The healthy people initiative: understanding the user's perspective.

OBJECTIVE: After 30 years of implementation, this study provides the first assessment of how the nation's preeminent health promotion and disease prevention initiative, Healthy People, is utilized by key stakeholders in state, local, and tribal health organizations. METHODS: Surveys of state, local, and tribal health organizations were conducted in 2005 and 2009. Respondents completed a questionnaire about their organization's awareness and the use of Healthy People 2010. RESULTS: The awareness and use of Healthy People have grown over time. However, states are 32% more likely than local organizations and more than 200% more likely than tribal organizations to use Healthy People, demonstrating a continued need for targeted outreach directed toward local, tribal, and smaller health organizations. Different stakeholders appreciate different aspects of Healthy People. Barriers to increased use of Healthy People are primarily attributed to organizations, rather than the Healthy People initiative itself. Implementation planning for Healthy People 2020 is well aligned with users' recommendations. CONCLUSIONS: The Healthy People initiative is useful to different stakeholder groups in different ways. Encouraging and assisting users to adopt a broader set of its functionalities could increase the overall utility of the initiative.

Field test results of a new ambulatory care Medication Error and Adverse Drug Event Reporting System--MEADERS.

PURPOSE: In this study, we developed and field tested the Medication Error and Adverse Drug Event Reporting System (MEADERS)-an easy-to-use, Web-based reporting system designed for busy office practices. METHODS: We conducted a 10-week field test of MEADERS in which 220 physicians and office staff from 24 practices reported medication errors and adverse drug events they observed during usual clinical care. The main outcomes were (1) use and acceptability of MEADERS measured with a postreporting survey and interviews with office managers and lead physicians, and (2) distributions of characteristics of the medication event reports. RESULTS: A total of 507 anonymous event reports were submitted. The mean reporting time was 4.3 minutes. Of these reports, 357 (70%) included medication errors only, 138 (27%) involved adverse drug events only, and 12 (2.4%) included both. Medication errors were roughly equally divided among ordering medications, implementing prescription orders, errors by patients receiving the medications, and documentation errors. The most frequent contributors to the medication errors and adverse drug events were communication problems (41%) and knowledge deficits (22%). Eight (1.6%) of the reported events led to hospitalization. Reporting raised staff and physician awareness of the kinds of errors that occur in office medication management; however, 36% agreed or strongly agreed that the event reporting "has increased the fear of repercussion in the practice." Time pressure was the main barrier to reporting. CONCLUSIONS: It is feasible for primary care clinicians and office staff to report medication errors and adverse drug events to a Web-based reporting system. Time pressures and a punitive culture are barriers to event reporting that must be overcome. Further testing of MEADERS as a quality improvement tool is warranted.

Obesity and the workplace: current programs and attitudes among employers and employees.

This paper presents findings about weight management programs at the workplace, and employers' and employees' views about these programs. Data are from a survey of 505 randomly selected public and private employers with fifty or more employees, and a survey of 1,352 households with employer-based insurance. The majority of employers with 5,000 or more workers offer programs such as on-site exercise facilities, nutritional counseling, and health risk appraisals, whereas sizable minorities of smaller employers offer them. Employers and employees view weight management programs as appropriate and effective. Employers want programs to pay for themselves, whereas employees are willing to pay higher premiums for them.