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BMC Primary Care

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Open Access 01-12-2021 | Care | Research

Patient perspectives on tablet-based technology to collect risk factor information in primary care

Authors: Leanne Kosowan, Alan Katz, Gayle Halas, Alexander Singer

Published in: BMC Primary Care | Issue 1/2021

Abstract

Background

Primary care provides an opportunity to introduce prevention strategies and identify risk behaviours. Algorithmic information technology such as the Risk Factor Identification Tool (RFIT) can support primary care counseling. This study explores the integration of the tablet-based RFIT in primary care clinics to support exploration of patient risk factor information.

Methods

Qualitative study to explore patients’ perspectives of RFIT. RFIT was implemented in two primary care clinics in Manitoba, Canada. There were 207 patients who completed RFIT, offered to them by eight family physicians. We conducted one-on-one patient interviews with 86 patients to capture the patient’s perspective. Responses were coded and categorized into five common themes.

Results

RFIT had a completion rate of 86%. Clinic staff reported that very few patients declined the use of RFIT or required assistance to use the tablet. Patients reported that the tablet-based RFIT provided a user-friendly interface that enabled self-reflection while in the waiting room. Patients discussed the impact of RFIT on the patient-provider interaction, utility for the clinician, their concerns and suggested improvements for RFIT. Among the patients who used RFIT 12.1% smoked, 21.2% felt their diet could be improved, 9.3% reported high alcohol consumption, 56.4% reported less than 150 min of PA a week, and 8.2% lived in poverty.

Conclusion

RFIT is a user-friendly tool for the collection of patient risk behaviour information. RFIT is particularly useful for patients lacking continuity in the care they receive. Information technology can promote self-reflection while providing useful information to the primary care clinician. When combined with practical tools and resources RFIT can assist in the reduction of risk behaviours.

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Lacombe J, Armstrong M, Wright FL, Foster C. The impact of physical activity and an additional behavioural risk factor on cardiovascular disease, cancer and all-cause mortality: a systematic review. BMC Public Health. 2019;19(1):900. https://doi.org/10.1186/s12889-019-7030-8.CrossRefPubMedPubMedCentral

Schulze MB, Hu FB. Primary prevention of diabetes: what can be done and how much can be prevented? Annu Rev Public Health. 2005;26:445–67. https://doi.org/10.1146/annurev.publhealth.26.021304.144532.CrossRefPubMed

Boyle P, Boffetta P, Autier P. Diet, nutrition and cancer: public, media and scientific confusion. Ann Oncol. 2008;19(10):1665–7. https://doi.org/10.1093/annonc/mdn561.CrossRefPubMed

Artinian N, Fletcher G, Mozaffarian D, Kris-Etherton P, Horn L, Lichtenstein A, et al. Interventions to Promote Physical Activity and Dietary Lifestyle Changes for Cardoivascular Risk Factor Reduction in Adults. Circulation. 2010;122(4):406–41. https://doi.org/10.1161/CIR.0b013e3181e8edf1.CrossRefPubMedPubMedCentral

Kosowan L, Wener P, Holmqvist M, Gonzalez M, Halas G, Rothney J, et al. Physical activity promotion in Manitoba: strengths, needs and moving forward. SAGE Open Medicine. 2019;7:1–10. https://doi.org/10.1177/2050312118822910.CrossRef

Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: The Evidence. CMAJ. 2006;174(6):801–9. https://doi.org/10.1503/cmaj.051351.CrossRefPubMedPubMedCentral

Kimokoti RW, Millen BE. Nutrition for the prevention of chronic diseases. Med Clin North Am. 2016;100(6):1185–98. https://doi.org/10.1016/j.mcna.2016.06.003.CrossRefPubMed

World Health Organization. Global status report on non-communicable disease 2014. Geneva: Switzerland. Available online from https://apps.who.int/iris/bitstream/handle/10665/148114/9789241564854_eng.pdf;jsessionid=C7631775E6B2A6FAECD6ED0982DAF4F6?sequence=1. Accessed 26 Mar 2020.

Milne-Ives M, Lam C, De Cook C, Van Velthoven MH, Meinert E. Mobile Apps for Health Behavior Change in Physical Activity, Diet, Drug and Alcohol Use and Mental Health: Systematic Review. JMIR Mhealth Uhealth. 2020;18(3):e17046. https://doi.org/10.2196/17046.CrossRef

10.

Zabaleta-del-olmo E, Bolibar B, García-Ortíz L, García-Campayo J, Llobera J, Ángel Bellón J, et al. Building interventions in primary care for long-term effectiveness in health promotion and disease prevention. Preventive Medicine. 2015;76(Supp):S1-S4. https://doi.org/10.1016/j.ypmed.2015.03.011.

11.

Sturgeon S. Promoting mental health as an essential aspect of health promotion. Health Promotion Int. 2006;21(Supp_1):36–41. https://doi.org/10.1093/heapro/dal049.

12.

The College of Family Physicians of Canada. Patient’s Medical Homes. Retrieved from https://patientsmedicalhome.ca/vision/. Accessed 26 Mar 2020.

13.

American College of Physicians. Understanding Patient-Centered Medical Home. Retrieve from https://www.acponline.org/practice-resources/businessresources/payment/delivery-and-payment-models/patient-centered-medical-home/understanding-the-patient-centered-medical-home/what-is-the-patient-centered-medical-home. Accessed 26 Mar 2020.

14.

Oberg EB, Frank E. Physicians' health practices strongly influence patient health practices. J Royal Coll Phys Edinburgh. 2009;39(4):290–1. https://doi.org/10.4997/JRCPE.2009.422.

15.

Thombs B, Lewin G, Tonelli M. Implementing preventive health care recommendations in family medicine: Introducing a series from the Canadian Task Force on Preventive Health Care. Canadian Family Physician; 2017;63:504–505 PMID 28701433.

16.

Katz A, Lambert-Lanning A, Miller A, Kaminsky B, Enns J. Delivery of preventive care: The national Canadian Family Physician Cancer and Chronic Disease Prevention Survey. Canadian Family Physician; 2012;58(1):e62-e69. PMID 22267643

17.

Lai JK, Lau F, Shaw N. A study of information technology use and implementation of electronic medical record systems in BC medical practices. Br Columbia Med J. 2009;51(3):114–21.

18.

Calderón C, Balagué L, Cortada JM, Sánchez Á. Health promotion in primary care: How should we intervene? A qualitative study involving both physicians and patients. BMC Health Serv Res. 2011;11:62–73. https://doi.org/10.1186/1472-6963-11-62.CrossRefPubMedPubMedCentral

19.

Gate L, Warren-Gash C, Clarke A, Bartley A, Fowler E, Semple G, et al. Promoting lifestyle behaviour change and well-being in hospital patients: a pilot study of an evidence-based psychological intervention. J Public Health (Oxf). 2016;38(3):e.292–e300. https://doi.org/10.1093/pubmed/fdv141.

20.

Boulware L, Marinopoulos S, Phillips K, Hwang C, Maynor K, Merenstein D, et al. Systematic review: the value of the periodic health evaluation. Ann Intern Med. 2007;20;146(4):289–300. https://doi.org/10.7326/0003-4819-146-4-200702200-00008.

21.

Prochaska JJ, Zabinski MF, Calfas KJ, Sallis JF, Patrick K. PACE+: interactive communication technology for behavior change in clinical settings. Am J Prev Med. 2000;19(2):127–31. https://doi.org/10.1016/s0749-3797(00)00187-2.

22.

Halas G, Katz A, Jin D. Computer-Based Risk Assessment: Evaluating Use in Primary Care. Electronic Healthcare. 2010;9(2):e10.

23.

Kosowan L, Katz A, Halas G, LaBine L, Singer A. Using information technology to assess patient risk factors in primary care clinics: Pragmatic evaluation. JMIR Form Res. 2021;5(2):e24382. https://doi.org/10.2196/24382 (PMID: 33528376).CrossRefPubMedPubMedCentral

24.

Krist A, Glenn B, Glasgow R, Balasubramanian B, Chambers D, Fernandez M, et al. Designing a valid randomized pragmatic primary care implementation trial: the my own health report (MOHR) project. Implement Sci. 2013;8:73–86. https://doi.org/10.1186/1748-5908-8-73.CrossRefPubMedPubMedCentral

25.

Ruland C, Roslien J, Bakken S, Kristiansen J. Comparing tailored computerized symptom assessments to interviews and questionnaires. AMIA Annu Symp Proc. 2006;2006:1081.

26.

Schumann A, Nigg CR, Rossi JS, Jordan PJ, Norman GJ, Garber CE, et al. Construct validity of the stages of change of exercise adoption for different intensities of physical activity in four samples of differing age groups. Am J Health Promot. 2002;16(5):280–7. https://doi.org/10.4278/0890-1171-16.5.280.

27.

Lindeman C, McCurdy A, Lamboglia CG, Wohlers B, Pham ANQ, Sivak A, Spence JC. The extent to which family physicians record their patients’ exercise in medical records: A scoping review. BJM Open. 2020;10(2):e034542. https://doi.org/10.1136/bmjopen-2019-034542.CrossRef

28.

Rodriguez HP, Glenn BA, Olmos T, Krist AH, Shimada SL, Kessler R, et al. Real-world implementation and outcomes of health behavior and mental health assessment. J Am Board Fam Med. 2014;27(3):356–66. https://doi.org/10.3122/jabfm.2014.03.130264.

29.

Zakim D, Braun N, Fritz P, Alscher MD. Underutilization of information and knowledge in everyday medical practice: Evaluation of a computer-based solution. BMC Med Inform Decis Mak. 2008;8:50–62. https://doi.org/10.1186/1472-6947-8-50.CrossRefPubMedPubMedCentral

30.

Akesson KM, Saveman BI, Nilsson G. Health care consumers' experiences of information communication technology--a summary of literature. Int J Med Inform. 2007;76(9):633–45. https://doi.org/10.1016/j.ijmedinf.2006.07.001.

31.

Jimison H, Gorman P, Woods S, Nygren P, Walker M, Norris S, et al. Barriers and drivers of health information technology use for the elderly, chronically ill, and underserved. Evidence Reports/Technology Assessments, No 175. 2008. Rockville.

32.

Spencer L, Pagell F, Hallion ME, Adams TB. Applying the transtheoretical model to tobacco cessation and prevention: a review of literature. Am J Health Promot. 2002;17(1):7–71. https://doi.org/10.4278/0890-1171-17.1.7.

33.

Hussain S, Taylor M, Waltermaurer E, McCauley J, Ford DE, Campbell JC. Computer-administered screening of reproductive-aged women for diabetes risk in primary care settings, feasibility and acceptability of such screening, and validity of risk assessments based on self-reported weight. Preventing chronic disease; 2007;4(3):54–65. PMID 17572958

34.

Ahmad F, Skinner HA, Stewart DE, Levinson W. Perspectives of family physicians on computer-assisted health-risk assessments. J Med Internet Res. 2010;12(2):e12. https://doi.org/10.2196/jmir.1260.CrossRefPubMedPubMedCentral

35.

Babor TF, Sciamanna CN, Pronk NP. Assessing multiple risk behaviors in primary care. Screening issues and related concepts. Am J Prev Med; 2004;27(2 Suppl):42–53. https://doi.org/10.1016/j.amepre.2004.04.018.

36.

Wright JA, Velicer WF, Prochaska JO. Testing the predictive power of the transtheoretical model of behavior change applied to dietary fat intake. Health Educ Res. 2009;24(2):224–36. https://doi.org/10.1093/her/cyn014.

37.

Godin G, Shephard RJ. Godin Leisure-Time Exercise Questionnaire. Medicine & Science in Sports & Exercise; 1997;29(6):36–38. ISSN:0195–9131.

38.

Health Canada. Canada’s Food Guide. 2020. 2019 Jan 22. Ontario Canada ISBN 978-0-660-28757-7.

39.

Health Canada. Canada’s Dietary Guidelines for Health Professionals and Policy Makers. 2019 Jan 22. Ontario, Canada. ISBN 978–0–660–25310–7

40.

Williams N. The CAGE questionnaire. Occup Med. 2014;64:473–4. https://doi.org/10.1093/occmed/kqu058.CrossRef

41.

Searight R. Counseling patients in primary care: evidence-based strategies. Am Fam Physician. 2018;98(12):719–28.PubMed

42.

Ainsworth BE, Bassett DR, Strath SJ, Swartz AM, O'Brien WL, Thompson RW, et al. Comparison of three methods for measuring the time spent in physical activity. Med Sci Sports Exerc; 2000;32(9 Suppl):S457–64. https://doi.org/10.1097/00005768-200009001-00004.

43.

CognisantMD. Ocean by CognisantMD. Retrieved from https://cognisantmd.com. Accessed 3 Mar 2020.

44.

Elley CR, Dawes D, Dawes M, Prive M, Draper H, Goodyear-Smith F. Screening for lifestyle and mental health risk factors in the waiting room: Feasibility study of the Case-finding Health Assessment Tool. Canadian Family Physician; 2014;60:e527-e534. PMID 25551137

45.

Goodyear-Smith F, Coupe N, Arroll B, Sullivan S, McGill AT. Case finding of lifestyle and mental health disorders in primary care: validation of the ‘CHAT’ tool. Br J Gen Pract. 2008;58(546):26–31. https://doi.org/10.3399/bjgp08X263785.CrossRefPubMedPubMedCentral

46.

Thabrew H, Kumar H, Goldfinch M, Cavadino A, Goodyear-Smith F. Repeated psychosocial screening of health school students using YouthCHAT: Cohort study. JMIR Pediatr Parent. 2020;3(2):e20976. https://doi.org/10.2196/20976.CrossRefPubMedPubMedCentral

47.

Goodyear-Smith F, Corter A, Suh H. Electronic screening for lifestyle issues and mental health in youth: a community-based participatory research approach. BMC Med Inform Decis Mak. 2016;16:140. https://doi.org/10.1186/s12911-016-0379-z.CrossRefPubMedPubMedCentral

48.

Goodyear-Smith F, Warren J, Bojic M, Chong A. eCHAT for lifestyle and mental health screening in primary care. Ann Fam Med. 2013;11(5):460–6. https://doi.org/10.1370/afm.1512.CrossRefPubMedPubMedCentral

49.

Tracy CS, Drummond N, Ferris LE, Globerman J, Hebert PC, Pringle DM, et al. To tell or not to tell? Professional and lay perspectives on the disclosure of personal health information in community-based dementia care. Can J Aging; 2004;23(3):203–215. https://doi.org/10.1353/cja.2004.0039.

50.

Lion A, Vuillemin A, Thornton J, Theisen D, Stranges S, Ward M. Physical activity promotion in primary care: a Utopian quest? Health Promot Int. 2019;34:877–86. https://doi.org/10.1093/heapro/day038.CrossRefPubMed

51.

Limb ES, Ahmad S, Cook DG, Kerry SM, Ekelund U, Whincup PH, et al. Measuring change in trials of physical activity interventions: a comparison of self-report questionnaire and accelerometry within the PACE-UP trial. Int J Behav Nutr Phys Act. 2019;16:10–21. https://doi.org/10.1186/s12966-018-0762-5.CrossRefPubMedPubMedCentral

52.

Pavey TG, Anokye N, Taylor AH, Trueman P, Moxhom T, Fox KR, et al. The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation. Health Technol Assess. 2011;15(44). https://doi.org/10.3310/hta15440.

53.

Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25(S3):1–72. https://doi.org/10.1111/sms.12581.CrossRef

54.

Keyworth C, Epton T, Goldthorpe J, Calam R, Armitage CJ. Delivering Opportunistic Behavior Change Interventions: a systematic review of systematic reviews. Prev Sci. 2020;21(3):319–31. https://doi.org/10.1007/s11121-020-01087-6.CrossRefPubMedPubMedCentral

Title: Patient perspectives on tablet-based technology to collect risk factor information in primary care
Authors: Leanne Kosowan
Alan Katz
Gayle Halas
Alexander Singer
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Care
Published in: BMC Primary Care / Issue 1/2021
Electronic ISSN: 2731-4553
DOI: https://doi.org/10.1186/s12875-021-01443-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Patient perspectives on tablet-based technology to collect risk factor information in primary care

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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