Eve Dexter

Patient-Provider Communication: Does Electronic Messaging Reduce Incoming Telephone Calls?

Purpose: Internet-based patient portals are increasingly being implemented throughout health care organizations to enhance health and optimize communication between patients and health professionals. The decision to adopt a patient portal requires careful examination of the advantages and disadvantages of implementation. This study aims to investigate 1 proposed advantage of implementation: alleviating some of the clinical workload faced by employees. Methods: A retrospective time-series analysis of the correlation between the rate of electronic patient-to-provider messages—a common attribute of Internet-based patient portals—and incoming telephone calls. The rate of electronic messages and incoming telephone calls were monitored from February 2009 to June 2014 at 4 economically diverse clinics (a federally qualified health center, a rural health clinic, a community-based clinic, and a university-based clinic) related to 1 university hospital. Results: All 4 clinics showed an increase in the rate of portal use as measured by electronic patient-to-provider messaging during the study period. Electronic patient-to-provider messaging was significantly positively correlated with incoming telephone calls at 2 of the clinics (r = 0.546, P < .001 and r = 0.543, P < .001). The remaining clinics were not significantly correlated but demonstrated a weak positive correlation (r = 0.098, P = .560 and r = 0.069, P = .671). Conclusions: Implementation and increased use of electronic patient-to-provider messaging was associated with increased use of telephone calls in 2 of the study clinics. While practices are increasingly making the decision of whether to implement a patient portal as part of their system of care, it is important that the motivation behind such a change not be based on the idea that it will alleviate clinical workload.

Pneumococcal vaccination in low-income latinos: An unexpected trend in oregon community health centers

Abstract:Background. In cross-sectional studies, Latino and Spanish-speaking U.S. residents age 65 and over are less likely to receive pneumococcal vaccination than non-Hispanic Whites.Methods. We performed a time-to-event, cohort analysis, in 23 Oregon community health centers of low-income patients who turned 65 in the study period (2009–2013; n = 1,248). The outcome measure was receipt of PPSV-23 in the study period by race / ethnicity, preferred language, and insurance status.Results. Insured Latino patients were more likely to receive PPSV-23 than insured non-Hispanic Whites (HR = 2.05, p < .001). Uninsured Latino seniors showed no difference from insured non-Hispanic Whites in PPSV-23 receipt (HR = 1.26, p = .381) unless they averaged fewer than one clinic visit yearly (HR = 1.80, p = .001).Conclusions. Low-income Latino seniors in Oregon community health centers were immunized against pneumococcus more frequently than insured non-Hispanic Whites, although this finding was mitigated in Latinos without insurance. This finding needs further research in order to reduce adult immunization disparities in the society at large.

Comparison of Opioid Prescribing Patterns in the United States and Japan: Primary Care Physicians' Attitudes and Perceptions

Introduction: Far fewer opioids are prescribed in Japan than in the United States. Methods: We conducted an online physician survey assessing attitudes and perceptions that might influence prescribing. A Japanese version was distributed to members of the Japan Primary Care Association and an English version to members of the American Academy of Family Physicians practicing in Oregon. Results: We received 461 Japanese responses and 198 from the United States, though overall response rates were low (Japan: 10.1%, United States: 18.5%). Japanese respondents reported far less opioid prescribing than US respondents, especially for acute pain (acute pain: 49.4% vs 97.0%; chronic pain: 63.7% vs 90.9%; P < .001 for both). Almost half of respondents from both countries indicated that patient expectations and satisfaction were important factors that influence prescribing. US respondents were significantly more likely to identify medical indication and legal expectation as reasons to prescribe opioids for acute pain. Most US respondents (95.4%) thought opioids were used too often, versus 6.6% of Japanese respondents. Conclusions: Lower opioid use was reported in Japan, especially for acute pain, which may help minimize long-term use. Patient expectations and satisfaction seem to influence opioid prescribing in both countries. The United States could learn from Japanese regulatory and cultural perspectives.

A Model for Catalyzing Educational and Clinical Transformation in Primary Care: Outcomes From a Partnership Among Family Medicine, Internal Medicine, and Pediatrics.

Purpose To report findings from a national effort initiated by three primary care certifying boards to catalyze change in primary care training. Method In this mixed-method pilot study (2012–2014), 36 faculty in 12 primary care residencies (family medicine, internal medicine, pediatrics) from four institutions participated in a professional development program designed to prepare faculty to accelerate change in primary care residency training by uniting them in a common mission to create effective ambulatory clinical learning environments. Surveys administered at baseline and 12 months after initial training measured changes in faculty members’ confidence and skills, continuity clinics, and residency training programs. Feasibility evaluation involved assessing participation. The authors compared quantitative data using Wilcoxon signed-rank and Bhapkar tests. Observational field notes underwent narrative analysis. Results Most participants attended two in-person training sessions (92% and 72%, respectively). Between baseline and 12 months, faculty members’ confidence in leadership improved significantly for 15/19 (79%) variables assessed; their self-assessed skills improved significantly for 21/22 (95%) competencies. Two medical home domains (“Continuity of Care,” “Support/Care Coordination”) improved significantly (P < .05) between the two time periods. Analyses of qualitative data revealed that interdisciplinary learning communities formed during the program and served to catalyze transformational change. Conclusions Results suggest that improvements in faculty perceptions of confidence and skills occurred and that the creation of interdisciplinary learning communities catalyzed transformation. Lengthening the intervention period, engaging other professions involved in training the primary care workforce, and a more discriminating evaluation design are needed to scale this model nationally.

Randomized Controlled Trial of Home‐Based Hormonal Contraceptive Dispensing for Women At Risk of Unintended Pregnancy

CONTEXT Women frequently experience barriers to obtaining effective contraceptives from clinic-based providers. Allowing nurses to dispense hormonal methods during home visits may be a way to reduce barriers and improve -effective contraceptive use. METHODS Between 2009 and 2013, a sample of 337 low-income, pregnant clients of a nurse home-visit program in Washington State were randomly selected to receive either usual care or enhanced care in which nurses were permitted to provide hormonal contraceptives postpartum. Participants were surveyed at baseline and every three months postpartum for up to two years. Longitudinal Poisson mixed-effects regression analysis was used to examine group differences in gaps in effective contraceptive use, and survival analysis was used to examine time until a subsequent pregnancy. RESULTS Compared with usual care participants, enhanced care participants had an average of 9.6 fewer days not covered by effective contraceptive use during the 90 days following a first birth (52.6 vs. 62.2). By six months postpartum, 50% of usual care participants and 39% of enhanced care participants were using a long-acting reversible contraceptive (LARC). In analyses excluding LARC use, enhanced care participants had an average of 14.2 fewer days not covered by effective contraceptive use 0-3 months postpartum (65.0 vs. 79.2) and 15.7 fewer uncovered days 4-6 months postpartum (39.2 vs. 54.9). CONCLUSION Home dispensing of hormonal contraceptives may improve womens postpartum contraceptive use and should be explored as an intervention in communities where contraceptives are not easily accessible.