Quality improvement and usability testing of the PortfolioDiet.app, a web-based health application to translate nutrition therapy for cardiovascular risk reduction in primary care (Preprint)

2021 ◽  
Author(s):  
Meaghan Elizabeth Kavanagh ◽  
Laura Chiavaroli ◽  
Andrea J Glenn ◽  
Genevieve Heijmans ◽  
Shannan M Grant ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Quality Improvement ◽  
Phase 1 ◽  
Nutrition Therapy ◽  
Phase 2 ◽  
Clinical Tool ◽  
Cardiovascular Risk Reduction ◽  
System Usability Scale ◽  
Prevention Of Cardiovascular Disease

BACKGROUND The Portfolio Diet, or Dietary Portfolio, is a therapeutic dietary pattern that combines cholesterol-lowering foods to manage dyslipidemia for the prevention of cardiovascular disease. To translate the Portfolio Diet for primary care, we developed the PortfolioDiet.app as a patient and physician educational and engagement tool for personal computers and smartphones. The PortfolioDiet.app is currently being used as an add-on therapy to the standard of care (usual care) for the prevention of cardiovascular disease in primary care. To enhance the adoption of this tool, it is important to ensure the PortfolioDiet.app meets the needs of its target end-users. OBJECTIVE The objective of this project was to undertake and describe user testing of the PortfolioDiet.app as part of ongoing engagement in quality improvement (QI). METHODS We undertook a 2-phase QI project between February 2021 to September 2021. We recruited users by convenience sampling. Users included patients, family physicians, dietitians, and nutrition and medical students. For both phases, users were asked to use the PortfolioDiet.app daily for seven days. In phase 1, a mixed-form questionnaire was administered to evaluate the user’s perceived acceptability, knowledge acquisition, and engagement with the PortfolioDiet.app. The questionnaire collected both quantitative data and qualitative data including two open-ended questions. Responses were used to inform modifications to the PortfolioDiet.app. In phase 2, the System Usability Scale (SUS) was used to assess the usability of the updated PortfolioDiet.app, with a score of above 70 being considered acceptable. RESULTS A total of 30 and 19 users were recruited for phase 1 and phase 2, respectively. For phase 1, the PortfolioDiet.app increased users’ perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Between the project phases, modifications were made to the PortfolioDiet.app to incorporate and address user feedback. At phase 2, the average SUS score was 85.39 ± 11.47, with 100 being the best possible. CONCLUSIONS The PortfolioDiet.app educates users on the Portfolio Diet and is considered acceptable by users. While further refinements to the app will continue to be made, the result of this QI project will now be an improved clinical tool that better meets user needs. CLINICALTRIAL This QI project was formally reviewed by institutional authorities at Unity Health Toronto and deemed to neither require Research Ethics Board approval nor written informed consent from participants.

scholarly journals Appropriateness of aspirin prescribing for primary and secondary prevention of cardiovascular disease in type 2 diabetes in different care settings

2021 ◽  
Author(s):  
Shi Ying Tan ◽  
Heather Cronin ◽  
Stephen Byrne ◽  
Adrian O’Donovan ◽  
Antoinette Tuthill
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Shared Care ◽  
University Hospital ◽  
Cross Sectional ◽  
Prevention Of Cardiovascular Disease

Abstract Background Type 2 diabetes is associated with an increased cardiovascular risk. Use of aspirin has been shown to be of benefit for secondary prevention of cardiovascular disease in patients with type 2 diabetes; benefits in primary prevention have not been clearly proven. Aims This study aims to (a) determine if aspirin is prescribed appropriately in type 2 diabetes for primary or secondary prevention of cardiovascular disease (CVD) and (b) evaluate whether there are differences in aspirin prescribing according to where people receive their care. Design Cross-sectional study Methods The medical records of individuals with type 2 diabetes aged over 18 years and attending Elmwood Primary Care Centre and Cork University Hospital Diabetes outpatient clinics (n = 400) between February and August 2017 were reviewed. Results There were 90 individuals exclusively attending primary care and 310 persons attending shared care. Overall, 49.0% (n = 196) of those were prescribed aspirin, of whom 42.3% were using it for secondary prevention. Aspirin was used significantly more in people attending shared care (p < 0.001). About 10.8% of individuals with diabetes and CVD attending shared care met guidelines for, but were not prescribed aspirin. Conclusion A significant number of people with type 2 diabetes who should have been prescribed aspirin for secondary prevention were not receiving it at the time of study assessment. In contrast, a substantial proportion who did not meet criteria for aspirin use was prescribed it for primary prevention.

scholarly journals Needs of patients with dementia and their caregivers in primary care: lessons learned from the Alzheimer plan of Quebec

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Vladimir Khanassov ◽  
Laura Rojas-Rozo ◽  
Rosa Sourial ◽  
Xin Qiang Yang ◽  
Isabelle Vedel
Keyword(s):  
Primary Care ◽  
Unmet Needs ◽  
Social Care ◽  
Phase 1 ◽  
Lessons Learned ◽  
Community Dwelling ◽  
Care Plan ◽  
Phase 2 ◽  
Care Needs ◽  
Health And Social Care

Abstract Background Persons living with dementia have various health and social care needs and expectations, some which are not fully met by health providers, including primary care clinicians. The Quebec Alzheimer plan, implemented in 2014, aimed to cover these needs, but there is no research on the effect this plan had on the needs and expectations of persons living with dementia. The objective of this study is to identify persons living with dementia and caregivers’ met and unmet needs and to describe their experience. Methods This is a sequential mixed methods explanatory design: Phase 1: cross-sectional study to describe the met and unmet health and social care needs of community-dwelling persons living with dementia using Camberwell Assessment of Need of the Elderly and Carers’ Assessment for Dementia tools. Phase 2: qualitative descriptive study to explore and understand the experiences of persons living with dementia and caregivers with the use of social and healthcare services, using semi-structured interviews. Data from phase 1 was analyzed with descriptive statistics, and from phase 2, with inductive thematic analysis. Results from phases 1 and 2 were compared, contrasted and interpreted together. Results The mean total number of needs reported by the patients was 5.03 (4.48 and 0.55 met and unmet needs, respectively). Caregivers had 0.52 met needs (3.16 unmet needs). The main needs for both were memory, physical health, eyesight/hearing/communication, medication, looking after home, money/budgeting. Three categories were mentioned by the participants: Persons living with dementia and caregiver’s attitude towards memory decline, their perception of community health services and of the family medicine practice. Conclusions Our study confirms the findings of other studies on the most common unmet needs of the patients and caregivers that are met partially or not at all. In addition, the participants were satisfied with access to care, and medical services in primary practices, being confident in their family. Our results indicate persons living with dementia and their caregivers need a contact person, a clear explanation of their dementia diagnosis, a care plan, written information on available services, and support for the caregivers.

scholarly journals The Role of Emotional Regulation and Affective Balance on Health Perception in Cardiovascular Disease Patients According to Sex Differences

2020 ◽  
Vol 9 (10) ◽  
pp. 3165
Author(s):  
Bárbara Luque ◽  
Rosario Castillo-Mayén ◽  
Esther Cuadrado ◽  
Tamara Gutiérrez-Domingo ◽  
Sebastián J. Rubio ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Sex Differences ◽  
Negative Affect ◽  
Self Efficacy ◽  
Emotional Regulation ◽  
Phase 1 ◽  
Health Perception ◽  
Phase 2 ◽  
Cardiovascular Patients ◽  
Affective Balance

One of the challenges of aging is the increase of people with chronic diseases, such as cardiovascular disease (CVD). Men and women experience the disease differently. Therefore, it has an impact on how CVD is treated and its outcomes. This research analyzed the relationship between psychosocial variables and health promotion among cardiovascular patients, paying special attention to sex differences. A longitudinal study with cardiovascular patients (747 in phase 1 (122 women) and 586 in phase 2 (83 women)) was carried out. Participants were evaluated based on their sociodemographic characteristics, affective balance, regulatory negative affect self-efficacy, stress and anxiety regulation strategies, and perceived global health. Results showed that men presented significantly higher scores in positive affect, affective balance, and self-efficacy to regulate negative emotions, while women presented significantly higher scores in negative affect and the use of passive strategies to cope with stressful situations. Regression analyses showed that all psychological variables studied in phase 1 were significant predictors of health perception in phase 2. According to the results, it is necessary to include strategies to improve cardiovascular health through education and emotional regulation, with a gender focus.

scholarly journals Developing Strategies to Reduce Unnecessary Services in Primary Care: Protocol for User-Centered Design Charrettes (Preprint)

2019 ◽  
Author(s):  
Mandi L Klamerus ◽  
Laura J Damschroder ◽  
Jordan B Sparks ◽  
Sarah E Skurla ◽  
Eve A Kerr ◽  
...  
Keyword(s):  
Primary Care ◽  
Design Process ◽  
Phase 1 ◽  
Primary Care Providers ◽  
Medical Services ◽  
Second Phase ◽  
Phase 2 ◽  
User Centered Design ◽  
The Impact ◽  
User Centered

BACKGROUND Overtreatment and overtesting expose patients to unnecessary, wasteful, and potentially harmful care. Reducing overtreatment or overtesting that has become ingrained in current clinical practices and is being delivered on a routine basis will require solutions that incorporate a deep understanding of multiple perspectives, particularly those on the front lines of clinical care: patients and their clinicians. Design approaches are a promising and innovative way to incorporate stakeholder needs, desires, and challenges to develop solutions to complex problems. OBJECTIVE This study aimed (1) to engage patients in a design process to develop high-level deintensification strategies for primary care (ie, strategies for scaling back or stopping routine medical services that more recent evidence reveals are not beneficial) and (2) to engage both patients and primary care providers in further co-design to develop and refine the broad deintensification strategies identified in phase 1. METHODS We engaged stakeholders in design charrettes—intensive workshops in which key stakeholders are brought together to develop creative solutions to a specific problem—focused on deintensification of routine overuse in primary care. We conducted the study in 2 phases: a 6.5-hour design charrette with 2 different groups of patients (phase 1) and a subsequent 4-hour charrette with clinicians and a subgroup of phase 1 patients (phase 2). Both phases included surveys and educational presentations related to deintensification. Phase 1 involved several design activities (mind mapping, business origami, and empathy mapping) to help patients gain a deeper understanding of the individuals involved in deintensification. Following that, we asked participants to review hypothetical scenarios where patients, clinicians, or the broader health system context posed a barrier to deintensification and then to brainstorm solutions. The deintensification themes identified in phase 1 were used to guide phase 2. This second phase primarily involved 1 design activity (<italic>WhoDo</italic>). In this activity, patients and clinicians worked together to develop concrete actions that specific stakeholders could take to support deintensification efforts. This activity included identifying barriers to the actions and approaches to overcoming those barriers. RESULTS A total of 35 patients participated in phase 1, and 9 patients and 7 clinicians participated in phase 2. The analysis of the deintensification strategies and survey data is currently underway. The results are expected to be submitted for publication in early 2020. CONCLUSIONS Health care interventions are frequently developed without input from the people who are most affected. The exclusion of these stakeholders in the design process often influences and limits the impact of the intervention. This study employed design charrettes, guided by a flexible user-centered design model, to bring clinicians and patients with differing backgrounds and with different expectations together to cocreate real-world solutions to the complex issue of deintensifying medical services.

State Consensus Guideline for the Prevention of Cardiovascular Disease in Primary Care Settings

2008 ◽  
Vol 7 (2) ◽  
pp. 122-125 ◽  
Author(s):  
Cassidy S. Smith ◽  
Marjie G. Harbrecht ◽  
Stephanie M. Coronel ◽  
Mori J. Krantz
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Consensus Guideline ◽  
Primary Care Settings ◽  
Prevention Of Cardiovascular Disease

scholarly journals Chronic Obstructive Pulmonary Disease (COPD) management in the community: how could primary care team contribute?

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
X. R. Catherine Chen ◽  
S. H. Leung ◽  
Y. C. Li
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Hong Kong ◽  
Phase 1 ◽  
Chronic Obstructive ◽  
Phase 2 ◽  
Obstructive Pulmonary Disease ◽  
Implementation Phase ◽  
Primary Care Clinics ◽  
Improvement Strategies

Abstract Background Chronic obstructive pulmonary disease (COPD) is a progressive lung disease commonly encountered in primary care. This study aimed to audit COPD care at primary care clinics of Hong Kong and to work out improvement strategies. Method All COPD patients aged 40 or above who had been followed up at 13 public primary care clinics of Kowloon Central Cluster (KCC) under the Hospital Authority of Hong Kong (HAHK) were included in this clinic audit. Evidence-based audit criteria and performance standards were established after thorough literature review. Phase 1 was from 1st April 2016 to 31st March 2017, with deficiencies of care identified. It was followed by a one-year implementation phase through which a series of improvement strategies were executed. Outcome of the enhancement was reviewed during Phase 2 from 1st April 2018 to 31st March 2019. Chi-square test and student’s t test were used to detect statistically significant changes between Phase 1 and Phase 2. Results A total of 2358 COPD cases were identified in Phase 1 where 658 of them were smokers. Of those smokers, 332 (50.5%) had been referred to Smoking Counselling and Cessation Service (SCCS) and 289 (43.9%) actually attended it. 991 cases (42%) received Seasonal Influenza Vaccine (SIV) and 938 cases (39.8%) received Pneumococcal Vaccine (PCV). 698 patients (29.6%) had spirometry done before and 423 patients (17.9%) had been admitted to hospital due to acute exacerbation of COPD (AECOPD). With the concerted effort taken during the implementation phase, Phase 2 data showed significant improvement in nearly all criteria. There was a marked increase in the SIV and PCV uptake rate, spirometry performance rate and most importantly, a significant reduction in AECOPD rate leading to hospital admission (13.5%, P = 0.000043). However, the referral rate and attendance rate of SCCS among smokers remained stagnant (P > 0.05). Conclusion Via a systematic team approach, COPD care at primary care clinics of KCC under HAHK had been significantly improved for most of the audit criteria, which in turn reduced the burden of the healthcare system.

Quality improvement using new technology to assess and reduce FDG PET/CT radiotracer infiltrations.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 313-313
Author(s):  
Jackson William Kiser
Keyword(s):  
Quality Improvement ◽  
Safety Issue ◽  
New Technology ◽  
Phase 1 ◽  
Infiltration Rate ◽  
Phase 2 ◽  
Contributing Factors ◽  
Therapy Assessment ◽  
Injection Process ◽  
Pet Ct

313 Background: The reported aggregated PET/CT 18F-FDG radiotracer injection infiltration rate from 3 centers in 6 studies is 15.2% (425 infiltrations/2804 patients). Infiltrations can negatively affect cancer patient staging, therapy assessment, treatment planning, and can lead to unnecessary invasive procedures and patient radiation exposure. The radiotracer dose is essential to PET image quality and quantification. Efforts are made to ensure the exact dose administered is used to create the patient image; but, no measures ensure the administered dose completely enters the patient circulation. Our objective was to use new technology (Lara, Lucerno Dynamics) to assess our infiltration rate, determine potential causes, reduce our rate, and assess results sustainability. Methods: Our IRB determined the project did not meet the definition of research as defined by 45 CFR 46.102(d) and classified the initiative as “quality improvement”. In Phase 1, our PET/CT center monitored the injection process. Lara data were analyzed (SAS Enterprise Miner, v. 14.1 and v.9.4) and identified potential contributing factors. We then implemented a quality improvement plan to address these factors. In Phase 2 we remeasured our infiltration rate. After Phase 2, we assessed our rate over an extended period. Results: Lara added 30 seconds to patient imaging. In Phase 1, 263 injections were monitored, and 35 infiltrations were identified (13.3%). Five technologists’ rates ranged from 8%-19%. Patients less than 145lbs with non-antecubital fossa injection sites were highly associated with infiltrations. In Phase 2, 278 injections were monitored, and 8 infiltrations were identified (2.9%), a 78% decrease (p < 0.0001). The same technologists’ rates ranged from 0%-4%. Eight technologists performed the next 504 injections and six were infiltrated (1.2%). Conclusions: Our findings supported published PET/CT infiltration rates. Using new technology provided technologists with feedback on injections and lead to significant and sustainable improvements quickly, with minimal patient/procedure disruption. Infiltrations are a quality and safety issue. As a result, the injection process requires ongoing monitoring.

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