Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice.

Aim To conduct an environmental scan of a rural primary care clinic to assess the feasibility of implementing an e-communications system between patients and clinic staff. BACKGROUND: Increasing demands on healthcare require greater efficiencies in communications and services, particularly in rural areas. E-communications may improve clinic efficiency and delivery of healthcare but raises concerns about patient privacy and data security. METHODS: We conducted an environmental scan at one family health team clinic, a high-volume interdisciplinary primary care practice in rural southwestern Ontario, Canada, to determine the feasibility of implementing an e-communications system between its patients and staff. A total of 28 qualitative interviews were conducted (with six physicians, four phone nurses, four physicians' nurses, five receptionists, one business office attendant, five patients, and three pharmacists who provide care to the clinic's patients) along with quantitative surveys of 131 clinic patients. Findings Patients reported using the internet regularly for multiple purposes. Patients indicated they would use email to communicate with their family doctor for prescription refills (65% of respondents), appointment booking (63%), obtaining lab results (60%), and education (50%). Clinic staff expressed concerns about patient confidentiality and data security, the timeliness, complexity and responsibility of responses, and increased workload. CONCLUSION: Clinic staff members are willing to use an e-communications system but clear guidelines are needed for successful adoption and to maintain privacy of patient health data. E-communications might improve access to and quality of care in rural primary care practices.

Drug-Related-Problem Outcomes and Program Satisfaction from a Comprehensive Brown Bag Medication Review.

OBJECTIVES: To classify and quantify drug-related problems (DRPs), determine acceptance of DRP recommendations, and assess medication review satisfaction. DESIGN: Comprehensive brown bag medication reviews. SETTING: Six senior centers and three senior high-rises. PARTICIPANTS: Individuals aged 60 and older (mean age 75.9 ± 8.5) taking five or more medications (n = 85). MEASUREMENTS: Two investigators independently classified DRPs using modified Pharmaceutical Care Network Europe classification scheme and severity of medication error and value of service scales. Two other investigators adjudicated classification differences. Satisfaction surveys were administered immediately and 3 months after review. A DRP recommendation implementation survey was completed at least 3 months after the review. RESULTS: Participants had a mean of 4.3 ± 2.8 DRPs (range 0-10). DRPs were classified as adverse reactions (30%), treatment effectiveness (28%), treatment costs (13%), information need (8%), and other (21%). Causes included drug selection (40%), wrong dosage (23%), participant problems (e.g., adherence, lack of medication knowledge, 16%), drug use process problems (12%), drug formulation (0.5%), treatment duration (0.5%), and other (7%). Interventions required drug changes (44%), prescriber input (37%), individual counseling (18%), or other (1%). DRP severities were significant (59%) or minor (35%). Participants expressed satisfaction with the program because they were able to ask questions, trusted the answers, and knew more about their medications. After 3 months, they had implemented 63% of the DRP recommendations. CONCLUSION: Older adults found the medication review helpful and implemented 63% of the DRP recommendations.