Background: Unprecedented federal interest and funding are focused on secure, standardized, electronic transfer of health information among health care organizations, termed health information exchange (HIE). The stated goals are improvements in health care quality, efficiency, and cost. Ambulatory primary care practices are essential to this process; however, the factors that motivate them to participate in HIE are not well studied, particularly among small practices.Methods: We conducted a systematic review of the literature about HIE participation from January 1990 through mid-September 2008 to identify peer-reviewed and non-peer-reviewed publications in bibliographic databases and websites. Reviewers abstracted each publication for predetermined key issues, including stakeholder participation in HIE, and the benefits, barriers, and overall value to primary care practices. We identified themes within each key issue, then grouped themes and identified supporting examples for analysis.Results: One hundred and sixteen peer-reviewed, non-peer-reviewed, and web publications were retrieved, and 61 met inclusion criteria. Of 39 peer-reviewed publications, one-half reported original research. Among themes of cost savings, workflow efficiency, and quality, the only benefits to be reliably documented were those regarding efficiency, including improved access to test results and other data from outside the practice and decreased staff time for handling referrals and claims processing. Barriers included cost, privacy and liability concerns, organizational characteristics, and technical barriers. A positive return on investment has not been documented.
Conclusions:The potential for HIE to reduce costs and improve the quality of health care in ambulatory primary care practices is well recognized but needs further empiric substantiation. (J Am Board Fam Med 2010;23:655-670.)
BACKGROUND We undertook a study to understand how women who are victims of intimate partner violence (IPV) want physicians to manage these abusive relationships in the primary care offi ce.METHODS Thirty-two mothers in IPV shelters or support groups in southwestern Ohio were interviewed to explore their abuse experiences and health care encounters retrospectively. The interviews were taped and transcribed. Using thematic analysis techniques, transcripts were read for indications of the stages of change and for participants' desires concerning appropriate physician management.RESULTS Participants believed that physicians should screen women for IPV both on a routine basis and when symptoms indicating possible abuse are present, even if the victim does not disclose the abuse. Screening is an important tool to capture those women early in the process of victimization. When a victim does not recognize her relationship as abusive, participants recommended that physicians raise the issue by asking, but they also warned that doing more may alienate the victim. Participants also encouraged physicians to explore clues that victims might give about the abuse. In later contemplation, victims are willing to disclose the abuse and are exploring options. Physicians were encouraged to affi rm the abuse, know local resources for IPV victims, make appropriate referrals, educate victims about how the abuse affects their health, and document the abuse. Participants identifi ed a variety of internal and external factors that had affected their processes.
CONCLUSIONSIn hindsight, IPV victims recommended desired actions from physicians that could help them during early stages of coming to terms with their abusive relationships. Stage-matched interventions may help physicians manage IPV more effectively and avoid overloading the victim with information for which she is not ready.
BACKGROUNDI n the primary care offi ce, 11% to 22% of women are currently experiencing physical abuse. [1][2][3] Studies show that intimate partner violence or abuse (IPV) affects the physical and mental health of victims [4][5][6][7][8][9][10][11][12] and of children who witness it. [13][14][15][16][17][18] Because IPV is commonplace and the consequences of IPV are serious, professional organizations recommend that physicians routinely screen the woman alone without her spouse or children. [19][20][21][22][23] The value of screening for IPV when effectiveness has not been proved remains subject to controversy. 24,25 Rhodes and Levinson 26 remind us, however, that physicians will continue to see both men and women who are abused and that the recognition of abuse may infl uence the evaluation of the patient' s complaints as well as the outcomes of care.Studies show that physicians are not screening. [27][28][29] The reported barriers One barrier not mentioned in the literature is that children are often with their mothers in the offi ce. Sometimes children accompany their mothers to her medical appointments (8%), and often mothers bring children to ...
Older women victims have difficulty initiating discussions about IPV with their providers. Providers are encouraged to identify signals of potential abuse and to create privacy with all patients to discuss difficult issues, such as IPV, and to be knowledgeable about appropriate referrals.
RPAP and UMN-Duluth provide significant, complementary educational programs that lead more graduates to choose rural and primary care practices. Efforts across the nation to address the crisis in rural primary care should build on these successful efforts.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.