Background In the era of precision medicine, it is critical for health communication efforts to prioritize personal health record (PHR) adoption. Objective The objective of this study was to describe the characteristics of patients with heart disease that choose to adopt a PHR. Methods A total of 79 patients with chronic cardiovascular disease participated in this study: 48 PHR users and 31 nonusers. They completed 5 surveys related to their choice to use or not use the PHR: demographics, patient activation, medication adherence, health literacy, and computer self-efficacy (CSE). Results There was a significant difference between users and nonusers in the sociodemographic measure education (P=.04). There was no significant difference between users and nonusers in other sociodemographic measures: age (P=.20), sex (P=.35), ethnicity (P=.43), race (P=.42), and employment (P=.63). There was a significant difference between PHR users and PHR nonusers in CSE (P=.006). Conclusions In this study, we demonstrate that sociodemographic characteristics were not an important factor in patients’ use of their PHR, except for education. This study had a small sample size and may not have been large enough to detect differences between groups. Our results did demonstrate that there is a difference between PHR users and nonusers related to their CSE. This work suggests that incorporating CSE into the design of PHRs is critical. The design of patient-facing tools must take into account patients’ preferences and abilities when developing effective user-friendly health information technologies.
BACKGROUND In the era of precision medicine, it is critical for health communication efforts to improve the comprehension level of the complex information being presented in the personal health record (PHR). OBJECTIVE To assess and understand the characteristics associated with patients’ choice to use or not use their PHR. METHODS A diverse group of patients with chronic cardiovascular disease was selected to participate in this study. They were screened by race, ethnicity, sex, age and zip code, specifically. Seventy-nine patients participated: 48 PHR users and 31 non-users. They completed seven surveys related to their choice to use or not use the PHR: demographics, patient activation, medication adherence, health literacy, computer self-efficacy, numeracy and graph literacy. RESULTS There is no significant difference between users and non-users in sociodemographic measures: age (P=0.17), sex (P=0.35), education (P=0.068), ethnicity (P=0.43), race (P=0.42), and employment (P=0.75). There is a significant difference between PHR users and PHR non-users in computer self-efficacy (P=0.0053), subjective graph literacy (P=0.0073), subjective numeracy scale (P=0.0074). CONCLUSIONS In this study, we demonstrate that sociodemographic characteristics were not an important factor in patients’ use of their PHR. Our results did demonstrate that there is a difference between PHR users and non-users related to their computer self-efficacy (CSE), graph literacy, and numeracy. This work suggests that incorporating CSE and graph literacy into the design of PHRs is critical. The design of patient facing tools must take into account patients’ preferences and abilities when developing effective user-friendly health information technologies (HIT). CLINICALTRIAL NA
Objective: To demonstrate that a syndromic stewardship intervention can safely reduce antipseudomonal antibiotic use in the treatment of inpatient diabetic foot infections (DFIs). Intervention and method: From November 2017 through March 2018, we performed an antimicrobial stewardship intervention that included creation of a DFI best-practice guideline, implementation of an electronic medical record order set, and targeted education of key providers. We conducted a retrospective before-and-after study evaluating guideline adherent antipseudomonal antibiotic use 1 year before and after the intervention using interrupted time-series analysis. Setting: University of Nebraska Medical Center, a 718-bed academic medical center in Omaha, Nebraska. Patients: The study included 193 adults aged ≥19 years (105 in the preintervention group and 88 in the postintervention group) admitted to non–intensive care units whose primary reason for antibiotic treatment was diabetic foot infection (DFI). Results: Guideline-adherent use of antipseudomonal antibiotics increased from 39% before the intervention to 68% after the intervention (P ≤ .0001). Antipseudomonal antibiotic use decreased from 538 days of therapy (DOT) per 1,000 DFI patient days (PD) before the intervention to 272 DOT per 1,000 DFI PD after the intervention (P < .0001), with a statistically significant decrease in both level of use and slope of change. We did not detect any changes in length of stay, readmission, amputation rate, subsequent positive Clostridioides difficile testing, or mortality. Conclusions: Our 3-component intervention of guideline creation, implementation of an order set, and targeted education was associated with a significant decrease in antipseudomonal antibiotic use in the management of inpatient DFIs. DFIs are common and should be considered as opportunities for syndromic stewardship intervention.
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