Discriminative Accuracy of the CAPTURE Tool for Identifying Chronic Obstructive Pulmonary Disease in US Primary Care Settings.

Importance: Chronic obstructive pulmonary disease (COPD) is underdiagnosed in primary care. Objective: To evaluate the operating characteristics of the CAPTURE (COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk) screening tool for identifying US primary care patients with undiagnosed, clinically significant COPD. Design, Setting, and Participants: In this cross-sectional study, 4679 primary care patients aged 45 years to 80 years without a prior COPD diagnosis were enrolled by 7 primary care practice-based research networks across the US between October 12, 2018, and April 1, 2022. The CAPTURE questionnaire responses, peak expiratory flow rate, COPD Assessment Test scores, history of acute respiratory illnesses, demographics, and spirometry results were collected. Exposure: Undiagnosed COPD. Main Outcomes and Measures: The primary outcome was the CAPTURE tool's sensitivity and specificity for identifying patients with undiagnosed, clinically significant COPD. The secondary outcomes included the analyses of varying thresholds for defining a positive screening result for clinically significant COPD. A positive screening result was defined as (1) a CAPTURE questionnaire score of 5 or 6 or (2) a questionnaire score of 2, 3, or 4 together with a peak expiratory flow rate of less than 250 L/min for females or less than 350 L/min for males. Clinically significant COPD was defined as spirometry-defined COPD (postbronchodilator ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity [FEV1:FVC] <0.70 or prebronchodilator FEV1:FVC <0.65 if postbronchodilator spirometry was not completed) combined with either an FEV1 less than 60% of the predicted value or a self-reported history of an acute respiratory illness within the past 12 months. Results: Of the 4325 patients who had adequate data for analysis (63.0% were women; the mean age was 61.6 years [SD, 9.1 years]), 44.6% had ever smoked cigarettes, 18.3% reported a prior asthma diagnosis or use of inhaled respiratory medications, 13.2% currently smoked cigarettes, and 10.0% reported at least 1 cardiovascular comorbidity. Among the 110 patients (2.5% of 4325) with undiagnosed, clinically significant COPD, 53 had a positive screening result with a sensitivity of 48.2% (95% CI, 38.6%-57.9%) and a specificity of 88.6% (95% CI, 87.6%-89.6%). The area under the receiver operating curve for varying positive screening thresholds was 0.81 (95% CI, 0.77-0.85). Conclusions and Relevance: Within this US primary care population, the CAPTURE screening tool had a low sensitivity but a high specificity for identifying clinically significant COPD defined by presence of airflow obstruction that is of moderate severity or accompanied by a history of acute respiratory illness. Further research is needed to optimize performance of the screening tool and to understand whether its use affects clinical outcomes.

An evaluation of the spread and scale of PatientToc™ from primary care to community pharmacy practice for the collection of patient-reported outcomes: A study protocol.

BACKGROUND: Medication non-adherence is a problem of critical importance, affecting approximately 50% of all persons taking at least one regularly scheduled prescription medication and costing the United States more than $100 billion annually. Traditional data sources for identifying and resolving medication non-adherence in community pharmacies include prescription fill histories. However, medication possession does not necessarily mean patients are taking their medications as prescribed. Patient-reported outcomes (PROs), measuring adherence challenges pertaining to both remembering and intention to take medication, offer a rich data source for pharmacists and prescribers to use to resolve medication non-adherence. PatientToc™ is a PROs collection software developed to facilitate collection of PROs data from low-literacy and non-English speaking patients in Los Angeles. OBJECTIVES: This study will evaluate the spread and scale of PatientToc™ from primary care to community pharmacies for the collection and use of PROs data pertaining to medication adherence. METHODS: The following implementation and evaluation steps will be conducted: 1) a pre-implementation developmental formative evaluation to determine community pharmacy workflow and current practices for identifying and resolving medication non-adherence, potential barriers and facilitators to PatientToc™ implementation, and to create a draft implementation toolkit, 2) two plan-do-study-act cycles to refine an implementation toolkit for spreading and scaling implementation of PatientToc™ in community pharmacies, and 3) a comprehensive, theory-driven evaluation of the quality of care, implementation, and patient health outcomes of spreading and scaling PatientToc™ to community pharmacies. EXPECTED IMPACT: This research will inform long-term collection and use of PROs data pertaining to medication adherence in community pharmacies.

Experiences Applying Technology to Overcome Common Challenges in Pharmacy Practice-Based Research in the United States.

Despite the importance of pharmacy practice-based research in generating knowledge that results in better outcomes for patients, health systems and society alike, common challenges to PPBR persist. Herein, we authors describe PPBR challenges our research teams have encountered, and our experiences using technology-driven solutions to overcome such challenges. Notably, limited financial resources reduce the time available for clinicians and researchers to participate in study activities; therefore, resource allocation must be optimized. We authors have also encountered primary data collection challenges due to unique data needs and data access/ownership issues. Moreover, we have experienced a wide geographic dispersion of study practices and collaborating researchers; a lack of trained, on-site research personnel; and the identification and enrollment of participants meeting study eligibility criteria. To address these PPBR challenges, we authors have begun to turn to technology-driven solutions, as described here.

Quality improvement as a tool for translating evidence based interventions into practice: what the youth violence prevention community can learn from healthcare.

Health care has been working for the past 2 decades to improve the translation of evidence based practice (EBPs) into care. The strategies used to facilitate this, and lessons learned, can provide useful models for similar work taking place in youth violence prevention. This article discusses the history of evidence translation in health care, reviews key strategies used to support translation of evidence based practice into care, and suggests lessons learned that may be useful to similar efforts in youth violence prevention and intervention services.

Field test results of a new ambulatory care Medication Error and Adverse Drug Event Reporting System--MEADERS.

PURPOSE: In this study, we developed and field tested the Medication Error and Adverse Drug Event Reporting System (MEADERS)-an easy-to-use, Web-based reporting system designed for busy office practices. METHODS: We conducted a 10-week field test of MEADERS in which 220 physicians and office staff from 24 practices reported medication errors and adverse drug events they observed during usual clinical care. The main outcomes were (1) use and acceptability of MEADERS measured with a postreporting survey and interviews with office managers and lead physicians, and (2) distributions of characteristics of the medication event reports. RESULTS: A total of 507 anonymous event reports were submitted. The mean reporting time was 4.3 minutes. Of these reports, 357 (70%) included medication errors only, 138 (27%) involved adverse drug events only, and 12 (2.4%) included both. Medication errors were roughly equally divided among ordering medications, implementing prescription orders, errors by patients receiving the medications, and documentation errors. The most frequent contributors to the medication errors and adverse drug events were communication problems (41%) and knowledge deficits (22%). Eight (1.6%) of the reported events led to hospitalization. Reporting raised staff and physician awareness of the kinds of errors that occur in office medication management; however, 36% agreed or strongly agreed that the event reporting "has increased the fear of repercussion in the practice." Time pressure was the main barrier to reporting. CONCLUSIONS: It is feasible for primary care clinicians and office staff to report medication errors and adverse drug events to a Web-based reporting system. Time pressures and a punitive culture are barriers to event reporting that must be overcome. Further testing of MEADERS as a quality improvement tool is warranted.

What health professionals should know: core competencies for effective practice in youth violence prevention.

BACKGROUND: Youth violence has been identified as a critical health concern in the United States; however, few training resources are available for preparing health professionals to contribute to prevention efforts in their professional practices. Identification of core competencies for health professionals in youth violence prevention can be used to support the development of training resources in this area of professional practice. METHODS: In 2001, experts in youth violence, health care, and health professional education from eight of the ten Academic Centers of Excellence on Youth Violence Prevention met to develop a list of core competencies that health professionals need for effective practice in youth violence prevention. Experts participated in a 2-day facilitated session to identify these competencies. RESULTS: The group identified 40 core competencies that health professionals should acquire for effective practice in youth violence prevention. The competencies were organized across seven domains of practice and at three levels of expertise. CONCLUSIONS: Training is needed to prepare health and public health professionals to contribute to efforts in youth violence prevention in the United States. The core competencies identified by the Academic Centers of Excellence Working Group can support the development of curricula in this area.

American Medical Association's Youth Violence Prevention Training and Outreach Guide.

This article describes the development and contents of a training and outreach guide Connecting the Dots to Prevent Youth Violence: A Training and Outreach Guide for Physicians and Other Health Professionals (the Guide) on youth violence prevention for healthcare providers developed by the American Medical Association. The Guide, was developed to help translate recommendations made by the Commission for the Prevention of Youth Violence in their 2000 report, Youth and Violence: Medicine, Nursing, and Public Health: Connecting the Dots to Prevent Violence, into healthcare practice. The Guide, which will also be available in Spanish in early 2006, is structured as a speaker's kit and includes prepared speeches, case studies, issue briefs, and copies of screening tools and patient education materials from a variety of sources appropriate for use in the clinical setting. Results of a preliminary evaluation of the Guide indicate that the training can be effective in increasing providers' awareness about the problem of youth violence and encouraging them to incorporate into healthcare visits violence prevention activities such as screening youth for exposure to violence and educating patients and caregivers on strategies for reducing the risk for violence.

World Health Organization's TEACH-VIP: contributing to capacity building for youth violence prevention.

Youth violence is a major public health problem in every region of the world, yet it is especially prevalent in specific settings. Youth homicide rates exceeding 10.0/100,000 occur most often in countries that are low or middle income, or which are experiencing rapid economic or social change. Particularly in low- and middle-income countries, the capacity to develop and implement the comprehensive, multisectoral strategies to prevent youth violence is only just emerging. The prevention of youth violence requires multidisciplinary approaches and a variety of trained professionals. A public health approach to training in the area of injury prevention focuses on providing professionals and paraprofessionals a common understanding of essential skills and knowledge. One important benefit of this is that it addresses a major gap in current public health training that until recently has devoted relatively little attention to injury prevention. Another benefit is that it allows professionals from a variety of backgrounds to work together more effectively to reduce injury. This article will provide a broad overview of youth violence in low- and middle-income countries and will discuss the existing level of capacity within healthcare and public health sectors for responding to these problems. It concludes with a discussion of next steps for increasing capacity and a profile of the World Health Organization (WHO) training curriculum on injury and violence prevention called TEACH-VIP, an acronym for Training, Education, and Advancing Collaboration in Health on Violence and Injury Prevention, as one important effort undertaken by WHO and global injury partners to build capacity.