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Abstracts
12th
Annual HMO Research Network Conference
Abstracts
from the HMO Research Network
With this
issue we include abstracts from the 2006 12th Annual HMO Research Network
Conference, held in Boston, Massachusetts, which focused on "Optimizing
Practice Through Interdisciplinary Research."
From Institute
on Multicultural Health, Henry Ford Health System, Department of Family
Medicine, University of Michigan
Preliminary
findings from a longitudinal examination of depression and diabetes outcomes
among African Americans.
Lipton
B, Perkins DW, Williams VH, Aikens JE.
background:
Previous research demonstrates that both depression and African-American
race are associated with poor diabetes mellitus (DM)-related outcomes.
In addition, African Americans have been vastly underrepresented in studies
of diabetes-depression comorbidity. The purpose of this study is to evaluate
associations between depression and diabetes outcomes in a racially balanced
sample of participants.
methods: The data for this analysis were drawn from baseline of
a longitudinal study of depression in diabetes being conducted within
a large urban health care system. African-American and Caucasian primary
care patients, 18 years of age with Type 2 DM, were eligible to participate.
Recruitment letters were sent to potentially eligible patients, followed
by telephone screening and informed consent. Participants completed a
measure of depression (Patient Health Questionnaire 9 [PHQ-9])
along with other self-report measures assessing diabetes self-care patterns,
treatment perceptions, and diabetes-related quality of life. Glycemic
control was assessed using HbA1c assays. Data were analyzed
by frequency analysis, student's t-test, and multiple regression analysis.
results:
Between January 2005 and December 2005, 208 participants were enrolled
(57% African American and 43% Caucasian; 55% male). Mean (± SD) participant
age was 56.0 ± 8.8 years and mean HbA1c was 7.6% ±
1.7 (slightly higher than the reference range). Using PHQ-9 guidelines,
18.3% of participants were classifiable as having probable depressive
disorder, which was not significantly associated with ethnicity. However,
compared to Caucasians, African Americans reported significantly more
barriers to glucose self-testing (p < .01), reported significantly
more negative illness perceptions (p < .05), and demonstrated significantly
poorer glycemic control (p < .05).
conclusions:
Compared to Caucasians with diabetes, African Americans with diabetes
experience more barriers to blood glucose testing, view themselves as
having more severe diabetes, and demonstrate poorer glycemic control.
These findings imply that efforts to improve African-Americans' diabetes
outcomes should be culturally tailored, and should address barriers to
glucose testing as well as negative perceptions of having diabetes. Although
the study is limited by its cross-sectional design, future studies of
its longitudinal extension will consider how depression and self-care
behaviors interact over a six-month period to impact long-term outcomes.
From Group
Health Center for Health Studies, Group Health Community Foundation
Identifying
the barriers to optimal healing in primary care.
Hawkes
RJ, Sherman KJ, Wiese CJ, Hsu CW, Cherkin DC.
background:
The current method of reimbursement for physician services encourages
a focus on the procedural and technical aspect of medicine and discourages
development of skills necessary to provide truly patient-centered care.
These emphases on prescriptive services coupled with increased patient
loads and diminished resources have left many primary care providers exhausted
and dispirited. Beleaguered clinicians are unlikely to cultivate effective
healing relationships with patients. In order to restore healing to health
care, clinicians will need to reconnect with patients and their passion
for the art of medicine. This study attempts to elucidate the barriers
to more effective healing from the perspectives of both patients and providers.
methods: Focus groups were conducted with Group Health Cooperative
Physicians (MDs), Registered Nurses (RNs), Licensed Practical Nurses (LPNs)
and Medical Assistants (MAs) working in primary care clinics in western
Washington and with patients who had utilized primary care. Focus groups
lasted two hours and were conducted with 23 MDs, 44 nursing staff (RNs,
LPNs, and MAs) and 28 patients. The proceedings were recorded and transcribed.
The ethnographic software, ATLAS.ti, is being used to analyze the data.
results: Preliminary results indicate that both patients and primary
care team members have a broad view of healing that includes emotional,
spiritual, and physical aspects. Providers and patients view time as an
important barrier to providing healing care and providers believe that
major changes that have occurred in recent years have exacerbated their
stress levels. Many providers noted that the inefficient functioning of
primary care teams contributed to both patient and provider dissatisfaction.
Finally, providers often commented that for meaningful change to occur,
it is important to empower local teams to identify ways to improve the
care they provide.
conclusions: Primary care is in crisis and transformative changes
will be necessary if primary care is to survive as a viable professional
role and as the foundation of rational health care systems. This study
elucidates the barriers that will need to be overcome if primary care
providers are to reconnect with their original passions for medicine and
healing and to be able to provide care that is truly healing.
From Meyers
Primary Care Institute, Worcester, MA; Kunin-Lunenfeld Applied Research
Unit, Toronto, ON, Canada; Masonicare, Wallingford, CG; Brigham and Women's
Hospital, Boston, MA; University of Toronto, Toronto, ON, Canada; University
of Massachusetts Medical School, Worcester, MA
Effect
of computerized physician order entry with clinical decision support on
adverse drug events in the long-term care setting.
Gurwitz
JH, Field TS, Rochon P, Judge JJ, Harrold LR, Lee M, White K, LaPrino
J, Erramuspe-Mainard J, DeFlorio M, Gavendo L, Bell C, Bates DW.
background:
Adverse drug events (ADEs) occur frequently among nursing home residents,
and preventable events are most commonly associated with errors in drug
ordering and monitoring. The purpose of this study was to evaluate the
efficacy of computerized physician order entry with clinical decision
support for preventing ADEs in the long-term setting.
methods: We performed a randomized controlled trial in two large
long-term care facilities for up to one year. Resident care units of the
two facilities were randomized to computerized physician order entry with
and without clinical decision support. Computer alerts included warnings
to reconsider specific drug orders, recommendations for laboratory monitoring,
and alerts to monitor closely for selected drug side effects. On the intervention
units, the alert messages were displayed in a pop-up box to prescribers
in real-time when a drug order was entered. We assessed the numbers and
rates of adverse drug events, as well as preventability.
results: The overall rate of ADEs was 10.8 per 100 resident-months
in the intervention units and 10.4 in the control unites (rate ratio =
1.04; 95% CI 0.89-1.29). The rate of preventable ADEs was 4.0 per 100
resident-months in the intervention units and 3.9 in the control units
(rate ratio = 1.03; 95% CI 0.81-1.32).
conclusions: Use of computerized physician order entry with clinical
decision support was not found to reduce the occurrence of preventable
ADEs in the long-term care setting. Further refinement of computerized
clinical decision support systems for use in the long-term care setting
is essential in order to enhance the impact on medication safety. Such
refinements might include improving the specificity of the alerts to reduce
alert burden for prescribers, incorporating additional alerts into the
clinical decision support system to address a broader range of ADEs, and
integrating more clinical and laboratory information into the clinical
decision support system.
From Center
for Health Research, Kaiser Permanente Northwest, Portland, OR
Clinician
awareness of low health literacy.
Vuckovic
NH, McMullen C, Schneider J.
background:
Literacy is a large and often under-recognized problem in health care
delivery in the US. As many as one in every five American are functionally
illiterate, and an additional 27% have marginal literacy skills. Health
literacy is a term that signifies the skills needed by individuals to
understand and carry out medical instructions and preventive care advice.
Individuals with low health literacy have difficulty reading and understanding
routine health information such as dosage instruction on medication bottles,
appointment slips, preprocedure instructions, and consent forms. Low health
literacy comprises an individual's ability to understand and carry out
medical instructions, and may lead to medication noncompliance, adverse
outcomes, increased outpatient utilization, and preventable hospitalizations.
Clinicians may have limited understanding of the presence and impact of
low health literacy.
methods: We conducted eight focus groups with clinicians and medical
assistants at clinics in Kaiser Permanente Northwest. Focus group interviews
were taped and transcribed, and content analyzed.
results:
Clinicians recognized the negative health impacts that could result from
low health literacy, but were largely unable to tell which patients had
such difficulties. Barriers to screening for low health literacy included
lack of time during the clinic visit and potential discomfort on the part
of the patient. Clinicians and medical assistants discussed the lack of
utility of such assessments if there were no way to document or respond
to positive findings.
conclusions:
While clinicians and staff are aware of the negative outcomes of low health
literacy, screening for low health literacy is seen as problematic. Systemwide
efforts to implement and respond to screening information must be addressed
along with developing proper tools to assess low health literacy.
To
Spring 2007 Contents >>
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