Evaluating Feasible and Referable Behavioral Counseling Interventions.

The U.S. Preventive Services Task Force (USPTF) recognizes that behaviors have a major impact on health and well-being. Currently, the USPSTF has 11 behavioral counseling intervention (BCI) recommendations. These BCIs can be delivered in a primary care setting or patients can be referred to other clinical or community programs. Unfortunately, many recommended BCIs are infrequently and ineffectually delivered, suggesting that more evidence is needed to understand which BCIs are feasible and referable. In response, the USPSTF convened an expert forum in 2013 to inform the evaluation of BCI feasibility. This manuscript reports on findings from the forum and proposes that researchers use several frameworks to help clinicians and the USPSTF evaluate which BCIs work under usual conditions. A key recommendation for BCI researchers is to use frameworks whose components can support dissemination and implementation efforts. These frameworks include the Template for Intervention Description and Replication (TIDieR), which helps describe the essential components of an intervention, and pragmatic frameworks like Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) or Pragmatic-Explanatory Continuum Indicator Summary (PRECIS), which help to report study design elements and outcomes. These frameworks can both guide the design of more-feasible BCIs and produce clearer feasibility evidence. Critical evidence gaps include a better understanding of which patients will benefit from a BCI, how flexible interventions can be without compromising effectiveness, required clinician expertise, necessary intervention intensity and follow-up, impact of patient and clinician intervention adherence, optimal conditions for BCI delivery, and how new care models will influence BCI feasibility.

Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems.

OBJECTIVE: Medication errors in hospitals are common, expensive, and sometimes harmful to patients. This study's objective was to derive a nationally representative estimate of medication error reduction in hospitals attributable to electronic prescribing through computerized provider order entry (CPOE) systems. MATERIALS AND METHODS: We conducted a systematic literature review and applied random-effects meta-analytic techniques to derive a summary estimate of the effect of CPOE on medication errors. This pooled estimate was combined with data from the 2006 American Society of Health-System Pharmacists Annual Survey, the 2007 American Hospital Association Annual Survey, and the latter's 2008 Electronic Health Record Adoption Database supplement to estimate the percentage and absolute reduction in medication errors attributable to CPOE. RESULTS: Processing a prescription drug order through a CPOE system decreases the likelihood of error on that order by 48% (95% CI 41% to 55%). Given this effect size, and the degree of CPOE adoption and use in hospitals in 2008, we estimate a 12.5% reduction in medication errors, or ∼17.4 million medication errors averted in the USA in 1 year. DISCUSSION: Our findings suggest that CPOE can substantially reduce the frequency of medication errors in inpatient acute-care settings; however, it is unclear whether this translates into reduced harm for patients. CONCLUSIONS: Despite CPOE systems' effectiveness at preventing medication errors, adoption and use in US hospitals remain modest. Current policies to increase CPOE adoption and use will likely prevent millions of additional medication errors each year. Further research is needed to better characterize links to patient harm.

Perceptions of quality of reproductive care services in Bolivia: use of photo prompts and surveys as an impetus for change.

Surveys are sometimes used to assess women's perceptions of the quality of reproductive health care, but less empowered women may feel uncomfortable expressing their views in this method. We demonstrate the use of a participatory approach, combining a standard survey with an innovative photonarrative method. Women in Cochabamba, Bolivia, were asked to participate in exit surveys (n = 108). A subsample did photonarratives (n = 20). The survey showed rural women had less access to care, but photonarratives revealed the cause - fear. Women asserted quality of care was high, but photonarratives contradicted survey results. Staff used photonarratives to select action items for quality improvement.

Strategies and cost of recruitment of middle-aged and older unmarried women in a cancer screening study.

OBJECTIVES: We compared strategies and costs associated with recruiting unmarried middle-aged and older women who partner with women (WPW) and women who partner with men (WPM) into an observational study about experiences with cancer screening. METHODS: We used targeted and respondent-driven sampling methods to recruit potential participants. Comparable recruitment strategies were used for WPW and WPM. RESULTS: During 25 months (June 1, 2003, through June 30, 2005), 773 women were screened for study eligibility; 630 were enrolled (213 WPW, 417 WPM). Average staff time spent for recruitment was 100 min per participant. There were no differences by partner gender in average recruitment time (WPW, 90 min; WPM, 100 min). Print media was the most efficient recruitment mode (time per participant: 10 min for WPW, 15 min for WPM). Recruitment costs differed by partner gender ($140 for WPW, $110 for WPM). Costs associated with print media were $10 per WPW and $20 per WPM. Recruitment through community events had higher costs ($490 per WPW, $275 per WPM) but yielded more women with less education and lower incomes, who identified as a racial or ethnic minority, and self-reported a disability. Compared with WPM, WPW had more education and higher incomes, but were less likely to identify as a racial minority and self-report a disability. CONCLUSIONS: There was a trade-off between cost and sample diversity for the different recruitment methods. The per-person costs were lowest for print media, but recruitment through community events ensured a more diverse representation of unmarried heterosexual and sexual minority women.

Social support among Latina immigrant women: bridge persons as mediators of cervical cancer screening.

New Latina immigrants face numerous linguistic, cultural, logistical, and material barriers to cervical cancer screenings. Promotoras (lay health advisors) are a proven strategy to promote utilization of care. Since the mid-1990s, interventions in North Carolina have aimed to connect Latina immigrants to a broader range of bridge persons. This study assessed the effect of bridge persons on utilization of cervical cancer screening by Latina immigrants in North Carolina. Women were recruited in Spanish-language churches in four counties (N = 223). Logistic regression results show that persons known through advocacy organizations appeared to increase probability of recent Pap screening by an average of 10.4 percentage points (p < 0.05). Promotoras remain more effective, increasing probability of screening by 12.9 percentage points (p < 0.05) but few women (14%) knew one. No association was found with other bridge person profiles. Interventions are needed to better engage all bridge persons in linking immigrants to preventive health services.