Naturopathy as a model of prevention-oriented, patient-centered primary care: A disruptive innovation in health care

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. Background and Objective: The concept of a “disruptive innovation,” recently extended to health care, refers to an emerging technology that represents a new market force combined with a new value system, that eventually displaces some, or all, of the current leading “stakeholders, products and strategic alliances.” Naturopathy is a distinct system of traditional and complementary medicine recognized by theWorld Health Organization (WHO), emerging as a model of primary care. The objective here is to describe Naturopathy in the context of the criteria for a disruptive innovation. Methods: An evidence synthesis was conducted to evaluate Naturopathy as a potentially disruptive technology according to the defining criteria established by leading economists and health technology experts: (1) The innovation must cure disease; (2) must transform the way medicine is practiced; or (3) have an impact that could be disruptive or sustaining, depending on how it is integrated into the current healthcare marketplace. Results: The fact that Naturopathy de-emphasizes prescription drug and surgical interventions in favor of nonpharmacological health promotion and self-care could disrupt the present economic model that fuels health care costs. The patient-centered orientation of Naturopathy, combined with an emphasis on preventive behaviors and popular complementary and integrative health services like natural products, mind and body therapies, and other therapies not widely represented in current primary care models increase the likelihood for disruption. Conclusions: Because of its patient-centered approach and emphasis on prevention, naturopathy may disrupt or remain a durable presence in healthcare delivery depending on policymaker decisions

Complementary and Integrative Health Lexicon (CIHLex) and Entity Recognition in the Literature

Objective: Our study aimed to construct an exhaustive Complementary and Integrative Health (CIH) Lexicon (CIHLex) to better represent the often underrepresented physical and psychological CIH approaches in standard terminologies. We also intended to apply advanced Natural Language Processing (NLP) models such as Bidirectional Encoder Representations from Transformers (BERT) and GPT-3.5 Turbo for CIH named entity recognition, evaluating their performance against established models like MetaMap and CLAMP. Materials and Methods: We constructed the CIHLex by integrating various resources, compiling and integrating data from biomedical literature and relevant knowledge bases. The Lexicon encompasses 198 unique concepts with 1090 corresponding unique terms. We matched these concepts to the Unified Medical Language System (UMLS). Additionally, we developed and utilized BERT models and compared their efficiency in CIH named entity recognition to that of other models such as MetaMap, CLAMP, and GPT3.5-turbo. Results: From the 198 unique concepts in CIHLex, 62.1% could be matched to at least one term in the UMLS. Moreover, 75.7% of the mapped UMLS Concept Unique Identifiers (CUIs) were categorized as "Therapeutic or Preventive Procedure." Among the models applied to CIH named entity recognition, BLUEBERT delivered the highest macro average F1-score of 0.90, surpassing other models. Conclusion: Our CIHLex significantly augments representation of CIH approaches in biomedical literature. Demonstrating the utility of advanced NLP models, BERT notably excelled in CIH entity recognition. These results highlight promising strategies for enhancing standardization and recognition of CIH terminology in biomedical contexts

Health Supplement Use and Related Adverse Events in Dubai, United Arab Emirates: A Cross-Study

Health supplement products contain ingredients of more than a thousand chemicals. Several of these chemicals may adversely affect human health. Previous studies have found that consumers are generally unaware of the risks of health supplements and their associated adverse events. In addition, they are unaware of the appropriate reporting process to relevant authorities should adverse events occur. Moreover, many healthcare professionals have inadequate knowledge, attitude, and practice in health supplement consumption-related adverse events and their reporting. The purpose of this research was to measure the health supplement consumption in the population of Dubai, the adverse events thereof, and the level of knowledge, attitude, and practice among healthcare professionals about the issue. This research project comprised two cross-sectional studies. The first was a telephone survey using computer-assisted personal interviewing carried out among the general population. The second study was an on-line survey among healthcare professionals from various private and government healthcare settings in Dubai that sought to assess their knowledge, attitude, and practice (KAP) toward health supplements. Descriptive statistics were used to describe the demographic characteristics of the sample using frequencies and percentages as appropriate. Chi-square, or ANOVA, was used as appropriate to test for statistical differences. Analyses were conducted using STATA version 14.2. In the first survey, among 1,203 participants, 455 (37.8%) reported either current or previous use of health supplements. Of the 455 users, 389 (85.54%) were knowledgeable about health supplements and 442 (97.14%) had encountered no adverse events. Of the 13 (2.86%) who had encountered adverse events, the degree of severity was either moderate or mild. Most (10, 76.92%) did not know how to report the adverse event to healthcare professionals. Only 3 (23.08%) had ever reported an event. In the second study, 427 healthcare professionals participated in the online survey. Of these, 78 (18.3%) had a good level of KAP towards health supplements, 166 (38.9%) had a fair level of KAP, while 183 (42.9%) had a poor level. Job experience of over 6 years resulted in a significant difference (P=0.017) in mean KAP scores. No statistically significant differences in scores were found with gender or educational levels. Significant differences, however, (P=0.001) were found with nationality where non-UAE national participants had a higher level of KAP than UAE nationals. There were also significant differences in mean KAP scores between occupational groups, physicians, and pharmacists having higher scores than other healthcare providers. The findings of this research provide important new knowledge about health supplement use in Dubai. The findings may be used to develop policies and programs on health supplements that will help to minimize the risk of adverse events arising from their use. The results also point out that it is important to institute educational initiatives to assess any risks related to the use of health supplements. Such initiatives will help to raise both awareness and knowledge in both the population and healthcare professionals regarding the use and adverse events of health supplements

The Advanced Practice Nurse and Patient-Centered Medical Home: Maintaining Patient Focus, Meeting the Institute for Healthcare Improvement Triple Aim Through the Electronic Health Record

The Federal Government enacted the Heath Information Technology for Economic and Clinical Health Act (HITECH) in 2009, which incentivized providers to use electronic health records (EHR) for meaningful use (MU); the Patient-Centered Medical Home (PCMH) stems from the Act. Research by the National Council on Quality Assurance (NCQA) shows that primary care practices have a positive influence on the health of patients, families and communities. These positive influences are related to their ability to deliver first-contact access, and to develop long-term therapeutic relationships that focus on the person rather than the disease, improving patient health outcomes and reducing health care cost. The project focuses on developing a standardized template to guide the primary care provider (PCP) to efficiently document in the EHR and according to the NCQA recommendations. The template includes specific recommendations to focus on during a primary care visit, which are in line with the PCMH model. Using the existing EHR software, a template was developed highlighting the elements identified by the NCQA to guide the provider to accurately document care plans he or she develops with the patient; to document identified patient barriers for those who have not met treatment goals; to make appropriate referrals and identify self-referrals; and to reconcile discrepancies in treatment when a patient transitions throughout the health care system, such as after hospitalization

Doctor of Philosophy

dissertationThe use of the various complementary and alternative medicine (CAM) modalities for the management of chronic illnesses is widespread, and still on the rise. Unfortunately, tools to support consumers in seeking information on the efficacy of these treatments are sparse and incomplete. The goals of this work were to understand CAM information needs in acquiring CAM information, assess currently available information resources, and investigate informatics methods to provide a foundation for the development of CAM information resources. This dissertation consists of four studies. The first was a quantitative study that aimed to assess the feasibility of delivering CAM-drug interaction information through a web-based application. This study resulted in an 85% participation rate and 33% of those patients reported the use of CAMs that had potential interactions with their conventional treatments. The next study aimed to assess online CAM information resources that provide information on drug-herb interactions to consumers. None of the sites scored high on the combination of completeness and accuracy and all sites were beyond the recommended reading level per the US Department of Health and Human Services. The third study investigated information-seeking behaviors for CAM information using an existing cohort of cancer survivors. The study showed that patients in the cohort continued to use CAM well into survivorship. Patients felt very much on their own in dealing with issues outside of direct treatment, which often resulted in a search for options and CAM use. Finally, a study was conducted to investigate two methods to semi-automatically extract CAM treatment relations from the biomedical literature. The methods rely on a database (SemMedDB) of semantic relations extracted from PubMed abstracts. This study demonstrated that SemMedDB can be used to reduce manual efforts, but review of the extracted sentences is still necessary due to a low mean precision of 23.7% and 26.4%. In summary, this dissertation provided greater insight into consumer information needs for CAM. Our findings provide an opportunity to leverage existing resources to improve the information-seeking experience for consumers through high-quality online tools, potentially moving them beyond the reliance on anecdotal evidence in the decision-making process for CAM

Concurrent Use of Prescription Drugs and Herbal Medicinal Products Among Older Adults

Background: Polypharmacy is a recognised patient safety risk, with older adults at greater risk due to co-morbidities and reduced clearance of drugs due to ageing. However, very little is known about the concurrent use of prescription drugs and herbal medicinal products (HMPs) among older adults. There is no common understanding of what HMPs are and no UK based studies among older adults completed in the last 15 years were identified. Aim: To understand the concurrent use of prescription drugs and HMPs among UK older adults. Research questions: The different phases of the study were guided by the following questions. Phase 1: Systematic Literature Review • What is the prevalence and pattern of concurrent use of prescription drugs and herbal medicinal products (HMPs) among older adults? • What patient and clinical characteristics are associated with concurrent use of prescription drugs and HMPs? • What are the range of prescription drugs and HMPs most concurrently used by older adults? • What safety issues and other factors are associated with concurrent prescription drug and HMPs use in older adults? Phase 2: Questionnaire Survey • What is the prevalence and patterns of concurrent prescription drugs and HMPs use among UK community dwelling older adults? • What types of HMPs and prescription drugs are concurrently used? • What is the potential herb-drug interactions from the HMPs, and prescription drugs reported? • What patient and clinical characteristics are associated with concurrent HMPs and prescription drugs use? Phase 3: In-depth exploration of older adults’ experiences of using HMPs with prescribed medications • Why do older adults concurrently use prescription drugs, HMPs and dietary supplements (DS)? • What is the experience of concurrent users? Methods: Three phased mixed method sequential explanatory study. Phase1 was a systematic literature review to evaluate and summarise available evidence. Phase 2 estimated the prevalence of concurrent use and identified the pattern and range of medicines combined using questionnaire survey among community dwelling older adults from two GP surgeries in Essex and London. Phase 3 Interviews with older people to gain in-depth understanding of the older peoples’ reasons for concurrently using HMPs with prescription medications, their experiences and views. Findings: Both the review and survey demonstrated that concurrent prescription drugs and HMPs use among older adults is widespread, with potentially serious herb-drug interactions from certain combinations. Prevalence among older adults varied widely between 5.3% and 88.3% among previous studies, while this study estimated it to be 33.5%. Dietary supplements (DS) are also concurrently used with prescribed medicines. The most commonly used HMPs were evening primrose oil, valerian, and Nytol Herbal® (a combination of hops, gentian, and passion flower) while cod liver oil, glucosamine, multivitamins and vitamin D were the dietary supplements most reported. The prescription drugs most commonly combined with HMPs are beta blockers, diuretics, antihyperlipidemic agents, anticoagulants, analgesics, antihistamines, antidiabetics, antihypertensive drugs, antidepressants, non-steroidal anti-inflammatory drugs (NSAIDs) and statins. Although most of the survey participants were not exposed to significant harm from concurrently using HMPs and DS with prescription medicines, the potential risk of herb-drug and supplement-drug interactions cannot be ignored. The interviews revealed that older adults draw on different rationale and sources of information when making the decision to use HMPs or dietary supplements concurrently with prescription drugs. Six main themes captured the range of experience and underlying reasons for concurrent use. These were: older people’s values and beliefs, the decision to use HMPs and DS, sources of information and advice, self-management and taking control, disclosure and non-disclosure, awareness of potential herb-drug interactions. Discussion: This study has provided the first estimate of the prevalence of concurrent HMPs and prescription drug use among UK older adults and established the range of HMPs and dietary supplements that older adults most commonly combine with prescribed medicines. It has highlighted potential interactions from certain combinations of prescription drugs, HMPs and dietary supplements which healthcare practitioners should routinely ask older adults about. As well as the need to systematically identify older people who may be at risk of potential herb-drug interactions, the range of reasons for concurrent use provided by this study adds to the literature on polypharmacy and interventions to support medicine management for older adults living at home with multiple health needs. Evidence from the study demonstrates the range of experience that reflects individual and system issues about accessing medical care and advice on medication. The findings highlight the difficulties that this population face in accessing the advice and support they need. It also indicates a need to revisit the responsibilities of clinicians and regulators with regards to the regulation and sale of HMPs. Likewise, accurate and key information regarding interactions with other products and possible adverse effects should be readily available. Future work could test what enables older consumers to make informed choices about the safe use of HMPs

EVALUATING PATIENT MEDICATION AND COMPLEMENTARY THERAPIES DOCUMENTATION: COMPARATIVE ANALYSIS OF SOURCES, DISCREPANCIES AND THE POTENTIAL IMPACT OF ERRORS ON PATIENT CARE

Complete knowledge of a patient's medications, including over-the-counter and alternative medicines, is essential to the healthcare professional in providing quality care. In addition to the multiple steps from prescribing, dispensing to administering of a drug medication, there are several factors that increase an individual's risk for an adverse event and approaches to reduce medication errors. The movement of healthcare systems to an electronic medical record provides the potential of building a better health care system. This retrospective study compares five sources of medication, medical record chart, specialist, electronic medical record, pharmacy, insurance provider and patient, to determine what is the most accurate source of documentation, and what factors leading to better knowledge and documentation of all of a patient's medications. This study also identifies additional risk factors, specifically drug affordability and the influence it has on a patient's behavior, and discusses some considerations for reducing medication errors. The prevention and reduction of adverse events is of public health significance as there is both a health and financial cost to treating these adverse events