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1.
Arch. argent. pediatr ; 117(6): S264-S276, dic. 2019. tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1051632

RESUMO

Introducción: No existen datos en la Argentina acerca de la adopción de tecnologías de información y comunicación (TIC) por parte de los pediatras. Objetivos: Estimar la prevalencia de uso de historia clínica electrónica (HCE) y de mensajería electrónica. Describir percepción de ventajas y desventajas. Población y métodos: Estudio observacional, exploratorio, descriptivo y transversal. Se envió una encuesta autoadministrada al padrón de socios de la Sociedad Argentina de Pediatría entre julio y septiembre de 2017. Resultados: De 14.604 socios, se recibieron 3468 respuestas (el 23,7 %); 2680 fueron completas (el 18,4 %). El porcentaje de uso de HCE fue del 44 %. Se destacaron ventajas: acceso a la información (el 23,2 %), agilización del trabajo (el 20,1 %), resguardo seguro de información (el 14,3 %), disponibilidad (el 11,9 %), cálculo de percentiles (el 11,1 %) y realización de estadísticas (el 9,2 %). Las desventajas percibidas fueron cuestiones técnicas (el 32 %), temor a pérdida de información (el 20 %), dudas sobre cuestiones legales (el 15,8 %). El 49,8 % consideró implementar el uso de HCE en el próximo año.El 76,9 % usaba aplicaciones para recibir consultas de sus pacientes. El WhatsApp (el 46,6 %) fue la plataforma más utilizada. El 74 % consideraba que las consultas no presenciales deberían ser remuneradas. Conclusión: El 44 % de los pediatras que respondieron utilizaba HCE. El 49,8 % consideró implementar algún sistema de HCE durante el año siguiente al estudio. La mensajería electrónica era ampliamente utilizada (el 76,9 %) en todos los rangos etarios.


Introduction: There are not data in Argentina about the percentages of use of Information and Communication Technologies by pediatricians yet. Objectives: To estimate the prevalence of the use of Electronic Health Records (EHR) and Electronic Messaging. To describe the perception of advantages and disadvantages. Population and methods: Observational, exploratory, descriptive and transversal study. Five submissions of a self-administered survey were made to the list of partners of the Sociedad Argentina de Pediatría between July and September of 2017. Results: Of 14,604 partners, 3468 responses were received (23.7 %); 2680 were complete (18.4 %). The overall percentage of use of EHR was 44 %. There were advantages: access to information (23.2 %), streamlining work (20.1 %), secure information backup (14.3 %) and availability (11.9 %), calculation of percentiles (11.1 %) and statistics (9.2 %). The perceived disadvantages: technical issues (32 %), fear of information loss (20 %), doubts about legal issues (15.8 %). The use of EHR was going to be implemented by 49.8 % of respondents in the next year. Applications to receive consultations from their patients were used by 76.9 % of pediatricians. WhatsApp (46.6 %) was the most integrated platform. It was considered by 74 % that non face to face consultations should be remunerated. Conclusion: EHR was used by 44 % of pediatricians who responded. And 49.8 % were considering the implementation of some EHR system during the next year. Electronic messaging was widespread (76.9 %) in all age ranges.


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Informática Médica/estatística & dados numéricos , Comunicação , Argentina , Estudos Transversais , Tecnologia da Informação/estatística & dados numéricos , Registros Eletrônicos de Saúde , Envio de Mensagens de Texto , Pediatras
2.
Int J Med Inform ; 131: 103954, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31513943

RESUMO

OBJECTIVE: To achieve universal access to medical resources-a partial goal of the second ambitious health reform since 2010-the Chinese government aimed to build a regional medical consortium and enhance the efficiency of health information exchange (HIE). We analyzed the experience of constructing a medical consortium in Chinese hospitals, which was based on regional health information technology (RHIT) promoted by HIE. METHOD: In this longitudinal study, we analyzed the results of the annual surveys that were conducted by the China Hospital Information Management Association from 2006 to 2015. The survey results mainly concerned whether hospitals should join the regional medical consortium, the methods used for sharing inter-hospital medical data, and the out-of-hospital information interaction system. The Bass diffusion model was adopted to fit and predict the proportion of Chinese hospitals joining the consortium from 2006 to 2025. RESULT: As of 2015, the survey results of 7272 hospitals were obtained. The proportion of hospitals in partnership systems increased from 3.0% in 2007 to 57.2% in 2015. There has been a rapid development in the electronic sharing of medical data between hospitals. The proportion of hospitals that relied solely on paper documents for data interaction decreased from 43.3% in 2011 to 8.0% in 2015. There was a strong positive linear correlation between hospitals joining the consortium and the accessibility of electronic medical data exchange within hospitals (r = 0.925). The proportions of hospitals that supported dual referral systems and appointments, data browsing between hospitals and regional information systems, and remote consultation services increased to 65.0%, 61.6%, and 81.9% in 2015, as compared to 18.8%, 16.8%, and 10.9% in 2011, respectively. The Bass prediction model showed that the goal of recruiting 90% of the hospitals to the consortium by 2020 will likely be achieved (adjusted R2 = 0.93). CONCLUSION: The Chinese government has applied a top-down, high-level design model to promote the rapid development of a medical consortium, in which the RHIT technologies are crucial technical enabler.


Assuntos
Reforma dos Serviços de Saúde , Hospitais/estatística & dados numéricos , Hospitais/normas , Informática Médica/estatística & dados numéricos , Sistemas Computadorizados de Registros Médicos/organização & administração , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos , China , Humanos , Estudos Longitudinais , Sistemas Computadorizados de Registros Médicos/normas
3.
Prim Health Care Res Dev ; 20: e123, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31434596

RESUMO

This study reports the first assessment of published comments in the family medicine literature using structured codes, which produced commentary annotations that will be the foundation of a knowledge base of appraisals of family medicine trials. Evidence appraisal occurs in a variety of formats and serves to shed light on the quality of research. However, scientific discourse generally and evidence appraisal in particular has not itself been analyzed for insights. A search strategy was devised to identify all journal comments indexed in PubMed linked to controlled intervention studies published in a recent 15-year period in major family medicine journals. A previously developed structured representation in the form of a list of appraisal concepts was used to formally annotate and categorize the journal comments through an iterative process. Trends in family medicine evidence appraisal were then analyzed. A total of 93 comments on studies from five journals over 15 years were included in the analysis. Two thirds of extracted appraisals were negative criticisms. All appraisals of measurement instruments were negative (100%). The participants baseline characteristics, the author discussions, and the design of the interventions were also criticized (respectively 91.7%, 84.6% and 83.3% negative). In contrast, appraisals of the scientific basis of the studies were positive (81.8%). The categories with the most appraisals were, most generally, those focused on the study design, and most specifically, those focused on the scientific basis. This study provides a new data-driven approach to review scientific discourse regarding the strengths and limitations of research within academic family medicine. This methodology can potentially generalize to other medical domains. Structured appraisal data generated here will enable future clinical, scientific, and policy decision-making and broader meta-research in family medicine.


Assuntos
Medicina Baseada em Evidências/organização & administração , Medicina de Família e Comunidade/organização & administração , Informática Médica/estatística & dados numéricos , Informática Médica/normas , Publicações Periódicas como Assunto/estatística & dados numéricos , Publicações Periódicas como Assunto/normas , Medicina Baseada em Evidências/estatística & dados numéricos , Medicina de Família e Comunidade/estatística & dados numéricos , Humanos , Revisão por Pares
4.
Int J Med Inform ; 130: 103893, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31442845

RESUMO

OBJECTIVE: To explore the relationship between the number (breadth) of patient engagement functionalities offered through health information technology (HIT) by hospitals and the hospitals' quality of care. METHODS: Data on hospital adoption of patient engagement functionalities were combined with quality data obtained from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare. Fixed effects regression models were used to analyze a panel data consisting 1,463 hospitals from 2012 to 2014. RESULTS: This study revealed a significant positive relationship between the breadth of patient engagement functionalities and patient satisfaction (ß = 0.126, p < 0.05). The number of functionalities was also found to be negatively associated with 30-day readmission rates for myocardial infarction (ß= -0.085, p < 0.05), heart failure (ß= -0.109, p < 0.05), and pneumonia (ß= -0.048, p < 0.05). DISCUSSION: The breadth of functionalities offered by hospitals to engage patients was a significant factor in decreasing hospital 30-day readmission rates for pneumonia, acute myocardial infarction, and heart failure, and also influenced patients' perception of the hospital. CONCLUSIONS: The findings suggest that hospitals with more patient engagement HIT functionalities are likely to have higher patient satisfaction and lower readmission rates for infarction, heart failure, and pneumonia. This study will potentially assist hospital administrators to justify their strategic deployment of HIT resources to improve both perceived and actual care quality.


Assuntos
Sistemas de Informação Hospitalar/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Informática Médica/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , Participação do Paciente , Pneumonia/fisiopatologia , Pneumonia/terapia
5.
Int J Med Inform ; 130: 103950, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31446357

RESUMO

INTRODUCTION: The development of health information and communication technologies (HICTs) could modify the quality and cost of healthcare services delivered to an aging population. However, the acceptance of HICTs - a prerequisite for users to benefit from them - remains a challenge. This population-based study aimed to 1) explore the acceptance of HICTs by community-dwelling older adults as well as the factors associated to the overall acceptance/refusal of HICTs; 2) identify the factors associated with confidentiality (i.e., access to data allowed to physicians only versus to all caregivers) in the subgroup of older adults willing to accept HICTs. METHODS: A total of 3195 community-dwelling 69-83 year-old members of the Lausanne cohort 65+ were included. In 2017, participants filled out a 9-item questionnaire to assess their acceptance of HICTs ("yes without reluctance"; "yes but with reluctance"; "no"). A bivariate analysis was conducted to examine gender and age differences in the acceptance of HICTs. A multivariable logistic regression was performed to model 1) accepting all or rejecting all HICTs items; 2) willing to share HICTs items with physicians only versus all caregivers. RESULTS: The answer "acceptance without reluctance" ranged from 26.4% to 70.4% across HICTs and was the most frequent answer to six out of nine HICT items. For every HICT item, the acceptance rate decreased across age categories in women. Overall, 20.2% accepted all the HICTs without reluctance and 9.9% rejected them all. Older age and a lower level of education were significantly associated with both accepting all HICTs without reluctance (OR = 0.78 and OR = 0.65, respectively) and rejecting all HICTs (OR = 1.54 and OR = 2.89, respectively). Women and participants with health vulnerability (depressive symptoms, difficulty in activities of daily living (ADLs)) were less likely to accept data accessibility to non-physicians. CONCLUSION: Acceptance of HICTs was relatively high. To deploy HICTs in the older population, demographic, socioeconomic and health profiles, alongside confidentiality concerns, should be considered.


Assuntos
Vida Independente/psicologia , Tecnologia da Informação/estatística & dados numéricos , Informática Médica/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vigilância da População , Inquéritos e Questionários
6.
Int J Med Inform ; 128: 1-6, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31160006

RESUMO

OBJECTIVE: To determine the impact in the adoption of electronic health records and health information exchanges by local health departments on population health. METHODS: The study analyzed 433 local health departments population-based data across 433 counties in the United States. Controlling for high school graduation rate, percentage of adults with some post- secondary education, race, median household income, percentage rural, population size served, governance structure of local health departments and revenue, the study used multiple linear regression to analyze the impact in the adoption of health information technology by local health departments on the population health of a county. RESULTS: Electronic health records adoption was statistically significant at improving population health at the county level. Health information exchange adoption was not statistically significant. CONCLUSION: When local health departments adopt electronic health records, it improves health- related quality of life and reduces years of potential life lost. POLICY IMPLICATIONS: The value derived from the adoption of electronic health records by local health departments deserves attention because of its abilities to enhance the services provided at local health departments. It is important for local health departments to use health information technology to electronically capture patient information to improve upon the services received at community health centers.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Informática Médica/estatística & dados numéricos , Saúde da População/estatística & dados numéricos , Qualidade de Vida , Adulto , Idoso , Feminino , Humanos , Governo Local , Masculino , Pessoa de Meia-Idade , População Rural , Estados Unidos
7.
Int J Med Inform ; 128: 7-17, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31160014

RESUMO

BACKGROUND: eHealth is defined as "the use of information and communication technology for health". Adoption and acceptance are key concepts to measure the level of eHealth impact. The aim of this systematic review was to critically appraise, synthesise and present evidence of the status of eHealth adoption and acceptance in Saudi Arabia from the perspectives of multiple stakeholders. METHODS: Based on a Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guided protocol published with the international prospective register of systematic reviews (Prospero), five databases were searched for articles published between 1993 and 2017. Inclusion and exclusion criteria of studies were applied in which only peer-reviewed, full-text primary research articles in English language were included. One reviewer performed the searches; two reviewers independently screened the titles then abstracts followed by full articles. Studies excluded were recorded with reasons. Critical appraisal tools appropriate to study design were applied. Eleven items from every study were extracted for further synthesis. RESULTS: After duplicates were removed, 110 papers were screened, and 15 studies met the inclusion criteria. Studies were generally of good quality. Thirty-nine factors were identified as influences affecting the adoption and acceptance of eHealth in Saudi Arabia. Lack of eHealth studies from the perspective of health managers and the limitation of studies to few geographical areas were identified as knowledge gaps. CONCLUSION: eHealth field in Saudi Arabia showed evidence of continual growth in both publications and awareness of significance. Therefore, findings from this review may help key professionals to address the current challenges and barriers and prioritise the main areas for improvement.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Informática Médica/estatística & dados numéricos , Saúde da População/estatística & dados numéricos , Telemedicina/métodos , Humanos , Metanálise como Assunto , Estudos Prospectivos , Arábia Saudita , Participação dos Interessados
9.
Med Ref Serv Q ; 38(1): 97-103, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30942681

RESUMO

With thanks for excellent service to departing co-editor Becky McKay Johnson, this is the first Informatics Education column under the sole current editor. A retrospective analysis of past columns identifies several major themes over the past six years. Different meanings for the term "informatics" are explored, and potential new areas for future Informatics Education columns are proposed.


Assuntos
Informática Médica/estatística & dados numéricos , Informática Médica/tendências , Publicações Periódicas como Assunto/estatística & dados numéricos , Publicações Periódicas como Assunto/tendências , Previsões , Humanos , Estudos Retrospectivos
10.
Artigo em Inglês | MEDLINE | ID: mdl-30884754

RESUMO

As a new type of public health service product, online medical websites (OMWs) are becoming quite popular. OMWs can address patients' basic medical problems remotely and give health guidance online. Compared to traditional hospitals, OMWs are more convenient and inexpensive, they can usually provide a better service for patients with poor medical conditions (especially in rural areas), and they also contribute to the rational distribution of medical resources. Therefore, key factors that affect patients' acceptance of OMWs must be identified to contribute to public health. By integrating perceived risk (PR) and the technology acceptance model (TAM), we proposed a modified TAM and clarified how PR and other factors affect patients' behavioral intention (BI) towards OMWs. A sample of 245 research participants in China took part in this study and the structural equation model (SEM) was used to test our hypotheses. The results revealed that perceived usefulness (PU) is a positive predictor of BI but has no significant effect on attitude (ATT), while perceived ease of use (PEOU) can affect BI through PU and attitude (ATT). Moreover, trust (TRU) was identified as a mediator of PR and PU/PEOU. Also, the doctor⁻patient relationship (DPR) was shown to moderate PR and TRU. In order to increase patients' BI, OMW providers need further innovations to improve patients' TRU and reduce their PR.


Assuntos
Atitude Frente aos Computadores , Internet , Informática Médica/estatística & dados numéricos , Sistemas On-Line/estatística & dados numéricos , China , Confidencialidade , Humanos , Modelos Teóricos , Relações Médico-Paciente , Confiança
11.
Rev Bras Enferm ; 72(1): 19-26, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30916263

RESUMO

OBJECTIVE: To evaluate the Primary Health Care attributes of Fortaleza city, Ceará State. METHOD: Evaluative study carried out at 97 Primary Health Care Units, from August 2015 to June 2016. 451 professionals from the Family Health Strategy participated in the study. We used the Primary Care Assessment Tool - Brazil, which evaluates the attributes, assigning scores on a scale of zero to ten. We adopted as a cut-off point, to consider high Primary Care score, attributes with a value of 6.60 or higher. RESULTS: Among the eight attributes evaluated the First Contact Access and the Coordination - Information System were the ones that obtained the lowest and highest scores, (2.98) and (7.82), respectively. The Overall Score, calculated by means of a mean of the attributes, was 6.34. CONCLUSION: The Primary Care evaluated had a low score, showing the need to discuss mechanisms to boost the attributes that obtained low scores.


Assuntos
Governo Local , Atenção Primária à Saúde/normas , Adulto , Idoso , Brasil , Distribuição de Qui-Quadrado , Continuidade da Assistência ao Paciente/normas , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Estudos Transversais , Escolaridade , Serviços de Planejamento Familiar/normas , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Assistência Domiciliar/normas , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Masculino , Informática Médica/normas , Informática Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Religião , Estatísticas não Paramétricas
12.
BMC Med Res Methodol ; 19(1): 53, 2019 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-30871502

RESUMO

BACKGROUND: The availability of clinical and therapeutic data drawn from medical records and administrative databases has entailed new opportunities for clinical and epidemiologic research. However, these databases present inherent limitations which may render them prone to new biases. We aimed to conduct a structured review of biases specific to observational clinical studies based on secondary databases, and to propose strategies for the mitigation of those biases. METHODS: Scoping review of the scientific literature published during the period 2000-2018 through an automated search of MEDLINE, EMBASE and Web of Science, supplemented with manually cross-checking of reference lists. We included opinion essays, methodological reviews, analyses or simulation studies, as well as letters to the editor or retractions, the principal objective of which was to highlight the existence of some type of bias in pharmacoepidemiologic studies using secondary databases. RESULTS: A total of 117 articles were included. An increasing trend in the number of publications concerning the potential limitations of secondary databases was observed over time and across medical research disciplines. Confounding was the most reported category of bias (63.2% of articles), followed by selection and measurement biases (47.0% and 46.2% respectively). Confounding by indication (32.5%), unmeasured/residual confounding (28.2%), outcome misclassification (28.2%) and "immortal time" bias (25.6%) were the subcategories most frequently mentioned. CONCLUSIONS: Suboptimal use of secondary databases in pharmacoepidemiologic studies has introduced biases in the studies, which may have led to erroneous conclusions. Methods to mitigate biases are available and must be considered in the design, analysis and interpretation phases of studies using these data sources.


Assuntos
Pesquisa Biomédica/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Armazenamento e Recuperação da Informação/estatística & dados numéricos , Farmacoepidemiologia/estatística & dados numéricos , Viés , Pesquisa Biomédica/métodos , Pesquisa Biomédica/normas , Assistência à Saúde/normas , Política de Saúde , Serviços de Saúde/normas , Serviços de Saúde/estatística & dados numéricos , Humanos , Armazenamento e Recuperação da Informação/métodos , Armazenamento e Recuperação da Informação/normas , Informática Médica/métodos , Informática Médica/normas , Informática Médica/estatística & dados numéricos , Farmacoepidemiologia/métodos
13.
BMC Health Serv Res ; 19(1): 128, 2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30782147

RESUMO

BACKGROUND: Patient and public involvement (PPI) in health education is a practice whereby research and education are carried in collaboration 'with' patients and/or citizens, maintaining their role as a team member or expert. PPI in health education is of great interest for all stakeholders in the field, as it can make program development more relevant to the public and increase its utilization by the target population. However, little is known about how PPI should be implemented in different settings particularly in rural and remote areas. Therefore, a deeper understanding of how PPI works in different environments is needed. We aim to explore how information and communication technologies (ICT) are used for PPI in health education programs in rural and remote areas. METHODS: We performed a scoping review. Two reviewers independently selected 641 studies from five electronic databases. Data were extracted, charted and validated by the senior researcher and study lead. We performed a narrative synthesis to map the literature. RESULTS: Of the initial 641 articles identified, 5 fit the eligibility criteria. Most of the studies targeted community members at large. Consultation and collaboration were the main levels of PPI, which included communities at large and specific at-risk groups. The main forms of ICT used were telephone and Internet, followed by teleconferences, electronic health records, and weblogs. No study measured the effectiveness of ICT for involving patients in health education in rural and remote areas. CONCLUSION: Telephone and Internet were the most frequently used forms of PPI in health education in rural areas with consultation and collaboration as the main levels of PPI there. No study measured the impact of ICT for PPI in health education in rural areas. Due to this, measuring the impact of ICT in rural and remote areas as a means for PPI in health education of medical students, health professionals and patients requires further study.


Assuntos
Comunicação , Educação em Saúde/organização & administração , Tecnologia da Informação/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Internet/estatística & dados numéricos , Masculino , Informática Médica/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Saúde da População Rural/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos
14.
Implement Sci ; 14(1): 10, 2019 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-30700316

RESUMO

BACKGROUND: Interpersonal relationships among professionals drive both the adoption and rejection of consequential innovations. Through relationships, decision-makers learn which colleagues are choosing to adopt innovations, and why. The purpose of our study was to understand how and why long-term care (LTC) leaders in a pan-Canadian interpersonal network provide and seek advice about care improvement innovations, for the eventual dissemination and implementation of these innovations. METHODS: We used a mixed methods approach. An online survey was sent to senior leaders in 958 LTC facilities in 11 Canadian provinces and territories. Participants were asked to name up to three individuals whose advice they most value when considering care improvement and practice innovations. Sociometric analysis revealed the structure of provincial-level advice networks and how those networks were linked. Using sociometric indicators, we purposively selected 39 key network actors to interview to explore the nature of advice relationships. Data were analyzed thematically. RESULTS: In this paper, we report our qualitative findings. We identified four themes from the data. One theme related to characteristics of particular network roles: opinion leaders, advice seekers, and boundary spanners. Opinion leaders and boundary spanners have long tenures in LTC, a broad knowledge of the network, and share an interest in advancing the sector. Advice seekers were similarly committed to LTC; they initially seek and then, over time, exchange advice with opinion leaders and become an important source of information for them. A second theme related to characterizing advice seeking relationships as formal, peer-to-peer, mentoring, or reciprocal. The third and fourth themes described motivations for providing and seeking advice, and the nature of advice given and sought. Advice seekers initially sought information to resolve clinical care problems; however, over time, the nature of advice sought expanded to include operational and strategic queries. Opinion leaders sought to expand their networks and to solicit information from their more established advice seekers that might benefit the network and advance LTC. CONCLUSIONS: New knowledge about the distinct roles that different network actors play vis-a-vis one another offers healthcare professionals, researchers, and decision- and policy-makers insights that are useful when formulating best practice dissemination strategies.


Assuntos
Difusão de Inovações , Relações Interprofissionais , Assistência de Longa Duração/normas , Prática Profissional/normas , Atitude do Pessoal de Saúde , Canadá , Aconselhamento , Feminino , Humanos , Comportamento de Busca de Informação , Entrevistas como Assunto/estatística & dados numéricos , Liderança , Masculino , Informática Médica/estatística & dados numéricos , Motivação
15.
PLoS One ; 14(1): e0209654, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30629632

RESUMO

BACKGROUND AND OBJECTIVES: The information technology is a pivotal source of communication between patients and healthcare providers for managing chronic diseases. The objective of this study is to assess the capacity and willingness of patients to use information technology for managing chronic diseases. METHODS: A descriptive, cross-sectional study design was employed. Study was conducted in six tertiary care hospitals of Lahore, Pakistan. The study population consisted of patients aged ≥18 years and diagnosed with a minimum of one chronic non-communicable disease. A structured questionnaire was administered to the study participants for data collection. SPSS was used for data analysis. RESULTS: Among the 400 respondents, hypertension (39.5%) was the leading chronic condition followed by diabetes (27.5%). Majority of the patients owned a cell phone (90.7%) and had internet access (66.2%). Almost half of the respondents (51.0%) were willing to use text messages; whereas 78.5% and 75.7% of the respondents were reluctant to use video conference and e-mail as a source of communication with healthcare providers. Reason for unwillingness to use e-mail was the patients' desire to be directly examined by the doctor; whereas unfamiliarity with the use of text message and video conference was the major reason for not using these technologies. Logistic regression analysis revealed that interest in using e-mail to interact with specialist was more among those participants who had good self-reported health (OR = 2.579, 95%CI = 1.276-5.212, p = .008), access to internet (OR = 5.416, 95%CI = 2.777-10.564, p < .001), and those who owned a cell phone (OR = 12.944, 95%CI = 1.751-95.704, p = .012). Interest in using text messages to interact with specialist was more among participants with middle-income group (OR = 2.303, 95%CI = 1.389-3.818, p < .001), residency in close proximity to healthcare professional (OR = 3.529, 95%CI = 2.333-5.339, p < .001), access to internet (OR = 3.253, 95%CI = 2.102-5.033, p < .001) and among those who owned a cell phone (OR = 46.709, 95%CI = 6.335-344.377, p < .001). Interest in using video conference to interact with specialist was more among those participants who had access to internet (OR = 5.840, 95%CI = 2.825-12.069, p < .001) and among those who owned a cell phone (OR = 11.177, 95%CI = 1.510-82.725, p = .018). CONCLUSION: This study concluded that nearly half of the respondents were willing to use text messages; whereas, majority was reluctant in using video conference and e-mail as a source of communication with healthcare providers. Most of the respondents who were located farther from the health care provider were willing to use video conferencing in case it could save more than 60 minutes of their time.


Assuntos
Informática Médica/tendências , Pacientes/psicologia , Telemedicina/métodos , Adolescente , Adulto , Idoso , Telefone Celular , Doença Crônica/psicologia , Comunicação , Estudos Transversais , Correio Eletrônico , Feminino , Humanos , Ciência da Informação , Tecnologia da Informação/estatística & dados numéricos , Tecnologia da Informação/tendências , Masculino , Informática Médica/métodos , Informática Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Paquistão , Inquéritos e Questionários , Telemedicina/estatística & dados numéricos , Envio de Mensagens de Texto , Comunicação por Videoconferência
16.
BMC Res Notes ; 12(1): 42, 2019 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-30658682

RESUMO

OBJECTIVE: Misspellings in clinical free text present challenges to natural language processing. With an objective to identify misspellings and their corrections, we developed a prototype spelling analysis method that implements Word2Vec, Levenshtein edit distance constraints, a lexical resource, and corpus term frequencies. We used the prototype method to process two different corpora, surgical pathology reports, and emergency department progress and visit notes, extracted from Veterans Health Administration resources. We evaluated performance by measuring positive predictive value and performing an error analysis of false positive output, using four classifications. We also performed an analysis of spelling errors in each corpus, using common error classifications. RESULTS: In this small-scale study utilizing a total of 76,786 clinical notes, the prototype method achieved positive predictive values of 0.9057 and 0.8979, respectively, for the surgical pathology reports, and emergency department progress and visit notes, in identifying and correcting misspelled words. False positives varied by corpus. Spelling error types were similar among the two corpora, however, the authors of emergency department progress and visit notes made over four times as many errors. Overall, the results of this study suggest that this method could also perform sufficiently in identifying misspellings in other clinical document types.


Assuntos
Dicionários como Assunto , Informática Médica/métodos , Processamento de Linguagem Natural , Vocabulário Controlado , Algoritmos , Humanos , Idioma , Informática Médica/normas , Informática Médica/estatística & dados numéricos , Sistemas Computadorizados de Registros Médicos/normas , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos , Patologia Cirúrgica/métodos , Reprodutibilidade dos Testes , Relatório de Pesquisa/normas , Unified Medical Language System/normas , Unified Medical Language System/estatística & dados numéricos
17.
BMC Health Serv Res ; 18(1): 854, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30428878

RESUMO

BACKGROUND: Both conventional health care providers and complementary therapists treat cancer patients. To provide effective treatment, both types of providers should to be familiar with their own as well as alternative types of treatment. Our aim was to compare how conventional health care providers (oncology doctors, oncology nurses, family physicians) and complementary therapists (acupuncturists, reflexologists, massage therapists) seek information about conventional and complementary cancer treatments. METHOD: This analysis was conducted on the basis of feedback from 466 participants. We used self-administered questionnaires in a cross-sectional study. RESULTS: The majority of the medical doctors (96%) searched for evidence-based information regarding conventional cancer treatments. They gathered this information mostly from guidelines, which is considered best practice and is expected from Norwegian health personnel. Eighty-one percent of the nurses gather this information from evidence based resources such as UpToDate. Colleagues were asked for information by 58% of the medical doctors and 64% of the nurses. Moreover, 50% of the medical doctors and 57% of the nurses searched for evidence-based information about complementary cancer modalities. The acupuncturists gathered evidence-based information for both conventional (79%) and complementary (77%) modalities, followed by the reflexologists (54 and 54%, respectively) and massage therapists (54 and 52%, respectively). Nearly half of the acupuncturist (49%) asked a colleague for information. CONCLUSION: To provide safe cancer care, it is important that advice about complementary modalities is based on current and evidence-based evaluations. The majority of the medical doctors and nurses in this study sought information according to evidence-based medicine regarding conventional cancer treatments, and about half of them gathered evidence-based information about complementary cancer modalities. This was also true for the complementary therapists as they gathered information about complementary and conventional treatments from evidence-based evaluations. This demonstrates that since the term evidence-based medicine was first introduced in 1991, the approach has grown extensively and both conventional and complementary providers use this approach to seek information.


Assuntos
Terapias Complementares/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Comportamento de Busca de Informação , Informática Médica/estatística & dados numéricos , Neoplasias/terapia , Terapias Complementares/psicologia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Humanos , Masculino , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Noruega , Médicos de Família/psicologia , Médicos de Família/estatística & dados numéricos , Inquéritos e Questionários
18.
BMC Med Res Methodol ; 18(1): 77, 2018 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-29986654

RESUMO

BACKGROUND: Clinical medicine has lagged behind other fields in understanding and utilizing frameworks to guide research. In this article, we introduce a new framework to examine why women choose mastectomy versus breast conserving therapy in early stage breast cancer, and highlight the importance of utilizing a conceptual framework to guide clinical research. METHODS: The framework we present was developed through integrating previous literature, frameworks, theories, models, and the author's past research. RESULTS: We present a conceptual framework that illustrates the central domains that influence women's choice between mastectomy versus breast conserving therapy. These have been organized into three broad constructs: clinicopathological factors, physician factors, and individual factors with subgroups of sociodemographic, geographic, and individual belief factors. The aim of this framework is to provide a comprehensive basis to describe, examine, and explain the factors that influence women's choice of mastectomy versus breast conserving therapy at the individual level. CONCLUSION: We have developed a framework with the purpose of helping health care workers and policy makers better understand the multitude of factors that influence a patient's choice of therapy at an individual level. We hope this framework is useful for future scholars to utilize, challenge, and build upon in their own work on decision-making in the setting of breast cancer. For clinician-researchers who have limited experience with frameworks, this paper will highlight the importance of utilizing a conceptual framework to guide future research and provide an example.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia Segmentar/métodos , Mastectomia/métodos , Informática Médica/métodos , Educação de Pacientes como Assunto/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Comportamento de Escolha , Tomada de Decisões , Feminino , Humanos , Informática Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/estatística & dados numéricos , Relações Médico-Paciente
19.
J Healthc Eng ; 2018: 2060138, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30057729

RESUMO

The inflow of refugees from Syria into Lebanon necessitates a robust and efficient healthcare system in Lebanon to withstand the growing demand for healthcare service. For this purpose, we evaluate the efficiency of healthcare system in Lebanon from 2000 through 2015 by applying a modified data envelopment analysis (DEA) model. We have selected four output variables: life expectancy at birth, maternal mortality ratio, infant mortality rate, and newly infected with HIV and two input variables: total health expenditure (% of GDP) and number of hospital beds. The findings of the paper show improvement in the efficiency of the healthcare system in Lebanon after the widespread of the health system reform in 2005. It also shows that reduction in health expenditure does not necessarily reduce efficiency if operational and technical aspect of the healthcare system is improved. The study infers that the healthcare system in Lebanon is capable of withstanding the increase in health demand provided further resources are made available and the existing technical and operational improvement are maintained.


Assuntos
Assistência à Saúde , Eficiência Organizacional , Informática Médica , Bases de Dados Factuais , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Humanos , Líbano , Informática Médica/métodos , Informática Médica/normas , Informática Médica/estatística & dados numéricos , Refugiados , Síria
20.
J Neurosurg Pediatr ; 21(5): 535-541, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29451451

RESUMO

OBJECTIVE The Internet is used frequently by patients and family members to acquire information about pediatric neurosurgical conditions. The sources, nature, accuracy, and usefulness of this information have not been examined recently. The authors analyzed the results from searches of 10 common pediatric neurosurgical terms using a novel scoring test to assess the value of the educational information obtained. METHODS Google and Bing searches were performed for 10 common pediatric neurosurgical topics (concussion, craniosynostosis, hydrocephalus, pediatric brain tumor, pediatric Chiari malformation, pediatric epilepsy surgery, pediatric neurosurgery, plagiocephaly, spina bifida, and tethered spinal cord). The first 10 "hits" obtained with each search engine were analyzed using the Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test, which assigns a numerical score in each of 5 domains. Agreement between results was assessed for 1) concurrent searches with Google and Bing; 2) Google searches over time (6 months apart); 3) Google searches using mobile and PC platforms concurrently; and 4) searches using privacy settings. Readability was assessed with an online analytical tool. RESULTS Google and Bing searches yielded information with similar CRAAP scores (mean 72% and 75%, respectively), but with frequently differing results (58% concordance/matching results). There was a high level of agreement (72% concordance) over time for Google searches and also between searches using general and privacy settings (92% concordance). Government sources scored the best in both CRAAP score and readability. Hospitals and universities were the most prevalent sources, but these sources had the lowest CRAAP scores, due in part to an abundance of self-marketing. The CRAAP scores for mobile and desktop platforms did not differ significantly (p = 0.49). CONCLUSIONS Google and Bing searches yielded useful educational information, using either mobile or PC platforms. Most information was relevant and accurate; however, the depth and breadth of information was variable. Search results over a 6-month period were moderately stable. Pediatric neurosurgery practices and neurosurgical professional organization websites were inferior (less current, less accurate, less authoritative, and less purposeful) to governmental and encyclopedia-type resources such as Wikipedia. This presents an opportunity for pediatric neurosurgeons to participate in the creation of better online patient/parent educational material.


Assuntos
Internet/normas , Procedimentos Neurocirúrgicos , Pais/educação , Educação de Pacientes como Assunto/normas , Ferramenta de Busca/normas , Estudos Transversais , Humanos , Internet/estatística & dados numéricos , Informática Médica/normas , Informática Médica/estatística & dados numéricos , Pais/psicologia , Educação de Pacientes como Assunto/estatística & dados numéricos , Ferramenta de Busca/estatística & dados numéricos
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