Using a sociotechnical systems analysis to evaluate an intervention to improve opioid prescribing in emergency medicine.

The United States is facing an unprecedented epidemic of opioid addiction and death due to opioid overdose. In an effort to improve patient knowledge and safe use about opioids, an Electronic Medication Complete Communication (EMC2) opioid strategy was developed targeting opioid naïve patients in the Emergency Department (ED). We conducted pre and post sociotechnical systems analyses to evaluate the variance between the process before the intervention and whether or not the process changed as expected with the new intervention. Results were analyzed using thematic qualitative analysis. Sociotechnical systems modeling illustrates the complexity of designing interventions for emergency medicine that affect multiple patients, providers, work systems, technologies, and processes. The post work systems model illustrates that several elements in the external ED environment can affect the effectiveness of the intervention. Sociotechnical systems analysis is an effective tool to illustrate the opportunities for designing health system interventions and evaluating the fidelity of such interventions.

What Did You Google? Describing Online Health Information Search Patterns of ED patients and Their Relationship with Final Diagnoses.

INTRODUCTION: Emergency department (ED) patients' Internet search terms prior to arrival have not been well characterized. The objective of this analysis was to characterize the Internet search terms patients used prior to ED arrival and their relationship to final diagnoses. METHODS: We collected data via survey; participants listed Internet search terms used. Terms were classified into categories: symptom, specific diagnosis, treatment options, anatomy questions, processes of care/physicians, or "other." We categorized each discharge diagnosis as either symptom-based or formal diagnosis. The relationship between the search term and final diagnosis was assigned to one of four categories of search/diagnosis combinations (symptom search/symptom diagnosis, symptom search/formal diagnosis, diagnosis search/symptom diagnosis, diagnosis search/formal diagnosis), representing different "trajectories." RESULTS: We approached 889 patients; 723 (81.3%) participated. Of these, 177 (24.5%) used the Internet prior to ED presentation; however, seven had incomplete data (N=170). Mean age was 47 years (standard deviation 18.2); 58.6% were female and 65.7% white. We found that 61.7% searched symptoms and 40.6% searched a specific diagnosis. Most patients received discharge diagnoses of equal specificity as their search terms (34% flat trajectory-symptoms and 34% flat trajectory-diagnosis). Ten percent searched for a diagnosis by name but received a symptom-based discharge diagnosis with less specificity. In contrast, 22% searched for a symptom and received a detailed diagnosis. Among those who searched for a diagnosis by name (n=69) only 29% received the diagnosis that they had searched. CONCLUSION: The majority of patients used symptoms as the basis of their pre-ED presentation Internet search. When patients did search for specific diagnoses, only a minority searched for the diagnosis they eventually received.

Use of Online Health Information by Geriatric and Adult Emergency Department Patients: Access, Understanding, and Trust.

OBJECTIVE: The objective was to characterize geriatric patients' use of online health information (OHI) relative to younger adults and assess their comfort ith OHI compared to health information (HI) from their physician. METHODS: This was a prospective cross-sectional survey study of adult emergency department (ED) patients. The survey assessed patients' self-reported use of OHI in the past year and immediately prior to ED visit and analyzed differences across four age groups: 18-39, 40-64, 65-74, and 75+. Patients' ability to access, understand, and trust OHI was assessed using a 7-point Likert scale and compared to parallel questions regarding HI obtained from their doctor. Patient use of OHI was compared across age groups. Comfort with OHI and HI obtained from a doctor was compared across age groups using the Kruskal-Wallis test. Comparisons between sources of HI were made within age groups using the Wilcoxon signed-rank test. RESULTS: Of 889 patients who were approached for study inclusion, 723 patients (81.3%) completed the survey. The majority of patients had used OHI in the past year in all age groups, but older patients were less likely to have used OHI: age 18-39, 90.3%; 40-64, 85.3%; 65-74, 76.4%; and 75+, 50.7% (p < 0.001). The youngest patients were most likely to have used OHI prior to coming to the ED, 47.1%, 28.3%, 17.1%, and 8.0% (p < 0.001). Older patients were more likely to have an established doctor-18-39, 79.4%; 40-64, 91.1%; 65-74, 97.5%; and 75+ 97.4% (p < 0.001)-and were more likely to have contacted their doctor prior to their ED visit: 36.7, 40.2, 46.7, and 53.5% (p = 0.02). The oldest patients were most likely to find HI more accessible from their doctor than the Internet, while the youngest patients found HI more accessible on the Internet than from their doctor. Regardless of age, patients noted that information from their physician was both easier to understand and more trustworthy than information found on the Internet. CONCLUSION: Although many older patients used OHI, they were less likely than younger adults to use the Internet immediately prior to an ED visit. Despite often using OHI, patients of all age groups found healthcare information from their doctor easier to understand and more trustworthy than information from the Internet. As health systems work to efficiently provide information to patients, addressing these perceived deficiencies may be necessary to build effective OHI programs.