Biomedical subjects

Thomas K Houston

Publications and source records attributed to Thomas K Houston.

16 recordsLinked to original sources

PubMed2004

Bridging the digital divide: reaching vulnerable populations.

The AMIA 2003 Spring Congress entitled "Bridging the Digital Divide: Informatics and Vulnerable Populations" convened 178 experts including medical informaticians, health care professionals, government leaders, policy makers, researchers, health care industry leaders, consumer advocates, and others specializing in health care provision to underserved populations. The primary objective of this working congress was to develop a framework for a national agenda in information and communication technology to enhance the health and health care of underserved populations. Discussions during four tracks addressed issues and trends in information and communication technologies for underserved populations, strategies learned from successful programs, evaluation methodologies for measuring the impact of informatics, and dissemination of information for replication of successful programs. Each track addressed current status, ideal state, barriers, strategies, and recommendations. Recommendations of the breakout sessions were summarized under the overarching themes of Policy, Funding, Research, and Education and Training. The general recommendations emphasized four key themes: revision in payment and reimbursement policies, integration of health care standards, partnerships as the key to success, and broad dissemination of findings including specific feedback to target populations and other key stakeholders.

Financing, Organized↗

PubMed2004

Visit satisfaction and tailored health behavior communications in primary care.

BACKGROUND: Although studies suggest that computer-tailored health communications can help patients improve health behaviors, their effect on patient satisfaction, when used in healthcare settings, has yet to be examined. METHODS: A stand-alone computer application was developed to provide tailored, printed feedback for patients and physicians about two of the most common adverse health behaviors seen in primary care: smoking and physical inactivity. Ten primary care providers and 150 of their patients were recruited to use the program in the office before their visit. After the visit, patients completed a self-report survey that addressed demographics, computer use history, satisfaction with the visit, and the extent to which the physician addressed the reports during the visit. All data presented were collected between October 2001 and February 2002. RESULTS: Most patients were female (67.6%), approximately half (46.0%) were seen for a routine exam, most (63.3%) had at least one chronic illness, and fewer than one third (31.3%) had ever used the Internet or e-mail. Most (81.1%) patients reported that the program was easy to use, but fewer than half of the doctors looked at the report in front of the patient (49.2%) or discussed the report with the patient (44.3%). Multivariate modeling showed that visit satisfaction was significantly greater among those whose doctor examined the report. This effect of the doctor examining the report on satisfaction was even greater for those who reported a chronic illness. CONCLUSIONS: Physicians who incorporate computer tailored messaging programs into the primary care setting, but who do not address the feedback reports that they create may contribute to patients being less satisfied with their care.

Adult↗

PubMed2004

A primary care musculoskeletal clinic for residents: success and sustainability.

Musculoskeletal complaints are common, but are often underemphasized in residency training. We evaluated the experience of residents (12) in 4 sessions of an innovative concentrated ambulatory, community-based musculoskeletal (MS) clinic precepted by general internists with additional training in teaching MS medicine. Compared with the year long longitudinal house staff (HS) clinic experience, the mean number of musculoskeletal diagnoses per resident seen in MS clinic was higher (13.9 [standard deviation 4.0] vs 5.4 [standard deviation 4.0]; P <.01). Common diagnoses in MS clinic included shoulder, hip, and knee tendonitis/bursitis, and the majority of diagnoses in HS clinic were nonspecific arthralgia (66%). Fifty-two injections were performed in MS clinic over the year, compared with one in HS clinic.

Ambulatory Care↗

PubMed2004

Teaching the teachers: national survey of faculty development in departments of medicine of U.S. teaching hospitals.

OBJECTIVE: To determine the prevalence, topics, methods, and intensity of ongoing faculty development (FD) in teaching skills. DESIGN: Mailed survey. PARTICIPANTS: Two hundred and seventy-seven of the 386 (72%) U.S. teaching hospitals with internal medicine residency programs. MEASUREMENTS: Prevalence and characteristics of ongoing FD. RESULTS: One hundred and eight teaching hospitals (39%) reported ongoing FD. Hospitals with a primary medical school affiliation (university hospitals) were more likely to have ongoing FD than non-university hospitals. For non-university hospitals, funding from the Health Resources Services Administration and >50 house staff were associated with ongoing FD. For university hospitals, >100 department of medicine faculty was associated. Ongoing programs included a mean of 10.4 topics (standard deviation, 5.4). Most offered half-day workshops (80%), but 22% offered > or =1-month programs. Evaluations were predominantly limited to postcourse evaluations forms. Only 14% of the hospitals with ongoing FD (5% of all hospitals) had "advanced" programs, defined as offering > or =10 topics, lasting >2 days, and using > or =3 experiential teaching methods. These were significantly more likely to be university hospitals and to offer salary support and/or protected time to their FD instructors. Generalists and hospital-based faculty were more likely to receive training than subspecialist and community-based faculty. Factors facilitating participation in FD activities were supervisor attitudes, FD expertise, and institutional culture. CONCLUSIONS: A minority of U.S. teaching hospitals offer ongoing faculty development in teaching skills. Continued progress will likely require increased institutional commitment, improved evaluations, and adequate resources, particularly FD instructors and funding.

Data Collection↗

PubMed2004

Faculty development needs.

We compared prior training in 4 areas (general teaching skills, teaching specific content areas, teaching by specific methods and in specific settings, and general professional skills) among community-based teachers based in private practices (N = 61) compared with those in community sites operated by teaching institutions (N = 64) and hospital-based faculty (N = 291), all of whom attended one of three national faculty development conferences. The prevalence of prior training was low. Hospital-based faculty reported the most prior training in all 4 categories, teaching hospital affiliated community-based teachers an intermediate amount, and private practice community-based teachers the least (all P <.05). This association remained after multivariable adjustment for age, gender, and amount of time spent in teaching and clinical activities. Preferences for future training reported frequently by the private practice community-based teachers included: time management (48%); teaching evidence-based medicine (46%); evaluation of learners (38%); giving feedback (39%); outpatient precepting (38%); and "teaching in the presence of the patient" (39%).

Adult↗

PubMed2004

Outcomes of a national faculty development program in teaching skills: prospective follow-up of 110 medicine faculty development teams.

BACKGROUND: Awareness of the need for ambulatory care teaching skills training for clinician-educators is increasing. A recent Health Resources and Services Administration (HRSA)-funded national initiative trained 110 teams from U.S. teaching hospitals to implement local faculty development (FD) in teaching skills. OBJECTIVE: To assess the rate of successful implementation of local FD initiatives by these teams. METHODS: A prospective observational study followed the 110 teams for up to 24 months. Self-reported implementation, our outcome, was defined as the time from the training conference until the team reported that implementation of their FD project was completely accomplished. Factors associated with success were assessed using Kaplan-Meier analysis. RESULTS: The median follow-up was 18 months. Fifty-nine of the teams (54%) implemented their local FD project and subsequently trained over 1,400 faculty, of whom over 500 were community based. Teams that implemented their FD projects were more likely than those that did not to have the following attributes: met more frequently (P=.001), had less turnover (P=.01), had protected time (P=.01), rated their likelihood of success high (P=.03), had some project or institutional funding for FD (P=.03), and came from institutions with more than 75 department of medicine faculty (P=.03). The cost to the HRSA was $22,033 per successful team and $533 per faculty member trained. CONCLUSIONS: This national initiative was able to disseminate teaching skills training to large numbers of faculty at modest cost. Smaller teaching hospitals may have limited success without additional support or targeted funding.

Education, Medical, Continuing↗

PubMed2004

Impact of patient feedback on residents' handheld computer use: a multi-site study.

Handheld computers are being proposed as a resource for ambulatory care, yet physician reluctance to use the devices in the presence of patients is reported to be a barrier to optimal use. This study examined patient attitudes toward the use of handheld computers and the impact of those attitudes on the physicians' use of the handheld computers in the patient care setting. Most patients hold favorable attitudes toward physician use of handheld computers. Providing these data to physicians, however, did not uniformly lead to significant increases in handheld use in the presence of the patient. More understanding of the factors that influence behavior change and methods that will decrease barriers to the use of handhelds is needed

Adult↗

PubMed2004

Experiences of patients who were early adopters of electronic communication with their physician: satisfaction, benefits, and concerns.

OBJECTIVE: To explore the experiences of patients who were early adopters of e-mail communication with their physicians. METHODS: Patients' experiences were assessed with an Internetbased survey of 1881 individuals and in-depth telephone follow-up interviews with 56 individuals who used e-mail to communicate with providers. Two investigators qualitatively coded interview comments independently, with differences adjudicated by group consensus. RESULTS: A total of 311 (16.5%) of the 1881 individuals reported using electronic mail to communicate with their physicians. Compared with the population-based Behavioral Risk Factor Surveillance Survey, users of e-mail with physicians were twice as likely to have a college education, were younger, were less frequently ethnic minorities, and more frequently reported fair/poor health. Among the 311 patients who used e-mail with their physicians, the most frequent topics were results of laboratory testing and prescription renewals. However, many of the 311 users (21%) also reported using asynchronous e-mail inappropriately to convey urgent or sensitive issues (suicidality, chest pain, etc). Almost all (95%) perceived that e-mail was more efficient than the telephone. Important benefits uncovered from the interviews were that some patients felt more emboldened to ask questions in e-mail compared with face-to-face communication with doctors, and liked the ability to save the e-mail messages. Users also expressed concerns about privacy. CONCLUSION: Patients that use electronic communication with their physicians find the communication efficient for disease management. Further patient education about inappropriate use of e-mail for urgent issues is needed.

Adolescent↗

PubMed2003

Experiences of physicians who frequently use e-mail with patients.

Despite its potential, the use of e-mail for physician-patient communication has not been widely adopted. Our purpose was to survey the experiences of physicians who are early adopters of the technology. Physicians, identified through a professional Internet information portal, completed a survey, including an assessment of satisfaction with using e-mail with patients. We identified 204 physicians who reported using e-mail with patients on a daily basis. Average age of the respondents was 49 years, 82% were male, and 35% were primary-care physicians. Among the 204 frequent users, commonly reported e-mail topics were new, nonurgent symptoms, and questions about lab results. Despite their daily use, 25% were not satisfied with physician-patient e-mail. The most important reasons for using e-mail with patients among those who were satisfied were "time saving" (33%) and "helps deliver better care" (28%) compared with "patient requested" (80%) among those who were not satisfied (p <.01). Dissatisfied physicians reported concerns about time demands, medicolegal risks, and ability of patients to use e-mail appropriately. Although the majority of these "vanguard" physicians reported benefits, some did not recommend that colleagues adopt this new technology. Increasing integration into practice to enhance time-saving aspects and improve patient education might lead to more sustained use of this promising communication tool.

Adult↗

PubMed2003

Patient perceptions of physician use of handheld computers.

BACKGROUND: Handheld computers have advantages for healthcare providers including portability and integration into office workflow. However, negative patient perceptions of physician use of handheld computers in the examining room might limit integration. OBJECTIVE: To survey patients' perceptions of handheld use, and compare those with their providers' perceptions. METHODS: A survey of patient attitudes toward handhelds was conducted among patients at a low-income university clinic. Internal Medicine residents providing care were also surveyed. RESULTS: Patients (N=93) were mostly female (79%) and ethnic minorities (67%) with average age of 39. Only 10% of patients did not like the idea of a handheld computer in the exam room. Other negative attitudes were also seen in a minority of patients. Some physicians (23%) reported reservations about using the handheld computer with patients. CONCLUSIONS: Negative attitudes were rare among patients, but some providers were concerned about using the handheld in the exam room.

Adult↗

PubMed2002

Sports ability in young men and the incidence of cardiovascular disease.

PURPOSE: For physical activity to reduce the risk of cardiovascular disease, it must be sustained throughout life. We sought to determine the relation between the ability of young adults in different sports and their continued physical activity in midlife, and subsequent cardiovascular disease. SUBJECTS AND METHODS: Baseline self-reported ability in tennis, golf, football, baseball, and basketball was assessed in a cohort study involving 1019 male medical students (median age, 22 years). Physical activity and sports participation were assessed 22 years later. The incidence of cardiovascular disease was assessed during a median follow-up of 40 years, using annual questionnaires, medical records, and death certificates. RESULTS: Subjects with high ability in tennis as young adults had the highest participation in the sport in midlife (median age, 48 years). In the midlife questionnaire administered in 1978, 33% reported playing tennis within the past week and 51% within the past year. Tennis was the only sport in which a higher ability during medical school was associated with a lower risk of cardiovascular disease. After adjustment for father's occupation, parental incidence of cardiovascular disease, serum cholesterol level, cigarette smoking, body mass index, and hypertension during follow-up, the relative hazard of developing cardiovascular disease was 0.56 (95% confidence interval [CI]: 0.35 to 0.89) in the high-ability group and 0.67 (95% CI: 0.47 to 0.96) in the low-ability group, compared with the no-ability group. CONCLUSION: Our results support the association between sustained activity in aerobic sports and a lower risk of cardiovascular disease. Sustainability of activity should be considered when developing physical education programs for young adults.

Adult↗

PubMed2002

Internet support groups for depression: a 1-year prospective cohort study.

OBJECTIVE: This study described the characteristics of users of Internet-based depression support groups and assessed whether use predicts change in depression symptoms and social support. METHOD: Users (N=103) of these groups were recruited into the study cohort and followed prospectively. Demographic characteristics, support group use, depression care, score on the Medical Outcomes Study Social Support Survey, and score on the Center for Epidemiologic Studies Depression Scale (CES-D Scale) were assessed by Internet survey at baseline, 6 months, and 12 months. RESULTS: Users' demographic characteristics included median age of 40 years, 78.6% women, and 56.3% unmarried. Most (86.4%) were currently depressed (CES-D Scale score >22). Over 50% of participants heavily used the support group (5 or more hours in 2 weeks), and 37.9% preferred online communication to face-to-face counseling. Social support scores were low, compared with those from other studies of primary care patients with depression. The overall follow-up rate was 81.6% at 6 or 12 months. During follow-up, 72.6% of responders still participated in the online group; 81.0% were still receiving face-to-face depression care. Heavy users of the Internet groups were more likely to have resolution of depression (CES-D Scale score < or =22) during follow-up than less frequent users, after adjustment for age, gender, employment, and baseline CES-D Scale score with logistic regression. Social support scores did not change during follow-up. CONCLUSIONS: Users had high depression severity scores, were socially isolated, and perceived considerable benefit from the group. Internet depression support groups warrant continued research regarding supplementation of face-to-face depression care.

Adolescent↗

PubMed2002

Unmet needs of primary care patients in using the Internet for health-related activities.

BACKGROUND: Millions of people use the Internet as a source for health information yet little is understood about the use of the Internet for other health-related activities. OBJECTIVE: We conducted the present study to understand, among primary care patients, the interest in and experience with using the Internet for a variety of health-related activities. METHODS: Cross-sectional survey in the setting of 4 community-based primary care practices in Rhode Island. A single self-administered questionnaire included the following: 14 items measuring interest in using the Internet for a variety of health-related purposes, demographics, self-reported health status, and self-reported health care quality. RESULTS: The survey was completed by 300 patients, 109 without access to the Internet and 191 with access to the Internet. Experiences with and attitudes about each of the health-related activities on the Internet varied widely across each activity. Regardless of access, patients were most interested in using the Internet for finding information about diseases and medications. However, patients with Internet access were more interested, compared to those without access, in each of the health-related activities on the Internet. Among patients with access to the Internet, the largest gap between interest and experience (the opportunity gap) was in using the Internet to investigate the quality of their care (eg, "find out if your health care provider was giving you all of the tests and treatments that you are due to have?") and administrative functions (eg, "schedule an appointment with your doctor?"). CONCLUSIONS: Much opportunity remains for developing health-related Internet Web sites to address the unmet needs of primary care patients.

Adolescent↗

PubMedDate not supplied

Beliefs and attitudes associated with the intention to not accept the diagnosis of depression among young adults.

PURPOSE: Negative attitudes and beliefs about depression treatment may prevent many young adults from accepting a diagnosis and treatment for depression. We undertook a study to determine the association between depressive symptom severity, beliefs about and attitudes toward treatment, subjective social norms, and past behavior on the intent not to accept a physician's diagnosis of depression. METHODS: We conducted a cross-sectional study of 10,962 persons aged 16 to 29 years who participated and had positive screening results on the Center for Epidemiologic Studies Depression (CES-D) score in an Internet-based public health depression screening program. Participants reported whether they would accept their physician's diagnosis of depression. Based on the theory of reasoned action, we developed a multivariate model of the factors that predict intent not to accept a diagnosis of depression. RESULTS: Twenty-six percent of the participants stated their intent not to accept their physician's diagnosis of depression. Disagreeing that medications are effective in treating depression (strongly disagree, odds ratio ( OR ) = 6.5, 95% confidence interval (CI), 4.6-9.3), that there is a biological cause for depression (strongly disagree, OR = 1.9, 95% CI, 1.3-2.7), and agreeing that you would be embarrassed if your friends knew you had depression were associated with the intent not to accept a diagnosis of depression (strongly agree, OR = 2.3, 95% CI, 1.8-2.9). Beliefs and attitudes, subjective social norms, and past behavior explained most of the variance in this model (84%). CONCLUSIONS: Negative beliefs and attitudes, subjective social norms, and lack of past helpful treatment experiences are associated with the intent to not accept the diagnosis of depression and may contribute to low rates of treatment among young adults.

Adolescent↗

PubMedDate not supplied

Users of Internet health information: differences by health status.

BACKGROUND: Millions of consumers have accessed health information online. However, little is known about their health status. OBJECTIVE: To explore use of Internet health information among those who were sicker (fair/poor general health status) compared with those reported being healthier. METHODS: A national, random-digit telephone survey by the Pew Internet & American Life Project identified 521 Internet users who go online for health care information. Our primary independent variable was general health status rated as excellent, good, fair, or poor. Patterns of Internet use, and types of information searched were assessed. RESULTS: Among the 521 users, 64% were female, most (87%) were white, and median age was 42 years. Most individuals indicated that they learned something new online (81%) and indicated that they believe most information on the Internet (52%). Compared with those with excellent/good health, those with fair/poor health (N = 59) were relative newcomers to the Internet but tended to use the Internet more frequently, were more likely to use online chats, were less likely to search for someone other than themselves, and were more likely to talk about the new information with their physician (odds ratio 3.3 [95% confidence interval 1.8-6.3]), after adjustment for age, education and income. CONCLUSIONS: Health care professionals should be aware that their sicker patients are more likely to ask them about information they found online. Physicians, public health professionals, and eHealth developers should work together to educate patients about searching for health information online and to provide tools for them to navigate to the highest quality information.

Adult↗

PubMedDate not supplied

Doctors who are using e-mail with their patients: a qualitative exploration.

BACKGROUND: Despite the potential for rapid, asynchronous, documentable communication, the use of e-mail for physician-patient communication has not been widely adopted. OBJECTIVE: To survey physicians currently using e-mail with their patients daily to understand their experiences. METHODS: In-depth phone interviews of 45 physicians currently using e-mail with patients were audio taped and transcribed verbatim. Two investigators independently qualitatively coded comments. Differences were adjudicated by group consensus. RESULTS: Almost all of the 642 comments from these physicians who currently use e-mail with patients daily could be grouped into 1 of 4 broad domains: (1) e-mail access and content, (2) effects of e-mail on the doctor-patient relationship, (3) managing clinical issues by e-mail, and (4) integrating e-mail into office processes. The most consistent theme was that e-mail communication enhances chronic-disease management. Many physicians also reported improved continuity of care and increased flexibility in responding to nonurgent issues. Integration of e-mail into daily workflow, such as utilization of office personnel, appears to be a significant area of concern for many of the physicians. For other issues, such as content, efficiency of e-mail, and confidentiality, there were diverging experiences and opinions. Physicians appear to be selective in choosing which patients they will communicate with via e-mail, but the criteria for selection is unclear. CONCLUSION: These physician respondents did perceive benefits to e-mail with a select group of patients. Several areas, such as identifying clinical situations where e-mail communication is effective, incorporating e-mail into office flow, and being reimbursed for online medical care/communication, need to be addressed before this mode of communication diffuses into most practices.

Adult↗