Email for clinical communication between healthcare professionals

Background Email is a popular and commonly-used method of communication, but its use in healthcare is not routine. Where email communication has been utilised in health care, its purposes have included use for clinical communication between healthcare professionals, but the effects of using email in this way are not known. This review assesses the use of email for two-way clinical communication between healthcare professionals. Objectives To assess the effects of healthcare professionals using email to communicate clinical information, on healthcare professional outcomes, patient outcomes, health service performance, and service efficiency and acceptability, when compared to other forms of communicating clinical information. Search methods We searched: the Cochrane Consumers and Communication Review Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP) (1980 to January 2010), PsycINFO (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February 2010), and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists, contacting authors. Selection criteria Randomised controlled trials, quasi-randomised trials, controlled before and after studies and interrupted time series studies examining interventions in which healthcare professionals used email for communicating clinical information, and that took the form of 1) unsecured email 2) secure email or 3) web messaging. All healthcare professionals, patients and caregivers in all settings were considered. Data collection and analysis Two authors independently assessed studies for inclusion, assessed the included studies' risk of bias, and extracted data. We contacted study authors for additional information. We report all measures as per the study report. Main results We included one randomised controlled trial involving 327 patients and 159 healthcare providers at baseline. It compared an email to physicians containing patient-specific osteoporosis risk information and guidelines for evaluation and treatment with usual care (no email). This study was at high risk of bias for the allocation concealment and blinding domains. The email reminder changed health professional actions significantly, with professionals more likely to provide guideline-recommended osteoporosis treatment (bone density measurement and/or osteoporosis medication) when compared with usual care. The evidence for its impact on patient behaviours/actions was inconclusive. One measure found that the electronic medical reminder message impacted patient behaviour positively: patients had a higher calcium intake, and two found no difference between the two groups. The study did not assess primary health service outcomes or harms. Authors' conclusions As only one study was identified for inclusion, the results are inadequate to inform clinical practice in regard to the use of email for clinical communication between healthcare professionals. Future research needs to use high-quality study designs that take advantage of the most recent developments in information technology, with consideration of the complexity of email as an intervention, and costs

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Prescription Drug Monitoring Programs: Evidence-based Practices to Optimize Prescriber Use

As the opioid crisis continues to ravage communities across the United States, policymakers and public health officials are increasingly using new tools such as prescription drug monitoring programs (PDMPs)—state-based electronic databases that track the dispensing of certain controlled substances—to stem the misuse of prescription opioids and reduce overdose deaths.   PDMPs can be used to monitor patient use of these drugs and inform prescribing decisions. However, the number of prescribers actually using these databases in clinical care remains low.A new report from The Pew Charitable Trusts and the Institute for Behavioral Health, Heller School for Social Policy and Management at Brandeis University finds that states can increase prescriber use of PDMPs by adopting one or more of eight evidence-based practices:  Prescriber use mandates, or state laws and regulations that require prescribers to view a patient's PDMP data under certain circumstances. Mandates can rapidly increase PDMP utilization and immediately affect prescriber behavior, which can help prevent "doctor shopping"—when patients seek the same or similar drugs from multiple prescribers and pharmacies in a short period.Delegate access, which allows prescribers to authorize someone on staff, such as a nurse or other member of the health care team, to access the PDMP data on their behalf. The majority of states allow delegate access; evidence suggests such access addresses workflow barriers and increases PDMP use.Unsolicited reports, where prescribers are proactively notified about patients who may be at risk for harm based on their controlled substance prescription history. These alerts can help increase prescriber use in two ways: by motivating them to review patient data and informing unenrolled prescribers about the existence of the PDMP.Improving data timeliness, or increasing the frequency at which data are uploaded into PDMP databases. Many states now require dispensers to upload new data on a daily basis, which increases the timeliness of information and encourages PDMP use.Streamlining enrollment by making it easier for prescribers and delegates to register with their state PDMPs. Enrollment is required before clinicians can check PDMP data, so making this process faster and easier can increase use.Educational and promotional initiatives that help prescribers understand how PDMPs work and encourage their use. Such activities can spur enrolled prescribers and delegates to check PDMP data and inform unenrolled clinicians about the value of these databases. Integrating PDMP data with health information technology, which helps prescribers seamlessly access PDMPs through electronic health records or other IT systems. Pilot projects across the country found that prescribers reported PDMP data were easier to access when the system was integrated into daily workflows. Enhancing PDMP user interfaces, or redesigning how data are presented, to help prescribers more quickly analyze prescribing information and make better-informed decisions.Of the eight practices, mandates are the single most effective way to increase prescriber use. But a mandate alone does not mean that prescribers will use the PDMP effectively in clinical decision-making. Therefore, state officials should explore the other seven strategies and adopt a combination of practices that works best for their program. PDMPs can play a critical role in curbing prescription opioid misuse, but only if states take steps to ensure that the data are easy to access and understand.

Overdose Spike Response Framework for Communities and Local Health Departments

The purpose of this resource is to help local health departments (LHDs) plan for, respond to, and evaluate public health responses to overdose spikes. LHDs play a leading role in detecting spikes and responding to them; but they are not alone. Much of their role requires coordination with other response partners in the planning, execution, and evaluation of an overdose spike response. As the local public health authority, LHDs are best suited to coordinate response efforts among first responders, healthcare, and community-based organizations to efficiently leverage available harm reduction, treatment and recovery resources. This unique role of convening multi-sector partners is even more critical when co-occurring crises, such as the COVID-19 pandemic, or other natural disasters, limit organizations\u2019 capacity to prepare for and respond to an overdose spike event.This framework was supported by funding from the U.S. Centers for Disease Control and Prevention (CDC). This publication was made possible by grant number 6 NU1ROT000015-01-02; Technical Assistance for Response to Public Health or Healthcare Crises from the CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.OVERDOSE-SPIKE-RESPONSE-FRAMEWORK-FOR-COMMUNITIES-LHDS.pdfgrant number 6 NU1ROT000015-01-02; Technical Assistance for Response to Public Health or Healthcare Crises from the CDC

Email for clinical communication between healthcare professionals

Email is one of the most widely used methods of communication, but its use in healthcare is still uncommon. Where email communication has been utilised in health care, its purposes have included clinical communication between healthcare professionals, but the effects of using email in this way are not well known. We updated a 2012 review of the use of email for two-way clinical communication between healthcare professionals

Preventing suicide by young people

Introduction In 2013, 2,522 people died by suicide in Australia. Twenty-two of these were children aged 5- 14 years, 148 were adolescents aged 15-19 years, and a further 200 were young people aged 20-24 years. Although the suicide rate for children and adolescents is lower than that for some older age groups, suicide is the leading cause of death in children and young people. Suicide has immense effects on the families, friends, and communities of people who die by suicide, causing long lasting grief and guilt. Arguably, these effects are even greater when the person who died by suicide is young. It is estimated that suicide costs the Australian economy more than $17 billion per year. Researchers and policy makers recognise that suicide is preventable, yet suicide rates have changed little in the past 10 years. This discussion paper aims to focus a spotlight on the unique experience of young people. It does this by providing a critical analysis of existing policy and evidence based responses relevant to young people

Timely Linkage of Individuals to Substance Use Disorder Treatment: Development, Implementation, and Evaluation of FindHelpNowKY.org

Background: Substance use disorders (SUD) have steadily increased over the last two decades. Seeking SUD treatment involves searching SUD treatment facility types (inpatient, outpatient and intensive outpatient, residential and family residential, and detoxification facilities) that offer specialized SUD treatment depending on individual needs and preferences. Referrals to SUD treatment require innovative strategies that rapidly link individuals to SUD treatment when they are at the critical stage of readiness. The aim of this study was to develop, implement, and evaluate a user-friendly SUD treatment facility opening availability website called FindHelpNowKY.org. The objectives of the study were to 1) recruit SUD treatment facility and partner participation; 2) develop platform, content, and analytics for the FindHelpNowKY.org website intervention with an information repository; 3) assess barriers and facilitators to implementation; and 4) evaluate the development and implementation of FindHelpNowKY.org. Methods: Website development stakeholders were identified and the website concept was developed. The logic model for FindHelpNowKY.org outlined resources, activities, and outputs as well as the associated short-term, medium-term, and long-term objectives, along with a website evaluation plan. Website usability and focus group testing was conducted. Information repository resource documents were compiled and categorized. An inventory of Kentucky-based SUD treatment facilities was compiled using various state and federal resources. Results: Development/implementation barriers were addressed, facilitators were identified, and the website was implemented; 83% of SUD treatment facilities were indexed on the website, and average website user time was 7 min. From February to October 2018, there were 29,000 visitors, and 30,000 unique searches. The most common website query was a friend or family member seeking long-term residential or outpatient treatment facilities accepting Medicaid or Medicare. Conclusions: FindHelpNowKY.org has the potential to fill a critical need for timely access to available SUD treatment in the state. The website may be a valuable resource for health professionals that can enhance clinical workflow and reduce staff time conducting phone and website searches for available SUD treatment. The website is a promising tool for assessing current SUD treatment capacity vs. SUD treatment need. The FindHelpNow model can be used by other states to increase timely access to SUD treatment

Contributions to interoperability, scalability and formalization of personal health systems

The ageing of the world's population combined with unhealthy lifestyles are contributing to a major prevalence of chronic diseases. This scenario poses the challenge of providing good healthcare services to that people affected by chronic illnesses, but without increasing its costs. A prominent way to face this challenge is through pervasive healthcare. Research in pervasive healthcare tries to shift the current centralized healthcare delivery model focused on the doctors, to a more distributed model focused on the patients. In this context Personal Health Systems (PHSs) consists on approaching sampling technologies into the hands of the patients, without disturbing its activities of the daily life, to monitor patient's physiological parameters and providing feedback on their state. The use of PHSs involves the patients in the management of their illness and in their own well being too. The development of PHSs has to face technological issues in order to be accepted by our society. Within them it is important to ensure interoperability between different systems in order to make them work together. Scalability it is also a concern, as their performance must not decrease when increasing the number of users. Another issue is how to formalize the medical knowledge for each patient, as different patients may have different target goals. Security and privacy are a must feature because of the sensitive nature of medical data. Other issues involve the the integration with legacy systems, and the usability of graphical user interfaces in order to encourage old people with the use these technologies. The aim of this PhD thesis is to contribute into the state-of-the-art of PHSs by tackling together different of the above-mentioned challenges. First, to achieve interoperability we use the CDA standard as a format to encode and exchange health data and alerts related with the status of the patient. We show how these documents can be generated automatically through the use of XML templates. Second, we address the scalability by distributing the computations needed to monitor the patients over their devices, rather than performing them in a centralized server. In this context we develop the MAGPIE agent platform, which runs on Android devices, as a framework able to provide intelligence to PHSs, and generate alerts that can be of interest for the patients and the medical doctors. Third, we focus on the formalization of PHSs by providing a tool for the practitioners where they can define, in a graphical way, monitoring rules related with chronic diseases that are integrated with the MAGPIE agent platform. The thesis also explores different ways to share the data collected with PHSs in order to improve the outcomes obtained with the use of this technology. Data is shared between individuals following a Distributed Event-Based System (DEBS) approach, where different people can subscribe to the alerts produced by the patient. Data is also shared between institutions with a network protocol called MOSAIC, and we focus on the security aspects of this protocol. The research in this PhD focuses in the use case of Diabetes Mellitus; and it has been developed in the context of the projects MONDAINE, MAGPIE, COMMODITY12 and TAMESIS.L'envelliment de la població mundial combinat amb uns estils de vida no saludables contribueixen a una major prevalença d'enfermetats cròniques. Aquest escenari presenta el repte de proporcionar uns bons serveis sanitaris a les persones afectades per aquestes enfermetats, sense incrementar-ne els costos. Una solució prometedora a aquest repte és mitjançant l'aplicació del que en anglès s'anomena "pervasive healthcare". L'investigació en aquesta camp tracta de canviar l'actual model centralitzat de serveis sanitaris enfocat en el personal sanitari, per un model de serveis distribuït enfocat en els pacients. En aquest context, els Personal Health Systems (PHSs) consisteixen en posar a l'abast dels pacients les tecnologies de monitorització, i proporcionar-los informació sobre el seu estat. L'ús de PHSs involucra els pacients en la gestió de la seva enfermetat i del seu propi benestar. L'acceptació dels PHSs per part de la societat implica certs reptes tecnològics en el seu desenvolupament. És important garantir la seva interoperabilitat per tal de que puguin treballar conjuntament. La seva escalabilitat també s'ha de tenir en compte, ja que el seu rendiment no s'ha de veure afectat al incrementar-ne el número d'usuaris. Un altre aspecte a considerar és com formalitzar el coneixement mèdic per cada pacient, ja que cada un d'ells pot tenir objectius diferents. La seguretat i privacitat són característiques desitjades degut a la naturalesa sensible de les dades mèdiques. Altres problemàtiques impliquen la integració amb sistemes heretats, i la usabilitat de les interfícies gràfiques per fomentar-ne el seu ús entre les persones grans. L'objectiu d'aquesta tesi és contribuir a l'estat de l'art dels PHSs tractant de manera conjunta varis dels reptes mencionats. Per abordar l'interoperabilitat s'utilitza l'estàndard CDA com a format per codificar les dades mèdiques i alertes relacionades amb el pacient. A més es mostra com aquests documents poden generar-se de forma automàtica mitjançant l' ús de plantilles XML. Per tractar l'escalabilitat es distribueixen les computacions per monitoritzar els pacients entre els seus terminals mòbils, en comptes de realitzar-les en un servidor central. En aquest context es desenvolupa la plataforma d'agents MAGPIE com a framework per proporcionar intelligència als PHSs i generar alertes d'interès per al metge i el pacient. La formalització s'aborda mitjançant una eina que permet als metges definir de manera gràfica regles de monitorització relacionades amb enfermetats cròniques, que a més estan integrades amb la plataforma d'agents MAGPIE. La tesi també explora diferents maneres de compartir les dades recol·lectades amb un PHS, amb l'objectiu de millorar els resultats obtinguts amb aquesta tecnologia. Les dades es comparteixen entre individus seguint un enfoc de sistemes distribuïts basats en events (DEBS), on diferents usuaris poden subscriure's a les alertes produïdes per el pacient. Les dades també es comparteixen entre institucions mitjançant un protocol de xarxa anomenat MOSAIC. A la tesi es desenvolupen els aspectes de seguretat d'aquest protocol. La test es centra en la Diabetis Mellitus com a cas d'ús, i s'ha realitzat en el context dels projectes MONDAINE, MAGPIE, COMMODITY12 i TAMESIS.El envejecimiento de la población mundial combinado con unos estilos de vida no saludables contribuyen a una mayor prevalencia de enfermedades crónicas. Este escenario presenta el reto de proporcionar unos buenos servicios sanitarios a las personas afectadas por estas enfermedades, sin incrementar sus costes. Una solución prometedora a este reto es mediante la aplicación de lo que en inglés se denomina "pervasive healthcare". La investigación en este campo trata de cambiar el actual modelo centralizado de servicios sanitarios enfocado hacia el personal sanitario, por un modelo distribuido enfocado hacia los pacientes. En este contexto, los Personal Health Systems (PHSs) consisten en poner al alcance de los pacientes las tecnologías de monitorización, y proporcionarles información sobre su estado. El uso de PHSs involucra a los pacientes en la gestión de su enfermedad y en su propio bienestar. La aceptación de los PHSs por parte de la sociedad implica ciertos retos tecnológicos en su desarrollo. Es importante garantizar su interoperabilidad para que puedan trabajar conjuntamente. Su escalabilidad también se debe tener en cuenta, ya que su rendimiento no tiene que verse afectado al incrementar su número de usuarios. Otro aspecto a considerar es cómo formalizar el conocimiento médico para cada paciente, ya que cada uno puede tener objetivos distintos. La seguridad y privacidad son características deseadas debido a la naturaleza sensible de los datos médicos. Otras problemáticas implican la integración con sistemas heredados, y la usabilidad de las interfaces gráficas para fomentar su uso entre las personas mayores. El objetivo de esta tesis es contribuir al estado del arte de los PHSs tratando de manera conjunta varios de los retos mencionados. Para abordar la interoperabilidad se usa el estándar CDA como formato para codificar los datos médicos y alertas relacionados con el paciente. Además se muestra como estros documentos pueden generarse de forma automática mediante el uso de plantillas XML. Para tratar la escalabilidad se distribuye la computación para monitorizar a los pacientes en sus terminales móbiles, en lugar de realizarla en un servidor central. En este contexto se desarrolla la plataforma de agentes MAGPIE como framework para proporcionar inteligencia a los PHSs y generar alertas de interés para el médico y el paciente. La formalización se aborda mediante una herramienta que permite a los médicos definir de manera gráfica reglas de monitorización relacionadas con enfermedades crónicas, que ademas están integradas con la plataforma de agentes MAGPIE. La tesis también explora distintas formas de compartir los datos recolectados con un PHS, con el fin de mejorar los resultados obtenidos mediante esta tecnología. Los datos se comparten entre individuos siguiendo un enfoque de sistemas distribuidos basados en eventos (DEBS), donde distintos usuarios pueden suscribirse a las alertas producidas por el paciente. Los datos también se comparten entre instituciones mediante un protocolo dered llamado MOSAIC. En la tesis se desarrollan los aspectos de seguridad de este protocolo. La tesis se centra en la Diabetes Mellitus como caso de uso, y se ha realizado en el contexto de los proyectos MONDAINE, MAGPIE, COMMODITY12 y TAMESIS.Postprint (published version