Care Users Research Articles

Validity of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adult primary care users in Bucaramanga, Colombia

The patient health questionnaire-9 (PHQ-9) is one of the most widely used self-report instruments in primary care. There is no criterion validity of the PHQ-9 in Colombia. The objective was to validate the PHQ-9 as a screening tool in primary care. A cross-sectional, scale criterion validity study was performed using as reference criterion the mini neuropsychiatric interview (MINI) in male and female adult users of primary care centres. We calculated the internal consistency and convergent and criterion validity of the PHQ-9 by analysing the receiver operating characteristics (ROC) and the area under the curve (AUC). We analysed 243 participants; 184 (75.7%) were female. The average age was 34.05 (median of 31 and SD=12.47). Cronbach's α was 0.80 and McDonald's ω was 0.81. Spearman's Rho was 0.64 for HADS-D (P<0.010) and 0.70 for PHQ-2 (P<0.010). The AUC was 0.92 (95% CI 0.880–0.963). The optimal cut-off point of PHQ-9 was ≥7: sensitivity of 90.38 (95% CI: 81.41–99.36); specificity of 81.68 (95% CI: 75.93–87.42); PPV 57.32 (95% CI: 46.00–68.63); NPV 96.89 (95% CI: 93.90–99.88); Youden index 0.72 (95% CI: 0.62–0.82); LR+ 4.93 (95% CI: 3.61–6.74); LR− 0.12 (95% CI: 0.005–0.270). In sum, the Colombian version of PHQ-9 is a valid and reliable instrument for depression screening in primary care in Bucaramanga, with a cut-off point ≥7.

Vitamin D deficiency in primary health care users at risk in Spain.

Background and objectives: despite long hours of sunlight in Spain, vitamin D deficiency has been rising of late. We aimed to describe vitamin D deficiency and insufficiency in at-risk patients in La Rioja, a region in northern Spain. Methods: a retrospective, cross-sectional study involving 21,490 patients (74.3 % women) aged 14-105 years, who were primary health care (PHC) users in La Rioja, with an available 25-hidroxyvitamin D (25(OH)D) test result corresponding to the first request from January 2013 to October 2015. Vitamin D deficiency, insufficiency, and sufficiency were defined as 25(OH)D levels < 12 ng/mL, 12-20 ng/mL, and ≥ 20 ng/mL, respectively. Hypovitaminosis D was defined considering 2 cut-off points for 25(OH)D: < 20 ng/mL and < 30 ng/mL. Results: mean 25(OH)D levels were 18.3 (SD, 11.6) ng/mL in the whole sample, being lower in men than in women (17.6 vs 18.5 ng/mL, p < 0.001). Significantly higher 25(OH)D levels were found in the groups with 55-59, 60-64, 65-69, and 70-74 years of age (range, 19.4-20.4 ng/mL), and lower levels were found in the groups with 80-85 years and older (16.7 and 14.5 ng/mL), as compared to other groups. Two thirds of the population were vitamin D-deficient (< 12 ng/mL, 30.9 %) or insufficient (12-20 ng/mL, 32.8 %), and only 32.8 % of patients were found to be vitamin D-sufficient (> 20 ng/ml). Hypovitaminosis D rate was higher (89.7 %) when the 25(OH)D cut-off point was set at < 30 ng/mL. A higher hypovitaminosis D rate (< 20 ng/mL) was found in men (67.1 %) vs women (62.6 %) (p < 0.001), and it was more prevalent in patients over 75 years (72.6 %). The prevalence of hypovitaminosis D followed a seasonal pattern ranging from 51.8 % to 76.5 %; the lowest 25(OH)D levels were found in winter, and the highest in summer, with levels above 20 ng/mL in all age groups except for patients over 75 years (17.7 ng/mL). Patients over 75 years exhibited high rates of deficiency or insufficiency across all seasons of the year. Conclusions: in La Rioja, Spain, hypovitaminosis D was highly prevalent among PHC users, and especially in older age groups and during the winter months.

Measuring Change in Activity Participation of Mental Health Care Users Attending an Occupational Therapy Programme in Rural South Africa

ABSTRACT INTRODUCTION: Lack of evidence on the effect of interventions is one of the several ongoing challenges facing healthcare services in South Africa. The increasing emphasis on routine outcome measurement has urged occupational therapists to demonstrate the impact of their intervention in mental health. This study aimed to evaluate the change in activity participation of the mental health care users attending an occupational therapy programme METHODS: A one-group pre/post-test design was used. The Activity Participation Outcome Measure (APOM) was administered to measure activity participation of 64 mental health care users. Five measurements were done between admission and follow-up after discharge RESULTS: Majority of the participants were between the ages of 20 - 29 and mainly diagnosed with substance use disorders. The effect sizes, Cohen's d (&gt; 0.80) and Cohen's r (&gt;0.37) demonstrated a significant positive change (p=0.00) across all APOM domains during hospitalisation. An insignificant change (p&gt; 0.05) was noted in the effect sizes during the follow-up stages with a substantial decline in some of the APOM domains indicating that patients were not well-integrated into their communities CONCLUSION: This study revealed the importance of measuring change in participation for shaping clinical practice, to ensure meaningful intervention, and successful integration of MHCUs in their communities Keywords: routine outcome measurement, activity participation, occupational therapy, mental health, rural context.

Kvalitet života starih osoba smeštenih u staračkom domu

Modern society in recent decades is facing a large increase in the share of people over 65 in the total population. The research shows that the trend of increasing the number of the elderly is such that it is estimated that the share of people aged 65 and over in the world population will increase significantly (by 56%), from 901 million (12.3%) in 2015 to 1.4 billion (16.5%) in 2030. Nursing homes for the accommodation and care of the elderly are safe places that provide the elderly with reduced physical and other abilities and a life worthy of a human being. A wide field of interest for the research is the perception and experience of home care users about what a quality life in this environment could represent. As part of the quality of life assessment, different domains are assessed, and a certain degree of subjective assessment is included in the choice of quality of life domains. Given the demographic changes that have led to an aging population, as well as longer life expectancy, new measures of social and health policy towards the elderly are increasingly aimed at raising the quality of life of the elderly, while scientific research is increasingly focused on identifying factors that affect the quality of life of the elderly.

Willingness and feasibility of utilising short messaging services (SMS) as reminders of follow-up care to mental health care users in the uMgungundlovu District, KwaZulu-Natal

Current trends in medical practise have shown increasing interest in the use of mobile technology, and this has been proven to increase treatment adherence. Short message service (SMS) may improve service delivery through appointment reminders and improve communication between health care workers and patients. The aim of the study was to determine the feasibility and acceptability of utilising SMS to remind outpatient mental health care users of their follow-up care in the uMgungundlovu District. The study took place at four outpatient mental health care clinics in the uMgungundlovu District in KwaZulu-Natal. This study employed a non-experimental quantitative survey. A non-probability convenient sampling method was used to select 182 participants at the mental health care clinics. Results showed that almost all 99.5% the participants have access to mobile phone, majority of the respondents who could access mobile phone n = 169 (93.4%) indicated that they would be interested in receiving SMS. There is significant association between willingness to receive medical SMS via mobile phone and being a single user of the phone (OR: 11.6, 96%, CI: 6.42–20.89), p < 0.001 and regular user of SMS (OR: 0.23, 96%, CI: 0.55–0.97), p = 0.045. In addition, most participants indicated that it would be feasible, acceptable and expedient to mental health care service. The study demonstrated that there was an interest and increased access in mobile technology. SMS is a viable method of improving attendance rates for follow-up care of mental health care users and endorse the use of existing mobile technology.

TECHNOSOCIALITY AND HEALTH PROMOTION IN THE DAILY LIVES OF PRIMARY CARE USERS: A SCOPING REVIEW

ABSTRACT Objective: to map available evidence on the use of technologies by Primary Health Care users in the context of health promotion. Method: this is a scoping review according to Joanna Briggs Institute, and the recommendations of the international guide Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were followed. The PCC strategy (participants, concept and context) was used. The search in the databases was carried out from January to April 2020. Results: a total of 5,267 studies were retrieved and 28 articles were selected for review. The article origin was diverse, with the largest number being from the United States of America (7), the predominant language is English, the year was 2018 and the level of evidence 2. Studies show that users obtain benefits in health care through the use of technologies. Conclusion: health interventions, using technology, positively impact people’s behavior and lifestyle, focusing on the prevention and control of chronic diseases. It is noteworthy that technologies used in isolation cannot overcome behavioral barriers and their use does not replace one-to-one care and monitoring.

Challenges impacting functional recovery experienced by Mental Health Care Users with Major Depressive Disorder after a short-term admission to hospital

ABSTRACT INTRODUCTION: Major Depressive Disorder often has a chronic course. Mental Health Care Users (MHCUs) with this diagnosis report experiencing challenges with the transition to their home and in resuming their previous activities of daily living or their functional recovery after a short-term admission to hospital. This research aimed to explore these challenges which these MHCUs perceived had contributed to their re-admission within a six-month period METHODS: A qualitative descriptive design was used to explore these challenges. Data were gathered through semi-structured interviews with eleven participants and analysed thematically RESULTS: Data analysis generated two themes: 'Inability to fully benefit from the therapeutic programme' and Life was not what I expected it to be after discharge'. Participants reported struggling to participate fully in the occupational therapy programme during admission and with the abrupt transition from hospital to home. They reported challenges in implementing changes that they had committed to in hospital and a lack of support from significant others. The greatest challenge reported by participants was in the social participation category of occupation and their experiencing extreme loneliness and isolation after discharge CONCLUSION: The unresolved challenges experienced by participants during hospitalisation and after discharge were perceived to be detrimental to their functional recovery Keywords: major depressive disorder, mental health, re-admission, functional recovery

Effects of formal home care on spousal health outcomes

This study estimates the impacts of formal home care provided by paid professionals on spousal health outcomes. We use data from the Survey of Health, Ageing, and Retirement in Europe, a panel of older adults living in several European countries, and match new formal home care users to non-users to account for the endogeneity of the decision to seek formal home care. After considering underlying mechanisms, our results suggest that at least in the short run, the use of formal home care does not impact spousal physical or mental health. We also find that formal home care use increases spousal informal caregiving —along the extensive margin—, although in our sample and short time horizon, spousal informal caregiving does not seem to impact health.

Medication use and its impact on high-cost health care users among older adults: protocol for the population-based matched cohort HiCOSTT study.

Background:Health interventions and policies for high-cost health care users (HCUs) who are older adults need to be informed by a better understanding of their multimorbidity and medication use. This study aims to determine the financial contribution of medications to HCU expenditures and explore whether potentially inappropriate prescribing is associated with incident HCU development.Methods:This is a protocol for a retrospective population-based matched cohort analysis of incident older adult HCUs (those with the highest 5% of costs and 66 years of age or older) in Ontario during fiscal year 2013. We will obtain person-level data for the index year and year before HCU status from health administrative databases and match each HCU to 3 non-HCUs based on age, sex and geographic location. Average annual medication costs (per patient) and the ratio of medication to total health care costs (at population level) will be examined over the HCU transition period and compared with non-HCUs. We will explore potential quality improvement areas for prescribing by analyzing chronic conditions and the use of medications with a strong evidence base for either clinical benefit or risk of harms outweighing benefits in older adults with these diagnoses. The relation between these medication classes and incident HCU status will be explored using logistic regression.Interpretation:Using a matched cohort design and focusing on incident rather than prevalent HCUs, this protocol will explore our hypotheses that medications and the quality of their prescribing may be important triggers of HCU status and facilitate the identification of potential preventive clinical interventions or policies. Dissemination of results will occur via publications in peer-reviewed journals, presentations at conferences and academic settings, and knowledge translation activities with relevant health system and patient stakeholder groups. Study registration:Clinicaltrials.gov, no. NCT02815930

Development of technology for controlling access to digital portals and platforms based on estimates of user reaction time built into the interface

The paper addresses the development of technology for controlling access to digital portals and platforms based on assessments of personal characteristics of user behavior built into the interface. In distributed digital platforms and portals using personal data, big data is collected and processed using specialized applications using computer networks. In accordance with the law, the data is stored on internal corporate servers and data centers. Special attention is paid to the tasks of differentiation and control of access in modern information systems. Wide availability and mass scale of services should be accompanied by more careful control and user verification. Access control to such systems cannot be ensured only through technologies and information security tools; efficiency can be increased through software and hardware architectural solutions. The paper proposes to expand the currently developing SIEM technology (Security information and event management), which combines the concept of security event management and information security management, with blocks of user behavior analysis. As a characteristic that can be measured without overloading communication channels and is independent of the type of device used, the psychomotor reaction time is proposed, measured as the performance of actions with the interface. A technological solution has been developed for implementation in a wide range of digital platforms: banking, medical, educational, etc. The results of experimental research using a digital platform of mass psychological research are presented. For the research, data from a mass survey were used when answering (in the form of a choice from the available options) to questions about the level of education. Analysis of the reaction time data showed the possibility of standardization and the same indicators of specific users when answering different questions.

Protocolo de atividade física remoto para grupos de Academia da Saúde e Estratégia de Saúde da Família

Considerando a necessidade de manter o vínculo e serviços prestados a usuários da atenção primária à saúde, durante o distanciamento social exigido pela pandemia provocada pelo SARS-CoV-2, o objetivo deste estudo foi apresentar o modelo lógico para elaboração e implementação de um protocolo de Prática Corporal/Atividade Física remota, disponibilizado por tecnologias, e avaliar a adesão dos usuários a este protocolo. O protocolo foi desenvolvido por profissionais de educação física das Academias de Saúde e Núcleo Ampliado em Saúde da Família e Atenção Básica (NASF-AB) do município de Arapiraca, Alagoas. Após reuniões virtuais entre gestão e profissionais e enquetes com os usuários, o Agite em Casa foi implementado em 32 grupos de saúde. Os exercícios estão sendo disponibilizados duas vezes por semana e são escolhidos de acordo com as características do grupo. Para facilitar a prescrição foi criado um banco com 53 vídeos e 26 mosaicos que apresentam a descrição e demonstração dos exercícios. Dos 754 usuários que participavam dos grupos de atividade física antes da pandemia, 344 (45,6%) aderiram ao protocolo remoto, e 225 (33,9%) participaram efetivamente do Agite em Casa.

Who Are the Heavy Users of Acute and Long-Term Care Services in Changhua County, Taiwan?

Identification of heavy health care users among community-dwelling older adults can lead to strategic care planning and management that positively impacts health care use and costs. This study aims to identify risk factors associated with heavy users of acute care and long-term care (LTC) in Changhua County, Taiwan. Study participants (n=8,090) included residents (age 65+) of Changhua County. Data were collected from 4/1/2017-10/26/2018. Linked hospitalization and LTC use information was provided by the Changhua County Public Health Bureau. Hospitalization was grouped into 1 vs. 2+. Univariate and multivariate logistic models will be used to address the study aim. Preliminary results show the average age was 81 years ranging from 65-105. Of this population, 56% are female, and 10% live alone. The average length of hospital stay was 9.7 days. Risk factors associated with heavy health care users identified in multivariate analysis will be presented and intervention strategies will be discussed. Part of a symposium sponsored by International Comparisons of Healthy Aging Interest Group.

Barriers to implementing guideline recommendations to improve childbirth care: rapid review of evidenceObstáculos a la aplicación de las recomendaciones para la atención del parto normal: revisión rápida de evidencia

RESUMOObjetivo.Identificar potenciais barreiras à implementação das recomendações das Diretrizes Nacionais de Assistência ao Parto Normal a partir das melhores evidências globais disponíveis.Métodos.Realizou-se uma revisão rápida com consulta a seis bases de dados em março/abril de 2019. Foram selecionados estudos secundários publicados em inglês, espanhol ou português sobre barreiras de qualquer natureza que pudessem ser relacionadas à implementação das recomendações das Diretrizes.Resultados.Foram incluídos 23 documentos (21 revisões sistemáticas e dois guias de prática clínica). As barreiras identificadas foram agrupadas em 52 categorias por semelhança de significado e, em seguida, reorganizadas em nove núcleos temáticos: modelo de atenção ao parto e nascimento, gestão de recursos humanos, crenças e saberes, relações de gênero, gestão de serviços de saúde, atitudes e comportamentos, comunicação, condições socioeconômicas e interesses políticos.Conclusões.Os resultados mostraram que a implementação das Diretrizes pode requerer abordagens combinadas para o enfrentamento de diferentes barreiras. O engajamento de gestores e profissionais de saúde no processo de mudança do modelo de atenção ao parto e nascimento e o envolvimento de usuários são indispensáveis para o sucesso da implementação. São necessárias, ainda, ações intersetoriais para melhorar as condições socioeconômicas de mulheres e famílias e para combater as iniquidades de gênero.

Characteristics of patients with mental illness and persistent high-cost status: a population-based analysis.

Most of the literature on high-cost users of health care has evaluated this population as a whole, but few studies have focused on high-cost patients with mental illness and whether they persist in the high-cost state. We sought to analyze this patient population in depth and determine predictors of persistency in the high-cost state. We used 8 years of longitudinal patient-level population data (2010-2017) from Ontario to follow high-cost patients (those in and above the 90th percentile of the cost distribution) with mental illness. We classified high-cost status, based on the proportion of the study period that patients spent in the high-cost state, as persistent (6-8 yr), sporadic (1-2 yr) or moderate (3-5 yr). We compared characteristics between groups and determined predictors of being a patient with mental illness and persistent high-cost status. Among 52 638 patients with mental illness and high-cost status, 18 149 (34.5%) were considered persistent high cost. These patients had higher mean annual costs of care ($44 714, 95% confidence interval [CI] $43 724-$45 703) than patients with sporadic ($23 205, 95% CI $22 741-$23 668) and moderate ($31 055, 95% CI $30 359-31 751) status, largely owing to psychiatric hospital admissions. Patients with mental illness and persistent high-cost status were more likely to be female, older, long-term residents of Ontario (information ascertained from the Immigrants, Refugees and Citizenship Canada Database), living in low-income or urban areas, or to have comorbidities. The strongest predictors of persistent (v. sporadic) high-cost status were HIV (relative risk ratio [RRR] 4.32, 95% CI 3.08-6.06), psychosis (RRR 3.41, 95% CI 3.25-3.58) and dementia (RRR 3.21, 95% CI 2.81-3.68). Among patients with mental illness and high-cost status, persistence in the high-cost state was determined mainly by psychosis and other comorbidities. Quality-of-care interventions directed at managing psychosis and multimorbidity, as well as preventive interventions to target patients with mental illness before they enter the persistent high-cost state, are needed.

Trends in demand for general anaesthetic care for paediatric caries in Western Australia: geographic and socio-economic modelling of service utilisation

This study aimed to assess the temporal and spatial changes in the demand for general anaesthesia, relative to disease incidence, in 0-19-year-olds. Hospitalisation data were obtained from the Western Australian Morbidity Data System for the financial years 1999/2000 to 2004/2005, and principal diagnosis was obtained from every patient discharged from a public or private hospital. Hospitalisation data was correlated with socioeconomic status and the geographical location of primary residence. In the public hospital sector, there were greater rates of people residing in Statistical Local Areas (SLAs) with decreasing accessibility to healthcare services utilising the option of treatment of dental caries under general anaesthetic (GA) compared to people living within highly accessible areas. In the private sector, children who resided in SLAs with the greatest access to healthcare facilities had a greater rate of being hospitalised for the treatment of dental caries under GA. The results demonstrated distinct patterns of trends in demand for general anaesthetic care among different SES groups and geographical location of primary residence. There was an overall emerging trend of increasing demand placed on public sector both among dental care users among high and low SES. Moreover, the results demonstrated the potential application of geographic modelling as a service planning tool for estimating the future demand for GA care for dental caries in addition to the timely need for focused attention on preventive services for early identification, prevention and control of dental caries among children.

Prejudiced Attitudes of Nursing Students in Southern Spain Toward Migrant Patients.

The increase in the migrant population in Spain has transformed the cultural profile of public health care users. The purpose of this study is to recognize the subtle and blatant prejudices nursing students have toward migrant patients. An ex post facto descriptive study, using a transversal design (N = 1,393). Males showed a higher degree of prejudice (p < .05). Students in their first year have more subtle prejudices than those in their fourth year (p < .005). Blatant prejudice increases from the first year to the fourth year of the degree program (p < .05). Regarding context, there were differences found between subtle and blatant prejudice (both, p < .05), as students in areas with high migratory pressure showed more prejudiced attitudes toward migrant patients. Students display subtle prejudices, which is why education in culturally congruent health care must be integrated across all levels of nursing education, with the objective of diminishing prejudice against the migrant population.

Outcomes of Medicaid home- and community-based long-term services relative to nursing home care among dual eligibles.

To provide the first plausibly causal national estimates of health outcomes for older dual-eligible recipients of Medicaid HCBS relative to nursing home care and to explore possible mechanisms for the effect. We use 2005 and 2012 Medicaid Analytic eXtract (MAX), a national compilation of Medicaid claims, merged with Medicare claims to identify hospital admissions, our main outcome variable. We model the effects of HCBS using a longitudinal instrumental variables framework. To address the endogeneity of HCBS receipt, we instrument for it using the county percentage of nonelderly long-term care users who receive HCBS. The percentage of nonelderly users is highly predictive of HCBS use for an elderly beneficiary, but because the instrument was derived from a separate population, the exclusion restriction is unlikely to be violated. 1,312,498 older adults (65+) dually enrolled in Medicaid and Medicare and are using long-term care. We also examine heterogeneity of effects by race/ethnicity and the presence of dementia. HCBS users have 10 percentage points higher (P<.01) annual rates of hospitalization than their nursing home counterparts when selection bias is addressed; rates of potentially avoidable hospitalizations are 3 percentage points higher (P<.01). These differences persist across races, dementia status, and intensity of HCBS spending. Shifting Medicaid long-term care funding for older adults from nursing homes to HCBS, while well-motivated, results in the unintended consequence of substantially higher hospitalization rates for older dual eligibles. The quality and/or quantity of services may be inadequate for some HCBS recipients. Hospitalizations are costly to Medicare but also to the HCBS recipient in terms of stress and risks. Although consumer preferences to remain at home may outweigh poor outcomes of HCBS, the full costs and benefits need to be considered. HCBS outcomes-not just expansion-need more attention.

Evaluation of Reablement Home Care: Effects on Care Attendants, Care Recipients, and Family Caregivers.

Background: The traditional home care model entails caring “for” people with disabilities, not “with” them. Reablement care has been applied to long-term care, but the evidence for care attendants, home care recipients, and family caregivers simultaneously is limited. Methods: First, a survey was conducted to explore the needs of home care recipients and family caregivers to achieve independence at home to develop the reablement home care model for home care. Then, an intervention with two groups was implemented. The experimental group included a total of 86 people who participated in the reablement home care model. The control group included 100 people and received usual home care. The self-reliance concept, job satisfaction, and sense of achievement for care attendants; quality of life for home care users; and caregiving burden for family caregivers were assessed. Results: The reablement home care model improved the job satisfaction and achievement of home care attendants, improved mutual support and independence in the self-reliance concept and quality of life among the users, and reduced the stress of the users and family caregivers. Conclusion: The reablement home care model improved the outcomes for providers, care recipients, and family caregivers. Reablement home care is suggested in long-term care policies.

Social and health sector reform towards 2040 in Japan

PurposeThe purpose of this paper is to examine the health sector reform toward 2040 of Japan as a super-aged society.Design/methodology/approachThis paper discusses the current healthcare policies adopted in Japan and projects the challenges in future as a super-aged society.FindingsThrough Japanese experiences, it is considered that Community-based Integrated Care System is useful, which takes into account the perspective of health care users. Being a super-aged society, it is essential for Japan to have more consensus by further removing obstacles, and paying attention to the change of paradigm and the purpose of care.Originality/valueBased on the case of Japan, this paper serves as a reference for other East Asian countries, which would sooner or later encounter the similar situation of becoming super-aged societies in the 21st century.

Working smarter, not harder: evaluating a population health approach to anticoagulation therapy management.

Inappropriate direct acting oral anti-coagulants (DOAC) prescribing increases the risk of adverse events. Population health management tools (PMTs) could help reduce adverse events through the early, efficient identification of questionable prescribing practices, but the impact of such a tool remains unknown. We evaluated the effect of PMT use on questionable DOAC dosing rates within 40 VHA medical centers and whether this effect differed by DOAC indication or agent. Medical centers were divided into PMT user or standard of care (SOC) groups based upon high or low tool access in the prior year. Questionable DOAC dosing rate was defined as the proportion of patients prescribed DOACs who were also flagged by the tool. Chi-square tests were used to determine if PMT user versus SOC groups differed with high (above 15.3%) versus low (below 15.3%) questionable dosing rates. T-tests were used to determine if mean questionable dosing rates significantly differed between the PMT user and SOC groups. DOAC PMT users were classified less frequently as being 'High" questionable dosage rate compared to SOCs (25% PMT vs. 75% SOC, respectively, p = 0.002). DOAC PMT utilization within the overall cohort was associated with a 4.3% absolute reduction in questionable DOAC dosing rates (13.2% PMT vs 17.5% SOC; p = 0.01). Tool use within the atrial fibrillation (AF) subgroup was associated with a 5.1% absolute reduction in questionable dosing rates (10.4% SOC vs. 5.3% PMT, p < 0.001). Tool use was also associated with lower questionable dosing rates in the apixaban (p < 0.001), dabigatran (p = 0.03) and AF plus venous thromboembolism (p < 0.001) subgroups. In our study, PMT use was associated with reduced questionable DOAC dosing, a difference most pronounced within AF patients. A population health approach has the potential to reduce adverse events among patients prescribed DOACs.