Sciamanna CN et al. 2004 "Feasibility of incorporating computer-tailored health behaviour communications in primary care settings."
Reference
Sciamanna CN, Marcus BH, Goldstein MG, et al. Feasibility of incorporating computer-tailored health behaviour communications in primary care settings. Inform Prim Care 2004;12(1):40-48.
Abstract
"Background: We set out to investigate the feasibility of incorporating a computer-tailored health behaviour program into routine care in a group of primary care practices in Rhode Island.
Methods: Two existing computer programs (physical activity, smoking) that tailored text and graphical feedback to survey responses were combined and adapted for use in primary care directly by patients. Ten primary care practices were recruited and worked closely with project staff to develop a practice-specific plan for incorporating the program into the workflow and office routine. Feasibility was measured by the percentage of patients who used the program during the day of their visit.
Results: Only one of the ten offices was able to successfully incorporate the program into their office workflow and delivery of routine care. The main categories of barriers to incorporating the computer program into routine care included: the program was viewed overall as inconsistent with practice workflow[;] the staff was inexperienced with the program[;] technical problems with the computer and/or printer[;] the program placed an additional time burden on staff who already felt overworked[;] shortening the program[;] modifying the program's orientation to a target population (such as patients with hypertension) and incorporating decision-support feedback to help physicians manage the target condition[;] modifying the program to include other programs pertinent to primary care (for example, depression screening)[; and] selecting patients to use the program, rather than asking all patients to use it.
Conclusions: After working closely with ten highly motivated primary care offices, we were able to fully implement a point-of-care health behaviour computer system for patients and providers. Suggestions for disseminating computer-tailored health behaviour communications in primary care settings are discussed."
Methods: Two existing computer programs (physical activity, smoking) that tailored text and graphical feedback to survey responses were combined and adapted for use in primary care directly by patients. Ten primary care practices were recruited and worked closely with project staff to develop a practice-specific plan for incorporating the program into the workflow and office routine. Feasibility was measured by the percentage of patients who used the program during the day of their visit.
Results: Only one of the ten offices was able to successfully incorporate the program into their office workflow and delivery of routine care. The main categories of barriers to incorporating the computer program into routine care included: the program was viewed overall as inconsistent with practice workflow[;] the staff was inexperienced with the program[;] technical problems with the computer and/or printer[;] the program placed an additional time burden on staff who already felt overworked[;] shortening the program[;] modifying the program's orientation to a target population (such as patients with hypertension) and incorporating decision-support feedback to help physicians manage the target condition[;] modifying the program to include other programs pertinent to primary care (for example, depression screening)[; and] selecting patients to use the program, rather than asking all patients to use it.
Conclusions: After working closely with ten highly motivated primary care offices, we were able to fully implement a point-of-care health behaviour computer system for patients and providers. Suggestions for disseminating computer-tailored health behaviour communications in primary care settings are discussed."
Objective
To "investigate the feasibility of incorporating an innovative computer-tailored health behaviour program in a group of primary care practices in Rhode Island."
Tools Used
Type Clinic
Primary care
Size
Small and/or medium
Other Information
The study took place in 10 clinics in Rhode Island. Six of the clinics were solo or dual-physician practices and four were low-income public health clinics staffed by at least three primary care providers.
Type of Health IT
Informational resource
Type of Health IT Functions
The system was designed with a self-explanatory graphical user interface, allowing the patient to enter their own information on two health behaviors - smoking and physical inactivity. The program asked questions about risk factors and frequency of symptoms related to these health behaviors, provided feedback about how changing the health behaviors would improve these risk factors and symptoms, and provided a "feedback report ... [to] physicians to prompt and guide them in counselling their patients."
Workflow-Related Findings
Only one office out of the 10 selected was able to successfully incorporate the patient-education program into their office workflow.
The program was viewed by providers and staff as "plac[ing] an additional time burden on staff who already felt overworked."
Staff reported that the program disrupted their workflow when the patient was still working with it at the time the physician was ready to see him.
One clinic reported that the bonus from their major payer was dependent on getting patients to complete their visit in 45 minutes. Using the program was incompatible with this goal.
Staff reported that the system, including the printer, would be unreliable and "go down a lot."
A physician reported that the program was not useful because most of the information would be covered in a primary care visit anyway.
Staff members reported that they could have encouraged patients more to use the program.
Staff members reported that patients were intimidated or afraid of using the computer.
Study Design
Only postintervention (no control group)
Study Participants
Ten primary care providers participated, each in separate practices.