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PubMed1991

Cervical cancer screening: women's knowledge, attitudes and preferences.

Screening status of women aged 20-64 registered with a large group practice was determined using laboratory and general practice records. A postal survey was carried out on 1,416 women divided into: 1. 'Non-attenders'--never had a smear. 2. 'Defaulters'--smear more than five years ago. 3. 'Attenders'--smear in last five years. Screening status was related to social class and education. Single and nulliparous women were less likely to have been screened. Knowledge of the test was poor in all three groups. Most women were willing to have a smear performed and previous non-attendance might have been overcome by a call/recall system. The woman's general practitioner was the preferred taker of smears, regardless of sex. Of those willing to have the test 95% would attend the general practitioner if no alternative was provided. Improved uptake depends on an organised call/recall system with smear taking based in primary care, and on improved health education.

Adult↗

PubMed2003

[The pediatrician's approach to bed-wetting. A survey shows that hospital clinics adhere to current recommendations].

On behalf of the Swedish Enuresis Academy a survey how children with primary enuresis nocturna are handled, a questionnaire about investigation and treatment of the condition was sent to all pediatric clinics in Sweden. It was found, that the care of children with enuresis nocturna is initiated at the age of 5-6 years. After a careful history (especially to exclude daytime incontinence problems or signs of bladder dysfunction), a clinical investigation of the child and an urinalysis (dipslide), treatment is started with bedalarm or desmopressin owing to what the child and parents have chosen after having been offered both alternatives. Bedalarm is available at all pediatric clinics, mostly for hire. Follow up is usually performed by telephone by a specialist nurse or urotherapist. Most children with enuresis nocturna are handled at primary care clinics by general practitioners. To complete the survey a similar study in the primary health care system is therefore suggested.

Child↗

PubMedDate not supplied

Improving the human readability of Arden Syntax medical logic modules using a concept-oriented terminology and object-oriented programming expressions.

Medical logic modules are a procedural representation for sharing task-specific knowledge for decision support systems. Based on the premise that clinicians may perceive object-oriented expressions as easier to read than procedural rules in Arden Syntax-based medical logic modules, we developed a method for improving the readability of medical logic modules. Two approaches were applied: exploiting the concept-oriented features of the Medical Entities Dictionary and building an executable Java program to replace Arden Syntax procedural expressions. The usability evaluation showed that 66% of participants successfully mapped all Arden Syntax rules to Java methods. These findings suggest that these approaches can play an essential role in the creation of human readable medical logic modules and can potentially increase the number of clinical experts who are able to participate in the creation of medical logic modules. Although our approaches are broadly applicable, we specifically discuss the relevance to concept-oriented nursing terminologies and automated processing of task-specific nursing knowledge.

Attitude of Health Personnel↗

PubMed2000

The reduction of broken appointments in general dental practice: an audit and intervention approach.

PURPOSE OF STUDY: Accumulation of time lost because of broken appointments in general dental practice can lead to an inefficiently-run practice and may also lead to reduced financial income. This study assessed the reasons for patients failing to attend and analysed the effect of two simple interventions in reducing the numbers of broken appointments. BASIC PROCEDURES: This study audited the causes of broken appointments in a Glasgow dental practice over a four-month period and, in a second four-month period, analysed the effect of using two new methods of patient information in reducing the number of broken appointments in two target groups of the practice population. MAIN FINDINGS: The majority of patients failing to attend for dental treatment were unemployed. Simple changes to recall letters and appointment cards significantly reduced the rates of failed appointments in patients attending the practice. PRINCIPAL CONCLUSIONS: Simple modification to existing practice systems (recall letters and appointment cards) led to a statistically significant reduction in the number of broken appointments.

Appointments and Schedules↗

PubMed2001

HIV adherence strategies take a high-tech route.

An investigational HIV-adherence device has demonstrated that it can keep patients on track with their antiretroviral therapy more effectively than a monthly educational session, according to a recent study. The pocket-sized device, called the Disease Management Assistance System, electronically tells patients when to take their medications and what side effects to monitor.

Anti-HIV Agents↗

PubMedDate not supplied

Maintenance of cholesterol reduction using automated telephone calls.

A critical problem in the dietary treatment of hypercholesterolemia is the long-term maintenance of cholesterol reduction. A system to maintain contact and provide feedback through a computer-interactive phone system was used with 115 subjects who completed a four-week diet and behavioral cholesterol reduction program. The subjects, mean age 48 years, were 87% non-Hispanic Caucasian and 74.8% were female. They were randomized to a control or maintenance group. The maintenance group received calls twice a month for six months. Total cholesterol (TC) and weight (lb) were obtained before and after a four-week program and after the six-month maintenance period. Neither group of subjects with all cholesterol measurements fully maintained initial cholesterol reductions (mean TC: in maintenance [n = 48) 248, 221, 231 versus control [n = 43] 243, 224, 232 mg/dL). All (n = 59) of the maintenance subjects used the phone system, with 83.3% of a subset evaluating it indicating the phone messages were helpful. Patients (n = 25) with > or = 5 lb weight loss and 10% TC decrease from baseline had a better maintenance of TC reduction in the maintenance versus control group (273,208,231 versus 259,205,246 mg/dL) (P < .05). We conclude that (1) maintenance remains a problem for cholesterol-lowering diet interventions, (2)automated phone calls are capable of maintaining contact and providing patient feedback, and (3) this system may help in the maintenance of TC levels for patients who made greater changes.

Cholesterol↗

PubMed1996

What have HMOs learned about clinical prevention services? An examination of the experience at Group Health Cooperative of Puget Sound.

Over the last 20 years, HMOs have begun to develop population- and evidence-based systems for their clinical prevention services. Because of their integrated information systems and staff communications, HMOs are uniquely positioned to help physicians to identify systematically the primary risk factors or secondary prevention needs of individuals and to provide specific referral or screening services and off-site telephone counseling services to effect seamless, organized intervention. A review of the relevant published literature was combined with the empirical experience of the Group Health Cooperative of Puget Sound in Seattle to illustrate the approach of one large staff-model HMO. Challenges for the future include creating clinical information systems, establishing adequate funding, instituting practitioner incentives, training practitioners for behavioral change, and developing and integrating patient self-care.

Health Maintenance Organizations↗

PubMed2004

Cost-effectiveness of an intervention to increase cancer screening in primary care settings.

BACKGROUND: The main goal was to conduct a cost-effectiveness analysis of an intervention designed to increase cancer screening rates in primary care settings serving disadvantaged populations. The Cancer Screening Office Systems intervention reminded clinicians whether screening mammography, Pap smears, and/or fecal occult blood tests were up-to-date in eligible patients and then established a division of office responsibilities to ensure that tests were ordered and completed. METHODS: The cost-effectiveness analysis was predicated on data generated from a cluster-randomized controlled trial of Cancer Screening Office Systems conducted at eight clinics participating in a county-funded health insurance plan in Florida. Cost numerators were computed from estimated time inputs of both clinical personnel and patients valued at nationally representative wages as well as expenses for Cancer Screening Office Systems-related materials and overhead. Effectiveness denominators were constructed from net changes in screening rates observed experimentally over a 12-month follow-up. Two types of incremental cost-effectiveness ratios were computed: the cost per extra screening test by type and the cost per life-year saved without and with Cancer Screening Office Systems. RESULTS: Cancer Screening Office Systems produced statistically significant increases in screening rates, and these gains more than outweighed the costs of the intervention viewed from either payer or societal perspectives. CONCLUSIONS: Cancer Screening Office Systems are a cost-effective means of addressing cancer-related health disparities.

Clinical Laboratory Techniques↗

PubMed2003

Measuring the impact of diagnostic decision support on the quality of clinical decision making: development of a reliable and valid composite score.

OBJECTIVE: Few previous studies evaluating the benefits of diagnostic decision support systems have simultaneously measured changes in diagnostic quality and clinical management prompted by use of the system. This report describes a reliable and valid scoring technique to measure the quality of clinical decision plans in an acute medical setting, where diagnostic decision support tools might prove most useful. DESIGN: Sets of differential diagnoses and clinical management plans generated by 71 clinicians for six simulated cases, before and after decision support from a Web-based pediatric differential diagnostic tool (ISABEL), were used. MEASUREMENTS: A composite quality score was calculated separately for each diagnostic and management plan by considering the appropriateness value of each component diagnostic or management suggestion, a weighted sum of individual suggestion ratings, relevance of the entire plan, and its comprehensiveness. The reliability and validity (face, concurrent, construct, and content) of these two final scores were examined. RESULTS: Two hundred fifty-two diagnostic and 350 management suggestions were included in the interrater reliability analysis. There was good agreement between raters (intraclass correlation coefficient, 0.79 for diagnoses, and 0.72 for management). No counterintuitive scores were demonstrated on visual inspection of the sets. Content validity was verified by a consultation process with pediatricians. Both scores discriminated adequately between the plans of consultants and medical students and correlated well with clinicians' subjective opinions of overall plan quality (Spearman rho 0.65, p < 0.01). The diagnostic and management scores for each episode showed moderate correlation (r = 0.51). CONCLUSION: The scores described can be used as key outcome measures in a larger study to fully assess the value of diagnostic decision aids, such as the ISABEL system.

Artificial Intelligence↗

PubMed2001

Reducing everyday memory and planning problems by means of a paging system: a randomised control crossover study.

OBJECTIVES: To evaluate a paging system designed to improve independence in people with memory problems and executive deficits. METHODS: After a successful pilot study, a randomised control trial was conducted involving a crossover design with 143 people aged between 8 and 83 years. All had one or more of the following: memory, planning, attention, or organisation problems. Most had sustained a traumatic head injury or a stroke although a few had developmental learning difficulties or other conditions. The crossover design ensured that some people received a pager after a 2 week baseline whereas others were required to wait for 7 weeks after the baseline before receiving the pager. Participants were assessed at three time periods-namely, at baseline, 7 weeks, and at 14 weeks postbaseline. RESULTS: More than 80% of those who completed the 16 week trial were significantly more successful in carrying out everyday activities (such as self care, self medication, and keeping appointments) when using the pager in comparison with the baseline period. For most of these, significant improvement was maintained when they were monitored 7 weeks after returning the pager. CONCLUSIONS: This particular paging system significantly reduces everyday failures of memory and planning in people with brain injury.

Adolescent↗

PubMed1995

Including smoking status as a new vital sign: it works!

BACKGROUND: Despite the adverse health consequences of smoking, many physicians still neglect to counsel smokers to quit. This study evaluated the effect of including smoking status as a vital sign on the frequency of physician discussions with patients about smoking and physician advice to quit smoking. METHODS: A consecutive sample of adult ambulatory patients in our metropolitan family practice residency program completed exit surveys on physician and nurse counseling about smoking. Control group data were collected for 1 month before the change was made to include smoking status as a vital sign on patient charts. Charts were then marked with a stamp as a chart prompt in the vital signs section. Data were collected for 2 months after smoking status was added to the stamp. RESULTS: There were 637 individuals surveyed, of whom 179 were current smokers; 95 in the "prestamp" group and 84 in the "poststamp" group. The percentage of patient-physician encounters during which smoking was discussed increased from 47% to 86% (P < .001). Physician advice to quit increased from 50% to 80% (P < .001). Physician discussion of smoking with patients increased across all of the five stages of change but most dramatically (53% to 95%) in the "preparation" stage. Physicians were much less likely to counsel patients in the "precontemplation" stage to quit smoking. CONCLUSIONS: Including smoking as a new vital sign significantly increased the likelihood of smoking-related discussions between patients and their physicians. The stamp is inexpensive and easy to use, and because it is a one-time office system change, it is more likely to be implemented and maintained in busy practices.

Adult↗

PubMed2002

A randomised controlled trial of a patient based Diabetes Recall and Management System: the DREAM trial: a study protocol [ISRCTN32042030].

BACKGROUND: Whilst there is broad agreement on what constitutes high quality health care for people with diabetes, there is little consensus on the most efficient way of delivering it. Structured recall systems can improve the quality of care but the systems evaluated to date have been of limited sophistication and the evaluations have been carried out in small numbers of relatively unrepresentative settings. Hartlepool, Easington and Stockton currently operate a computerised diabetes register which has to date produced improvements in the quality of care but performance has now plateaued leaving substantial scope for further improvement. This study will evaluate the effectiveness and efficiency of an area wide 'extended' system incorporating a full structured recall and management system, actively involving patients and including clinical management prompts to primary care clinicians based on locally-adapted evidence based guidelines. METHODS: The study design is a two-armed cluster randomised controlled trial of 61 practices incorporating evaluations of the effectiveness of the system, its economic impact and its impact on patient wellbeing and functioning.

Database Management Systems↗

PubMed2006

Reducing waiting times for GU medicine appointments: the impact of a new appointment system.

Our objective was to reduce the 'did not attend' (DNA) rates and waiting times by introducing a new confirmatory appointment system prior to their attendance at both Hartlepool and Middlesbrough genitourinary (GU) medicine departments. In Middlesbrough it was previous day appointment confirmation, whereas at Hartlepool it was 10 days. Both systems achieved significant attendance rates of 83.4% and 79.1% at Hartlepool and Middlesbrough, in comparison to 68.7% and 75.0% prior to the new system. The new system will improve the departmental capacity.

Ambulatory Care Facilities↗

PubMed1998

Automated telephone conversations to assess health behavior and deliver behavioral interventions.

The medical care system is not very effective in modifying health behavior of individuals, in particular, ensuring patient compliance with medication regimens, healthy diets, regular physical activity, and regular health screening, and in the avoidance of substance abuse. Telephone-Linked Care (TLC) is a telecommunications technology that enables computer-controlled telephone counseling with patients in their homes. It has been applied to the task of improving a number of different health behaviors. Randomized controlled studies suggest that use of the system for as little as 3 months is associated with improvement in adherence to medication regimens, dietary change in hypercholesterolemia, and increased physical activity among sedentary individuals. Future work involves applying the technology to other important health behaviors, optimally using health behavior theory in the system design, targeting use of TLC to the most appropriate patient groups, incorporating new computer and telecommunications technology into the system, and interfacing TLC into the health care delivery system.

Aged↗

PubMedDate not supplied

Assistive computing devices: a pilot study to explore nurses' preferences and needs.

Healthcare errors among nurses are common because of the fast-paced work environment, in which extensive data must be analyzed and quick decision making is required. Assistive computing devices can help reduce nursing errors by providing timely access to client information and by assisting nurses with client monitoring, decision making, and bedside documentation. The purpose of this pilot study was to determine what assistive computing device features, functions, and input/output modalities nurses would find most useful as support for their nursing duties. Twenty nurses completed a questionnaire that examined their needs and preferences. Data analysis revealed a strong desire for capabilities related to facilitating information access and administering safe medication. The results of this study will be used to develop design criteria for an assistive computing device that will aim to improve the performance of nurses through appropriate information and data support.

Attitude of Health Personnel↗

PubMed2001

A prospective study of immunisation for a cohort of children.

AIMS: To determine rates of immunisation by 24 months of age, the number of times children were recalled and the cost of immunisation for a cohort of children in general practices in Wellington. METHODS: A prospective study of 979 children registered with 27 general practices. Children in the cohort were followed from 9-24 months old. Data collected included immunisation status, the number of times children were recalled and demographic data. RESULTS: At the end of the study period (when children reached 24 months of age) 803 (82%) remained with the practices and 176 (18%) had left. At 24 months 724 (74%) of the total cohort and 685 (85.3%) of registered children who stayed with the practice were fully immunised for the early childhood vaccinations. 54% of the cohort were fully immunised after a standard recall process. The average cost per child immunised was $13.33. CONCLUSION: It is possible to achieve high rates of full immunisation in children registered with a general practice using an effective system of facilitation and support.

Child, Preschool↗

PubMedDate not supplied

Phone technology systems help practices communicate with patients.

Modern computer technology provides practices with modalities to communicate directly with patients at low cost. This article describes several TeleVox systems that allow managers to confirm appointments, issue recalls, and transmit laboratory and other data. Other systems allow patients to leave messages for their providers more directly and also allow practices to supply educational information on medical topics while patients are on hold.

Computer Communication Networks↗

PubMed1992

Screening for cervical cancer: attitudes and policies among Auckland general practitioners.

OBJECTS: to survey Auckland general practitioners and evaluate their attitudes and policies toward screening for cervical cancer. METHODS: an interviewer administered questionnaire asking questions based mainly on the recommendations of the 1985 Working Party on screening for cervical cancer and on some issues resulting from the Cartwright Inquiry. RESULTS: the response rate was 96% of the 100 general practitioners approached. The mean screening interval was 24.1 months. Eighty-eight percent of Auckland general practitioners used a recall system for cervical cancer screening. Doctors more likely to report adherence to the recommendations of the Working Party on screening for cervical cancer were: members and associates of the Royal New Zealand College of General Practitioners; doctors with less than 15 years experience; female doctors; doctors with a diploma of obstetrics and doctors in group practices. CONCLUSIONS: the majority of Auckland general practitioners adhere to the recommendations of the 1985 Working Party on screening for cervical cancer although there is some evidence of overscreening. Areas for improvement include the need for more general practitioners to have a recall system and the need to increase the rate of referral for women with two consecutive smears showing mild dysplasia.

Age Factors↗