Henry N. Young

How physician electronic health record screen sharing affects patient and doctor non-verbal communication in primary care

OBJECTIVEnUse of electronic health records (EHRs) in primary-care exam rooms changes the dynamics of patient-physician interaction. This study examines and compares doctor-patient non-verbal communication (eye-gaze patterns) during primary care encounters for three different screen/information sharing groups: (1) active information sharing, (2) passive information sharing, and (3) technology withdrawal.nnnMETHODSnResearchers video recorded 100 primary-care visits and coded the direction and duration of doctor and patient gaze. Descriptive statistics compared the length of gaze patterns as a percentage of visit length. Lag sequential analysis determined whether physician eye-gaze influenced patient eye gaze, and vice versa, and examined variations across groups.nnnRESULTSnSignificant differences were found in duration of gaze across groups. Lag sequential analysis found significant associations between several gaze patterns. Some, such as DGP-PGD (doctor gaze patient followed by patient gaze doctor) were significant for all groups. Others, such DGT-PGU (doctor gaze technology followed by patient gaze unknown) were unique to one group.nnnCONCLUSIONnSome technology use styles (active information sharing) seem to create more patient engagement, while others (passive information sharing) lead to patient disengagement.nnnPRACTICE IMPLICATIONSnDoctors can engage patients in communication by using EHRs in the visits. EHR training and design should facilitate this.

Underage College Students' Alcohol Displays on Facebook and Real-Time Alcohol Behaviors

PURPOSEnCollege is often a time of alcohol use initiation and displayed Facebook alcohol references. The purpose of this longitudinal study was to determine associations between initial references to alcohol on social media and college students self-reported recent drinking, binge drinking, and excessive drinking.nnnMETHODSnFirst-year students from two U.S. public universities were randomly selected from registrar lists for recruitment. Data collection included 2xa0years of monthly Facebook evaluation. When an initial displayed Facebook alcohol reference was identified, these New Alcohol Displayers were contacted for phone interviews. Phone interviews used the validated timeline followback method to evaluate recent alcohol use, binge episodes, and excessive drinking. Analyses included calculation of positive predictive value and Poisson regression.nnnRESULTSnA total of 338 participants were enrolled; 56.1% participants were female, 74.8% were Caucasian, and 58.8% were from the Midwestern University. A total of 167 (49.4%) participants became new alcohol displayers during the first 2 years of college. Among new alcohol displayers, 78.5% reported past 28-day alcohol use. Among new alcohol displayers who reported recent alcohol use, 84.9% reported at least one binge episode. Posting an initial Facebook alcohol reference as a profile picture or cover photo was positively associated with excessive drinking (risk ratioxa0= 2.34; 95% confidence interval, 1.54-3.58).nnnCONCLUSIONSnFindings suggest positive associations between references to alcohol on social media and self-reported recent alcohol use. Location of initial reference as a profile picture or cover photo was associated with problematic drinking and may suggest that a student would benefit from clinical investigation or resources.

Asthma medication use among U.S. adults 18 and older

BACKGROUNDnAsthma is a chronic lung disease that currently affects an estimated 25 million Americans. One way to control the disease is by regular use of preventive asthma medications and controlled use of acute medications. However, little is known about adults with asthma and factors associated with their medication use.nnnOBJECTIVEnTo identify factors associated with asthma medication use among U.S. adults aged 18 and older.nnnMETHODSnData were obtained from the 2006 to 2010 Medical Expenditure Panel Survey (MEPS). Medication use outcome variables include: a) daily use of a preventive asthma medication (yes/no) and b) overuse (3+) of acute inhalers in last 3 months (yes/no). The Andersen Behavioral Model of Health Care was used to guide the selection of independent variables. The independent variables were categorized as predisposing, enabling and medical need factors. Logistic regression models were used to examine the relationship between asthma medication use in adults with asthma. Point estimates were weighted to the U.S. non-institutionalized population, and standard errors were adjusted to account for the complex survey design.nnnRESULTSnCompared to Whites, minority adults 18 and older were less likely to use preventive asthma medication daily (Hispanic-OR: 0.72, CI: 0.54-0.96; African American-OR: 0.62, CI: 0.51-0.75 respectively). Similarly, Hispanic adults age 18 and older were at a significantly higher likelihood of overusing rescue medications compared to Whites (OR: 1.47, CI: 1.03-2.11). Non-metropolitan adults age 18 and older were more likely to overuse acute asthma medications than those from Metropolitan Statistical Area (OR: 1.57, CI: 1.15-2.16). Compared to older adults age 65 and over, late mid-life 50-64 year old adults were less likely to use a daily preventive asthma medication (OR: 0.67, CI: 0.54-0.83).nnnCONCLUSIONSnRace, rurality and age were important factors associated with poor asthma medication use in U.S. adults. Although this is a first step toward identifying factors that may influence the use of asthma medications, future studies are needed to develop and implement interventions to overcome issues to improve asthma care.

Family Engagement in Pediatric Sickle Cell Disease Visits.

ABSTRACT Adults with sickle cell disease (SCD) report problems in relationship building and information exchange during clinic visits. To explore the origin of these communication challenges, we compare communication in pediatric SCD, diabetes, and asthma visits. We collected visit videos and parent surveys from 78 children ages 9–16 years with SCD, asthma, or diabetes. Coders assessed child, parent, and physician utterances reflecting relationship building, information giving, and information gathering. Associations of engagement with type of chronic disease visit were performed with negative binomial regression. Compared to SCD visits, children in diabetes visits spoke 53% more relationship-building utterances (p < .05) and physicians in asthma visits spoke 48% fewer relationship building utterances to the child (p < .01). In diabetes visits, physicians gave almost twice as much information to children and gave 48% less information to parents (both p < .01) compared to SCD visits. Compared to SCD visits, physicians spoke fewer information-gathering utterances to parents in diabetes and asthma visits (85% and 72% respectively, both p < .001). SCD visits reflect less engagement of the children and greater physician effort to gather information from parents. These differences highlight opportunities to enhance engagement as a mechanism for ultimately improving SCD care.

Asthma medication use among late midlife U.S. Adults.

Abstract Objective: Despite substantial prevalence of asthma, little is known about asthma in late midlife adults (50–64 years). The objective of this study was to examine the factors associated with the use of asthma medications among late midlife adults. Methods: Pooled data were obtained from the 2006 to 2010 Medical Expenditure Panel Survey. Medication use outcome variables include: (a) daily use of a preventive asthma medication and (b) use of more than three canisters of rescue inhalers in last 3 months. The Andersen Behavioral Model of Health Services Utilization was used to guide the selection of independent variables. Descriptive, unadjusted and adjusted logistic regression analyses were performed. Point estimates were weighted to the US civilian population and variance estimates were adjusted to obtain appropriate standard errors. All analyses were conducted using STATA (version 12). Results: A total of 1414 (weighted sample of 15u2009030u2009364) self-reported late midlife asthmatics were identified. About 31% of late midlife adults with asthma were using a preventive medication on a daily basis while 11% reported overusing acute medications. Adjusted analyses found that race, rurality and smoking were related to poor use of asthma medications among late midlife adults. Conclusion: Results suggest that asthma medication use is far from optimal among vulnerable groups of late midlife US adults.

How does patient-provider communication influence adherence to asthma medications?

OBJECTIVEnTo assess hypothesized pathways through which patient-provider communication impacts asthma medication adherence.nnnMETHODSnA national sample of 452 adults with asthma reported assessments of patient-provider communication, proximal outcomes (understanding of asthma self-management, patient-provider agreement, trust in the clinician, involvement in care, motivation), and adherence to asthma medications. Structural equation modeling was used to examine hypothesized pathways.nnnRESULTSnSignificantly positive direct pathways were found between patient-provider communication and all proximal outcomes. Only positive indirect pathways, operating through trust and motivation, were found between patient-provider communication and medication adherence.nnnCONCLUSIONnPatient-provider communication influences many desirable proximal outcomes, but only influences adherence through trust and motivation.nnnPRACTICE IMPLICATIONSnTo promote better adherence to asthma medication regimens and, ultimately positive asthma outcomes, healthcare providers can focus on implementing communication strategies that strengthen patients trust and increase patient motivation to use asthma medications.

Barriers to medication use in rural underserved patients with asthma

BACKGROUNDnAsthma control is especially challenging for underserved populations. Medication use is critical to asthma control, but patients with asthma can experience barriers to using these medications.nnnOBJECTIVESnTo assess the nature, frequency and impact of barriers to medication use in rural underserved patients with asthma.nnnMETHODSnA retrospective review of documentation from pharmacists initial consultations with asthma patients was conducted. Pharmacist classified barriers in the following categories: knowledge, beliefs and practical issues. The Asthma Control Test (ACT) was used to assess disease control. Descriptive statistics and multivariate analyses were conducted.nnnRESULTSnDocumentation from 46 consultations were examined. Eighteen participants (39%) had knowledge barriers, 18 (39%) had belief barriers and 16 (35%) had practical barriers. In bivariate analyses, only belief barriers were related to significantly worse asthma control (t = 1.83, P = 0.04). Adjusted analyses found that participants with both belief and practical barriers had significantly worse asthma control (β = -3.44, P = 0.03) in comparison to others without both barriers.nnnCONCLUSIONSnBarriers around medications beliefs were frequent and associated with worse asthma control. Programs that identify and tailor interventions to address these patient-specific barriers may improve outcomes in rural underserved patients with asthma.

Pharmacy language assistance resources and their association with pharmacists' self-efficacy in communicating with Spanish-speaking patients

Background: Spanish‐speaking patients experience significant disparities in care and poorer health outcomes in comparison to English‐speaking patients, often due to language barriers. Providers should be equipped with resources to effectively communicate with Spanish‐speaking patients to provide the best possible care. Purpose: The purpose of this study is to examine the resources available to support pharmacists communication with Spanish‐speaking patients. Methods: A cross‐sectional study design was used to examine language‐assistance resources in community pharmacies throughout the state of Illinois. A telephone survey contained items to examine the accessibility, frequency of use, ease of use, and helpfulness of language‐assistance resources; items were rated on a 5‐point Likert‐type scale (1 = Never to 5 = Always). The survey also included nine items to assess pharmacists self‐efficacy in communicating with Spanish‐speaking patients. Purposeful sampling was utilized to increase the likelihood of obtaining information from pharmacies serving Hispanic populations. The sample was categorized into high and low Spanish‐speaking populations based on pharmacists self‐reported data. Bivariate and multivariate analyses were used to examine relationships between language‐assistance resources and pharmacist self‐efficacy. Results: A total of 231 community pharmacists participated in the survey. The most accessible language‐assistance resources were computer‐based (92%) and telephone help lines (80%). Among various computer‐based resources, Spanish labels (M = 2.12, SD = 1.58) and leaflets (M = 2.04, SD = 1.49) were the most frequently used. Computer generated Spanish leaflets and labels, and language‐assistance telephone lines were also perceived to be easier to use and more helpful in comparison to paper‐based resources and personnel. Respondents also reported that it was easy to use friends and family (M = 3.5, SD = 1.8) and that they were helpful (M = 3.58, SD = 1.26). Access to computer‐based resources (&bgr; = 0.16, P = 0.02), and to family or friends who speak Spanish (&bgr; = 0.24, P < 0.01) were significantly associated with self‐efficacy (P < 0.01), after controlling for race and education. Conclusions: Despite having access to computer‐based resources and language‐assistance telephone lines, pharmacists rarely used these resources to communicate with Spanish‐speaking patients. Efforts such as workplace resource training and pharmacy school cultural competency curricula should be implemented to promote as well as support pharmacists use of language‐assistance resources to provide optimal care to Spanish‐speaking patients.

Patient-centred outcomes research: brave new world meets old institutional policies

BackgroundnEngaging patients across the research trajectory supports research that is generalizable, high quality, timely and actionable. However, this approach comes with challenges and opportunities as investigators and engaged patient stakeholders encounter institutional policies around patient engagement, privacy and research participant protection.nnnObjectivenTo describe the resolution and impact of quandaries arising when patient stakeholders values and preferences conflicted with institutional policies.nnnMethodsnCase study from a Patient-Centered Outcomes Research Institute-funded trial.nnnResultsnThe first example focuses on the tension between the health care organizations requirements for background checks for all patient advisors and the funders requirement to engage hard-to-reach populations. To create an environment of mutual trust and respect with patient stakeholders, the research team decided against imposing background checks. All 53 patient and parent advisors have served continuously for 2 years and meeting attendance exceeds 95%. The second example describes parent stakeholders role in revising a letter informing patients about a privacy violation. Among 49 families affected by and informed about this violation, 35 (71%) agreed to participate. The third example focuses on how patient stakeholder preferences about study reminders conflict with the 1996 Health Insurance Portability and Accountability Act rules. While patient stakeholders strongly endorsed text message reminders, regulations and technology do not permit reminders with enough detail to ensure clarity. Although retention rates exceeded 90%, attendance at study appointments was below 75% and below 60% for minority and low socio-economic status families.nnnConclusionnPatient engagement positively impacts research. Resolving conflicts between patient-engaged research and existing institutional policies and regulations would allow this impact to become fully realized.

The relationship of Type 1 diabetes self-management barriers to child and parent quality of life: a US cross-sectional study

Families of children and adolescents with Type 1 diabetes experience self‐management challenges that negatively impact diabetes control. This study assesses whether self‐management challenges are also associated with quality of life (QOL) for children and adolescents with Type 1 diabetes and their parents.