Barriers and Facilitators to the Collection and Aggregation of Electronic Health Record HIV Data: An Analysis of Study Recruitment Venues Within the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN).

Electronic health record (EHR) data can be leveraged for prospective cohort studies and pragmatic clinical trials, targeting youth living with HIV (YLH). Using EHRs in this manner may minimize the need for costly research infrastructure in service to lowering disease burden. This study characterizes HIV prevention and care continua variables and identifies factors likely to impede or facilitate EHR use for research and interventions. We conducted telephone-based qualitative interviews with National Experts (n = 10) and Key Stakeholders (n = 19) from subject recruitment venues (SRVs), providing care services to YLH and youth at risk for HIV. We found 17 different EHR systems being used for various purposes (e.g., workflow management and billing). Thematic content analysis of interviews highlighted six broad categories of perspectives on barriers to and facilitators of EHR use: specific variable collection, general use barriers, and facilitators, general data collection barriers and facilitators, EHRs for surveillance and research, EHRs for personnel and resource management and capture of HIV specific variables. These findings may inform implementation strategies of future studies, in which we conduct routine monitoring of the youth HIV prevention and care continua using EHRs and test an eHealth intervention.

Ethnic differences in the reliability and validity of a Panic Disorder Screen.

PURPOSE: The purpose of this study was to compare the reliability and validity of the Brief Panic Disorder Screen (BPDS) in samples of African American and Caucasian American primary care patients. METHODS: The BPDS was administered to 295 patients scheduled to visit a primary care clinic for medical reasons. The presence or absence of a panic disorder diagnosis was established during a clinical interview with a psychiatrist. Measures of reliability (internal consistency) and validity (criterion validity) were compared between the two ethnic subgroups. FINDINGS: The BPDS demonstrated greater reliability and validity for Caucasians than African Americans. This effect was maintained even after controlling for group differences in key demographic variables. Differences between ethnic groups were apparent in both those with and those without panic disorder (PD). BPDS responses of African Americans with PD demonstrated very low internal consistency whereas a high rate of false positive PD diagnoses was related to higher than expected BPDS scores among African Americans without PD, particularly on the level of fear felt when experiencing shortness of breath or heart palpitations. DISCUSSION: These findings support the notion that cultural differences in the language and meaning associated with anxiety disorders contribute to the difficulty of accurately diagnosing PD in primary care populations. Additional research is needed to provide a better understanding of the cultural aspects of the anxiety experience. Such research would facilitate the development of better screening tools for panic and other anxiety disorders for ethnic minority primary care populations.

Planning for pharmacy health information technology in critical access hospitals.

PURPOSE: A plan for the implementation of medication-related health information technology (HIT) in 12 critical access hospitals (CAHs) to improve safety and reduce medication errors is described. SUMMARY: Interviews were conducted to assess the status of HIT in 12 CAHs, including HIT needs and desires and barriers to HIT adoption. Two conferences were held as part of the planning process. It was determined that pharmacy HIT (pHIT) should be implemented in three phases in the CAHs. In phase 1, it was found that the first HIT needed by the CAHs was pharmacy information management systems (PIMS), the cornerstone for the implementation of other HITs. Criteria were developed for the appropriate selection of PIMS for the CAHs. Phase 2 revealed that automated dispensing cabinets (ADCs) should be the next HIT implementation. ADCs are effective in the reduction of medication errors in the dispensing stage. Phase 3 dealt with the implementation of smart infusion pumps. Smart infusion pumps contain a standard data set that includes parameters for infusion fluids and a clinical decision-support system, and they keep a record of rule violations. Barriers to HIT implementation included funding, staff resistance to change, staff adaptation to HIT and workflow changes, time constraints on small sta., facility and building barriers, and lack of information technology support. CONCLUSION: Planning conferences and interviews with hospital representatives helped to identify the HIT needs of 12 CAHs. The planning process resulted in a three-phase plan for pHIT implementation, which will include PIMS, ADCs, and smart infusion pumps.

Medication safety infrastructure in critical-access hospitals in Florida.

PURPOSE: The medication safety infrastructure of critical-access hospitals (CAHs) in Florida was evaluated. METHODS: Qualitative assessments, including a self-administered survey and site visits, were conducted in seven of nine CAHs between January and June 2003. The survey consisted of the Institute for Safe Medication Practices Medication Safety Self-assessment, the 2003 Joint Commission on Accreditation of Healthcare Organizations patient safety goals, health information technology (HIT) questions, and medication-use-process flow charts. On-site visits included interviews of CAH personnel who had safety responsibility and inspections of pharmacy facilities. The findings were compiled into a matrix reflecting structural and procedural components of the CAH medication safety infrastructure. RESULTS: The nine characteristics that emerged as targets for quality improvement (QI) were medication accessibility and storage, sterile product compounding, access to drug information, access to and utilization of patient information in medication order review, advanced safety technology, drug formularies and standardized medication protocols, safety culture, and medication reconciliation. CONCLUSION: Based on weighted importance and feasibility, QI efforts in CAHs should focus on enhancing medication order review systems, standardizing procedures for handling high-risk medications, promoting an appropriate safety culture, involvement in seamless care, and investment in HIT.

Effect of clinical breast examination training on practitioner's perceived competence.

Effective clinical breast exam (CBE) training should not only improve screening technique but also reduce barriers to performing CBE by increasing perceived competence and self-efficacy. Using the vertical strip technique with silicone breast models and live patients, 4-day CBE training sessions were provided to 34 nurse-practitioners. Trainees perceived a significant decrease in the size of breast lesion they could detect after training (P < 0.0001). The size of the detectable lesion reported prior to training was correlated with the years of CBE experience (P < 0.05); however, the size of the detectable lesion after training was not significantly related to previous CBE experience. Trainees with less CBE experience prior to training reported greater improvement in the ability to detect smaller lesions (P < 0.05). Results indicate a significant CBE training effect on perceived competence, and suggest that nurse practitioners from all levels of experience can benefit significantly from CBE training. O 2002 International Society for Preventive Oncology.