eHealth Literacy in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Subanalysis of a 2014 Community-Based Survey

BackgroundDigital health interventions are efficient and flexible methods for enhancing the prevention and management of cardiovascular disease and type 2 diabetes. However, little is known about the characteristics associated with eHealth literacy in the Canadian South Asian population. ObjectiveThe aim of this study is to describe perceived eHealth literacy and explore the extent to which it is associated with sociodemographic, health status, and technology use variables in a subset of South Asian Canadians. MethodsWe analyzed data from the e-Patient Project survey, a mixed-mode cross-sectional survey that occurred in 2014. The eHealth Literacy Scale (eHEALS) was used to measure eHealth literacy in a convenience sample of 511 English- or Punjabi-speaking South Asian adults recruited from a community pharmacy, a family physician office, and community events in Edmonton, Alberta. Multivariable quantile regression was used to explore variables associated with eHealth literacy. ResultsThe analysis was restricted to 301 internet users (mean age 39.9, SD 14.8 years; 166/301, 55.1% female) who provided responses to all 8 eHEALS questions and complete demographic information. The mean overall eHEALS score was 29.3 (SD 6.8) out of 40, and 71.4% (215/301) agreed to at least 5 out of the 8 eHEALS items. The eHEALS item with the lowest level of agreement was “I can tell high-quality health resources from low-quality health resources on the internet” (182/301, 60.5%). Although there were statistically significant differences in eHEALS scores according to age, educational achievement, language preference, and the presence of chronic medical conditions, multivariable regression analysis indicated that language preference was the only variable independently associated with eHealth literacy (coefficient –6.0, 95% CI –9.61 to –2.39). ConclusionsIn our sample of South Asian Canadian internet users, preference for written health information in languages other than English was associated with lower eHealth literacy. Opportunities exist to improve eHealth literacy using culturally and linguistically tailored interventions

The Capturing Outcomes of Clinical Activities Performed by a Rounding Pharmacist Practicing in a Team Environment

(COLLABORATE) study was a controlled clinical trial that demonstrated the beneficial effect of team-based care by

An Assessment of Vancomycin Use in 2 Tertiary Care Hospitals

ABSTRACT Background and Objective: The emergence of vancomycin resistance among gram-positive organisms over the past 10 years has raised serious health concerns worldwide. In response, several government organizations have developed recommendations for the appropriate use of vancomycin. The goal of this study was to assess the appropriateness of vancomycin use at 2 tertiary care teaching hospitals in relation to a set of modified guidelines.Methods: All adult patients receiving vancomycin at the Health Sciences Centre and St Boniface General Hospital in Winnipeg, Manitoba, between October 1 and November 30, 1999, were eligible for prospective or retrospective chart review. Patients were identified during order entry and by means of the pharmacy information system. Each patient’s vancomycin therapy was assessed according to modified Centers for Disease Control and Prevention and Laboratory Centre for Disease Control guidelines.Results: A total of 199 courses of vancomycin therapy were assessed. Vancomycin was started for prophylaxis in 54 (27%) cases, empiric use in 116 (58%) cases, and documented infections in 28 (14%) cases (indication was unknown in one case). Vancomycin use was inappropriate in 89 (45%) of 199 courses of therapy. Inappropriate empiric use (52 courses) and prophylatic use (27 courses) accounted for the majority of these inappropriate cases (58% and 30%, respectively).Conclusions: Vancomycin was prescribed inappropriately in almost half of all cases in these 2 institutions. These results are comparable to previously reported assessments of vancomycin use. Despite availability of guidelines on vancomycin use, it appears that clinician education, improved ß-lactam allergy workup, and vigilance are warranted, even in the absence of vancomycin resistance.RÉSUMÉ Historique et objectif : L’émergence de bactéries Gram-positives résistant à la vancomycine au cours des dix dernières années a soulevé de sérieuses préoccupations pour la santé partout dans le monde. Nombre d’organisations gouvernementales ont réagi en mettant de l’avant des recommandations sur l’utilisation appropriée de la vancomycine. L’objectif de cette étude était d’évaluer, à partir de lignes directrices modifiées, la pertinence de l’utilisation de la vancomycine dans deux hôpitaux universitaires de soins tertiaires.Méthodes : Tous les patients adultes du Health Sciences Centre et de l’Hôpital général St-Boniface de Winnipeg, au Manitoba, qui ont reçu de la vancomycine entre le 1er octobre et le 30 novembre 1999, étaient admissibles à l’étude prospective et rétrospective de leurs dossiers médicaux. Les patients ont été identifiés lors de la saisie des ordonnances et à l’aide du système d’information de la pharmacie. Pour chacun des patients, le traitement à la vancomycine a été évalué en fonction des lignes directrices modifiées des Centers for Disease Control and Prevention et du Laboratoire de lutte contre la maladie.Résultats : Au total, 199 traitements à la vancomycine ont été évalués. La vancomycine a été prescrite comme traitement prophylactique dans 54 (27 %) cas, comme traitement empirique dans 116 (58 %) cas et dans 28 (14 %) cas documentés d’infections (aucune indication n’était spécifiée dans un des cas). L’utilisation de la vancomycine était inappropriée dans 89 (45 %) des 199 traitements. Cinquante-deux traitements empiriques et 27 traitements prophylactiques représentaient la plupart de ces cas inappropriés (respectivement 58 % et 30 %).Conclusions : La vancomycine a été prescrite de façon inappropriée dans près de la moitié des cas dans ces deux établissements. Ces résultats sont comparables à ceux d’études antérieures sur l’utilisation de la vancomycine. Malgré la disponibilité de lignes directrices sur l’utilisation de la vancomycine, il semble que l’éducation des cliniciens, de meilleurs tests d’allergie aux ß-lactamines et la vigilance s’imposent, même en l’absence de résistance à la vancomycine

Development and Validation of a Survey Instrument to Measure Factors that Influence Pharmacist Prescribing

Objective: Study objectives were to develop a questionnaire to assess factors influencing pharmacists’ adoption of prescribing (i.e., continuing, adapting or initiating therapy), describe use of pre-incentive and mixed mode survey, and establish survey psychometric properties. Methods: Questions were developed based on prior qualitative research and Diffusion of Innovation theory. Expert review, cognitive testing, survey pilot, and main survey were used to test the questionnaire. Six content experts reviewed the questionnaire to establish face and content validity. Ten pharmacists from diverse practice settings were purposefully recruited for a cognitive interview to verify question readability. Content analysis was used to analyze the results. A pre-survey introduction letter with a monetary incentive was mailed via post to 100 (i.e. pilot) and 700 (i.e., main survey) randomly selected pharmacists. This was followed by an e-mail with a personalized link to the online questionnaire, e-mail reminders, and a telephone reminder if required. The psychometric properties of scales were evaluated with an exploratory factor analysis and Cronbach’s alpha. Scale responses were described. Results: Engagement of six experts and ten pharmacists clarified definitions (e.g., prescribing), terminology, recall periods, and response options for the 34-item response scale. Fifty-six pharmacists completed the online pilot survey. Based on this data, ambiguous questions and routing issues were addressed. Three hundred and seventy-eight pharmacists completed the online main survey for a response rate of 54.6%. The factors analysis resulted in 27 questions in eight scales: (1) self-efficacy, (2) support from practice environment, (3) support from interprofessional relationship, (4) impact on professionalism, (5) impact on patient care), (6) prescribing beliefs, (7) technical use of electronic health record (EHR) and (8) patient care use of the EHR. Prescribing beliefs and technical use of the EHR scales had low reliability while the remaining six scales had strong evidence for reliability and validity. Conclusion: Through a multi-stage process, a survey instrument was developed to capture pharmacists’ perceptions of prescribing influences. This questionnaire may support future research to develop interventions to enhance adoption of prescribing and enhance direct patient care by pharmacists