Internet Programming to Reduce Loneliness and Social Isolation in Aging.

Loneliness and social isolation in older adults carry mortality risks similar to cigarette smoking. The study aim was to use a Culturally Informed Healthy Aging (CIHA) assessment process in Housing and Urban Development (HUD) communities of older adults (N = 262). Through the CIHA assessment process, older adults identified pertinent health problems and the study team developed a health intervention, an Internet Information Station (IIS). The IIS pilot study included computer lesson participation (n = 261), written feedback (n = 42), and the revised University of California, Los Angeles (R-UCLA) Loneliness Scale (n = 11). Increased confidence with technology and connectedness were reported, and a significant difference in "There is no one I can turn to" was observed (IIS compared to non-IIS). The IIS remains an active site for interaction 1-year post intervention. These pilot results supplement the research on older adult engagement in problem identification, intervention design, and outcomes measurement. TARGET: Older adults living in HUD communities. INTERVENTION DESCRIPTION: Through CIHA assessment, health problems were identified, and the IIS was developed and implemented. MECHANISMS OF ACTION: Lessons were developed (e.g., computer basics, connecting with technology, open forum) and evaluated. Pre and post lesson, the R-UCLA Loneliness Scale measured social isolation and loneliness. OUTCOMES: Older adults were engaged in problem identification, program development, and implementation. Feelings of connectedness improved; however, program evaluation with the R-UCLA scale was difficult to obtain. [Research in Gerontological Nursing, 13(5), 233-242.].

Email teleconsultations: well formulated clinical referrals reduce the need for clinic consultation.

We examined how well primary-care physicians formulated their clinical referrals when asking for help with patient-related clinical problems using an email-based teleconsultation service. Over 100 family physicians made use of the service. The specialists were medical school faculty members. The service was initiated in May 1996 with 19 specialists and expanded to 34 specialties over the next five years. A total of 1618 patient-related clinical questions were analysed, the outcome for the analysis being whether specialists recommended a clinic consultation. Specialists recommended a clinic consultation in response to 10% of their clinical questions about patients. There was a strong association between how family physicians formulated their clinical questions and whether the specialist recommended a clinic consultation. When the family physicians specified a clinical task (P < 0.001), intervention (P = 0.004) and outcome (P < 0.001) in their questions, specialists were less likely to recommend a clinic consultation. This influence was independent of the amount of clinical information included with the question (P > 0.05). About 5% of the questions that included all three question components resulted in the recommendation for a clinic consultation, compared with nearly 30% of the questions containing none of these components. How family physicians formulate their clinical questions influences whether specialists request a clinic consultation.

Family medicine residents do not ask better-formulated clinical questions as they advance in their training.

OBJECTIVE: We investigated whether family medicine residents demonstrated increased skill in formulating clinical questions over their 3 years of training. METHODS: We conducted an analysis of 454 questions asked by 49 family physician residents engaged in informal consultation with subspecialists using an e-mail-based system. Clinical question formulation was measured on a scale of 0 to 2 by awarding 1 point each for the presence of a proposed intervention and a desired outcome. Changes in question formulation as residents progressed in their training were assessed using cross-sectional and repeated measures. FINDINGS: The mean question quality was scored at 1.10, and there was no significant change over the 3 years. Thirteen residents used the e-mail service over their entire 3-year training period. The individual residents showed substantial differences in how well they formulated clinical questions, with their mean question quality scores ranging from 0.38 to 1.45. There was, however, no evidence that the quality of their questions changed as they progressed in their medical training. CONCLUSIONS: Resident physicians asked moderately well-formulated clinical questions, but question formulation did not improve as they progressed in clinical training. Further training in formulating clinical questions may be helpful.