Waiting Room Health Promotion for Older Adults in Rural Primary Care

Background: Advances in health care technology have lead to adults living longer than in previous decades. Longer life expectancy in combination with the aging of the Baby Boomer generation is predicted to result in rapid and exponential growth among the older adult population. Adults in the U.S. over the age of 65 have on average five or more chronic illnesses, many of which are often poorly managed. Older adults who experience chronic diseases often report decreased quality of life, limitations in functional ability, loss of independence, and periods of decline and increasing disability. Health promotion efforts can help in delaying the onset of disability and preventing rapid decline associated with many chronic conditions. Purpose: The purpose of this project was to assess the effectiveness of the implementation of a brief waiting room health promotion activity that informs older adults about the benefits of walking, such as reducing the risk of chronic disease, improving mood, and maintaining weight, physical and cognitive function. This project took place at a federally qualified health center in Plainfield, Vermont. Methods: The target population for this educational intervention included patients, as well as family members and visitors to the primary care practice who were age 55 and older. All age-eligible participants were encouraged to participate regardless of health status or the presence of comorbid health conditions. The activity comprised of participants viewing a brief audiovisual educational activity explaining the health benefits of walking, supplemented with paper materials to support the health messages; the intervention was then followed by completion of a brief paper survey evaluation. Results: During the two-month period the health promotion activity was available, 56 individuals participated and completed the survey. Of the 56 participants, 87% indicated they either “strongly agreed” or “agreed” that watching the video increased knowledge about health-related benefits of walking. In total, approximately 73% of participants who participated in this health promotion activity agreed that they paid attention to educational materials in the waiting room setting. Approximately 57% of participants shared a health related goal that they created as a result of the health promotion activity. Conclusion: This project has suggested that implementation of waiting room health promotion activities, specifically for older adults, is a simple and cost-effective way to promote good health practices and provide patients with in-depth health care information that may not be addressed during the health care visit. Activities in the waiting room can help to supplement information provided during the clinical encounter, leaving patients more satisfied with their visits, and promoting positive behavior change

Iowa Health Focus, December 2005

Monthly newsletter for the Iowa Department of Public Healt

Proposal Defense: Improving Patient Portal Adoption in Primary Care

Introduction: Stage three of Meaningful Use (MU) is currently underway and is focused on promoting patient portal use. If the electronic medical record patient portal use is less than 25%, primary care providers face reductions in value-based reimbursements. National adoption rates from portal use remain under 27% with some providers averaging well below the needed 25%. The following practice question is proposed, “In a low-income urban adult clinic, how does an interactive electronic education intervention compared to no education intervention affect patient portal adoption rates?” Objectives: The purpose of this project is to identify whether an electronic patient educational video and self-service kiosk will increase the use of portals among low income older adults in a primary care office. The overreaching goal of the proposed project is to increase patient portal adoption to the MU requirement of 25% of participants by March 4, 2019. Methods: A convenience sample of 1,894 adult patients attending a primary care appointment is expected. A retrospective data analysis will be used to gather pre and post-intervention portal adoption percentages. Data will be compared using chi-square methodology. Demographic information will be used for descriptive statistics. Survey data will be used to capture study learnings and to evaluate the intervention. In this quality improvement project, data will be collected from persons receiving a primary care appointment at the clinic that participate in the patient education video and self-serve kiosk over a 84-day period. The rate of portal adoption for persons using the video and kiosk will be compared to the portal adoption rate before the video was available. Additional, de-identified demographic information will be collected in order to understand if there are differences in portal adoption among patient types. Results: It is predicted that patient portal use rates will reach 30% in response to the evidence-based intervention. Conclusions: It is expected that the proposed workflow changes with an educational intervention will eliminate the barrier of a lack internet access and will thus increase patient portal rates. Implications: The vision of the proposed project is to be cycle one of many cycles. With the clinic’s vast number of students and support of educational staff, this project can provide a framework for future quality improvement projects aimed at improving patient portal use and patient outcomes

Combating Infant Mortality in Rural India: Evidence from a Field Study of eHealth Kiosk Imlementations

The United Nations’ Millennium Development Goals listed high infant mortality rates as a major problem in developing countries, especially in rural areas. Given the powerful information dissemination capabilities, information and communication technologies (ICTs) have been suggested as interventions to build infant care awareness and to modify healthcare behaviors. We examine how the use of one ICT intervention—specifically, eHealth kiosks disseminating authenticated and accessible medical information—can alleviate the problem of high infant mortality in rural India. We investigate how mothers’ social networks affect their use of eHealth kiosks, seeking professional medical care for their infants and, ultimately, infant mortality. Drawing on the social epidemiology and social networks literatures, we focus on advice and hindrance from both strong and weak ties as the conduit of social influence on mothers’ health-related behaviors for the care of their infants. Over a period of 7 years, we studied 4,620 infants across 10 villages where the eHealth kiosks were implemented along with support resources for proxy use. The results revealed that (1) eHealth kiosk use promotes seeking professional medical care and reduces infant mortality, (2) mothers are especially vulnerable to hindrance from both strong and weak ties as they choose to maintain the status quo of traditional infant healthcare practices (e.g., reliance on untrained personnel, superstitions, fatalism) in villages, and (3) advice from both strong and weak ties offers the potential to break down misplaced beliefs about infant healthcare practices and to develop literacy on seeking professional medical care. In contrast, in a comparative group of 10 neighboring villages, the reduction in infant mortality was not as pronounced and the effect of professional medical care in reducing infant mortality was lower. Our findings suggest that an ICT intervention can effectively address one of society’s most important problems (i.e., infant mortality) even in parts of the world with limited resources and deep suspicion of technology and change. Overall, we believe such an ICT intervention will complement other investments being made, including the facilitation of use (proxy use) and provision of professional medical facilities to reduce infant mortality

Codman Square Health Center Earned Income Tax Credit Kiosk

I worked with the Codman Square Health Center (CSHC) to develop a community information kiosk to serve the lower and moderate-income residents and households of the Codman Square neighborhood of the Dorchester area of Boston, Massachusetts. Residents who visited the kiosk were able to take part in an earned income tax credit consultation (EITC), see a copy of their credit report, receive credit counseling, and receive information on federal, state and local health programs. Initial funds came from a grant the Codman Square Health Center (CSHC) received to start this pilot initiative. The health center established a site within one of its buildings and staffed the site on Monday, Wednesday afternoons and evenings and Saturday mornings and afternoons. The director and a site coordinator directed the staff at the site. The success of this project was evaluated by determining the number of kiosk participants, their enrollment in additional services and if the participation in the credit intervention improved participants' credit ratings over the course of a year. (Author abstract)Seward, L. (2007). Codman Square Health Center Earned Income Tax Credit Kiosk. Retrieved from http://academicarchive.snhu.eduMaster of Science (M.S.)School of Community Economic Developmen

Contact Point

https://scholarlycommons.pacific.edu/contact-point/1003/thumbnail.jp

Los Arcos - Spring 2011

https://scholarworks.utrgv.edu/losarcos/1004/thumbnail.jp

Contact Point

https://scholarlycommons.pacific.edu/contact-point/1003/thumbnail.jp

Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa.

INTRODUCTION: Implementation data for digital unsupervised HIV self-testing (HIVST) are sparse. We evaluated the impact of an app-based, personalised, oral HIVST program offered by healthcare workers in Western Cape, South Africa. METHODS: In a quasirandomised study (n=3095), we recruited consenting adults with undiagnosed HIV infection from township clinics. To the HIVST arm participants (n=1535), we offered a choice of an offsite (home, office or kiosk based), unsupervised digital HIVST program (n=962), or an onsite, clinic-based, supervised digital HIVST program (n=573) with 24/7 linkages services.With propensity score analyses, we compared outcomes (ie, linkages, new HIV infections and test referrals) with conventional HIV testing (ConvHT) arm participants (n=1560), recruited randomly from geographically separated clinics. RESULTS: In both arms, participants were young (HIVST vs ConvHT) (mean age: 28.2 years vs 29.2 years), female (65.0% vs 76.0%) and had monthly income <3000 rand (80.8% vs 75%).Participants chose unsupervised HIVST (62.7%) versus supervised HIVST and reported multiple sex partners (10.88% vs 8.7%), exposure to sex workers (1.4% vs 0.2%) and fewer comorbidities (0.9% vs 1.9%). Almost all HIVST participants were linked (unsupervised HIVST (99.7%), supervised HIVST (99.8%) vs ConvHT (98.5%)) (adj RR 1.012; 95% CI 1.005 to 1.018) with new HIV infections: overall HIVST (9%); supervised HIVST (10.9%) and unsupervised HIVST (7.6%) versus ConvHT (6.79%) (adj RR 1.305; 95% CI 1.023 to 1.665); test referrals: 16.7% HIVST versus 3.1% ConvHT (adj RR 5.435; 95% CI 4.024 to 7.340). CONCLUSIONS: Our flexible, personalised, app-based HIVST program, offered by healthcare workers, successfully linked almost all HIV self-testers, detected new infections and increased referrals to self-test. Data are relevant for digital HIVST initiatives worldwide

Introduction of a Medical Patient Portal to the Uninsured Patient

abstract: Purpose: The purpose of this evidence-based practice project was to improve participation by increasing registration on to a medical patient portal to an uninsured population. Medical patient portals have the potential to provide patients with timely, transparent access to health care information and engage them in their health care process and management. This may result in improved disease management outcomes. Methods: This project was guided by a The Rosswurm and Larrabee Model for Change to Evidence- Based Practice and Pender’s health promotion framework. IRB Approved by ASU. The instruction was implemented at an urban clinic in downtown phoenix that serves uninsured and underserved individuals. Uninsured participants were recruited (n=50). A survey pre and post registration was conducted to assess knowledge and medical portal participation in addition a random pre and post chart review was performed. Results: Descriptive statistics was used to describe sample and outcome variables. A chi-square test of independence was calculated comparing pre and post intervention significant change was found (χ2 (1) = .002, P<0.05.), a paired sample t test was calculated to compare knowledge pre and post registration instruction the mean pre-10.187(SD = 4.422), post mean was 16.958(SD=.856). A significant increase of knowledge was found (t (47) =-9.573, p (<.001). Outcomes: In this population both patients and providers have seen significant benefits such as increased communication and patient participation, from the implementation of evidence based educational tools such as instruction with teach back, and the usage of brochures. Potential Implication for sustainability includes the lack of a designated individual that is bilingual to register patients, making patients aware of the existence of a medical patient portal, patient’s fear of sharing immigration status