Building digital solutions to support brain health prescribing in primary care: Where to begin?
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ABSTRACT:
SUBMITTER: Siette J
PROVIDER: S-EPMC10865480 | biostudies-literature | 2024 Jan-Mar
REPOSITORIES: biostudies-literature
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Building digital solutions to support brain health prescribing in primary care: Where to begin?
Siette Joyce J Adam Patrick J PJ
Alzheimer's & dementia (New York, N. Y.) 20240124 1
National and international policy goals on healthy ageing and dementia risk reduction are yet to be fully realised in community healthcare settings. Disease modification strategies through lifestyle and social interventions are viable, evidence-based solutions to reduce age-related disease burden. However, prescribing lifestyle interventions targeting dementia risk in primary care remains deficient. Using digital technologies to support older individuals and healthcare professionals through form ...[more]
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Project description:Background "Direct-to-consumer (DTC) telemedicine" is increasing worldwide and changing the map of primary health care (PHC). Virtual care has increased in the last decade and with the ongoing COVID-19 pandemic, patients' use of online care has increased even further. In Sweden, online consultations are a part of government-supported health care today, and there are several digital care providers on the Swedish market, which makes it possible to get in touch with a doctor within a few minutes. The fast expansion of this market has raised questions about the quality of primary care provided only in an online setting without any physical appointments. Antibiotic prescribing is a common treatment in PHC.Objective This study aimed to compare antibiotic prescribing between digital PHC providers (internet-PHC) and traditional physical PHC providers (physical-PHC) and to determine whether prescriptions for specific diagnoses differed between internet-PHC and physical-PHC appointments, adjusted for the effects of attained age at the time of appointment, gender, and time relative to the COVID-19 pandemic.Methods Antibiotic prescribing data based on Anatomical Therapeutic Chemical (ATC) codes were obtained for Region Sörmland residents from January 2020 until March 2021 from the Regional Administrative Office. In total, 160,238 appointments for 68,332 Sörmland residents were included (124,398 physical-PHC and 35,840 internet-PHC appointments). Prescriptions issued by internet-PHC or physical-PHC physicians were considered. Information on the appointment date, staff category serving the patient, ICD-10 (International Statistical Classification of Diseases, Tenth Revision) diagnosis codes, ATC codes of prescribed medicines, and patient-attained age and gender were used.Results A total of 160,238 health care appointments were registered, of which 18,433 led to an infection diagnosis. There were large differences in gender and attained age distributions among physical-PHC and internet-PHC appointments. Physical-PHC appointments peaked among patients aged 60-80 years while internet-PHC appointments peaked at 20-30 years of age for both genders. Antibiotics with the ATC codes J01A-J01X were prescribed in 9.3% (11,609/124,398) of physical-PHC appointments as compared with 6.1% (2201/35,840) of internet-PHC appointments. In addition, 61.3% (6412/10,454) of physical-PHC infection appointments resulted in antibiotic prescriptions, as compared with only 25.8% (2057/7979) of internet-PHC appointments. Analyses of the prescribed antibiotics showed that internet-PHC followed regional recommendations for all diagnoses. Physical-PHC also followed the recommendations but used a wider spectrum of antibiotics. The odds ratio of receiving an antibiotic prescription (after adjustments for attained age at the time of appointment, patient gender, and whether the prescription was issued before or during the COVID-19 pandemic) during an internet-PHC appointment was 0.23-0.39 as compared with a physical-PHC appointment.Conclusions Internet-PHC appointments resulted in a significantly lower number of antibiotics prescriptions than physical-PHC appointments, adjusted for the large differences in the characteristics of patients who consult internet-PHC and physical-PHC. Internet-PHC prescribers showed appropriate prescribing according to guidelines.
| S-EPMC11237768 | biostudies-literature
Project description:BackgroundThe acceptance of digital health technologies to support patient care for various clinical conditions among primary care providers and staff has not been explored.ObjectiveThe purpose of this study was to explore the extent of potential differences between major groups of providers and staff in primary care, including behavioral health consultants (BHCs; eg, psychologists, social workers, and counselors), primary care providers (PCPs; eg, physicians and nurse practitioners), and nurses (registered nurses and licensed practical nurses) in the acceptance of various health technologies (ie, mobile apps, wearables, live video, phone, email, instant chats, text messages, social media, and patient portals) to support patient care across a variety of clinical situations.MethodsWe surveyed 151 providers (51 BHCs, 52 PCPs, and 48 nurses) embedded in primary care clinics across the United States who volunteered to respond to a web-based survey distributed in December 2020 by a large health care market research company. Respondents indicated the technologies they consider appropriate to support patients' health care needs across the following clinical contexts: acute and chronic disease, medication management, health-promoting behaviors, sleep, substance use, and common and serious mental health conditions. We used descriptive statistics to summarize the distribution of demographic characteristics by provider type. We used contingency tables to compile summaries of the proportion of provider types endorsing each technology within and across clinical contexts. This study was exploratory in nature, with the intent to inform future research.ResultsMost of the respondents were from urban and suburban settings (125/151, 82.8%), with 12.6% (n=19) practicing in rural or frontier settings and 4.6% (n=7) practicing in rural-serving clinics. Respondents were dispersed across the United States, including the Northeast (31/151, 20.5%), Midwest (n=32, 21.2%), South (n=49, 32.5%), and West (n=39, 25.8%). The highest acceptance for technologies across clinical contexts was among BHCs (32/51, 63%) and PCPs (30/52, 58%) for live video and among nurses for mobile apps (30/48, 63%). A higher percentage of nurses accepted all other technologies relative to BHCs and PCPs. Similarly, relative to other groups, PCPs indicated lower levels of acceptance. Within clinical contexts, the highest acceptance rates were reported among 80% (41/51) of BHCs and 69% (36/52) of PCPs endorsing live video for common mental health conditions and 75% (36/48) of nurses endorsing mobile apps for health-promoting behaviors. The lowest acceptance across providers was for social media in the context of medication management (9.3% [14/151] endorsement across provider type).ConclusionsThe survey suggests potential differences in the way primary care clinicians and staff envision using technologies to support patient care. Future work must attend to reasons for differences in the acceptance of various technologies across providers and clinical contexts. Such an understanding will help inform appropriate implementation strategies to increase acceptability and gain greater adoption of appropriate technologies across conditions and patient populations.
| S-EPMC8917439 | biostudies-literature
Project description:BackgroundGenerative artificial intelligence has the potential to revolutionize health technology product development by improving coding quality, efficiency, documentation, quality assessment and review, and troubleshooting.ObjectiveThis paper explores the application of a commercially available generative artificial intelligence tool (ChatGPT) to the development of a digital health behavior change intervention designed to support patient engagement in a commercial digital diabetes prevention program.MethodsWe examined the capacity, advantages, and limitations of ChatGPT to support digital product idea conceptualization, intervention content development, and the software engineering process, including software requirement generation, software design, and code production. In total, 11 evaluators, each with at least 10 years of experience in fields of study ranging from medicine and implementation science to computer science, participated in the output review process (ChatGPT vs human-generated output). All had familiarity or prior exposure to the original personalized automatic messaging system intervention. The evaluators rated the ChatGPT-produced outputs in terms of understandability, usability, novelty, relevance, completeness, and efficiency.ResultsMost metrics received positive scores. We identified that ChatGPT can (1) support developers to achieve high-quality products faster and (2) facilitate nontechnical communication and system understanding between technical and nontechnical team members around the development goal of rapid and easy-to-build computational solutions for medical technologies.ConclusionsChatGPT can serve as a usable facilitator for researchers engaging in the software development life cycle, from product conceptualization to feature identification and user story development to code generation.Trial registrationClinicalTrials.gov NCT04049500; https://clinicaltrials.gov/ct2/show/NCT04049500.
| S-EPMC10955400 | biostudies-literature
Project description:BackgroundDuring the COVID-19 pandemic, digital health solutions ensured the continuity of care especially in primary healthcare practices. COVID-19 accelerated the adoption of digital health solutions. The aim of this study is to describe the digital health-related attitudes and experiences of Hungarian Primary Care Physicians (PCPs) and also analyse the socio-demographic effects on digital health attitudes among PCPs.MethodsThis study used a quantitative and qualitative mixed methodological approach to examine the digital health-related attitudes and experience of Hungarian PCPs. As part of the "E-physicians and E-patients in Hungary" survey, we conducted an online survey among medical doctors working in Hungary between July 2021 to May 2022. A total of 1,774 questionnaires were received, consisting of 1,576 medical doctors and 198 dentists. Among the medical doctors there were 415 primary care physicians (PCPs). In addition to the online questionnaire survey, qualitative research in the form of semi-structured interviews with doctors was also conducted. These interviews took place between October 2021 and June 2022. A total of 62 interviews were conducted,19 with PCPs.ResultsPrimary care physicians are more open to technologies that facilitate communication and collaboration with patients, while showing less interest in technologies that support clinical work. Of the demographic variables (age, gender, type of settlement), age was found to have the most significant effect on digital health knowledge, use and intended use. Both the interviews and the multivariate analysis indicate that individuals with greater knowledge, expertise, and experience are more likely to perceive the advantages of digital solutions. This highlights the importance of training, especially given the significant aging population among Hungarian primary care physicians, who may not be accustomed to using these tools naturally. The way PCPs perceive patient expectations regarding the use of digital health tools has a significant impact on the PCPs' use and intended use of digital tools. When looking at perceived patient needs among PCPs the effect of age and municipality type of PCPs is significant. As age increases, the perception of patient needs decreases (from 5.02 to 4.47), and by municipality type, the average number of perceived needs decreases as one moves from larger cities to smaller municipalities (from 4.85 to 4.14).ConclusionsDigital health solutions have the potential to enhance the work of PCPs, but successful implementation requires addressing specific needs, demographic differences, and challenges faced by PCPs. Development of infrastructure, education, and institutional support is necessary to ensure more efficient and higher-quality healthcare delivery through the use of digital technologies.
| S-EPMC11566197 | biostudies-literature
Project description:BackgroundHealth care personnel's (HCP) engagement in patient portal implementation is necessary in embedding the use of the portal in everyday practices of a health care organization. While portal implementation may raise personnel's positive expectations of the benefits in patient care, it is often also stressful for them due to increased workloads and disruptions in clinical workflows. An understanding of social and technical factors that build personnel's support for patient portal implementation and alleviate their eHealth-related stress is therefore needed to realize the full potential of portals.ObjectiveThe aim of this study was to explore the influence of managerial implementation practices, information technology (IT) usability, and personnel's eHealth competences on support for patient portal implementation and eHealth-related stress among primary HCP.MethodsThe data were collected through a survey of 919 members at 2 health organizations in Finland. Linear and logistic regression models were fitted to study the associations between the variables.ResultsProfessionals' eHealth competence (β=.15, P<.001), usability (β=.11, P<.001), and implementation practices (β=.07, P<.001) were positively associated with professionals' support and negatively associated with professionals eHealth-related stress (β=-.07, P=.010; β=-.27, P<.001; and β=-.14, P<.001, respectively). Professionals' support was associated with their promotion of the portal to the patients (odds ratio 1.22, 95% CI 1.07-1.40).ConclusionsThe adoption of appropriate implementation practices and the usability of the technology can build personnel's support for a patient portal and alleviate their stress related to eHealth. Personnel's support is manifested in their promotion of the portal to patients. Health care managers are encouraged to consider the usability of the technology and the good implementation practices, such as proper informing, engagement of the personnel in planning the services, and allocation of resources to improve eHealth competence, as prerequisites for meaningful and sustainable use of patient portals.
| S-EPMC8495577 | biostudies-literature
Project description:BackgroundThe number of people receiving antidepressants has increased in the past 3 decades, mainly because of people staying on them longer. However, in many cases long-term treatment is not evidence based and risks increasing side effects. Additionally, prompting general practitioners (GPs) to review medication does not improve the rate of appropriate discontinuation. Therefore, GPs and other health professionals may need help to support patients discontinuing antidepressants in primary care.ObjectiveThis study aims to develop a digital intervention to support practitioners in helping patients discontinue inappropriate long-term antidepressants (as part of a wider intervention package including a patient digital intervention and patient telephone support).MethodsA prototype digital intervention called Advisor for Health Professionals (ADvisor HP) was planned and developed using theory, evidence, and a person-based approach. The following elements informed development: a literature review and qualitative synthesis, an in-depth qualitative study, the development of guiding principles for design elements, and theoretical behavioral analyses. The intervention was then optimized through think-aloud qualitative interviews with health professionals while they were using the prototype intervention.ResultsThink-aloud qualitative interviews with 19 health professionals suggested that the digital intervention contained useful information and was readily accessible to practitioners. The development work highlighted a need for further guidance on drug tapering schedules for practitioners and clarity about who is responsible for broaching the subject of discontinuation. Practitioners highlighted the need to have information in easily and quickly accessible formats because of time constraints in day-to-day practice. Some GPs felt that some information was already known to them but understood why this was included. Practitioners differed in their ideas about how they would use ADvisor HP in practice, with some preferring to read the resource in its entirety and others wanting to dip in and out as needed. Changes were made to the wording and structure of the intervention in response to the feedback provided.ConclusionsADvisor HP is a digital intervention that has been developed using theory, evidence, and a person-based approach. The optimization work suggests that practitioners may find this tool to be useful in supporting the reduction of long-term antidepressant use. Further quantitative and qualitative evaluation through a randomized controlled trial is needed to examine the feasibility, effectiveness, and cost-effectiveness of the intervention.
| S-EPMC8325079 | biostudies-literature
Project description:BackgroundDigital consultation with primary care physicians via mobile telephone apps has been spreading rapidly in Sweden since 2014. Digital consultation allows remote working because physicians can work from home, outside their traditional primary care environment. Despite the spread of digital consultation in primary care, there is a lack of knowledge concerning how the new service affects physicians' psychosocial work environment. Previous research has focused primarily on the patients' point of view and the cost-effectiveness of digital consultation. Hence, there is a paucity of studies from the perspective of physicians, focusing on their psychosocial work environment. The aim of this study was to investigate primary care physicians' perceived work demands, control over working processes, and social support when providing digital consultation to primary care patients.MethodsThe study has a qualitative design, using semi-structured interviews conducted in Sweden in 2019. We used a purposeful sampling strategy to achieve a heterogeneous sample of physicians who represented a broad spectrum of experiences and perceptions. The interviews were conducted by video meeting, telephone, or a personal meeting, depending on what suited the participant best. The interview questions were informed by the Job Demand-Control-Support (JDCS) model, which was also used as the framework to analyze the data by categorizing the physicians' perceptions and experiences into the three categories of the model (Demand, Control, Support), in the deductive analysis of the data.ResultsAnalysis of the data yielded 9 subcategories, which were mapped onto the 3 categories of the JDCS model. Overall, the participants saw numerous benefits with digital consultations, not only with regard to their own job situation but also for patients and the health care system in general even though they identified some shortcomings and risks with digital care.ConclusionsThis study has demonstrated that physicians perceive working with digital consultation as flexible with a high grade of autonomy and reasonable to low demands. According to the participants, digital consultation is not something you can work with full time if medical skills and abilities are to be maintained and developed.
| S-EPMC7684852 | biostudies-literature
Project description:The agenda for Universal Health Coverage has driven the exploration of various innovative approaches to expanding health services to the general population. As more African countries have adopted digital health tools as part of the strategic approach to expanding health services, there is a need for defining a standard framework for implementation across board. Therefore, there is a need to review and employ an evidence-based approach to inform managing challenges, adopting best approaches, and implement informed recommendations. We reviewed a variety of digital health tools applied to different health conditions in primary care settings and highlighted the challenges faced, approaches that worked and relevant recommendations. These include limited coverage and network connectivity, lack of technological competence, lack of power supply, limited mobile phone usage and application design challenges. Despite these challenges, this review suggests that mHealth solutions could attain effective usage when healthcare workers receive adequate onsite training, deploying applications designed in an intuitive and easy to understand approach in a manner that fits into the users existing workflows, and involvement of the stakeholders at all levels in the design, planning, and implementation stages of the interventions.
| S-EPMC9215204 | biostudies-literature
Project description:To improve population health, one must put emphasis on reducing health inequities and enhancing health protection and disease prevention, and early diagnosis and treatment of diseases by tackling the determinants of health at the downstream, midstream, and upstream levels. There is strong theoretical and empirical evidence for the association between strong national primary care systems and improved health indicators. The setting approach to promote health such as healthy schools, healthy cities also aims to address the determinants of health and build the capacity of individuals, families, and communities to create strong human and social capitals. The notion of human and social capitals begins to offer explanations why certain communities are unable to achieve better health than other communities with similar demography. In this paper, a review of studies conducted in different countries illustrate how a well-developed primary health care system would reduce all causes of mortalities, improve health status, reduce hospitalization, and be cost saving despite a disparity in socioeconomic conditions. The intervention strategy recommended in this paper is developing a model of comprehensive primary health care system by joining up different settings integrating the efforts of different parties within and outside the health sector. Different components of primary health care team would then work more closely with individuals and families and different healthy settings. This synergistic effect would help to strengthen human and social capital development. The model can then combine the efforts of upstream, midstream, and downstream approaches to improve population health and reduce health inequity. Otherwise, health would easily be jeopardized as a result of rapid urbanization.
| S-EPMC1891639 | biostudies-other
Project description:IntroductionThe implementation of technologies in Primary Health Care with monitoring and evaluation of the quality of health care is fundamental to direct the access and quality of health care in the context of the Sustainable Development Goals. Our objective was to develop a model for evaluating digital health interventions in primary care, considering its impact on first contact, longitudinality, integrality and coordination in health.MethodologyThis is an exploratory methodological study of a qualitative nature. This study seeks to explore strategic actors' perceptions of an evaluation model, and was developed in a process between June 2021 and March 2024. The following stages were followed: Identification of previous models available in the literature, model development, model validation, model update. We performed a nominal group consensus technique online with seven experts. Stages taken to define the design of the model: sending the elaborated model, together with an electronic form with 18 subjective questions, such as brainstorming strategy, for recording impressions, judgment of agreement and suggestions; workshop for discussion by videoconference, at the time the objectives and the model diagram were presented, followed by debate with clarification of doubts and suggestions for clarification of the step-by-step design. After incorporating the suggestions, the model agreed upon in the workshop was subjected to another analysis by the same experts, sent in an online Google document, in which possible inconsistencies between the proposed model and the agreed one were verified, as well as the final agreement on the recommended proposal. At the end of this stage, with synchronous and asynchronous remote procedures, consensus was reached.ResultsThe proposed evaluation model presents as primary categories, structure, process and result. The structure encompasses four indicators, namely, employees; financial resources; infrastructure resources; and regulatory and strategic resources. The process is organized into three dimensions, namely: technical dimension, organizational dimension and relational dimension. The results will be evaluated in products; intermediate results; and impacts (short, medium and long term). The results will be measured by the seven pillars of quality: efficacy, effectiveness, efficiency, optimization, acceptability, legitimacy, equity.ConclusionThis study achieved the goal of developing a model to evaluate digital health interventions in Primary Health Care, helping to identify adequate and useful evaluation methods filling the gap of the lack of quality evaluation standards in the brazilian Digital Health Strategy. It presents an important difference in relation to models from different countries, as it considers the impacts on Primary Health Care quality attributes such as first contact care, longitudinality, integrality and coordination of care. The model will be used by managers and health professionals of Primary Health Care in a case study in Brazil to evaluate the quality of health care. It is expected that the proposed model may be used in other evaluation studies and countries through contextual adaptations.
| S-EPMC11580794 | biostudies-literature