An Exploration of Trends in Patient Health Data Safety Concerns: Does Heterogeneity Matter?

There have been ongoing discussions on threats to patients' electronic health information/records (EHR). This study aims to examine the 1) trend in electronic data safeguard concerns and 2) factors associated with such perceptions. Using the Health Information National Trends Survey (HINTS) data from 2014, 2017, and 2018, the study analyzed 7527 patients (representing approximately, 175 million US adult subjects) for their perceptions on information safeguard and withholding information from providers due to privacy/security. About 24%, 24%, and 15% respondents reported not confident about data safeguard in 2014, 2017, and 2018, respectively. A large population is not firmly confident about data safety and many would withhold information. Although there is a significant trend in improvement of safeguard concerns, there is patient characteristics-related heterogeneity and there are communication quality effects on adverse outcomes of privacy/security concerns. The results will be useful for improving patient utilization of EHRs benefiting patients or healthcare systems

Exploration of Health Technology Nonuse: The Case of Online Medical Records

Online Medical Records (OMR) platforms remain a key enabler to health management. Yet, how beliefs toward OMR and its subsequent nonuse are related is not understood. Applying the status quo bias (SQB) theory and the privacy paradox paradigm the study examines OMR nonusers and contributes to the health technology use literature. Using the Health Information National Trends Survey (HINTS) iteration 5, Cycle 1 and 3 data, mediation analysis reveals that inertia expressed as preference for speaking directly with healthcare providers predicts perceived need for OMR and partially mediates the relationship between perceived privacy concerns and need; having a chronic disease partially moderates such relationships. Thus, not all nonusers are created equal. Attaining benefits that come with capabilities and functionalities of OMR necessitates meaningful use of OMR by individuals. Healthcare providers or policymakers should intervene to dispel inertia or patient concerns to expand OMR use to facilitate healthcare decision making

Association Between Choice of Radical Prostatectomy, External Beam Radiotherapy, Brachytherapy, or Active Surveillance and Patient-Reported Quality of Life Among Men With Localized Prostate Cancer

Importance Patients diagnosed with localized prostate cancer have to decide among treatment strategies that may differ in their likelihood of adverse effects. Objective To compare quality of life (QOL) after radical prostatectomy, external beam radiotherapy, and brachytherapy vs active surveillance. Design, Setting, and Participants Population-based prospective cohort of 1141 men (57% participation among eligible men) with newly diagnosed prostate cancer were enrolled from January 2011 through June 2013 in collaboration with the North Carolina Central Cancer Registry. Median time from diagnosis to enrollment was 5 weeks, and all men were enrolled with written informed consent prior to treatment. Final follow-up date for current analysis was September 9, 2015. Exposures Treatment with radical prostatectomy, external beam radiotherapy, brachytherapy, or active surveillance. Main Outcomes and Measures Quality of life using the validated instrument Prostate Cancer Symptom Indices was assessed at baseline (pretreatment) and 3, 12, and 24 months after treatment. The instrument contains 4 domains—sexual dysfunction, urinary obstruction and irritation, urinary incontinence, and bowel problems—each scored from 0 (no dysfunction) to 100 (maximum dysfunction). Propensity-weighted mean domain scores were compared between each treatment group vs active surveillance at each time point. Results Of 1141 enrolled men, 314 pursued active surveillance (27.5%), 469 radical prostatectomy (41.1%), 249 external beam radiotherapy (21.8%), and 109 brachytherapy (9.6%). After propensity weighting, median age was 66 to 67 years across groups, and 77% to 80% of participants were white. Across groups, propensity-weighted mean baseline scores were 41.8 to 46.4 for sexual dysfunction, 20.8 to 22.8 for urinary obstruction and irritation, 9.7 to 10.5 for urinary incontinence, and 5.7 to 6.1 for bowel problems. Compared with active surveillance, mean sexual dysfunction scores worsened by 3 months for patients who received radical prostatectomy (36.2 [95% CI, 30.4-42.0]), external beam radiotherapy (13.9 [95% CI, 6.7-21.2]), and brachytherapy (17.1 [95% CI, 7.8-26.6]). Compared with active surveillance at 3 months, worsened urinary incontinence was associated with radical prostatectomy (33.6 [95% CI, 27.8-39.2]); acute worsening of urinary obstruction and irritation with external beam radiotherapy (11.7 [95% CI, 8.7-14.8]) and brachytherapy (20.5 [95% CI, 15.1-25.9]); and worsened bowel symptoms with external beam radiotherapy (4.9 [95% CI, 2.4-7.4]). By 24 months, mean scores between treatment groups vs active surveillance were not significantly different in most domains

Barriers Driving Nonuse of Online Medical Records: Latent Class Analysis of Chronic Patients

Online Medical Records (OMR) platforms can provide benefits to chronic disease patients. Yet, OMR use among them is suboptimal. The study identifies clusters among nonusers of OMR among chronic patients. The Health Information National Trends Survey (HINTS) iteration 5, Cycle 3 data were used to analyze 1071 respondents. Latent Class Analysis was run on the six reasons for nonuse (no record, speaking directly, privacy or security of the website, no Internet, login issues, and no need to access) and resulted in 3 clusters. About 19% subjects expressed multiple reasons and 69% just one strong reason. Demographic and clinical attributes were partially associated. For electronic wearable/tracking device use or electronic communication, differences among clusters were noted; persistent resisters showed lower propensities to use. Interventions to improve patient use of Internet-based health technologies should be customized and help produce patient-generated data facilitating healthcare decision-making

Hospital pharmacists’ perceived beliefs and responsibilities in indication-based off-label prescribing

Background Off-label prescribing is prevalent in healthcare. There is a lack of understanding of pharmacists’ attitudes toward the practice of off-label prescribing, especially those that are prescribed for other indications than approved ones (termed as indication-based off-label prescribing). Objective Explore hospital pharmacists’ attitudes toward and perceived responsibility in off-label and indication-based off-label prescribing in hospital pharmacy practice. Setting Pharmacists practicing in hospitals in the United States were investigated. Method Pharmacists were contacted via email through State affiliates of the American Society of Health-System Pharmacist. The survey described an indication-based off-label medication order for a hospitalized patient and the prescribing physician. Data were collected via Qualtrics. Main outcome measure Questions focused on awareness, beliefs, and responsibility—including, risk assessment and monitoring outcomes—related to off-label and indication-based offlabel prescribing. Results Of 107 pharmacist respondents, about 79% and 98% reported being familiar with offlabel and indication-based off-label prescribing, respectively. While 77.6% pharmacists believed that patients should be informed, only 37.4% agreed that they had responsibility of informing physicians; presence of policy was associated (p \u3c 0.02) with pharmacist agreeing to inform physicians. Over 70% agreed that patients should be closely monitored for outcomes and 43.1% believed physicians had predominant responsibility of monitoring outcomes. Conclusion Pharmacists’ perceived responsibility and beliefs regarding off-label prescribing are insightful that can be utilized for improving patient care

Hospital pharmacists’ perceived beliefs and responsibilities in indication-based off-label prescribing

Background Off-label prescribing is prevalent in healthcare. There is a lack of understanding of pharmacists’ attitudes toward the practice of off-label prescribing, especially those that are prescribed for other indications than approved ones (termed as indication-based off-label prescribing). Objective Explore hospital pharmacists’ attitudes toward and perceived responsibility in off-label and indication-based off-label prescribing in hospital pharmacy practice. Setting Pharmacists practicing in hospitals in the United States were investigated. Method Pharmacists were contacted via email through State affiliates of the American Society of Health-System Pharmacist. The survey described an indication-based off-label medication order for a hospitalized patient and the prescribing physician. Data were collected via Qualtrics. Main outcome measure Questions focused on awareness, beliefs, and responsibility—including, risk assessment and monitoring outcomes—related to off-label and indication-based offlabel prescribing. Results Of 107 pharmacist respondents, about 79% and 98% reported being familiar with offlabel and indication-based off-label prescribing, respectively. While 77.6% pharmacists believed that patients should be informed, only 37.4% agreed that they had responsibility of informing physicians; presence of policy was associated (p \u3c 0.02) with pharmacist agreeing to inform physicians. Over 70% agreed that patients should be closely monitored for outcomes and 43.1% believed physicians had predominant responsibility of monitoring outcomes. Conclusion Pharmacists’ perceived responsibility and beliefs regarding off-label prescribing are insightful that can be utilized for improving patient care

The role of perceived impact on relationship quality in pharmacists\u27 willingness to influence indication-based off-label prescribing decisions

Little is known about factors that affect pharmacists\u27 roles in off-label prescribing. This study examined the effect of perceived impact on relationship quality (IRQ) on hospital pharmacists\u27 willingness to influence a physician\u27s decision regarding an indication-based off-label medication order (WTIP) (i.e., beyond FDA-approved indications) and the moderating roles of the appropriateness of the medication order and the relative expert power of the pharmacist. Pharmacists practicing in U.S. hospitals, recruited from membership rolls of state affiliates of the American Society of Health-System Pharmacists, were sent an electronic link to a questionnaire via their respective affiliates. A cross-sectional, randomized, 2 × 2 experimental design was used; participants were assigned to one of the indication-based off-label medication order scenarios. Relative expert power (i.e., power differential between the pharmacist and the physician) and appropriateness of the prescription were manipulated. Perceived IRQ was measured with multiple items. Pharmacists\u27 WTIP in the scenario was the outcome variable. A total of 243 responses were included in multiple linear regression analyses. After controlling for dependence power, information power, communication effectiveness, perceived responsibility, and attitude, pharmacists\u27 WTIP was negatively affected by perceived IRQ (estimate = −0.309, P \u3c 0.05). This effect was more pronounced in groups exposed to the scenario where the pharmacist had lower relative expert power (estimate = −0.438, P \u3c 0.05) and where the medication was less appropriate (estimate = −0.503, P \u3c 0.05). Although willing to ensure rationality of off-label prescribing, pharmacists\u27 WTIP was affected by a complex array of factors – the perceived impact of influence attempts on relationship quality between the pharmacist and the prescriber, the pharmacist\u27s relative expert power, and the appropriateness of the off-label prescription. Increasing pharmacists\u27 expert power and collaboration with physicians and promoting pharmacists\u27 multifaceted contribution, collaborative or independent, to patient care may facilitate pharmacist services in off-label pharmaceutical care