service and roles for nonphysician clinical staff on their teams. Significant associations were identified between years in practice and confidence for leading faculty scholarship, trainee staffing ratios and roles, fee coding, measurement of faculty clinical productivity, and faculty recruitment. Leadership training correlated with confidence in demonstrating service value, measuring faculty clinical productivity, novel models of care, and growing a new service. Consultation-Liaison directors with fewer years of experience and minimal health care management training need time and support to grow into their roles. They should be pointed toward training opportunities to improve their confidence to lead the wide range of management tasks that are important to their roles.

Navigating TRAP Laws, Protesters, and Police Presence at a Midwestern Abortion Clinic in the United States: A Case Study

Patient-level outcomes are frequently the focus of research on restrictive abortion laws, and qualitative literature examining the experiences of volunteers and non-physicians is sparse. To better understand how TRAP (Targeted Regulation of Abortion Provider) laws and abortion restrictions affect abortion clinic operations in the United States, I conducted a case study of 11 non-physician staff and volunteers at an abortion clinic in a low-income, Midwestern city. Findings include participants negotiating troublesome and costly TRAP laws, specifically the process of obtaining a transfer agreement with a local hospital in order to stay open. Study participants felt safe at the clinic due to their relationship with local police. Lastly, participants commented on a recent increase in protester presence, but acknowledged that other clinics experience even worse harassment. I conclude that non-physician experiences should be included when we are examining the impact of TRAP laws and abortion restrictions if we are to provide a more nuanced understanding of the complexities of abortion work. These interviews provide qualitative data on the experiential evidence of the impact of TRAP laws and abortion restrictions which are the consequence of various Supreme Court decisions over the past several decades.

Survivorship Care Plans: Reaching a Benchmark and Striving to Achieve Intent

Survivorship care plans (SCPs) have been endorsed by major oncologic organizations despite challenges in implementation and unclear patient-specific benefits. In January 2020, the Commission on Cancer removed a 2018 provision that required accredited programs to deliver SCPs to eligible patients. Programs must determine whether to continue SCP use or begin de-implementation. We detail a framework to increase SCP delivery for programs continuing to provide SCPs as a component of survivorship care and suggest a patient-centered approach to evaluate continued utility amidst updated national standards. We surveyed medical, surgical, and radiation oncologists at our academic and community sites to identify barriers to SCP use and performed a Pareto analysis to highlight the most notable barriers. We then designed an intervention that used SCP templates within the medical record, disease-specific recommendations, delegation to nonphysician staff, and provider education. We monitored our intervention via a statistical process control analysis and assessed patient perceptions of SCP usefulness via a questionnaire. Before implementing our process improvements, our SCP completion rate during a 10-month period was 45%. During the 6-month period after our intervention, the SCP completion rate increased to 89%. Greater than 80% of patients who had recently received an SCP found the information helpful and were satisfied with the amount of information received. More than 40% did not remember receiving their original SCP. We demonstrated a feasible method for increasing SCP delivery for all cancers across a cancer network and used a patient-specific questionnaire to assess continued value amidst changing national standards.

IMPROVEjob \u2013 Participatory intervention to improve job satisfaction of general practice teams: a model for structural and behavioural prevention in small and medium-sized enterprises \u2013 a study protocol of a cluster-randomised controlled trial

BackgroundPerceived high chronic stress is twice as prevalent among German general practitioners (GPs) and non-physician medical staff compared to the general population. The reasons are multi-factorial and include patient, practice, healthcare system and societal factors, such as multi-morbidity, the diversity of populations and innovations in medical care. Also, practice-related factors, like stressful patient-staff interactions, poor process management of waiting times and lack of leadership, play a role. This publicly funded study evaluates the effectiveness of the newly developed participatory, interdisciplinary, and multimodal IMPROVEjob intervention on improving job satisfaction among general practice personnel. The intervention aims at structural stress prevention with regard to working conditions and behavioural stress prevention for leaders and other practice personnel.MethodsIn this cluster-randomised controlled trial, a total of 56 general practices will be assigned to either (1) participation in the IMPROVEjob intervention or (2) the waiting-list control group. The IMPROVEjob intervention consists of the following elements: three workshops, a toolbox with supplemental material and an implementation period with regular contact to so-called IMPROVEjob facilitators. The first workshop, addressing leadership issues, is designed for physicians with leadership responsibilities only. The two subsequent workshops target all GP and non-physician personnel; they address issues of communication (with patients and within the team), self-care and team-care and practice organisation. During the 9-month implementation period, practices will be contacted by IMPROVEjob facilitators to enhance motivation. Additionally, the practices will have access to the toolbox materials online. All participants will complete questionnaires at baseline and follow up. The primary outcome is the change in job satisfaction as measured by the respective scale of the validated German version of the Copenhagen Psychosocial Questionnaire (COPSOQ, version 2018). Secondary outcomes obtained by questionnaires and - qualitatively - by facilitators comprise psychosocial working conditions including leadership aspects, expectations and experiences of the workshops, team and individual efforts and organisational changes.DiscussionIt is hypothesised that participation in the IMPROVEjob intervention will improve job satisfaction and thus constitute a structural and behavioural prevention strategy for the promotion of psychological wellbeing of personnel in general practices and prospectively in other small and medium sized enterprises.Trial registrationGerman Clinical Trials Register: DRKS00012677. Registered on 16 October 2019. Retrospectively, https://www.drks.de/drks_web/navigate.do?navigationId=trial. HTML&TRIAL_ID = DRKS00012677.

Development and Validation of the Pediatric Physician Interpersonal Communication Skills Assessment of Emergency Physicians by Pediatric Patients and Their Caregivers

AbstractObjectiveThe objective was to develop and validate an evaluation tool containing scaled items with behaviorally descriptive responses for pediatric patients and their caregivers (PCs) to evaluate and provide anonymous constructive feedback regarding interpersonal communication skills of pediatric emergency department (ED) physicians.MethodsA multistep validity‐driven approach consisting of literature review, structured input by subject matter experts, and end‐user focus group reviews was conducted to develop the Pediatric Physician Interpersonal Communication Skills Assessment (P‐PICSA) tool. Study subjects were enrolled prospectively (2011–2015). Psychometric analysis included exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and item response analysis. Cronbach’s alpha coefficient to determine internal consistency of subscale items, Pearson's correlation coefficient to estimate interscale correlations, and Spearman rank correlation coefficient to assess correlations between physician scores and ED factors that influence PC evaluations were calculated.ResultsFirst‐order EFA of 389 evaluations for 98 physicians yielded a two‐factor model: 1) physician engagement of PCs (six items) and 2) physician delivery of information to PCs (seven items). An additional 3,089 evaluations for 128 physicians were collected to test factor structure and scale quality. CFA was conducted on calibration (n = 1,222) and validation (n = 1,190) samples. A two‐factor structure was confirmed with satisfactory fit for both samples. Cronbach's alpha was 0.81 for factor 1 and 0.87 for factor 2. Physicians received lower scores if PCs perceived nonrespectful behavior from nonphysician staff or long ED lengths of stay, completed the Spanish version of the P‐PICSA, or were admitted to the hospital.ConclusionThe P‐PICSA is a reliable and valid tool for pediatric PCs to evaluate pediatric ED physicians’ interpersonal and communication skills. Compared to Likert‐type rating scales, the P‐PICSA’s behaviorally descriptive response items may provide ED physicians with more descriptive feedback and direction for skills improvement.

Endoscopy Staff Are Concerned About Acquiring Coronavirus Disease 2019 Infection When Resuming Elective Endoscopy

Endoscopy Staff Are Concerned About Acquiring Coronavirus Disease 2019 Infection When Resuming Elective Endoscopy

A Qualitative Evaluation of the Pain Management VA-ECHO Program Using the RE-AIM Framework: The Participant's Perspective.

Introduction: Veterans frequently seek chronic pain care from their primary care providers (PCPs) who may not be adequately trained to provide pain management. To address this issue the Veterans Health Administration (VHA) Office of Specialty Care adopted the Specialty Care Access Network Extension for Community Healthcare Outcomes (VA-ECHO née SCAN-ECHO). The VA-ECHO program offered training and mentoring by specialists to PCPs and their staff. VA-ECHO included virtual sessions where expertise was shared in two formats: (1) didactics on common pain conditions, relevant psychological disorders, and treatment options and (2) real-time consultation on patient cases.Materials and methods: VA-ECHO participants' perspectives were obtained using a semi-structured interview guide designed to elicit responses based on the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. A convenience sampling was used to recruit PCPs and non-physician support staff participants. Non-physicians from rural VHA sites were purposively sampled to gain diverse perspectives.Findings: This qualitative study yielded data on each RE-AIM domain except reach. Program reach was not measured as it is outside the scope of this study. Respondents reported program effectiveness as gains in knowledge and skills to improve pain care delivery. Effective incorporation of learning into practice was reflected in respondents' perceptions of improvements in: patient engagement, evidenced-based approaches, appropriate referrals, and opioid use. Program adoption included how participating health care systems selected trainees from a range of sites and roles to achieve a wide reach of pain expertise. Participation was limited by time to attend and facilitated by institutional support. Differences and similarities were noted in implementation between hub sites. Maintenance was revealed when respondents noted the importance of the lasting relationships formed between fellow participants.Discussion: This study highlights VA-ECHO program attributes and unintended consequences. These findings are expected to inform future use of VA-ECHO as a means to establish a supportive consultation network between primary and specialty care providers to promote the delivery evidence-based pain management practices.

The Emergence of a Sustainable Tobacco Treatment Program across the Cancer Care Continuum: A Systems Approach for Implementation at the University of California Davis Comprehensive Cancer Center.

Tobacco treatment is increasingly recognized as important to cancer care, but few cancer centers have implemented sustainable tobacco treatment programs. The University of California Davis Comprehensive Cancer Center (UCD CCC) was funded to integrate tobacco treatment into cancer care. Lessons learned from the UCD CCC are illustrated across a systems framework with the Cancer Care Continuum and by applying constructs from the Consolidated Framework for Implementation Research. Findings demonstrate different motivational drivers for the cancer center and the broader health system. Implementation readiness across the domains of the Cancer Care Continuum with clinical entities was more mature in the Prevention domain, but Screening, Diagnosis, Treatment, and Survivorship domains demonstrated less implementation readiness despite leadership engagement. Over a two-year implementation process, the UCD CCC focused on enhancing information and knowledge sharing within the treatment domain with the support of the cancer committee infrastructure, while identifying available resources and adapting workflows for various cancer care service lines. The UCD CCC findings, while it may not be generalizable to all cancer centers, demonstrate the application of conceptual frameworks to accelerate implementation for a sustainable tobacco treatment program. Key common elements that may be shared across oncology settings include a state quitline for an adaptable intervention, cancer committees for outer/inner setting infrastructure, tobacco quality metrics for data reporting, and non-physician staff for integrated services.

Concomitant treatment with omalizumab and cyclosporine for chronic spontaneous urticaria

Abstract Background Severe asthma (SA) often requires subspecialist management and treatment with biologic therapies and/or maintenance systemic corticosteroids (mSCS). Objective: To describe contemporary, real-world biologic and mSCS use among U.S., subspecialist-treated patients with SA. Methods CHRONICLE is an ongoing, noninterventional study of U.S. adults with SA treated by allergists/immunologists or pulmonologists. Eligible patients are receiving biologics and/or mSCS or are uncontrolled on high-dosage inhaled corticosteroids with additional controllers (HD ICS+). Biologic and mSCS use patterns and patient characteristics were summarized for patients enrolled between February 2018 and February 2019. Results Among protocol-eligible patients, 58% and 12% were receiving biologics and mSCS respectively, with 7% receiving both. Among 796 enrolled, most were female (67%), non-Hispanic white (71%), of suburban residence (50%), and had elevated body mass index (median 31). Respiratory and nonrespiratory comorbidities were highly prevalent. With biologics (n=557), 51% were anti-IgE and 48% were anti–IL5/IL-5Rα; from May 2018, 76% of initiations were anti–IL-5/IL-5Rα. In patients receiving mSCS, median prednisone-equivalent daily dose was 10 mg. Multivariate logistic regression demonstrated patients of hospital clinics, sites with fewer nonphysician staff, and with a recorded concurrent chronic obstructive pulmonary disease diagnosis were less likely to receive biologics and more likely to receive mSCS. Conclusion In this real-world sample of U.S., subspecialist-treated patients with SA not controlled by HD ICS+, mSCS use was infrequent and biologic use was common, with similar prevalence of anti-IgE and anti–IL-5/IL-5Rα biologics. Treatment differences associated with patient and site characteristics should be investigated to ensure equitable access to biologics and minimize mSCS use.

Commuting Accidents among Non-Physician Staff of a Large University Hospital Center from 2012 to 2016: A Case-Control Study.

Road risks (commuting and on-duty accidents) have been responsible for 44% of work-related fatalities compensated by the French system of Social Security in 2012 and still represented 37% in 2018. Our objective was to assess risk factors for commuting accidents among the non-physician staff in a French university hospital. We conducted a case-control study of commuting accidents from 2012 to 2016. Cases were identified and controls were randomly selected from the hospital’s personnel file with matches by year of the accident, gender and age. Risk factors were assessed using conditional logistic regression analysis. An increased risk was observed for 2 × 8 hour shifts, crude OR = 1.40 (95% CI = 1.05–1.86) compared to daytime schedules, but not confirmed in the multiple model. Being a duty officer and not working the day before the accident were associated with increased risk of accidents with adjusted OR = 1.9 (95% CI = 1.1; 3.3) and OR = 1.5, (95% CI = 1.1; 2.1), respectively. The risk increased as the distance between home and work increased, such as adjusted OR = 2.2 (95% CI = 1.4; 3.4) for a distance of >3.6 to 9 km, OR = 2.6, (95% CI = 1.7; 4.0) for a distance of >9 km to 19 km, and OR = 4.2, (95% CI = 2.8; 6.2) for >19 km vs. <3.6 km. The distance between home and work, not working the day before the accident, and certain categories of personnel were related to commuting accidents.

Biologic and maintenance systemic corticosteroid therapy among US subspecialist-treated patients with severe asthma

BackgroundSevere asthma (SA) often requires subspecialist management and treatment with biologic therapies or maintenance systemic corticosteroids (mSCS). ObjectiveTo describe contemporary, real-world biologic and mSCS use among US subspecialist-treated patients with SA. MethodsCHRONICLE is an ongoing, noninterventional study of US adults with SA treated by allergists/immunologists or pulmonologists. Eligible patients are receiving biologics or mSCS or are uncontrolled on high-dosage inhaled corticosteroids with additional controllers. Biologic and mSCS use patterns and patient characteristics were summarized for patients enrolled between February 2018 and February 2019. ResultsAmong protocol-eligible patients, 58% and 12% were receiving biologics and mSCS, respectively, with 7% receiving both. Among 796 enrolled, most were women (67%), non-Hispanic white (71%), of suburban residence (50%), and had elevated body mass index (median: 31). Respiratory and nonrespiratory comorbidities were highly prevalent. With biologics (n = 557), 51% were anti–immunoglobulin E and 48% were anti–interleukin (IL)-5/IL-5Rα; from May 2018, 76% of initiations were anti–IL-5/IL-5Rα. In patients receiving mSCS, median prednisone-equivalent daily dose was 10 mg. Multivariate logistic regression found that patients of hospital clinics, sites with fewer nonphysician staff, and with a recorded concurrent chronic obstructive pulmonary disease diagnosis were less likely to receive biologics and more likely to receive mSCS. ConclusionIn this real-world sample of US subspecialist-treated patients with SA not controlled by high-dosage inhaled corticosteroids with additional controllers, mSCS use was infrequent and biologic use was common, with similar prevalence of anti–immunoglobulin E and anti–IL-5/IL-5Rα biologics. Treatment differences associated with patient and site characteristics should be investigated to ensure equitable access to biologics and minimize mSCS use. Trial RegistrationClinicalTrials.gov Identifier: NCT03373045.

Influence of thrombectomy volume on non-physician staff burnout and attrition in neurointerventional teams

BackgroundBurnout takes a heavy toll on healthcare providers. We sought to assess the prevalence and risk factors for burnout among neurointerventional (NI) non-physician procedural staff (nurses and technologists) given increasing...

Exploring Drivers of Work-Related Stress in General Practice Teams as an Example for Small and Medium-Sized Enterprises: Protocol for an Integrated Ethnographic Approach of Social Research Methods.

BackgroundAn increasing shortage of skilled personnel, including medical personnel, has been reported in many postindustrial economies. Persisting and growing trends in absenteeism and incapacity to work due to mental disorders are concerning and have increased political, economic, and scientific interest in better understanding and management of determinants related to the work environment and health.ObjectiveThis study protocol describes an integrated approach of social research methods to explore determinants of work-related stress in general practice teams as an example for micro, small, and medium-sized enterprises (SMEs).MethodsThe methods applied will allow an in-depth exploration of work practices and experiences relating to psychological well-being in general practice teams. An ethnographic approach will be used to develop an in-depth understanding of the drivers of work-related stress in general practice teams. We will combine participating observation and individual interviews with five to seven general practitioners (GPs), and five to seven focus group discussions with the nonphysician staff (3-4 participants per group) in approximately four GP group practices and one single practice in Germany. Data collection and analysis will follow a grounded theory approach.ResultsThe Ethics Committee of the Medical Faculty, University Hospital of Tuebingen, Germany, has approved this study (reference number: 640/2017BO2). Recruitment has commenced with study completion anticipated in mid-2020.ConclusionsThe data from this project will be used in follow-up projects to develop and test an intervention to reduce and prevent work-related stress in GP practices and other SMEs.International Registered Report Identifier (IRRID)DERR1-10.2196/15809

The impact of patient-generated contextual data on communication in clinical practice: A qualitative assessment of patient and clinician perspectives

BackgroundEffective communication is integral to patient-centered care, yet external pressures can impede the ability to discuss important topics. One strategy to facilitate communication is pre-visit collection and sharing of patient contextual data (PCD), including life circumstances such as their beliefs, needs, and concerns. ObjectiveTo understand how patients and care team members perceive the electronic collection of PCD and its impact on communication in the context of a large academic health system that implemented PatientWisdom, a new technology that elicits PCD from patients and integrates within the electronic health record (EHR). MethodsWe conducted focus groups with patients (n = 26) and semi-structured interviews with primary care team members (n = 20). Qualitative analysis of focus group/interviews included an iterative and reflexive inductive technique to uncover emergent themes. ResultsFour themes were reflected among both patient and care team: (1) the technology enhances the patient’s voice; (2) the technology creates a safe space for patients to share sensitive topics; (3) PCD facilitates rapport not only between patient and provider but the entire care team; (4) PCD aligns patient and clinician goals. Two unique themes emerged among patients: (1) PCD provides opportunity for reflection; (2) PCD humanizes patients in the clinical context. One theme was evident in provider comments: collecting PCD may potentially undermine trust if not reviewed by clinical teams. ConclusionPCD collected directly from patients and available within the EHR was seen by patients and care team members as beneficial to communication. PCD collection supports a paradigm shift towards coproduction of health information and a shared responsibility for information gathering but requires investment from patients and care team to ensure the data are effectively utilized. Practice valuePCD may be useful for team-based care, enabling physicians and non-physician staff to more quickly and responsively connect with patients.