Despite efforts to enhance the quality of medication prescribing in outpatient settings, potentially inappropriate prescribing remains common, particularly in unscheduled settings where patients can ...present with infectious and pain-related complaints. Two of the most commonly prescribed medication classes in outpatient settings with frequent rates of potentially inappropriate prescribing include antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). In the setting of persistent inappropriate prescribing, we sought to understand a diverse set of perspectives on the determinants of inappropriate prescribing of antibiotics and NSAIDs in the Veterans Health Administration.
We conducted a qualitative study guided by the Consolidated Framework for Implementation Research and Theory of Planned Behavior. Semi-structured interviews were conducted with clinicians, stakeholders, and Veterans from March 1, 2021 through December 31, 2021 within the Veteran Affairs Health System in unscheduled outpatient settings at the Tennessee Valley Healthcare System. Stakeholders included clinical operations leadership and methodological experts. Audio-recorded interviews were transcribed and de-identified. Data coding and analysis were conducted by experienced qualitative methodologists adhering to the Consolidated Criteria for Reporting Qualitative Studies guidelines. Analysis was conducted using an iterative inductive/deductive process.
We conducted semi-structured interviews with 66 participants: clinicians (N = 25), stakeholders (N = 24), and Veterans (N = 17). We identified six themes contributing to potentially inappropriate prescribing of antibiotics and NSAIDs: 1) Perceived versus actual Veterans expectations about prescribing; 2) the influence of a time-pressured clinical environment on prescribing stewardship; 3) Limited clinician knowledge, awareness, and willingness to use evidence-based care; 4) Prescriber uncertainties about the Veteran condition at the time of the clinical encounter; 5) Limited communication; and 6) Technology barriers of the electronic health record and patient portal.
The diverse perspectives on prescribing underscore the need for interventions that recognize the detrimental impact of high workload on prescribing stewardship and the need to design interventions with the end-user in mind. This study revealed actionable themes that could be addressed to improve guideline concordant prescribing to enhance the quality of prescribing and to reduce patient harm.
Abstract
Background
Usability problems in the electronic health record (EHR) lead to workflow inefficiencies when navigating charts and entering or retrieving data using standard keyboard and mouse ...interfaces. Voice input technology has been used to overcome some of the challenges associated with conventional interfaces and continues to evolve as a promising way to interact with the EHR.
Objective
This article reviews the literature and evidence on voice input technology used to facilitate work in the EHR. It also reviews the benefits and challenges of implementation and use of voice technologies, and discusses emerging opportunities with voice assistant technology.
Methods
We performed a systematic review of the literature to identify articles that discuss the use of voice technology to facilitate health care work. We searched MEDLINE and the Google search engine to identify relevant articles. We evaluated articles that discussed the strengths and limitations of voice technology to facilitate health care work. Consumer articles from leading technology publications addressing emerging use of voice assistants were reviewed to ascertain functionalities in existing consumer applications.
Results
Using a MEDLINE search, we identified 683 articles that were reviewed for inclusion eligibility. The references of included articles were also reviewed. Sixty-one papers that discussed the use of voice tools in health care were included, of which 32 detailed the use of voice technologies in production environments. Articles were organized into three domains: Voice for (1) documentation, (2) commands, and (3) interactive response and navigation for patients. Of 31 articles that discussed usability attributes of consumer voice assistant technology, 12 were included in the review.
Conclusion
We highlight the successes and challenges of voice input technologies in health care and discuss opportunities to incorporate emerging voice assistant technologies used in the consumer domain.
Highlights ► Health IT system designers and implementers may have frames of orientation regarding medical work that differ from the frames held by practitioners. ► Collisions in system frames and ...practitioner frames can result in adaptations by individuals and organizations. ► Adaptations are not universally negative, but instead sometimes result in productive changes to workflow, organizational policy and/or informatics tools.
Background
Little is known about how primary care clinicians (PCCs) approach chronic pain management in the current climate of rapidly changing guidelines and the growing body of research about risks ...and benefits of opioid therapy.
Objective
To better understand PCCs’ approaches to managing patients with chronic pain and explore implications for technological and administrative interventions.
Design
We conducted adapted critical decision method interviews with 20 PCCs. Each PCC participated in 1–5 interviews.
Participants
PCCs interviewed had a mean of 14 years of experience. They were sampled from 13 different clinics in rural, suburban, and urban health settings across the state of Indiana.
Approach
Interviews included discussion of participants’ general approach to managing chronic pain, as well as in-depth discussion of specific patients with chronic pain. Interviews were audio recorded. Transcripts were analyzed thematically.
Key Results
PCCs reflected on strategies they use to encourage and motivate patients. We identified four associated strategic themes: (1) developing trust, (2) eliciting information from the patient, (3) diverting attention from pain to function, and (4) articulating realistic goals for the patient. In discussion of chronic pain management, PCCs often explained their beliefs about opioid therapy. Three themes emerged: (1) Opioid use tends to reduce function, (2) Opioids are often not effective for long-term pain treatment, and (3) Response to pain and opioids is highly variable.
Conclusions
PCC beliefs about opioid therapy generally align with the clinical evidence, but may have some important gaps. These findings suggest the potential value of interventions that include improved access to research findings; organizational changes to support PCCs in spending time with patients to develop rapport and trust, elicit information about pain, and manage patient expectations; and the need for innovative clinical cognitive support.
Highlights • There are minimal treatments available to address morbidity with mild traumatic brain injuries (mTBI). • We created a Self-Monitoring Activity-Restriction and Relaxation Treatment ...(SMART) program for adolescents with mTBI. • We evaluated the usability of the Web-based system with parents and children. • The system has favorable feedback and supports the feasibility of using SMART as a resource to manage recovery from mTBI.
Highlights ► Nurses found the integrated graphical display more usable than their current hospital system. ► Performance improved using the graphical display only at the primary design institution. ► ...Medical information displays optimized for use at one clinical site may not be as favorable for other clinical sites. ► Health information technology needs to be flexible and configurable to meet local design constraints.
The rapid evolution of communication technologies has created new ways for healthcare consumers to manage their health. In a mixed-methods study, we examined technology use and willingness to use in ...pregnant women and caregivers, using surveys and semi-structured interviews. Most participants had used text messaging, automated phone calls, Skype/FaceTime, social media, and online discussion forums. To communicate with healthcare providers, most were willing to use text messaging and had not, but desired to use Skype/FaceTime. Fewer were willing to use social media or online discussion forums due to concerns about privacy and security. Most were willing to use text messaging, Skype/FaceTime, or online discussion forums to support health in other ways, but few had done so. About half were willing to use automated phone calls, but most did not like them due to the impersonal nature and time required. Developers should consider such preferences in design of health information technologies.
Thirty million Americans currently have diabetes, and a substantial portion do not reach the goals of clinical treatment. This is in part due to the complex barriers to effective self-care faced by ...people with diabetes. This study uses a patient work perspective, focusing on the everyday, lived experience of managing diabetes. Our primary research goal was to explore how the work of self-care is embedded in the other routines of everyday living. We found that everyday objects and spaces were instrumental in the incorporation of diabetes work into daily routines. Objects anchored diabetes tasks by linking illness-specific artifacts to space and time (e.g. a morning routine), and by enabling the performance on diabetes tasks while on the move in either planned or unplanned ways.
•Diabetes self-care is a challenge in the U.S.; many people do not meet treatment goals.•Everyday objects and spaces can enhance the resilience of a patient's illness routines.•Using objects and spaces to blend cultural routines with self-care tasks is a resilience strategy.
Background:
The significant role of lay caregivers has been explored in chronic and acute illnesses. In pregnancy, caregivers’ (eg, the baby’s father, friends, and family) roles in promoting the ...health of the mother and baby are not well understood.
Objective:
We characterize the activities and roles of pregnancy caregivers and offer opportunities for engaging this important group.
Method:
We conducted interviews with 29 pregnancy caregivers. Interview transcripts were analyzed inductively, resulting in a coding scheme of actions and roles that pregnancy caregivers perform.
Results:
The most common actions and roles included searching for information (97%), accompanying patients to medical appointments (69%), and being a source of emotional support (76%). Identified actions and roles fit a patient work framework, including work types identified by Corbin and Strauss: illness, everyday life, biographical, articulation, and invisible.
Conclusion:
The patient work framework can be employed to describe the activities and roles of pregnancy caregivers. We have contributed new insights into the experiences of pregnancy caregivers and recommendations for educational and technological interventions.
With growth in consumer health technologies, patients and caregivers have become increasingly involved in their health and medical care. Such health-related engagement often occurs at home. Pregnancy ...is a common condition and, for many women, their first exposure to health management practices. This study examined how pregnant women and caregivers managed health in their homes. Participants completed sociodemographic surveys and semi-structured interviews about living situation, information needs, and technology use. Using an iterative, inductive coding approach, we identified themes about health management, including the physical home, help at home, community, the virtual home, and biggest concerns. Most expectant mothers encountered everyday problems with mobility and household management. Pregnant women desired more assistance from caregivers, who often did not know how to help. Caregivers who provided help took on new roles. Many expectant families did not trust advice found online. Over half of expectant families had biggest concerns that involved the home.
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