Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists.

PubMed

Barnett, Michael L; Yee, Hal F; Mehrotra, Ateev; Giboney, Paul

2017-03-01

Lack of timely access to specialty care is a significant problem among disadvantaged populations, such as those served by the Los Angeles County Department of Health Services. In 2012 the department implemented an electronic system for the provision of specialty care called the eConsult system, in which all requests from primary care providers for specialty assistance were reviewed by specialists. In many cases, the specialist can address the primary care provider's question via an electronic dialogue, thereby eliminating the need for the patient to see a specialist in person. We observed rapid growth in the use of eConsult: By 2015 the system was in use by over 3,000 primary care providers, and 12,082 consultations were taking place per month, compared to 86 in the third quarter of 2012. The median time to an electronic response from a specialist was one day, and 25 percent of eConsults were resolved without a specialist visit. Three to four years after implementation, the median time to a specialist appointment decreased significantly, while the volume of visits remained stable. eConsult systems are a promising and sustainable intervention that could improve access to specialist care for underserved patients. Project HOPE—The People-to-People Health Foundation, Inc.

Facilitators and barriers to implementing electronic referral and/or consultation systems: a qualitative study of 16 health organizations.

PubMed

Tuot, Delphine S; Leeds, Kiren; Murphy, Elizabeth J; Sarkar, Urmimala; Lyles, Courtney R; Mekonnen, Tekeshe; Chen, Alice H M

2015-12-19

Access to specialty care remains a challenge for primary care providers and patients. Implementation of electronic referral and/or consultation (eCR) systems provides an opportunity for innovations in the delivery of specialty care. We conducted key informant interviews to identify drivers, facilitators, barriers and evaluation metrics of diverse eCR systems to inform widespread implementation of this model of specialty care delivery. Interviews were conducted with leaders of 16 diverse health care delivery organizations between January 2013 and April 2014. A limited snowball sampling approach was used for recruitment. Content analysis was used to examine key informant interview transcripts. Electronic referral systems, which provide referral management and triage by specialists, were developed to enhance tracking and operational efficiency. Electronic consultation systems, which encourage bi-directional communication between primary care and specialist providers facilitating longitudinal virtual co-management, were developed to improve access to specialty expertise. Integrated eCR systems leverage both functionalities to enhance the delivery of coordinated, specialty care at the population level. Elements of successful eCR system implementation included executive and clinician leadership, established funding models for specialist clinician reimbursement, and a commitment to optimizing clinician workflows. eCR systems have great potential to streamline access to and enhance the coordination of specialty care delivery. While different eCR models help solve different organizational challenges, all require institutional investments for successful implementation, such as funding for program management, leadership and clinician incentives.

Patients' online access to their electronic health records and linked online services: a systematic interpretative review.

PubMed

de Lusignan, Simon; Mold, Freda; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Gronlund, Toto Anne; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Barker, Fiona; Ellis, Beverley; Koczan, Phil; Arvanitis, Theodoros N; McCarthy, Mary; Jones, Simon; Rafi, Imran

2014-09-08

To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues. Primary care. A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol. Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services. No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt. Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients. A1 SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42012003091. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

MRAM Technology Status

NASA Technical Reports Server (NTRS)

Heidecker, Jason

2013-01-01

Magnetoresistive Random Access Memory (MRAM) is much different from conventional types of memory like SRAM, DRAM, and Flash, where electric charge is used to store information. Instead of exploiting the charge of an electron, MRAM uses its spin to store data. This new type of electronics is known as "spintronics." The primary focus of this report is the current generation of MRAM technology, and its reliability, vendors, and space-readiness.

The provision and impact of online patient access to their electronic health records (EHR) and transactional services on the quality and safety of health care: systematic review protocol.

PubMed

Mold, Freda; Ellis, Beverley; de Lusignan, Simon; Sheikh, Aziz; Wyatt, Jeremy C; Cavill, Mary; Michalakidis, Georgios; Barker, Fiona; Majeed, Azeem; Quinn, Tom; Koczan, Phil; Avanitis, Theo; Gronlund, Toto Anne; Franco, Christina; McCarthy, Mary; Renton, Zoë; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Jones, Simon; Rafi, Imran

2012-01-01

Innovators have piloted improvements in communication, changed patterns of practice and patient empowerment from online access to electronic health records (EHR). International studies of online services, such as prescription ordering, online appointment booking and secure communications with primary care, show good uptake of email consultations, accessing test results and booking appointments; when technologies and business process are in place. Online access and transactional services are due to be rolled out across England by 2015; this review seeks to explore the impact of online access to health records and other online services on the quality and safety of primary health care. To assess the factors that may affect the provision of online patient access to their EHR and transactional services, and the impact of such access on the quality and safety of health care. Two reviewers independently searched 11 international databases during the period 1999-2012. A range of papers including descriptive studies using qualitative or quantitative methods, hypothesis-testing studies and systematic reviews were included. A detailed eligibility criterion will be used to shape study inclusion. A team of experts will review these papers for eligibility, extract data using a customised extraction form and use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument to determine the quality of the evidence and the strengths of any recommendation. Data will then be descriptively summarised and thematically synthesised. Where feasible, we will perform a quantitative meta-analysis. Prospero (International Prospective Register of Systematic Reviews) registration number: crd42012003091.

Online medical care: the current state of "eVisits" in acute primary care delivery.

PubMed

Hickson, Ryan; Talbert, Jeffery; Thornbury, William C; Perin, Nathan R; Goodin, Amie J

2015-02-01

Online technologies offer the promise of an efficient, improved healthcare system. Patients benefit from increased access to care, physicians are afforded greater flexibility in care delivery, and the health system itself benefits from lower costs to provide such care. One method of incorporating online care into clinical practice, called electronic office visits or "eVisits," allows physicians to provide a consultation with patients online. We performed an analysis of the current published literature on eVisits as well as present emerging research describing the use of mobile platforms as the delivery model. We focused on the role of eVisits in acute primary care practice. A literature review was conducted using electronic databases with a variety of search terms related to the use of eVisits in primary care. Several advantages to eVisit utilization in the primary care setting were identified, namely, improvements in efficiency, continuity of care, quality of care, and access to care. Barriers to eVisit implementation were also identified, including challenges with incorporation into workflow, reimbursement, physician technological literacy, patient health literacy, overuse, security, confidentiality, and integration with existing medical technologies. Only one study of patient satisfaction with eVisit acute primary care services was identified, and this suggests that previous analyses of eVisit utilization are lacking this key component of healthcare service delivery evaluations. The delivery of primary care via eVisits on mobile platforms is still in adolescence, with few methodologically rigorous analyses of outcomes of efficiency, patient health, and satisfaction.

Internet access and electronic communication among families in an urban pediatric emergency department.

PubMed

Saidinejad, Mohsen; Teach, Stephen J; Chamberlain, James M

2012-06-01

The Internet may represent an opportunity for health care providers in the emergency department (ED) to deliver discharge instructions and after-care educational materials electronically to patients and their caregivers. The objectives of this study were to determine the prevalence of Internet access and use among caregivers of children who visit the ED and to evaluate their interest in receiving after-care communication and educational material electronically. We distributed a self-administered survey to a convenience sample of English-speaking caregivers of children who presented to the ED of an urban, academic, pediatric hospital during November and December 2009. The survey was distributed to and completed by 509 English-speaking respondents. Of the participants, 423 (83.1%) of 509 identified themselves as black/African American, and 397 (77.9%) of 509 were publicly insured. Of the participants, 503 of 509 (98.9%; 95% confidence interval [CI], 97.9%-99.8%) reported that they have access to the Internet. Of the participants with Internet access, 312 of 503 (62.0%; 95% CI, 57.8%-66.3%) have access at home, 166 of 503 (33.0%; 95% CI, 28.9%-33.1%) have access at work, and 112 of 503 (22.3%; 95% CI, 18.6%-25.9%) have access by mobile phone. When asked about electronic communication and social networking, 483 of 503 (96.0%; 95% CI, 94.3%-97.7%) have an e-mail account, and 304 of 503 (60.4%; 95% CI, 56.2%-64.7%) have a Facebook account. Furthermore, 353 of 503 (70.1%; 95% CI, 66.2%-74.2%) reported accessing the Internet daily, whereas 128 of 503 (25.4%; 95% CI, 21.6%-29.3%) access the Internet at least 2 to 6 times per week. Among all respondents, interest in receiving communication from the ED only electronically was expressed by 259 of 509 participants (50.9%; 95% CI, 46.5%-55.2%). Approximately one third of the participants (173/509 [34%; 95% CI, 29.9%-38.1%]) expressed interest in an electronic channel for communication between the ED and their child's patient primary care provider. In this predominantly minority and economically disadvantaged population of caregivers presenting to an urban pediatric ED, a large majority reported regular access to the Internet and willingness and ability to receive communication from the ED via electronic means.

Facilitating the Information Exchange Using a Modular Electronic Discharge Summary.

PubMed

Denecke, Kerstin; Dittli, Pascal A; Kanagarasa, Niveadha; Nüssli, Stephan

2018-01-01

Discharge summaries are a standard communication tool delivering important clinical information from inpatient to ambulatory care. To ensure a high quality, correctness and completeness, the generation process is time consuming. It requires also contributions of multiple persons. This is problematic since the primary care provider needs the information from the discharge summary for continuing the intended treatment. To address this challenge, we developed a concept for exchanging a modular electronic discharge summary. Through a literature review and interviews with multiple stakeholders, we analysed existing processes and derived requirements for an improved communication of the discharge summary. In this paper, we suggest a concept of a modular electronic discharge summary that is exchanged through the electronic patient dossier in CDA CH level 2 documents. Until 2020, all Swiss hospitals are obliged to connect to the electronic patient dossier. Our concept allows to access already completed modules of the discharge summary from the primary care side, before the entire report is entirely finalised. The data is automatically merged with the local patient record on the physician side and prepared for data integration into the practice information system. Our concept offers the opportunity not only to improve the information exchange between hospital and primary care, but it also provides a potential use case and demonstrates a benefit of the electronic patient dossier for primary care providers who are so far not obliged to connect to the patient dossier in Switzerland.

A sustainable primary care system: lessons from the Netherlands.

PubMed

Faber, Marjan J; Burgers, Jako S; Westert, Gert P

2012-01-01

The Dutch primary care system has drawn international attention, because of its high performance at low cost. Primary care practices are easily accessible during office hours and collaborate in a unique out-of-hours system. After the reforms in 2006, there are no copayments for patients receiving care in the primary care practice in which they are registered. Financial incentives support the transfer of care from hospital specialists to primary care physicians, and task delegation from primary care physicians to practice nurses. Regional collaborative care groups of primary care practices offer disease management programs. The quality assessment system and the electronic medical record system are predominantly driven by health care professionals. Bottom-up and top-down activities contributed to a successful Dutch primary care system.

Use of Web-based library resources by medical students in community and ambulatory settings.

PubMed

Tannery, Nancy Hrinya; Foust, Jill E; Gregg, Amy L; Hartman, Linda M; Kuller, Alice B; Worona, Paul; Tulsky, Asher A

2002-07-01

The purpose was to evaluate the use of Web-based library resources by third-year medical students. Third-year medical students (147) in a twelve-week multidisciplinary primary care rotation in community and ambulatory settings. Individual user surveys and log file analysis of Website were used. Twenty resource topics were compiled into a Website to provide students with access to electronic library resources from any community-based clerkship location. These resource topics, covering subjects such as hypertension and back pain, linked to curriculum training problems, full-text journal articles, MEDLINE searches, electronic book chapters, and relevant Websites. More than half of the students (69%) accessed the Website on a daily or weekly basis. Over 80% thought the Website was a valuable addition to their clerkship. Web-based information resources can provide curriculum support to students for whom access to the library is difficult and time consuming.

48 CFR 5.201 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Business Act (15 U.S.C. 637(e)) and the Office of Federal Procurement Policy Act (41 U.S.C. 416), agencies... electronic commerce, contracting officers must ensure the notice is forwarded to the GPE. (c) The primary purposes of the notice are to improve small business access to acquisition information and enhance...

Barriers to patient portal access among veterans receiving home-based primary care: a qualitative study.

PubMed

Mishuris, Rebecca G; Stewart, Max; Fix, Gemmae M; Marcello, Thomas; McInnes, D Keith; Hogan, Timothy P; Boardman, Judith B; Simon, Steven R

2015-12-01

Electronic, or web-based, patient portals can improve patient satisfaction, engagement and health outcomes and are becoming more prevalent with the advent of meaningful use incentives. However, adoption rates are low, particularly among vulnerable patient populations, such as those patients who are home-bound with multiple comorbidities. Little is known about how these patients view patient portals or their barriers to using them. To identify barriers to and facilitators of using My HealtheVet (MHV), the United States Department of Veterans Affairs (VA) patient portal, among Veterans using home-based primary care services. Qualitative study using in-depth semi-structured interviews. We conducted a content analysis informed by grounded theory. Fourteen Veterans receiving home-based primary care, surrogates of two of these Veterans, and three home-based primary care (HBPC) staff members. We identified five themes related to the use of MHV: limited knowledge; satisfaction with current HBPC care; limited computer and Internet access; desire to learn more about MHV and its potential use; and value of surrogates acting as intermediaries between Veterans and MHV. Despite their limited knowledge of MHV and computer access, home-bound Veterans are interested in accessing MHV and using it as an additional point of care. Surrogates are also potential users of MHV on behalf of these Veterans and may have different barriers to and benefits from use. © 2014 John Wiley & Sons Ltd.

Provider responses to patients controlling access to their electronic health records: a prospective cohort study in primary care.

PubMed

Tierney, William M; Alpert, Sheri A; Byrket, Amy; Caine, Kelly; Leventhal, Jeremy C; Meslin, Eric M; Schwartz, Peter H

2015-01-01

Applying Fair Information Practice principles to electronic health records (EHRs) requires allowing patient control over who views their data. We designed a program that captures patients' preferences for provider access to an urban health system's EHR. Patients could allow or restrict providers' access to all data (diagnoses, medications, test results, reports, etc.) or only highly sensitive data (sexually transmitted infections, HIV/AIDS, drugs/alcohol, mental or reproductive health). Except for information in free-text reports, we redacted EHR data shown to providers according to patients' preferences. Providers could "break the glass" to display redacted information. We prospectively studied this system in one primary care clinic, noting redactions and when users "broke the glass," and surveyed providers about their experiences and opinions. Eight of nine eligible clinic physicians and all 23 clinic staff participated. All 105 patients who enrolled completed the preference program. Providers did not know which of their patients were enrolled, nor their preferences for accessing their EHRs. During the 6-month prospective study, 92 study patients (88 %) returned 261 times, during which providers viewed their EHRs 126 times (48 %). Providers "broke the glass" 102 times, 92 times for patients not in the study and ten times for six returning study patients, all of whom had restricted EHR access. Providers "broke the glass" for six (14 %) of 43 returning study patients with redacted data vs. zero among 49 study patients without redactions (p = 0.01). Although 54 % of providers agreed that patients should have control over who sees their EHR information, 58 % believed restricting EHR access could harm provider-patient relationships and 71 % felt quality of care would suffer. Patients frequently preferred restricting provider access to their EHRs. Providers infrequently overrode patients' preferences to view hidden data. Providers believed that restricting EHR access would adversely impact patient care. Applying Fair Information Practice principles to EHRs will require balancing patient preferences, providers' needs, and health care quality.

Patients' online access to their electronic health records and linked online services: a systematic review in primary care.

PubMed

Mold, Freda; de Lusignan, Simon; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Arvanitis, Theodoros N; Ellis, Beverley

2015-03-01

Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider. To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. A systematic review was conducted that focused on all studies about online record access and transactional services in primary care. Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King's Fund, Nuffield Health, PsycINFO, OpenGrey (1999-2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted. A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so. © British Journal of General Practice 2015.

Patients’ online access to their electronic health records and linked online services: a systematic review in primary care

PubMed Central

Mold, Freda; de Lusignan, Simon; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Arvanitis, Theodoros N; Ellis, Beverley

2015-01-01

Background Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider. Aim To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. Design and setting A systematic review was conducted that focused on all studies about online record access and transactional services in primary care. Method Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King’s Fund, Nuffield Health, PsycINFO, OpenGrey (1999–2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted. Results A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. Conclusion While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so. PMID:25733435

Pathways to ambulatory sensitive hospitalisations for Māori in the Auckland and Waitemata regions.

PubMed

Barker, Carol; Crengle, Sue; Bramley, Dale; Bartholomew, Karen; Bolton, Patricia; Walsh, Michael; Wignall, Jean

2016-10-28

Ambulatory Sensitive Hospitalisations (ASH) are a group of conditions potentially preventable through interventions delivered in the primary health care setting. ASH rates are consistently higher for Māori compared with non-Māori. This study aimed to establish Māori experience of factors driving the use of hospital services for ASH conditions, including barriers to accessing primary care. A telephone questionnaire exploring pathways to ASH was administered to Māori (n=150) admitted to Auckland and Waitemata District Health Board (DHB) hospitals with an ASH condition between January 1st-June 30th 2015. A cohort of 1,013 participants were identified; 842 (83.1%) were unable to be contacted. Of the 171 people contactable, 150 agreed to participate, giving an overall response rate of 14.8% and response rate of contactable patients of 87.7%. Results demonstrated high rates of self-reported enrolment, utilisation and preference for primary care. Many participants demonstrated appropriate health seeking behaviour and accurate recall of diagnoses. While financial barriers to accessing primary care were reported, non-financial barriers including lack of after-hours provision (12.6% adults, 37.7% children), appointment availability (7.4% adults, 17.0% children) and lack of transport (13.7% adults, 20.8% children) also featured in participant responses. Interventions to reduce Māori ASH include: timely access to primary care through electronic communications, increased appointment availability, extended opening hours, low cost after-hours care and consistent best management of ASH conditions in general practice through clinical pathways. Facilitated enrolment of ASH patients with no general practitioner could also reduce ASH. Research into transport barriers and enablers for Māori accessing primary care is required to support future interventions.

Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data.

PubMed

Widdifield, Jessica; Bernatsky, Sasha; Thorne, J Carter; Bombardier, Claire; Jaakkimainen, R Liisa; Wing, Laura; Paterson, J Michael; Ivers, Noah; Butt, Debra; Lyddiatt, Anne; Hofstetter, Catherine; Ahluwalia, Vandana; Tu, Karen

2016-01-01

The Wait Time Alliance recently established wait time benchmarks for rheumatology consultations in Canada. Our aim was to quantify wait times to primary and rheumatology care for patients with rheumatic diseases. We identified patients from primary care practices in the Electronic Medical Record Administrative data Linked Database who had referrals to Ontario rheumatologists over the period 2000-2013. To assess the full care pathway, we identified dates of symptom onset, presentation in primary care and referral from electronic medical records. Dates of rheumatologist consultations were obtained by linking with physician service claims. We determined the duration of each phase of the care pathway (symptom onset to primary care encounter, primary care encounter to referral, and referral to rheumatologist consultation) and compared them with established benchmarks. Among 2430 referrals from 168 family physicians, 2015 patients (82.9%) were seen by 146 rheumatologists within 1 year of referral. Of the 2430 referrals, 2417 (99.5%) occurred between 2005 and 2013. The main reasons for referral were osteoarthritis (32.4%) and systemic inflammatory rheumatic diseases (30.6%). Wait times varied by diagnosis and geographic region. Overall, the median wait time from referral to rheumatologist consultation was 74 (interquartile range 27-101) days; it was 66 (interquartile range 18-84) days for systemic inflammatory rheumatic diseases. Wait time benchmarks were not achieved, even for the most urgent types of referral. For systemic inflammatory rheumatic diseases, most of the delays occurred before referral. Rheumatology wait times exceeded established benchmarks. Targeted efforts are needed to promote more timely access to both primary and rheumatology care. Routine linkage of electronic medical records with administrative data may help fill important gaps in knowledge about waits to primary and specialty care.

Pediatric caregiver attitudes toward email communication: survey in an urban primary care setting.

PubMed

Dudas, Robert Arthur; Crocetti, Michael

2013-10-23

Overall usage of email communication between patients and physicians continues to increase, due in part to expanding the adoption of electronic health records and patient portals. Unequal access and acceptance of these technologies has the potential to exacerbate disparities in care. Little is known about the attitudes of pediatric caregivers with regard to their acceptance of email as a means to communicate with their health care providers. We conducted a survey to assess pediatric caregiver access to and attitudes toward the use of electronic communication modalities to communicate with health care providers in an urban pediatric primary care clinic. Participants were pediatric caregivers recruited from an urban pediatric primary care clinic in Baltimore, Maryland, who completed a 35-item questionnaire in this cross-sectional study. Of the 229 caregivers who completed the survey (91.2% response rate), 171 (74.6%) reported that they use email to communicate with others. Of the email users, 145 respondents (86.3%) stated that they would like to email doctors, although only 18 (10.7%) actually do so. Among email users, African-American caregivers were much less likely to support the expanded use of email communication with health care providers (adjusted OR 0.34, 95% CI 0.14-0.82) as were those with annual incomes less than US $30,000 (adjusted OR 0.26, 95% CI 0.09-0.74). Caregivers of children have access to email and many would be interested in communicating with health care providers. However, African-Americans and those in lower socioeconomic groups were much less likely to have positive attitudes toward email.

Correlation of the Care by Design primary care practice redesign model and the principles of the patient-centered medical home.

PubMed

Egger, Marlene J; Day, Julie; Scammon, Debra L; Li, Yao; Wilson, Andrew; Magill, Michael K

2012-01-01

Health care reform requires major changes in the organization and delivery of primary care. In 2003, the University of Utah Community Clinics began developing Care by Design (CBD), a primary care model emphasizing access, care teams, and planned care. In 2007, leading primary care organizations published joint principles of the patient-centered medical home (PCMH), the basis for recognition of practices as PCMHs by the National Committee for Quality Assurance (NCQA). The objective of this study was to compare CBD and PCMH metrics conceptually and statistically. This was an observational study in 10 urban and rural primary care clinics including 56 providers. A self-evaluation included the CBD Extent of Use survey and self-estimated PCMH values. The main and secondary outcome measures were CBD scores and PCMH values, respectively. CBD and PCMH principles share common themes such as appropriate access, team-based care, the use of an augmented electronic medical record, planned care, and self-management support. CBD focuses more on the process of practice transformation. The NCQA PCMH standards focus more on structure, including policy, capacity, and populated electronic medical record fields. The Community Clinics' clinic-level PCMH/CBD correlations were low (P > .05.) Practice redesign requires an ability to assess uptake of the redesign as a transformation progresses. The correlation of CBD and PCMH is substantial conceptually but low statistically. PCMH and CBD focus on complementary aspects of redesign: PCMH on structure and CBD on process. Both domains should be addressed in practice reform. Both metrics are works in progress.

Expanding rural primary care training by employing information technologies: the need for participation by medical reference librarians.

PubMed

Coggan, J M; Crandall, L A

1995-01-01

The use of rural sites to train badly needed primary care providers requires access to sophisticated medical information not traditionally available outside of academic health centers. Medical reference librarians can play a key role in the development of primary care training sites in rural settings. Electronic information technologies, with proactive support from medical reference librarians, can provide current and detailed information without concern for distance from the health science center library. This paper discusses recent developments in technology, describes current challenges to the application of this technology in rural settings, and provides policy recommendations for medical reference librarians to enhance rural primary care training.

The wired patient: patterns of electronic patient portal use among patients with cardiac disease or diabetes.

PubMed

Jones, James Brian; Weiner, Jonathan P; Shah, Nirav R; Stewart, Walter F

2015-02-20

As providers develop an electronic health record-based infrastructure, patients are increasingly using Web portals to access their health information and participate electronically in the health care process. Little is known about how such portals are actually used. In this paper, our goal was to describe the types and patterns of portal users in an integrated delivery system. We analyzed 12 months of data from Web server log files on 2282 patients using a Web-based portal to their electronic health record (EHR). We obtained data for patients with cardiovascular disease and/or diabetes who had a Geisinger Clinic primary care provider and were registered "MyGeisinger" Web portal users. Hierarchical cluster analysis was applied to longitudinal data to profile users based on their frequency, intensity, and consistency of use. User types were characterized by basic demographic data from the EHR. We identified eight distinct portal user groups. The two largest groups (41.98%, 948/2258 and 24.84%, 561/2258) logged into the portal infrequently but had markedly different levels of engagement with their medical record. Other distinct groups were characterized by tracking biometric measures (10.54%, 238/2258), sending electronic messages to their provider (9.25%, 209/2258), preparing for an office visit (5.98%, 135/2258), and tracking laboratory results (4.16%, 94/2258). There are naturally occurring groups of EHR Web portal users within a population of adult primary care patients with chronic conditions. More than half of the patient cohort exhibited distinct patterns of portal use linked to key features. These patterns of portal access and interaction provide insight into opportunities for electronic patient engagement strategies.

Communication technology access, use, and preferences among primary care patients: from the Residency Research Network of Texas (RRNeT).

PubMed

Hill, Jason H; Burge, Sandra; Haring, Anna; Young, Richard A

2012-01-01

The digital revolution is changing the manner in which patients communicate with their health care providers, yet many patients still lack access to communication technology. We conducted this study to evaluate access to, use of, and preferences for using communication technology among a predominantly low-income patient population. We determined whether access, use, and preferences were associated with type of health insurance, sex, age, and ethnicity. In 2011, medical student researchers administered questionnaires to patients of randomly selected physicians within 9 primary care clinics in the Residency Research Network of Texas. Surveys addressed access to and use of cell phones and home computers and preferences for communicating with health care providers. In this sample of 533 patients (77% response rate), 448 (84%) owned a cell phone and 325 (62%) owned computers. Only 48% reported conducting Internet searches, sending and receiving E-mails, and looking up health information on the Internet. Older individuals, those in government sponsored insurance programs, and individuals from racial/ethnic minority groups had the lowest levels of technology adoption. In addition, more than 60% of patients preferred not to send and receive health information over the Internet, by instant messaging, or by text messaging. Many patients in this sample did not seek health information electronically nor did they want to communicate electronically with their physicians. This finding raises concerns about the vision of the patient-centered medical home to enhance the doctor-patient relationship through communication technology. Our patients represent some of the more vulnerable populations in the United States and, as such, deserve attention from health care policymakers who are promoting widespread use of communication technology.

Tools, Techniques, and Training: Results of an E-Resources Troubleshooting Survey

ERIC Educational Resources Information Center

Rathmel, Angela; Mobley, Liisa; Pennington, Buddy; Chandler, Adam

2015-01-01

A primary role of any e-resources librarian or staff is troubleshooting electronic resources (e-resources). While much progress has been made in many areas of e-resources management (ERM) to understand the ERM lifecycle and to manage workflows, troubleshooting access remains a challenge. This collaborative study is the result of the well-received…

Long-Term Surveillance and Maintenance Records: Maintaining Access to the Knowledge - 13122

DOE Office of Scientific and Technical Information (OSTI.GOV)

Montgomery, John; Gueretta, Jeanie; McKinney, Ruth

The U.S. Department of Energy (DOE) Office of Legacy Management (LM) is an integral part of DOE's strategy to ensure that legacy liabilities of former nuclear weapons production sites are properly managed following the completion of environmental cleanup activities. In the area of environmental legacy management, records management is crucial to the protection of health, environmental, and legal interests of the Department and the public. LM is responsible for maintaining long-term surveillance and maintenance (LTS and M) records in performance of its mission. Maintaining access to the knowledge contained in these record collections is one of LM's primary responsibilities. Tomore » fulfill this responsibility, LM established a consolidated records management facility, the LM Business Center (LMBC), to house physical media records and electronic records. A new electronic record keeping system (ERKS) was needed to replace an obsolete system while helping to ensure LM is able to meet ongoing responsibilities to maintain access to knowledge and control the life cycle management of records. (authors)« less

Use of Web-based library resources by medical students in community and ambulatory settings*

PubMed Central

Tannery, Nancy Hrinya; Foust, Jill E.; Gregg, Amy L.; Hartman, Linda M.; Kuller, Alice B.; Worona, Paul; Tulsky, Asher A.

2002-01-01

Purpose: The purpose was to evaluate the use of Web-based library resources by third-year medical students. Setting/Participants/Resources: Third-year medical students (147) in a twelve-week multidisciplinary primary care rotation in community and ambulatory settings. Methodology: Individual user surveys and log file analysis of Website were used. Results/Outcomes: Twenty resource topics were compiled into a Website to provide students with access to electronic library resources from any community-based clerkship location. These resource topics, covering subjects such as hypertension and back pain, linked to curriculum training problems, full-text journal articles, MEDLINE searches, electronic book chapters, and relevant Websites. More than half of the students (69%) accessed the Website on a daily or weekly basis. Over 80% thought the Website was a valuable addition to their clerkship. Discussion/Conclusion: Web-based information resources can provide curriculum support to students for whom access to the library is difficult and time consuming. PMID:12113515

The role and benefits of accessing primary care patient records during unscheduled care: a systematic review.

PubMed

Bowden, Tom; Coiera, Enrico

2017-09-22

The purpose of this study was to assess the impact of accessing primary care records on unscheduled care. Unscheduled care is typically delivered in hospital Emergency Departments. Studies published to December 2014 reporting on primary care record access during unscheduled care were retrieved. Twenty-two articles met inclusion criteria from a pool of 192. Many shared electronic health records (SEHRs) were large in scale, servicing many millions of patients. Reported utilization rates by clinicians was variable, with rates >20% amongst health management organizations but much lower in nation-scale systems. No study reported on clinical outcomes or patient safety, and no economic studies of SEHR access during unscheduled care were available. Design factors that may affect utilization included consent and access models, SEHR content, and system usability and reliability. Despite their size and expense, SEHRs designed to support unscheduled care have been poorly evaluated, and it is not possible to draw conclusions about any likely benefits associated with their use. Heterogeneity across the systems and the populations they serve make generalization about system design or performance difficult. None of the reviewed studies used a theoretical model to guide evaluation. Value of Information models may be a useful theoretical approach to design evaluation metrics, facilitating comparison across systems in future studies. Well-designed SEHRs should in principle be capable of improving the efficiency, quality and safety of unscheduled care, but at present the evidence for such benefits is weak, largely because it has not been sought.

Rationale, design and methods for a randomised and controlled trial to investigate whether home access to electronic games decreases children's physical activity.

PubMed

Straker, Leon M; Abbott, Rebecca A; Piek, Jan P; Pollock, Clare M; Davies, Peter S; Smith, Anne J

2009-06-29

Many children are reported to have insufficient physical activity (PA) placing them at greater risk of poor health outcomes. Participating in sedentary activities such as playing electronic games is widely believed to contribute to less PA. However there is no experimental evidence that playing electronic games reduces PA. There is also no evidence regarding the effect of different types of electronic games (traditional sedentary electronic games versus new active input electronic games) on PA. Further, there is a poor understanding about how characteristics of children may moderate the impact of electronic game access on PA and about what leisure activities are displaced when children play electronic games. Given that many children play electronic games, a better understanding of the effect of electronic game use on PA is critical to inform child health policy and intervention. This randomised and controlled trial will examine whether PA is decreased by access to electronic games and whether any effect is dependent on the type of game input or the child's characteristics. Children aged 10-12 years (N = 72, 36 females) will be recruited and randomised to a balanced ordering of 'no electronic games', 'traditional' electronic games and 'active' electronic games. Each child will participate in each condition for 8 weeks, and be assessed prior to participation and at the end of each condition. The primary outcome is PA, assessed by Actical accelerometers worn for 7 days on the wrist and hip. Energy expenditure will be assessed by the doubly labelled water technique and motor coordination, adiposity, self-confidence, attitudes to technology and PA and leisure activities will also be assessed. A sample of 72 will provide a power of > 0.9 for detecting a 15 mins difference in PA (sd = 30 mins). This is the first such trial and will provide critical information to understand whether access to electronic games affects children's PA. Given the vital importance of adequate PA to a healthy start to life and establishing patterns which may track into adulthood, this project can inform interventions which could have a profound impact on the long term health of children. This trial is registered in the Australia and New Zealand Clinical Trials Registry (ACTRN 12609000279224).

Rationale, design and methods for a randomised and controlled trial to investigate whether home access to electronic games decreases children's physical activity

PubMed Central

Straker, Leon M; Abbott, Rebecca A; Piek, Jan P; Pollock, Clare M; Davies, Peter S; Smith, Anne J

2009-01-01

Background Many children are reported to have insufficient physical activity (PA) placing them at greater risk of poor health outcomes. Participating in sedentary activities such as playing electronic games is widely believed to contribute to less PA. However there is no experimental evidence that playing electronic games reduces PA. There is also no evidence regarding the effect of different types of electronic games (traditional sedentary electronic games versus new active input electronic games) on PA. Further, there is a poor understanding about how characteristics of children may moderate the impact of electronic game access on PA and about what leisure activities are displaced when children play electronic games. Given that many children play electronic games, a better understanding of the effect of electronic game use on PA is critical to inform child health policy and intervention. Methods This randomised and controlled trial will examine whether PA is decreased by access to electronic games and whether any effect is dependent on the type of game input or the child's characteristics. Children aged 10–12 years (N = 72, 36 females) will be recruited and randomised to a balanced ordering of 'no electronic games', 'traditional' electronic games and 'active' electronic games. Each child will participate in each condition for 8 weeks, and be assessed prior to participation and at the end of each condition. The primary outcome is PA, assessed by Actical accelerometers worn for 7 days on the wrist and hip. Energy expenditure will be assessed by the doubly labelled water technique and motor coordination, adiposity, self-confidence, attitudes to technology and PA and leisure activities will also be assessed. A sample of 72 will provide a power of > 0.9 for detecting a 15 mins difference in PA (sd = 30 mins). Discussion This is the first such trial and will provide critical information to understand whether access to electronic games affects children's PA. Given the vital importance of adequate PA to a healthy start to life and establishing patterns which may track into adulthood, this project can inform interventions which could have a profound impact on the long term health of children. Trial registration This trial is registered in the Australia and New Zealand Clinical Trials Registry (ACTRN 12609000279224). PMID:19563680

Pediatric Caregiver Attitudes Toward Email Communication: Survey in an Urban Primary Care Setting

PubMed Central

2013-01-01

Background Overall usage of email communication between patients and physicians continues to increase, due in part to expanding the adoption of electronic health records and patient portals. Unequal access and acceptance of these technologies has the potential to exacerbate disparities in care. Little is known about the attitudes of pediatric caregivers with regard to their acceptance of email as a means to communicate with their health care providers. Objective We conducted a survey to assess pediatric caregiver access to and attitudes toward the use of electronic communication modalities to communicate with health care providers in an urban pediatric primary care clinic. Methods Participants were pediatric caregivers recruited from an urban pediatric primary care clinic in Baltimore, Maryland, who completed a 35-item questionnaire in this cross-sectional study. Results Of the 229 caregivers who completed the survey (91.2% response rate), 171 (74.6%) reported that they use email to communicate with others. Of the email users, 145 respondents (86.3%) stated that they would like to email doctors, although only 18 (10.7%) actually do so. Among email users, African-American caregivers were much less likely to support the expanded use of email communication with health care providers (adjusted OR 0.34, 95% CI 0.14-0.82) as were those with annual incomes less than US $30,000 (adjusted OR 0.26, 95% CI 0.09-0.74). Conclusions Caregivers of children have access to email and many would be interested in communicating with health care providers. However, African-Americans and those in lower socioeconomic groups were much less likely to have positive attitudes toward email. PMID:24152542

Real-Space Imaging of Carrier Dynamics of Materials Surfaces by Second-Generation Four-Dimensional Scanning Ultrafast Electron Microscopy.

PubMed

Sun, Jingya; Melnikov, Vasily A; Khan, Jafar I; Mohammed, Omar F

2015-10-01

In the fields of photocatalysis and photovoltaics, ultrafast dynamical processes, including carrier trapping and recombination on material surfaces, are among the key factors that determine the overall energy conversion efficiency. A precise knowledge of these dynamical events on the nanometer (nm) and femtosecond (fs) scales was not accessible until recently. The only way to access such fundamental processes fully is to map the surface dynamics selectively in real space and time. In this study, we establish a second generation of four-dimensional scanning ultrafast electron microscopy (4D S-UEM) and demonstrate the ability to record time-resolved images (snapshots) of material surfaces with 650 fs and ∼5 nm temporal and spatial resolutions, respectively. In this method, the surface of a specimen is excited by a clocking optical pulse and imaged using a pulsed primary electron beam as a probe pulse, generating secondary electrons (SEs), which are emitted from the surface of the specimen in a manner that is sensitive to the local electron/hole density. This method provides direct and controllable information regarding surface dynamics. We clearly demonstrate how the surface morphology, grains, defects, and nanostructured features can significantly impact the overall dynamical processes on the surface of photoactive-materials. In addition, the ability to access two regimes of dynamical probing in a single experiment and the energy loss of SEs in semiconductor-nanoscale materials will also be discussed.

Access to primary care for socioeconomically disadvantaged older people in rural areas: a realist review.

PubMed

Ford, John A; Wong, Geoff; Jones, Andy P; Steel, Nick

2016-05-17

The aim of this review is to identify and understand the contexts that effect access to high-quality primary care for socioeconomically disadvantaged older people in rural areas. A realist review. MEDLINE and EMBASE electronic databases and grey literature (from inception to December 2014). Broad inclusion criteria were used to allow articles which were not specific, but might be relevant to the population of interest to be considered. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded for concepts relating to context, mechanism or outcome. An overarching patient pathway was generated and used as the basis to explore contexts, causal mechanisms and outcomes. 162 articles were included. Most were from the USA or the UK, cross-sectional in design and presented subgroup data by age, rurality or deprivation. From these studies, a patient pathway was generated which included 7 steps (problem identified, decision to seek help, actively seek help, obtain appointment, get to appointment, primary care interaction and outcome). Important contexts were stoicism, education status, expectations of ageing, financial resources, understanding the healthcare system, access to suitable transport, capacity within practice, the booking system and experience of healthcare. Prominent causal mechanisms were health literacy, perceived convenience, patient empowerment and responsiveness of the practice. Socioeconomically disadvantaged older people in rural areas face personal, community and healthcare barriers that limit their access to primary care. Initiatives should be targeted at local contextual factors to help individuals recognise problems, feel welcome, navigate the healthcare system, book appointments easily, access appropriate transport and have sufficient time with professional staff to improve their experience of healthcare; all of which will require dedicated primary care resources. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Where are we on the diffusion curve? Trends and drivers of primary care physicians' use of health information technology.

PubMed

Audet, Anne-Marie; Squires, David; Doty, Michelle M

2014-02-01

To describe trends in primary care physicians' use of health information technology (HIT) between 2009 and 2012, examine practice characteristics associated with greater HIT capacity in 2012, and explore factors such as delivery system and payment reforms that may affect adoption and functionality. We used data from the 2012 and 2009 Commonwealth Fund International Health Policy Surveys of Primary Care Physicians. The data were collected in both years by postal mail between March and July among a nationally representative sample of primary care physicians in the United States. We compared primary care physicians' HIT capacity in 2009 and 2012. We employed multivariable logistic regression to analyze whether participating in an integrated delivery system, sharing resources and support with other practices, and being eligible for financial incentives were associated with greater HIT capacity in 2012. Primary care physicians' HIT capacity has significantly expanded since 2009, although solo practices continue to lag. Practices that are part of an integrated delivery system or share resources with other practices have higher rates of electronic medical record (EMR) adoption, multifunctional HIT, electronic information exchange, and electronic access for patients. Receiving or being eligible for financial incentives is associated with greater adoption of EMRs and information exchange. Federal efforts to increase adoption have coincided with a rapid increase in HIT capacity. Delivery system and payment reforms and federally funded extension programs could offer promising pathways for further diffusion. © Health Research and Educational Trust.

Brief Report: The Medical Care of Adults with Autism Spectrum Disorders--Identifying the Needs

ERIC Educational Resources Information Center

Bruder, Mary Beth; Kerins, Gerard; Mazzarella, Cynthia; Sims, Jessica; Stein, Neil

2012-01-01

There is a lack of information concerning adults with autism spectrum disorder (ASD), especially with regards to their access to health care. A paper and electronic survey was sent to 1,580 primary care physicians in Connecticut. 346 respondents returned a survey and provided care to adults with an ASD. This physician survey provides data on…

A study of general practitioners' perspectives on electronic medical records systems in NHSScotland.

PubMed

Bouamrane, Matt-Mouley; Mair, Frances S

2013-05-21

Primary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012. We carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs' perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees' responses, using Normalisation Process Theory as the underpinning conceptual framework. The majority of GPs' interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities - for example: in relation to usability, system navigation and information visualisation. Our study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs' interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors.

A study of general practitioners’ perspectives on electronic medical records systems in NHSScotland

PubMed Central

2013-01-01

Background Primary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012. Methods We carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs’ perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees’ responses, using Normalisation Process Theory as the underpinning conceptual framework. Results The majority of GPs’ interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities – for example: in relation to usability, system navigation and information visualisation. Conclusion Our study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs’ interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors. PMID:23688255

Bridging the gap between primary care and the cancer system

PubMed Central

Sisler, Jeffrey; McCormack-Speak, Pat

2009-01-01

ABSTRACT PROBLEM BEING ADDRESSED Patient care is poorly coordinated between family physicians and the cancer system and the working relationships are not strong. OBJECTIVE OF PROGRAM To improve integration of patient care and communication between FPs and cancer specialists; enhance FPs’ knowledge of cancer and the cancer system; and promote the role of primary care within the cancer care system. PROGRAM DESCRIPTION The Uniting Primary Care and Oncology (UPCON) Network of CancerCare Manitoba has created partnerships with 12 primary care clinics in Winnipeg, Man, by providing the following: access to the provincial electronic medical record for cancer; small group continuing professional development for a “lead physician” from each clinic to make him or her the local cancer resource; educational outreach to all clinic staff; and changes within CancerCare Manitoba to highlight the role of FPs. CONCLUSION Lead physicians are appreciated by their clinic colleagues, and these FPs are the main users of the cancer electronic medical record. A strong cancer continuing professional development program has been implemented and a voice for primary care has been created within the agency. The UPCON Network is now expanding throughout Manitoba. PMID:19282538

Physics design of the in-vessel collection optics for the ITER electron cyclotron emission diagnostic.

PubMed

Rowan, W L; Houshmandyar, S; Phillips, P E; Austin, M E; Beno, J H; Hubbard, A E; Khodak, A; Ouroua, A; Taylor, G

2016-11-01

Measurement of the electron cyclotron emission (ECE) is one of the primary diagnostics for electron temperature in ITER. In-vessel, in-vacuum, and quasi-optical antennas capture sufficient ECE to achieve large signal to noise with microsecond temporal resolution and high spatial resolution while maintaining polarization fidelity. Two similar systems are required. One views the plasma radially. The other is an oblique view. Both views can be used to measure the electron temperature, while the oblique is also sensitive to non-thermal distortion in the bulk electron distribution. The in-vacuum optics for both systems are subject to degradation as they have a direct view of the ITER plasma and will not be accessible for cleaning or replacement for extended periods. Blackbody radiation sources are provided for in situ calibration.

Physics design of the in-vessel collection optics for the ITER electron cyclotron emission diagnostic

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rowan, W. L., E-mail: w.l.rowan@austin.utexas.edu; Houshmandyar, S.; Phillips, P. E.

2016-11-15

Measurement of the electron cyclotron emission (ECE) is one of the primary diagnostics for electron temperature in ITER. In-vessel, in-vacuum, and quasi-optical antennas capture sufficient ECE to achieve large signal to noise with microsecond temporal resolution and high spatial resolution while maintaining polarization fidelity. Two similar systems are required. One views the plasma radially. The other is an oblique view. Both views can be used to measure the electron temperature, while the oblique is also sensitive to non-thermal distortion in the bulk electron distribution. The in-vacuum optics for both systems are subject to degradation as they have a direct viewmore » of the ITER plasma and will not be accessible for cleaning or replacement for extended periods. Blackbody radiation sources are provided for in situ calibration.« less

Physics design of the in-vessel collection optics for the ITER electron cyclotron emission diagnostic

DOE PAGES

Rowan, W. L.; Houshmandyar, S.; Phillips, P. E.; ...

2016-09-07

Measurement of the electron cyclotron emission (ECE) is one of the primary diagnostics for electron temperature in ITER. In-vessel, in-vacuum, and quasi-optical antennas capture sufficient ECE to achieve large signal to noise with microsecond temporal resolution and high spatial resolution while maintaining polarization fidelity. Two similar systems are required. One views the plasma radially. The other is an oblique view. Both views can be used to measure the electron temperature, while the oblique is also sensitive to non-thermal distortion in the bulk electron distribution. The in-vacuum optics for both systems are subject to degradation as they have a direct viewmore » of the ITER plasma and will not be accessible for cleaning or replacement for extended periods. Here, blackbody radiation sources are provided for in situ calibration.« less

Disruption of the cytochrome c gene in xylose-utilizing yeast Pichia stipitis leads to higher ethanol production

Treesearch

Nian-Qing Shi; Brian Davis; Fred Sherman; Jose Cruz; Thomas W. Jeffries

1999-01-01

The xylose-utilizing yeast, Pichia stipitis, has a complex respiratory system that contains cytochrome and non-cytochrome alternative electron transport chains in its mitochondria. To gain primary insights into the alternative respiratory pathway, a cytochrome c gene (PsCYC1, Accession No. AF030426) was cloned from wild-type P. stipitis CBS 6054 by cross-hybridization...

Care Coordination and Electronic Health Records: Connecting Clinicians

PubMed Central

Graetz, Ilana; Reed, Mary; Rundall, Thomas; Bellows, Jim; Brand, Richard; Hsu, John

2009-01-01

Objective: To examine the association between use of electronic health records (EHR) and care coordination. Study Design: Two surveys, in 2005 and again in 2006, of primary care clinicians working in a prepaid integrated delivery system during the staggered implementation of an EHR system. Using multivariate logistic regression to adjust for clinician characteristics, we examined the association between EHR use and clinicians’ perceptions of three dimensions of care coordination: timely access to complete information; treatment goal agreement; and role/responsibility agreement. Results: Compared to clinicians without EHR, clinicians with 6+ months of EHR use more frequently reported timely access to complete information, and being in agreement on treatment goals with other involved clinicians. There was no significant association between EHR use and being in agreement on roles and responsibilities with other clinicians. Conclusions: EHR use is associated with aspects of care coordination involving information transfer and communication of treatment goals. PMID:20351851

An electronic consumer health library: NetWellness.

PubMed Central

Guard, R; Haag, D; Kaya, B; Marine, S; Morris, T; Schick, L; Shoemaker, S

1996-01-01

NetWellness is a community-based, consumer-defined grant program supporting the delivery of electronic health information to rural residents of southern Ohio and urban and suburban communities in the Greater Cincinnati tri-state region. NetWellness is a collaboratively developed and publicly and privately funded demonstration project. Information is delivered via ISDN, standard dial, dedicated network connections, and the Internet. TriState Online (Greater Cincinnati's Free-Net) and other southern Ohio Free-Nets are key access points in the larger project communities. The other access points are more than forty workstations distributed at public sites throughout the project's primary geographical area. Design strengths and limitations, training initiatives, technical issues, and the project's impact on medical librarianship are examined in this paper. Also discussed are ways of determining community needs and interest, building political alliances, finding and developing funding sources, and overcoming technical obstacles. NetWellness's Internet address is: http:@www.netwellness.org. PMID:8913548

Patient Summary and medicines reconciliation: application of the ISO/CEN EN 13606 standard in clinical practice.

PubMed

Farfán Sedano, Francisco J; Terrón Cuadrado, Marta; Castellanos Clemente, Yolanda; Serrano Balazote, Pablo; Moner Cano, David; Robles Viejo, Montserrat

2011-01-01

The comparison of the patient's current medication list with the medication being ordered when admitted to Hospital, identifying omissions, duplications, dosing errors, and potential interactions, constitutes the core process of medicines reconciliation. Access to the medication the patient is taking at home could be unfeasible as this information is frequently stored in various locations and in diverse proprietary formats. The lack of interoperability between those information systems, namely the Primary Care and the Specialized Electronic Health Records (EHRs), facilitates medication errors and endangers patient safety. Thus, the development of a Patient Summary that includes clinical data from different electronic systems will allow doctors access to relevant information enabling a safer and more efficient assistance. Such a collection of data from heterogeneous and distributed systems has been achieved in this Project through the construction of a federated view based on the ISO/CEN EN13606 Standard for architecture and communication of EHRs.

[The interface between primary and secondary care in dentistry in the Unified Health System (SUS): an integrative systematic review].

PubMed

Silva, Helbert Eustáquio Cardoso da; Gottems, Leila Bernarda Donato

2017-08-01

Secondary care in dentistry in Brazil has scarce and broadly underutilized resources. The challenge is to organize the interface between primary health care (PHC) and secondary care in order to consolidate the population's access to specialist dental care in the Unified Health System (SUS). This article seeks to analyze national publications in Portuguese and English on the interface between secondary health care and primary health care in dentistry from the perspective of comprehensive care in the SUS. It is an integrative review, considering the publications of the following databases: SciELO (Scientific Electronic Library Online), LILACS (Latin American and Caribbean Literature) WEB OF SCIENCE, SCOPUS, PubMed (International Literature on Health Sciences) and GOOGLE SCHOLAR. The search located 966 articles, of which 12 were used in full. Coverage of the oral health teams (ESB) in the family health strategy (ESF), primary health care implementation in a structured way, access to secondary health care, counter-referral to PHC, development of indicators and socioeconomic conditions and inequalities in the distribution of dental specialist centers (CEO) are factors that influence the integrity of oral health care in the SUS.

Children's Use of Electronic Technologies in the Home (Based on Discussions with 190 K-6 Children in Three Sydney Metropolitan Schools). October 1995.

ERIC Educational Resources Information Center

Downes, Toni; Reddacliff, Cathy; Moont, Sue

This study examined how children, drawn from K-6 grades in 3 primary schools in southwest Sydney, use computers in their homes and the physical and social environments within which they use them. Key issues explored were diversity of access, range of uses, and factors which influence use, including gender, age, and parental and sibling role…

We need to talk: Primary care provider communication at discharge in the era of a shared electronic medical record.

PubMed

Sheu, Leslie; Fung, Kelly; Mourad, Michelle; Ranji, Sumant; Wu, Ethel

2015-05-01

Poor communication between hospitalists and outpatient physicians can contribute to adverse events after discharge. Electronic medical records (EMRs) shared by inpatient and outpatient clinicians offer primary care providers (PCPs) better access to information surrounding a patient's hospitalization. However, the PCP experience and subsequent expectations for discharge communication within a shared EMR are unknown. We surveyed PCPs 1 year after a shared EMR was implemented at our institution to assess PCP satisfaction with current discharge communication practices and identify areas for improvement. Seventy-five of 124 (60%) clinicians completed the survey. Although most PCPs reported receiving automated discharge notifications (71%), only 39% felt that notifications plus discharge summaries were adequate for safe transitions of care. PCPs expressed that complex hospitalizations necessitated additional communication via e-mail or telephone; only 31% reported receiving such communication. The content most important in additional communication included medication changes, follow-up actions, and active medical issues. Despite optimized access to information provided by a shared EMR, only 52% of PCPs were satisfied with current discharge communication. PCPs express a continued need for high-touch communication for safe transitions of care. Further standardization of discharge communication practices is necessary. © 2015 Society of Hospital Medicine.

Highly Chemoselective Reduction of Amides (Primary, Secondary, Tertiary) to Alcohols using SmI2/Amine/H2O under Mild Conditions

PubMed Central

2014-01-01

Highly chemoselective direct reduction of primary, secondary, and tertiary amides to alcohols using SmI2/amine/H2O is reported. The reaction proceeds with C–N bond cleavage in the carbinolamine intermediate, shows excellent functional group tolerance, and delivers the alcohol products in very high yields. The expected C–O cleavage products are not formed under the reaction conditions. The observed reactivity is opposite to the electrophilicity of polar carbonyl groups resulting from the nX → π*C=O (X = O, N) conjugation. Mechanistic studies suggest that coordination of Sm to the carbonyl and then to Lewis basic nitrogen in the tetrahedral intermediate facilitate electron transfer and control the selectivity of the C–N/C–O cleavage. Notably, the method provides direct access to acyl-type radicals from unactivated amides under mild electron transfer conditions. PMID:24460078

Impact of electronic clinical decision support on adherence to guideline-recommended treatment for hyperlipidaemia, atrial fibrillation and heart failure: protocol for a cluster randomised trial

PubMed Central

Kessler, Maya Elizabeth; Cook, David A; Kor, Daryl Jon; McKie, Paul M; Pencille, Laurie J; Scheitel, Marianne R; Chaudhry, Rajeev

2017-01-01

Introduction Clinical practice guidelines facilitate optimal clinical practice. Point of care access, interpretation and application of such guidelines, however, is inconsistent. Informatics-based tools may help clinicians apply guidelines more consistently. We have developed a novel clinical decision support tool that presents guideline-relevant information and actionable items to clinicians at the point of care. We aim to test whether this tool improves the management of hyperlipidaemia, atrial fibrillation and heart failure by primary care clinicians. Methods/analysis Clinician care teams were cluster randomised to receive access to the clinical decision support tool or passive access to institutional guidelines on 16 May 2016. The trial began on 1 June 2016 when access to the tool was granted to the intervention clinicians. The trial will be run for 6 months to ensure a sufficient number of patient encounters to achieve 80% power to detect a twofold increase in the primary outcome at the 0.05 level of significance. The primary outcome measure will be the percentage of guideline-based recommendations acted on by clinicians for hyperlipidaemia, atrial fibrillation and heart failure. We hypothesise care teams with access to the clinical decision support tool will act on recommendations at a higher rate than care teams in the standard of care arm. Ethics and dissemination The Mayo Clinic Institutional Review Board approved all study procedures. Informed consent was obtained from clinicians. A waiver of informed consent and of Health Insurance Portability and Accountability Act (HIPAA) authorisation for patients managed by clinicians in the study was granted. In addition to publication, results will be disseminated via meetings and newsletters. Trial registration number NCT02742545. PMID:29208620

Open-source point-of-care electronic medical records for use in resource-limited settings: systematic review and questionnaire surveys

PubMed Central

Bru, Juan; Berger, Christopher A

2012-01-01

Background Point-of-care electronic medical records (EMRs) are a key tool to manage chronic illness. Several EMRs have been developed for use in treating HIV and tuberculosis, but their applicability to primary care, technical requirements and clinical functionalities are largely unknown. Objectives This study aimed to address the needs of clinicians from resource-limited settings without reliable internet access who are considering adopting an open-source EMR. Study eligibility criteria Open-source point-of-care EMRs suitable for use in areas without reliable internet access. Study appraisal and synthesis methods The authors conducted a comprehensive search of all open-source EMRs suitable for sites without reliable internet access. The authors surveyed clinician users and technical implementers from a single site and technical developers of each software product. The authors evaluated availability, cost and technical requirements. Results The hardware and software for all six systems is easily available, but they vary considerably in proprietary components, installation requirements and customisability. Limitations This study relied solely on self-report from informants who developed and who actively use the included products. Conclusions and implications of key findings Clinical functionalities vary greatly among the systems, and none of the systems yet meet minimum requirements for effective implementation in a primary care resource-limited setting. The safe prescribing of medications is a particular concern with current tools. The dearth of fully functional EMR systems indicates a need for a greater emphasis by global funding agencies to move beyond disease-specific EMR systems and develop a universal open-source health informatics platform. PMID:22763661

Community nursing needs more silver surfers: a questionnaire survey of primary care nurses' use of information technology

PubMed Central

Chan, Tom; Brew, Sarah; de Lusignan, Simon

2004-01-01

Background In the UK the health service is investing more than ever before in information technology (IT) and primary care nurses will have to work with computers. Information about patients will be almost exclusively held in electronic patient records; and much of the information about best practice is most readily accessible via computer terminals. Objective To examine the influence of age and nursing profession on the level of computer use. Methods A questionnaire was developed to examine: access, training received, confidence and use of IT. The survey was carried out in a Sussex Primary Care Trust, in the UK. Results The questionnaire was sent to 109 nurses with a 64% response rate. Most primary care nurses (89%) use their computer regularly at work: 100% of practice nurses daily, compared with 60% of district nurses and 59% of health visitors (p < 0.01). Access to IT was not significantly different between different age groups; but 91% of practice nurses had their own computer while many district nurses and health visitors had to share (p < 0.01). Nurses over 50 had received more training that their younger colleagues (p < 0.01); yet despite this, they lacked confidence and used computers less (p < 0.001). 96% of practice nurses were confident at in using computerised medical records, compared with 53% of district nurses and 44% of health visitors (p < 0.01.) One-to-one training and workshops were the preferred formats for training, with Internet based learning and printed manuals the least popular (p < 0.001). Conclusions Using computers in the surgery has become the norm for primary care nurses. However, nurses over 50, working out in the community, lack the confidence and skill of their younger and practice based colleagues. PMID:15469616

The Danish health system through an American lens.

PubMed

Davis, Karen

2002-02-01

The organization and financing of the Danish health care system was evaluated within the framework of a SWOT analysis (analysis of strengths, weaknesses, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on reading an extensive amount of selected documents and literature on the Danish health care system and a 1-week visit to health care authorities, providers and key persons. The present paper includes the main findings by one of the panel members. Primary care is much more accessible in Denmark than the USA. A mixed capitation-fee-for-service method of paying generalist physicians in Denmark ensures that everyone has a primary care physician and generalist physicians are responsive to providing services quickly, typically same-day appointments. An organized off-hours service ensures accessible care 24 h a day, 7 days a week. Denmark has the highest public satisfaction with health care, reflecting the value placed on accessibility of primary care. Inpatient hospital care consumes a disproportionate share of Danish health expenditures. Global hospital budgets provide little incentive for hospital or surgical productivity. Long waits for hospitalization, especially surgical procedures and cancellation of scheduled surgery, are a source of patient dissatisfaction. Women's health, patient health risk counseling and coordination of preventive and primary care are major weaknesses of the Danish health system. Patients have a choice of primary care physician within a given geographic area and may go to a hospital of their choice. However, patient surveys and feedback are underdeveloped and very little effort has been made to make services responsive to patients' preferences. While innovations in electronic prescribing are noteworthy, further development of health information technology is needed.

76 FR 77738 - Telecommunications Act Accessibility Guidelines; Electronic and Information Technology...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-14

... Telecommunications Act Accessibility Guidelines and its Electronic and Information Technology Accessibility Standards... electronic and information technology covered by Section 508 of the Rehabilitation Act Amendments of 1998. 76.... 2011-07] RIN 3014-AA37 Telecommunications Act Accessibility Guidelines; Electronic and Information...

48 CFR 204.270 - Electronic Document Access.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Electronic Document Access..., DEPARTMENT OF DEFENSE GENERAL ADMINISTRATIVE MATTERS Contract Distribution 204.270 Electronic Document Access. Follow the procedures at PGI 204.270 relating to obtaining an account in the Electronic Document Access...

48 CFR 204.270 - Electronic Document Access.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Electronic Document Access..., DEPARTMENT OF DEFENSE GENERAL ADMINISTRATIVE MATTERS Contract Distribution 204.270 Electronic Document Access. Follow the procedures at PGI 204.270 relating to obtaining an account in the Electronic Document Access...

48 CFR 204.270 - Electronic Document Access.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false Electronic Document Access..., DEPARTMENT OF DEFENSE GENERAL ADMINISTRATIVE MATTERS Contract Distribution 204.270 Electronic Document Access. Follow the procedures at PGI 204.270 relating to obtaining an account in the Electronic Document Access...

48 CFR 204.270 - Electronic Document Access.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Electronic Document Access..., DEPARTMENT OF DEFENSE GENERAL ADMINISTRATIVE MATTERS Contract Distribution 204.270 Electronic Document Access. Follow the procedures at PGI 204.270 relating to obtaining an account in the Electronic Document Access...

48 CFR 204.270 - Electronic Document Access.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Electronic Document Access..., DEPARTMENT OF DEFENSE GENERAL ADMINISTRATIVE MATTERS Contract Distribution 204.270 Electronic Document Access. Follow the procedures at PGI 204.270 relating to obtaining an account in the Electronic Document Access...

Comparing Acquisition Strategies: Open Architecture versus Product Lines

DTIC Science & Technology

2010-04-30

software • New SOW language for accepting software deliveries – Enables third-party reuse • Additional SOW language regarding conducting software code walkthroughs and for using integrated development environments ...change the business environment must be the primary factor that drives the technical approach. Accordingly, there are business case decisions to be...elements of a system design should be made available to the customer to observe throughout the design process. Electronic access to the design environment

CINAHL: an exploratory analysis of the current status of nursing theory construction as reflected by the electronic domain.

PubMed

Riddlesperger, K L; Beard, M; Flowers, D L; Hisley, S M; Pfeifer, K A; Stiller, J J

1996-09-01

Since the 1980s the electronic domain has become the primary method for academic and professional communication of research and information. Papers relating to theory construction in nursing are a frequently occurring phenomenon within the electronic domain. Theory construction provides the underpinning for the advancement of professional nursing, facilitating the conceptualization of nursing actions leading to theory-based practice and research. The purpose of this study was to address the research question, 'What are the similarities and differences among theory construction papers that are accessible electronically in nursing literature today?' The Cumulative Index to Nursing and Allied Health Literature (CINAHL) was accessed to obtain a listing of papers from which an overall description of the type of theory construction papers being published in the nursing literature today could be determined. A literature search was conducted using the description 'theory construction'. Papers were limited to publication years from 1990 onwards. A total of 125 papers were obtained and read by one of the six authors. Using grounded theory, categories emerged by identification of similarities and differences among the papers. The findings are discussed here along with suggestions for further study. A second purpose of this paper was to present both traditional and non-traditional methods of tapping into the electronic domain when searching for assistance with theory construction.

The next step towards making use meaningful: electronic information exchange and care coordination across clinicians and delivery sites.

PubMed

Graetz, Ilana; Reed, Mary; Shortell, Stephen M; Rundall, Thomas G; Bellows, Jim; Hsu, John

2014-12-01

Care for patients with chronic conditions often requires coordination between multiple physicians and delivery sites. Electronic Health Record (EHR) use could improve care quality and efficiency in part by facilitating care coordination. We examined the association between EHR use and clinician perceptions of care coordination for patients transferred across clinicians and delivery sites. Repeated surveys of primary care clinicians during the staggered implementation of an outpatient EHR (2005-2008), followed by an integrated inpatient EHR (2006-2010). We measured the association between EHR use stages (no use, outpatient EHR only, and integrated inpatient-outpatient EHR) and care coordination using logistic regression, adjusting for clinician characteristics, study year, and medical center. Adult primary care clinicians in a large Integrated Delivery System. Three measures of clinician-reported care coordination for patient care transferred across clinicians (eg, from specialist to primary care team) and across delivery sites (eg, from the hospital to outpatient care). Outpatient EHR use was associated with higher reports of access to complete and timely clinical information and higher agreement on clinician roles and responsibilities for patients transferred across clinicians, but not for patients transferred across delivery sites. Use of the integrated outpatient-inpatient EHR was associated with higher reports of access to timely and complete clinical information, clinician agreement on the patient's treatment plan for patients transferred across delivery sites, and with all coordination measures for patients transferred across clinicians. Use of an integrated EHR with health information exchange across delivery settings improved patient care coordination.

Workforce characteristics of privately practicing nurse practitioners in Australia: Results from a national survey.

PubMed

Currie, Jane; Chiarella, Mary; Buckley, Thomas

2016-10-01

Australian private practice nurse practitioner (PPNP) services have grown since legislative changes in 2010 enabled eligible nurse practitioners (NPs) to access reimbursement for care delivered through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). This article provides data from a national survey on the workforce characteristics of PPNPs in Australia. PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. There were 73 completed surveys. One of the intentions of expanding access to MBS and PBS for patients treated by NPs was to increase patients' access to health care through greater flexibility in the healthcare workforce. The results of this survey confirm that the workforce characteristics of PPNPs provide a potentially untapped resource to meet current primary healthcare demand. The findings of this study allow us to understand the characteristics of PPNP services, which are significant for workforce planning. The focus of PPNP practice is toward primary health care with PPNPs working predominantly in general practice settings. The largest age group of PPNPs is over 50 years and means a proportion will be retiring in the next 15 years. ©2016 American Association of Nurse Practitioners.

Catalyst-Directed Diastereoselective Isomerization of Allylic Alcohols for the Stereoselective Construction of C(20) in Steroid Side Chains: Scope and Topological Diversification.

PubMed

Li, Houhua; Mazet, Clément

2015-08-26

The stereoselective construction of C20 in steroidal derivatives by a highly diastereoselective Ir-catalyzed isomerization of primary allylic alcohols is reported. A key aspect of this strategy is a straightforward access to geometrically pure steroidal enol tosylate and enol triflate intermediates for subsequent high yielding stereoretentive Negishi cross-coupling reactions to allow structural diversity to be introduced. A range of allylic alcohols participates in the diastereoselective isomerization under the optimized reaction conditions. Electron-rich and electron-poor aryl or heteroaryl substituents are particularly well-tolerated, and the stereospecific nature of the reaction provides indifferently access to the natural C20-(R) and unnatural C20-(S) configurations. Alkyl containing substrates are more challenging as they affect regioselectivity of iridium-hydride insertion. A rationale for the high diastereoselectivities observed is proposed for aryl containing precursors. The scope of our method is further highlighted through topological diversification in the side chain and within the polycyclic domain of advanced and complex steroidal architectures. These findings have the potential to greatly simplify access to epimeric structural analogues of important steroid scaffolds for applications in biological, pharmaceutical, and medical sciences.

Primary Care Provider Views About Usefulness and Dissemination of a Web-Based Depression Treatment Information Decision Aid.

PubMed

Beaulac, Julie; Westmacott, Robin; Walker, John R; Vardanyan, Gohar

2016-06-08

Decisions related to mental health are often complex, problems often remain undetected and untreated, information unavailable or not used, and treatment decisions frequently not informed by best practice or patient preferences. The objective of this paper was to obtain the opinions of health professionals working in primary health care settings about a Web-based information decision aid (IDA) for patients concerning treatment options for depression and the dissemination of the resources in primary care settings. Participants were recruited from primary care clinics in Winnipeg and Ottawa, Canada, and included 48 family physicians, nurses, and primary care staff. The study design was a qualitative framework analytic approach of 5 focus groups. Focus groups were conducted during regular staff meetings, were digitally recorded, and transcripts created. Analysis involved a content and theme analysis. Seven key themes emerged including the key role of the primary care provider, common questions about treatments, treatment barriers, sources of patient information, concern about quality and quantity of available information, positive opinions about the IDA, and disseminating the IDA. The most common questions mentioned were about medication and side effects and alternatives to medication. Patients have limited access to alternative treatment options owing to cost and availability. Practitioners evaluated the IDA positively. The resources were described as useful, supportive of providers' messages, and accessible for patients. There was unanimous consensus that information needs to be available electronically through the Internet.

Technical support and delegation to practice staff - status quo and (possible) future perspectives for primary health care in Germany.

PubMed

Urban, Elisabeth; Ose, Dominik; Joos, Stefanie; Szecsenyi, Joachim; Miksch, Antje

2012-08-01

Primary health care in industrialized countries faces major challenges due to demographic changes, an increasing prevalence of chronic diseases and a shortage of primary care physicians. One approach to counteract these developments might be to reduce primary care physicians' workload supported by the use of health information technology (HIT) and non-physician practice staff. In 2009, the U.S. Commonwealth Fund (CWF) conducted an international survey of primary care physicians which the present secondary descriptive analysis is based on. The aim of this analysis was twofold: First, to explore to what extend German primary care physicians already get support by HIT and non-physician practice staff, and second, to show possible future perspectives. The CWF questionnaire was sent to a representative random sample of 1,500 primary care physicians all over Germany. The data was descriptively analyzed. Group comparisons regarding differences in gender and age groups were made by means of Chi Square Tests for categorical variables. An alpha-level of p < 0.05 was used for statistical significance. Altogether 715 primary care physicians answered the questionnaire (response rate 49%). Seventy percent of the physicians use electronic medical records. Technical features such as electronic ordering and access to laboratory parameters are mainly used. However, the majority does not routinely use technical functions for drug prescribing, reminder-systems for guideline-based interventions or recall of patients. Six percent of surveyed physicians are able to transfer prescriptions electronically to a pharmacy, 1% use email communication with patients regularly. Seventy-two percent of primary care physicians get support by non-physician practice staff in patient care, mostly in administrative tasks or routine preventive services. One fourth of physicians is supported in telephone calls to the patient or in patient education and counseling. Within this sample the majority of primary care physicians get support by HIT and non-physician practice staff in their daily work. However, the potential has not yet been fully used. Supportive technical functions like electronic alarm functions for medication or electronic prescribing should be improved technically and more adapted to physicians' needs. To warrant pro-active health care, recall and reminder systems should get refined to encourage their use. Adequately qualified non-physician practice staff could play a more active role in patient care. Reimbursement should not only be linked to doctors', but also to non-physician practice staff services.

Dietary Behaviors among Public Health Center Clients with Electronic Benefit Transfer Access at Farmers' Markets.

PubMed

Robles, Brenda; Montes, Christine E; Nobari, Tabashir Z; Wang, May C; Kuo, Tony

2017-01-01

Although increasing access to electronic benefit transfer (EBT) at farmers' markets has become a popular strategy for encouraging healthy eating, its relationships to a number of dietary behaviors in low-income populations are not well understood. To describe the frequency of and relationships between EBT access, fruit and vegetable intake, and sugar-sweetened beverage (SSB) consumption among public health center (PHC) clients with access to EBT at farmers' markets during 2011-2012. Cross-sectional. Low-income participants recruited from the waiting rooms of five multipurpose PHCs operated by the Los Angeles County Department of Public Health. Fruit and vegetable and SSB consumption (number per week). Data from the 2012 Los Angeles County Health and Nutrition Examination Survey were analyzed using multivariable regressions, with EBT access at farmers' markets as the primary independent variable. Covariates included EBT use, transportation behaviors, neighborhood attributes, and sociodemographic characteristics. A total of 1,503 adults participated in the survey (response rate=69%). Of these, 529 reported receiving EBT benefits. Among these benefits recipients, 64% were women, 54% were aged 25 to 44 years, 62% were black, and 75% were unemployed or part-time employed. In multivariable regression analyses, EBT access at farmers' markets was positively associated with higher fruit and vegetable consumption; however, an association to SSB consumption was not demonstrated. EBT access at farmers' markets is related to higher fruit and vegetable consumption among PHC clients in Los Angeles County. However, the finding of no association to SSB consumption raises important questions about the need for strategies to discourage EBT recipients' purchase of foods of minimal nutritional value in other venues that accept nutrition assistance program benefits. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Does access to general dental treatment affect the number and complexity of patients presenting to the acute hospital service with severe dentofacial infections?

PubMed

Bowe, Conor M; Gargan, Mary Louise; Kearns, Gerard J; Stassen, Leo F A

2015-01-01

This is a retrospective study to review the treatment and management of patients presenting with odontogenic infections in a large urban teaching hospital over a four-year period, comparing the number and complexity of odontogenic infections presenting to an acute general hospital in two periods, as follows: Group A (January 2008 to March 2010) versus Group B (April 2010 to December 2011). The background to the study is 'An alteration in patient access to primary dental care instituted by the Department of Health in April 2010'. a) to identify any alteration in the pattern and complexity of patients' presentation with odontogenic infections following recent changes in access to treatment via the Dental Treatment Services Scheme (DTSS) and the Dental Treatment Benefit Scheme (DTBS) in April 2010; and, b) to evaluate the management of severe odontogenic infections. Data was collated by a combination of a comprehensive chart review and electronic patient record analysis based on the primary discharge diagnosis as recorded in the Hospital In-Patient Enquiry (HIPE) system. Fifty patients were admitted to the National Maxillofacial Unit, St James's Hospital, under the oral and maxillofacial service over a four-year period, with an odontogenic infection as the primary diagnosis. There was an increased number of patients presenting with odontogenic infections during Group B of the study. These patients showed an increased complexity and severity of infection. Although there was an upward trend in the numbers and complexity of infections, this trending did not reach statistical significance. The primary cause of infection was dental caries in all patients. Dental caries is a preventable and treatable disease. Increased resources should be made available to support access to dental care, and thereby lessen the potential for the morbidity and mortality associated with serious odontogenic infections. The study at present continues as a prospective study.

Use of Electronic Resources for Psychiatry Clerkship Learning: A Medical Student Survey.

PubMed

Snow, Caitlin E; Torous, John; Gordon-Elliott, Janna S; Penzner, Julie B; Meyer, Fermonta; Boland, Robert

2017-10-01

The primary aim of this study is to examine medical students' use patterns, preferences, and perceptions of electronic educational resources available for psychiatry clerkship learning. Eligible participants included medical students who had completed the psychiatry clerkship during a 24-month period. An internet-based questionnaire was used to collect information regarding the outcomes described above. A total of 68 medical students responded to the survey. Most respondents reported high utilization of electronic resources on an array of devices for psychiatry clerkship learning and indicated a preference for electronic over print resources. The most commonly endorsed barriers to the use of electronic resources were that the source contained irrelevant and non-specific content, access was associated with a financial cost, and faculty guidance on recommended resources was insufficient. Respondents indicated a wish for more psychiatry-specific electronic learning resources. The authors' results suggest that a demand exists for high-quality electronic and portable learning tools that are relevant to medical student education in psychiatry. Psychiatry educators are usefully positioned to be involved in the development of such resources.

49 CFR 228.205 - Access to electronic records.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Access to electronic records. 228.205 Section 228.205 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD...; SLEEPING QUARTERS Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and...

49 CFR 228.205 - Access to electronic records.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Access to electronic records. 228.205 Section 228.205 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD...; SLEEPING QUARTERS Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and...

49 CFR 228.205 - Access to electronic records.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Access to electronic records. 228.205 Section 228.205 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD...; SLEEPING QUARTERS Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and...

Spatial accessibility of primary health care in China: A case study in Sichuan Province.

PubMed

Wang, Xiuli; Yang, Huazhen; Duan, Zhanqi; Pan, Jay

2018-05-10

Access to primary health care is considered a fundamental right and an important facilitator of overall population health. Township health centers (THCs) and Community health centers (CHCs) serve as central hubs of China's primary health care system and have been emphasized during recent health care reforms. Accessibility of these hubs is poorly understood and a better understanding of the current situation is essential for proper decision making. This study assesses spatial access to health care provided by primary health care institutions (THCs/CHCs) in Sichuan Province as a microcosm in China. The Nearest-Neighbor method, Enhanced Two-Step Floating Catchment Area (E2SFCA) method, and Gini Coefficient are utilized to represent travel impedance, spatial accessibility, and disparity of primary health care resources (hospital beds, doctors, and health professionals). Accessibilities and Gini Coefficients are correlated with social development indexes (GDP, ethnicity, etc.) to identify influencing factors. Spatial access to primary health care is better in southeastern Sichuan compared to northwestern Sichuan in terms of shorter travel time, higher spatial accessibility, and lower inequity. Social development indexes all showed significant correlation with county averaged spatial accessibilities/Gini Coefficients, with population density ranking top. The disparity of access to primary health care is also apparent between ethnic minority and non-minority regions. To improve spatial access to primary health care and narrow the inequity, more township health centers staffed by qualified health professionals are recommended for northwestern Sichuan. Improved road networks will also help. Among areas with insufficient primary health care, the specific counties where demographics are dominated by older people and children due to widespread rural-urban migration of the workforce, and by ethnic minorities, should be especially emphasized in future planning. Copyright © 2018 Elsevier Ltd. All rights reserved.

Combating information overload: a six-month pilot evaluation of a knowledge management system in general practice.

PubMed Central

O'Brien, C; Cambouropoulos, P

2000-01-01

A six-month prospective study was conducted on the usefulness and usability of a representative electronic knowledge management tool, the WAX Active Library, for 19 general practitioners (GPs) evaluated using questionnaires and audit trail data. The number of pages accessed was highest in the final two months, when over half of the access trails were completed within 40 seconds. Most GPs rated the system as easy to learn, fast to use, and preferable to paper for providing information during consultations. Such tools could provide a medium for the activities of knowledge officers, help demand management, and promote sharing of information within primary care groups and across NHSnet or the Internet. PMID:10962792

Characterization of the Geosynchronous Plasma Environment for the SENSER/RROE Optical Instrument

DOE Office of Scientific and Technical Information (OSTI.GOV)

Woodroffe, Jesse Richard

2016-11-08

In this report, we summarize available research in order to characterize expected rates of particle incidence on the SENSER/RROE optical instrument. We first investigate the “normal” background levels using data from statistical studies of spacecraft in geosynchronous orbit and empirical models. We then consider “worst case” scenarios based on event studies in which extreme fluxes have been observed. We use these data to define “maximum” rates of particle incidence. We then consider how incident particles will actually produce counts in the instrument by considering the effects of screening by the instrument housing and the possibility of direct particle access tomore » the housing, with rates for both primary access and secondary electron generation.« less

Integrating and visualizing primary data from prospective and legacy taxonomic literature

PubMed Central

Agosti, Donat; Penev, Lyubomir; Sautter, Guido; Georgiev, Teodor; Catapano, Terry; Patterson, David; King, David; Pereira, Serrano; Vos, Rutger Aldo; Sierra, Soraya

2015-01-01

Abstract Specimen data in taxonomic literature are among the highest quality primary biodiversity data. Innovative cybertaxonomic journals are using workflows that maintain data structure and disseminate electronic content to aggregators and other users; such structure is lost in traditional taxonomic publishing. Legacy taxonomic literature is a vast repository of knowledge about biodiversity. Currently, access to that resource is cumbersome, especially for non-specialist data consumers. Markup is a mechanism that makes this content more accessible, and is especially suited to machine analysis. Fine-grained XML (Extensible Markup Language) markup was applied to all (37) open-access articles published in the journal Zootaxa containing treatments on spiders (Order: Araneae). The markup approach was optimized to extract primary specimen data from legacy publications. These data were combined with data from articles containing treatments on spiders published in Biodiversity Data Journal where XML structure is part of the routine publication process. A series of charts was developed to visualize the content of specimen data in XML-tagged taxonomic treatments, either singly or in aggregate. The data can be filtered by several fields (including journal, taxon, institutional collection, collecting country, collector, author, article and treatment) to query particular aspects of the data. We demonstrate here that XML markup using GoldenGATE can address the challenge presented by unstructured legacy data, can extract structured primary biodiversity data which can be aggregated with and jointly queried with data from other Darwin Core-compatible sources, and show how visualization of these data can communicate key information contained in biodiversity literature. We complement recent studies on aspects of biodiversity knowledge using XML structured data to explore 1) the time lag between species discovry and description, and 2) the prevelence of rarity in species descriptions. PMID:26023286

48 CFR 552.238-70 - Identification of Electronic Office Equipment Providing Accessibility for the Handicapped.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Electronic Office Equipment Providing Accessibility for the Handicapped. 552.238-70 Section 552.238-70... Equipment Providing Accessibility for the Handicapped. As prescribed in 538.273(a)(1), insert the following clause: Identification of Electronic Office Equipment Providing Accessibility for the Handicapped (SEP...

48 CFR 552.238-70 - Identification of Electronic Office Equipment Providing Accessibility for the Handicapped.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Electronic Office Equipment Providing Accessibility for the Handicapped. 552.238-70 Section 552.238-70... Equipment Providing Accessibility for the Handicapped. As prescribed in 538.273(a)(1), insert the following clause: Identification of Electronic Office Equipment Providing Accessibility for the Handicapped (SEP...

48 CFR 552.238-70 - Identification of Electronic Office Equipment Providing Accessibility for the Handicapped.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Electronic Office Equipment Providing Accessibility for the Handicapped. 552.238-70 Section 552.238-70... Equipment Providing Accessibility for the Handicapped. As prescribed in 538.273(a)(1), insert the following clause: Identification of Electronic Office Equipment Providing Accessibility for the Handicapped (SEP...

48 CFR 552.238-70 - Identification of Electronic Office Equipment Providing Accessibility for the Handicapped.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Electronic Office Equipment Providing Accessibility for the Handicapped. 552.238-70 Section 552.238-70... Equipment Providing Accessibility for the Handicapped. As prescribed in 538.273(a)(1), insert the following clause: Identification of Electronic Office Equipment Providing Accessibility for the Handicapped (SEP...

48 CFR 552.238-70 - Identification of Electronic Office Equipment Providing Accessibility for the Handicapped.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Electronic Office Equipment Providing Accessibility for the Handicapped. 552.238-70 Section 552.238-70... Equipment Providing Accessibility for the Handicapped. As prescribed in 538.273(a)(1), insert the following clause: Identification of Electronic Office Equipment Providing Accessibility for the Handicapped (SEP...

Social, ethical and legal barriers to e-health.

PubMed

Anderson, James G

2007-01-01

Information technology such as electronic medical records (EMRs), electronic prescribing and decision support systems are recognized as essential tools in Europe, the U.S., Canada, Australia, and New Zealand. But significant barriers impede wide-scale adoption of these tools, especially EMR systems. The objectives of this study were to investigate the present status of information technology in health care, the perceived benefits and barriers by primary care physicians. Literature analysis and survey data from primary care physicians on adoption of information technology are reviewed. The U.S. trails European countries as well as Canada, Australia and New Zealand in the use of information technology in primary care. The results of the study indicate that physicians in general perceive benefits to information technology, but also cite major barriers to its implementation in their practices. These barriers include lack of access to capital by health care providers, complex systems and lack of data standards that permit exchange of clinical data, privacy concerns and legal barriers. Overcoming these barriers will require subsidies and performance incentives by payers and government; certification and standardization of vendor applications that permit clinical data exchange; removal of legal barriers; and greater security of medical data to convince practitioners and patients of the value of EMRs.

39 CFR 255.4 - Accessibility to electronic and information technology.

Code of Federal Regulations, 2013 CFR

2013-07-01

... AND INFORMATION TECHNOLOGY § 255.4 Accessibility to electronic and information technology. (a) In... burden, that the electronic and information technology the agency procures allows— (1) Individuals with... 39 Postal Service 1 2013-07-01 2013-07-01 false Accessibility to electronic and information...

39 CFR 255.4 - Accessibility to electronic and information technology.

Code of Federal Regulations, 2014 CFR

2014-07-01

... AND INFORMATION TECHNOLOGY § 255.4 Accessibility to electronic and information technology. (a) In... burden, that the electronic and information technology the agency procures allows— (1) Individuals with... 39 Postal Service 1 2014-07-01 2014-07-01 false Accessibility to electronic and information...

39 CFR 255.4 - Accessibility to electronic and information technology.

Code of Federal Regulations, 2012 CFR

2012-07-01

... AND INFORMATION TECHNOLOGY § 255.4 Accessibility to electronic and information technology. (a) In... burden, that the electronic and information technology the agency procures allows— (1) Individuals with... 39 Postal Service 1 2012-07-01 2012-07-01 false Accessibility to electronic and information...

39 CFR 255.4 - Accessibility to electronic and information technology.

Code of Federal Regulations, 2011 CFR

2011-07-01

... AND INFORMATION TECHNOLOGY § 255.4 Accessibility to electronic and information technology. (a) In... burden, that the electronic and information technology the agency procures allows— (1) Individuals with... 39 Postal Service 1 2011-07-01 2011-07-01 false Accessibility to electronic and information...

49 CFR 228.205 - Access to electronic records.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Access to electronic records. 228.205 Section 228... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HOURS OF SERVICE OF RAILROAD EMPLOYEES Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and State inspectors participating under 49...

49 CFR 228.205 - Access to electronic records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Access to electronic records. 228.205 Section 228... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HOURS OF SERVICE OF RAILROAD EMPLOYEES Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and State inspectors participating under 49...

Realization of a universal patient identifier for electronic medical records through biometric technology.

PubMed

Leonard, D C; Pons, Alexander P; Asfour, Shihab S

2009-07-01

The technology exists for the migration of healthcare data from its archaic paper-based system to an electronic one, and, once in digital form, to be transported anywhere in the world in a matter of seconds. The advent of universally accessible healthcare data has benefited all participants, but one of the outstanding problems that must be addressed is how the creation of a standardized nationwide electronic healthcare record system in the United States would uniquely identify and match a composite of an individual's recorded healthcare information to an identified individual patients out of approximately 300 million people to a 1:1 match. To date, a few solutions to this problem have been proposed that are limited in their effectiveness. We propose the use of biometric technology within our fingerprint, iris, retina scan, and DNA (FIRD) framework, which is a multiphase system whose primary phase is a multilayer consisting of these four types of biometric identifiers: 1) fingerprint; 2) iris; 3) retina scan; and 4) DNA. In addition, it also consists of additional phases of integration, consolidation, and data discrepancy functions to solve the unique association of a patient to their medical data distinctively. This would allow a patient to have real-time access to all of their recorded healthcare information electronically whenever it is necessary, securely with minimal effort, greater effectiveness, and ease.

Do difficulties in accessing in-hours primary care predict higher use of out-of-hours GP services? Evidence from an English National Patient Survey.

PubMed

Zhou, Yin; Abel, Gary; Warren, Fiona; Roland, Martin; Campbell, John; Lyratzopoulos, Georgios

2015-05-01

It is believed that some patients are more likely to use out-of-hours primary care services because of difficulties in accessing in-hours care, but substantial evidence about any such association is missing. We analysed data from 567,049 respondents to the 2011/2012 English General Practice Patient Survey who reported at least one in-hours primary care consultation in the preceding 6 months. Of those respondents, 7% also reported using out-of-hours primary care. We used logistic regression to explore associations between use of out-of-hours primary care and five measures of in-hours access (ease of getting through on the telephone, ability to see a preferred general practitioner, ability to get an urgent or routine appointment and convenience of opening hours). We illustrated the potential for reduction in use of out-of-hours primary care in a model where access to in-hours care was made optimal. Worse in-hours access was associated with greater use of out-of-hours primary care for each access factor. In multivariable analysis adjusting for access and patient characteristic variables, worse access was independently associated with increased out-of-hours use for all measures except ease of telephone access. Assuming these associations were causal, we estimated that an 11% relative reduction in use of out-of-hours primary care services in England could be achievable if access to in-hours care were optimal. This secondary quantitative analysis provides evidence for an association between difficulty in accessing in-hours care and use of out-of-hours primary care services. The findings can motivate the development of interventions to improve in-hour access. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Racial Disparities In Geographic Access To Primary Care In Philadelphia.

PubMed

Brown, Elizabeth J; Polsky, Daniel; Barbu, Corentin M; Seymour, Jane W; Grande, David

2016-08-01

Primary care is often thought of as the gateway to improved health outcomes and can lead to more efficient use of health care resources. Because of primary care's cardinal importance, adequate access is an important health policy priority. In densely populated urban areas, spatial access to primary care providers across neighborhoods is poorly understood. We examined spatial variation in primary care access in Philadelphia, Pennsylvania. We calculated ratios of adults per primary care provider for each census tract and included buffer zones based on prespecified drive times around each tract. We found that the average ratio was 1,073; the supply of primary care providers varied widely across census tracts, ranging from 105 to 10,321. We identified six areas of Philadelphia that have much lower spatial accessibility to primary care relative to the rest of the city. After adjustment for sociodemographic and insurance characteristics, the odds of being in a low-access area were twenty-eight times greater for census tracts with a high proportion of African Americans than in tracts with a low proportion of African Americans. Project HOPE—The People-to-People Health Foundation, Inc.

Critical issues in an electronic documentation system.

PubMed

Weir, Charlene R; Nebeker, Jonathan R

2007-10-11

The Veterans Health Administration (VHA), of the U.S. Department of Veteran Affairs has instituted a medical record (EMR) that includes electronic documentation of all narrative components of the medical record. To support clinicians using the system, multiple efforts have been instituted to ease the creation of narrative reports. Although electronic documentation is easier to read and improves access to information, it also may create new and additional hazards for users. This study is the first step in a series of studies to evaluate the issues surrounding the creation and use of electronic documentation. Eighty-eight providers across multiple clinical roles were interviewed in 10 primary care sites in the VA system. Interviews were tape-recorded, transcribed and qualitatively analyzed for themes. In addition, specific questions were asked about perceived harm due to electronic documentation practices. Five themes relating to difficulties with electronic documentation were identified: 1) information overload; 2) hidden information; 3) lack of trust; 4) communication; 5) decision-making. Three providers reported that they knew of an incident where current documentation practices had caused patient harm and over 75% of respondents reported significant mis-trust of the system.

Patients’ Online Access to Their Primary Care Electronic Health Records and Linked Online Services: Implications for Research and Practice

PubMed Central

Mold, Freda; de Lusignan, Simon

2015-01-01

Online access to medical records and linked services, including requesting repeat prescriptions and booking appointments, enables patients to personalize their access to care. However, online access creates opportunities and challenges for both health professionals and their patients, in practices and in research. The challenges for practice are the impact of online services on workload and the quality and safety of health care. Health professionals are concerned about the impact on workload, especially from email or other online enquiry systems, as well as risks to privacy. Patients report how online access provides a convenient means through which to access their health provider and may offer greater satisfaction if they get a timely response from a clinician. Online access and services may also result in unforeseen consequences and may change the nature of the patient-clinician interaction. Research challenges include: (1) Ensuring privacy, including how to control inappropriate carer and guardian access to medical records; (2) Whether online access to records improves patient safety and health outcomes; (3) Whether record access increases disparities across social classes and between genders; and (4) Improving efficiency. The challenges for practice are: (1) How to incorporate online access into clinical workflow; (2) The need for a business model to fund the additional time taken. Creating a sustainable business model for a safe, private, informative, more equitable online service is needed if online access to records is to be provided outside of pay-for-service systems. PMID:26690225

Patients' Online Access to Their Primary Care Electronic Health Records and Linked Online Services: Implications for Research and Practice.

PubMed

Mold, Freda; de Lusignan, Simon

2015-12-04

Online access to medical records and linked services, including requesting repeat prescriptions and booking appointments, enables patients to personalize their access to care. However, online access creates opportunities and challenges for both health professionals and their patients, in practices and in research. The challenges for practice are the impact of online services on workload and the quality and safety of health care. Health professionals are concerned about the impact on workload, especially from email or other online enquiry systems, as well as risks to privacy. Patients report how online access provides a convenient means through which to access their health provider and may offer greater satisfaction if they get a timely response from a clinician. Online access and services may also result in unforeseen consequences and may change the nature of the patient-clinician interaction. Research challenges include: (1) Ensuring privacy, including how to control inappropriate carer and guardian access to medical records; (2) Whether online access to records improves patient safety and health outcomes; (3) Whether record access increases disparities across social classes and between genders; and (4) Improving efficiency. The challenges for practice are: (1) How to incorporate online access into clinical workflow; (2) The need for a business model to fund the additional time taken. Creating a sustainable business model for a safe, private, informative, more equitable online service is needed if online access to records is to be provided outside of pay-for-service systems.

Using Geographic Information Systems (GIS) to understand a community's primary care needs.

PubMed

Dulin, Michael F; Ludden, Thomas M; Tapp, Hazel; Blackwell, Joshua; de Hernandez, Brisa Urquieta; Smith, Heather A; Furuseth, Owen J

2010-01-01

A key element for reducing health care costs and improving community health is increased access to primary care and preventative health services. Geographic information systems (GIS) have the potential to assess patterns of health care utilization and community-level attributes to identify geographic regions most in need of primary care access. GIS, analytical hierarchy process, and multiattribute assessment and evaluation techniques were used to examine attributes describing primary care need and identify areas that would benefit from increased access to primary care services. Attributes were identified by a collaborative partnership working within a practice-based research network using tenets of community-based participatory research. Maps were created based on socioeconomic status, population density, insurance status, and emergency department and primary care safety-net utilization. Individual and composite maps identified areas in our community with the greatest need for increased access to primary care services. Applying GIS to commonly available community- and patient-level data can rapidly identify areas most in need of increased access to primary care services. We have termed this a Multiple Attribute Primary Care Targeting Strategy. This model can be used to plan health services delivery as well as to target and evaluate interventions designed to improve health care access.

Is Team-Based Primary Care Associated with Less Access Problems and Self-Reported Unmet Need in Canada?

PubMed

Zygmunt, Austin; Asada, Yukiko; Burge, Frederick

2017-10-01

As in many jurisdictions, the delivery of primary care in Canada is being transformed from solo practice to team-based care. In Canada, team-based primary care involves general practitioners working with nurses or other health care providers, and it is expected to improve equity in access to care. This study examined whether team-based care is associated with fewer access problems and less unmet need and whether socioeconomic gradients in access problems and unmet need are smaller in team-based care than in non-team-based care. Data came from the 2008 Canadian Survey of Experiences with Primary Health Care (sample size: 10,858). We measured primary care type as team-based or non-team-based and socioeconomic status by income and education. We created four access problem variables and four unmet need variables (overall and three specific components). For each, we ran separate logistic regression models to examine their associations with primary care type. We examined socioeconomic gradients in access problems and unmet need stratified by primary care type. Primary care type had no statistically significant, independent associations with access problems or unmet need. Among those with non-team-based care, a statistically significant education gradient for overall access problems existed, whereas among those with team-based care, no statistically significant socioeconomic gradients existed.

Online access to doctors' notes: patient concerns about privacy.

PubMed

Vodicka, Elisabeth; Mejilla, Roanne; Leveille, Suzanne G; Ralston, James D; Darer, Jonathan D; Delbanco, Tom; Walker, Jan; Elmore, Joann G

2013-09-26

Offering patients online access to medical records, including doctors' visit notes, holds considerable potential to improve care. However, patients may worry about loss of privacy when accessing personal health information through Internet-based patient portals. The OpenNotes study provided patients at three US health care institutions with online access to their primary care doctors' notes and then collected survey data about their experiences, including their concerns about privacy before and after participation in the intervention. To identify patients' attitudes toward privacy when given electronic access to their medical records, including visit notes. The design used a nested cohort study of patients surveyed at baseline and after a 1-year period during which they were invited to read their visit notes through secure patient portals. Participants consisted of 3874 primary care patients from Beth Israel Deaconess Medical Center (Boston, MA), Geisinger Health System (Danville, PA), and Harborview Medical Center (Seattle, WA) who completed surveys before and after the OpenNotes intervention. The measures were patient-reported levels of concern regarding privacy associated with online access to visit notes. 32.91% of patients (1275/3874 respondents) reported concerns about privacy at baseline versus 36.63% (1419/3874 respondents) post-intervention. Baseline concerns were associated with non-white race/ethnicity and lower confidence in communicating with doctors, but were not associated with choosing to read notes or desire for continued online access post-intervention (nearly all patients with notes available chose to read them and wanted continued access). While the level of concern among most participants did not change during the intervention, 15.54% (602/3874 respondents, excluding participants who responded "don't know") reported more concern post-intervention, and 12.73% (493/3874 respondents, excluding participants who responded "don't know") reported less concern. When considering online access to visit notes, approximately one-third of patients had concerns about privacy at baseline and post-intervention. These perceptions did not deter participants from accessing their notes, suggesting that the benefits of online access to medical records may outweigh patients' perceived risks to privacy.

Online Access to Doctors' Notes: Patient Concerns About Privacy

PubMed Central

Mejilla, Roanne; Leveille, Suzanne G; Ralston, James D; Darer, Jonathan D; Delbanco, Tom; Walker, Jan; Elmore, Joann G

2013-01-01

Background Offering patients online access to medical records, including doctors’ visit notes, holds considerable potential to improve care. However, patients may worry about loss of privacy when accessing personal health information through Internet-based patient portals. The OpenNotes study provided patients at three US health care institutions with online access to their primary care doctors’ notes and then collected survey data about their experiences, including their concerns about privacy before and after participation in the intervention. Objective To identify patients’ attitudes toward privacy when given electronic access to their medical records, including visit notes. Methods The design used a nested cohort study of patients surveyed at baseline and after a 1-year period during which they were invited to read their visit notes through secure patient portals. Participants consisted of 3874 primary care patients from Beth Israel Deaconess Medical Center (Boston, MA), Geisinger Health System (Danville, PA), and Harborview Medical Center (Seattle, WA) who completed surveys before and after the OpenNotes intervention. The measures were patient-reported levels of concern regarding privacy associated with online access to visit notes. Results 32.91% of patients (1275/3874 respondents) reported concerns about privacy at baseline versus 36.63% (1419/3874 respondents) post-intervention. Baseline concerns were associated with non-white race/ethnicity and lower confidence in communicating with doctors, but were not associated with choosing to read notes or desire for continued online access post-intervention (nearly all patients with notes available chose to read them and wanted continued access). While the level of concern among most participants did not change during the intervention, 15.54% (602/3874 respondents, excluding participants who responded “don’t know”) reported more concern post-intervention, and 12.73% (493/3874 respondents, excluding participants who responded “don’t know”) reported less concern. Conclusions When considering online access to visit notes, approximately one-third of patients had concerns about privacy at baseline and post-intervention. These perceptions did not deter participants from accessing their notes, suggesting that the benefits of online access to medical records may outweigh patients’ perceived risks to privacy. PMID:24072335

76 FR 40454 - Proposed Information Collection (VSO Access to VHA Electronic Health Records) Activity; Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-08

... Access to VHA Electronic Health Records) Activity; Comment Request AGENCY: Veterans Health Administration... Access to VHA Electronic Health Records, VA Form 10- 0400. OMB Control Number: 2900-0710. Type of Review... were granted power of attorney by veterans who have medical information recorded in VHA electronic...

Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis.

PubMed

Whittaker, William; Anselmi, Laura; Kristensen, Søren Rud; Lau, Yiu-Shing; Bailey, Simon; Bower, Peter; Checkland, Katherine; Elvey, Rebecca; Rothwell, Katy; Stokes, Jonathan; Hodgson, Damian

2016-09-01

Health services across the world increasingly face pressures on the use of expensive hospital services. Better organisation and delivery of primary care has the potential to manage demand and reduce costs for hospital services, but routine primary care services are not open during evenings and weekends. Extended access (evening and weekend opening) is hypothesized to reduce pressure on hospital services from emergency department visits. However, the existing evidence-base is weak, largely focused on emergency out-of-hours services, and analysed using a before-and after-methodology without effective comparators. Throughout 2014, 56 primary care practices (346,024 patients) in Greater Manchester, England, offered 7-day extended access, compared with 469 primary care practices (2,596,330 patients) providing routine access. Extended access included evening and weekend opening and served both urgent and routine appointments. To assess the effects of extended primary care access on hospital services, we apply a difference-in-differences analysis using hospital administrative data from 2011 to 2014. Propensity score matching techniques were used to match practices without extended access to practices with extended access. Differences in the change in "minor" patient-initiated emergency department visits per 1,000 population were compared between practices with and without extended access. Populations registered to primary care practices with extended access demonstrated a 26.4% relative reduction (compared to practices without extended access) in patient-initiated emergency department visits for "minor" problems (95% CI -38.6% to -14.2%, absolute difference: -10,933 per year, 95% CI -15,995 to -5,866), and a 26.6% (95% CI -39.2% to -14.1%) relative reduction in costs of patient-initiated visits to emergency departments for minor problems (absolute difference: -£767,976, -£1,130,767 to -£405,184). There was an insignificant relative reduction of 3.1% in total emergency department visits (95% CI -6.4% to 0.2%). Our results were robust to several sensitivity checks. A lack of detailed cost reporting of the running costs of extended access and an inability to capture health outcomes and other health service impacts constrain the study from assessing the full cost-effectiveness of extended access to primary care. The study found that extending access was associated with a reduction in emergency department visits in the first 12 months. The results of the research have already informed the decision by National Health Service England to extend primary care access across Greater Manchester from 2016. However, further evidence is needed to understand whether extending primary care access is cost-effective and sustainable.

Implementing an electronic medication overview in Belgium.

PubMed

Storms, Hannelore; Marquet, Kristel; Nelissen, Katherine; Hulshagen, Leen; Lenie, Jan; Remmen, Roy; Claes, Neree

2014-12-16

An accurate medication overview is essential to reduce medication errors. Therefore, it is essential to keep the medication overview up-to-date and to exchange healthcare information between healthcare professionals and patients. Digitally shared information yields possibilities to improve communication. However, implementing a digitally shared medication overview is challenging. This articles describes the development process of a secured, electronic platform designed for exchanging medication information as executed in a pilot study in Belgium, called "Vitalink". The goal of "Vitalink" is to improve the exchange of medication information between professionals working in healthcare and patients in order to achieve a more efficient cooperation and better quality of care. Healthcare professionals of primary and secondary health care and patients of four Belgian regions participated in the project. In each region project groups coordinated implementation and reported back to the steering committee supervising the pilot study. The electronic medication overview was developed based on consensus in the project groups. The steering committee agreed to establish secured and authorized access through the use of electronic identity documents (eID) and a secured, eHealth-platform conform prior governmental regulations regarding privacy and security of healthcare information. A successful implementation of an electronic medication overview strongly depends on the accessibility and usability of the tool for healthcare professionals. Coordinating teams of the project groups concluded, based on their own observations and on problems reported to them, that secured and quick access to medical data needed to be pursued. According to their observations, the identification process using the eHealth platform, crucial to ensure secured data, was very time consuming. Secondly, software packages should meet the needs of their users, thus be adapted to daily activities of healthcare professionals. Moreover, software should be easy to install and run properly. The project would have benefited from a cost analysis executed by the national bodies prior to implementation.

Acceptance of New Medicaid Patients by Primary Care Physicians and Experiences with Physician Availability among Children on Medicaid or the Children's Health Insurance Program

PubMed Central

Decker, Sandra L

2015-01-01

Objective To estimate the relationship between physicians' acceptance of new Medicaid patients and access to health care. Data Sources The National Ambulatory Medical Care Survey (NAMCS) Electronic Health Records Survey and the National Health Interview Survey (NHIS) 2011/2012. Study Design Linear probability models estimated the relationship between measures of experiences with physician availability among children on Medicaid or the Children's Health Insurance Program (CHIP) from the NHIS and state-level estimates of the percent of primary care physicians accepting new Medicaid patients from the NAMCS, controlling for other factors. Principal Findings Nearly 16 percent of children with a significant health condition or development delay had a doctor's office or clinic indicate that the child's health insurance was not accepted in states with less than 60 percent of physicians accepting new Medicaid patients, compared to less than 4 percent in states with at least 75 percent of physicians accepting new Medicaid patients. Adjusted estimates and estimates for other measures of access to care were similar. Conclusions Measures of experiences with physician availability for children on Medicaid/CHIP were generally good, though better in states where more primary care physicians accepted new Medicaid patients. PMID:25683869

A blended learning approach to teaching CVAD care and maintenance.

PubMed

Hainey, Karen; Kelly, Linda J; Green, Audrey

2017-01-26

Nurses working within both acute and primary care settings are required to care for and maintain central venous access devices (CVADs). To support these nurses in practice, a higher education institution and local health board developed and delivered CVAD workshops, which were supported by a workbook and competency portfolio. Following positive evaluation of the workshops, an electronic learning (e-learning) package was also introduced to further support this clinical skill in practice. To ascertain whether this blended learning approach to teaching CVAD care and maintenance prepared nurses for practice, the learning package was evaluated through the use of electronic questionnaires. Results highlighted that the introduction of the e-learning package supported nurses' practice, and increased their confidence around correct clinical procedures.

Public Trust in Health Information Sharing: Implications for Biobanking and Electronic Health Record Systems

PubMed Central

Platt, Jodyn; Kardia, Sharon

2015-01-01

Biobanks are made all the more valuable when the biological samples they hold can be linked to health information collected in research, electronic health records, or public health practice. Public trust in such systems that share health information for research and health care practice is understudied. Our research examines characteristics of the general public that predict trust in a health system that includes researchers, health care providers, insurance companies and public health departments. We created a 119-item survey of predictors and attributes of system trust and fielded it using Amazon’s MTurk system (n = 447). We found that seeing one’s primary care provider, having a favorable view of data sharing and believing that data sharing will improve the quality of health care, as well as psychosocial factors (altruism and generalized trust) were positively and significantly associated with system trust. As expected, privacy concern, but counterintuitively, knowledge about health information sharing were negatively associated with system trust. We conclude that, in order to assure the public’s trust, policy makers charged with setting best practices for governance of biobanks and access to electronic health records should leverage critical access points to engage a diverse public in joint decision making. PMID:25654300

Electronic journal access: how does it affect the print subscription price?*

PubMed Central

Chen, Frances L.; Wrynn, Paul; Rieke, Judith L.

2001-01-01

Objective: This study examined the rates of print journal subscription price increases according to the type of available electronic access. The types of access included: electronic priced separately from the print, combination print with “free online” access, and aggregated, defined here as electronic access purchased as part of a collection. The percentages of print price increases were compared to each other and to that for titles available only in print. The authors were not aware of prior objective research in this area. Methods: The authors analyzed the percentage print price increases of 300 journals over a five-year time period. The titles were grouped according to type of available electronic access. The median and mean percentage print price increases were calculated and plotted for all titles within each group. Results: Using both the median and the mean to look at the percentage print price increases over five years, it was obvious that print prices for journals with electronic access exceeded journals that did not offer an electronic option. Electronic priced separately averaged 3% to 5% higher than print only titles using both measures. Combination print with “free online” access had higher increases from 1996 to 1999, but, in 2000, their percentage increases were about the same as print only titles. The rate of price increases for aggregated titles consistently went down over the past five years. Journals with no electronic option showed the lowest percentage rates of print price increase. Conclusions: The authors' findings reveal that the increases of print prices for their sample of titles were higher if a type of electronic access was offered. According to the results of this study, aggregated collections currently represent the electronic option whose percentage price increase for print prices was lowest. However, the uneven fluctuations in rates of subscription prices revealed that the pricing of journals with electronic access is still evolving. More study is recommended to see if the trends observed in this study are sustained over a longer time period. PMID:11837258

The role of molecular genetic analysis in the diagnosis of primary ciliary dyskinesia.

PubMed

Kim, Raymond H; A Hall, David; Cutz, Ernest; Knowles, Michael R; Nelligan, Kathleen A; Nykamp, Keith; Zariwala, Maimoona A; Dell, Sharon D

2014-03-01

Primary ciliary dyskinesia (PCD) is an autosomal recessive genetic disorder of motile cilia. The diagnosis of PCD has previously relied on ciliary analysis with transmission electron microscopy or video microscopy. However, patients with PCD may have normal ultrastructural appearance, and ciliary analysis has limited accessibility. Alternatively, PCD can be diagnosed by demonstrating biallelic mutations in known PCD genes. Genetic testing is emerging as a diagnostic tool to complement ciliary analysis where interpretation and access may delay diagnosis. To determine the diagnostic yield of genetic testing of patients with a confirmed or suspected diagnosis of PCD in a multiethnic urban center. Twenty-eight individuals with confirmed PCD on transmission electron microscopy of ciliary ultrastructure and 24 individuals with a probable diagnosis of PCD based on a classical PCD phenotype and low nasal nitric oxide had molecular analysis of 12 genes associated with PCD. Of 49 subjects who underwent ciliary biopsy, 28 (57%) were diagnosed with PCD through an ultrastructural defect. Of the 52 individuals who underwent molecular genetic analysis, 22 (42%) individuals had two mutations in known PCD genes. Twenty-four previously unreported mutations in known PCD genes were observed. Combining both diagnostic modalities of biopsy and molecular genetics, the diagnostic yield increased to 69% compared with 57% based on biopsy alone. The diagnosis of PCD is challenging and has traditionally relied on ciliary biopsy, which is unreliable as the sole criterion for a definitive diagnosis. Molecular genetic analysis can be used as a complementary test to increase the diagnostic yield.

A new role for primary care teams in the United States after “Obamacare:” Track and improve health insurance coverage rates

PubMed Central

DeVoe, Jennifer; Angier, Heather; Hoopes, Megan; Gold, Rachel

2017-01-01

Maintaining continuous health insurance coverage is important. With recent expansions in access to coverage in the United States after “Obamacare,” primary care teams have a new role in helping to track and improve coverage rates and to provide outreach to patients. We describe efforts to longitudinally track health insurance rates using data from the electronic health record (EHR) of a primary care network and to use these data to support practice-based insurance outreach and assistance. Although we highlight a few examples from one network, we believe there is great potential for doing this type of work in a broad range of family medicine and community health clinics that provide continuity of care. By partnering with researchers through practice-based research networks and other similar collaboratives, primary care practices can greatly expand the use of EHR data and EHR-based tools targeting improvements in health insurance and quality health care. PMID:28966926

Health information technology to guide pediatric obesity management.

PubMed

McDonald, Julia; Goldman, Roberta E; O'Brien, Ashley; Ayash, Christine; Mitchell, Kathy; Marshall, Richard; Simon, Steven R; Taveras, Elsie M

2011-06-01

The purpose of this study was to examine pediatricians' familiarity with expert committee recommendations on the management of childhood obesity and their use of health information technology for obesity-related care. The authors interviewed 35 pediatricians from 17 primary care practices using an electronic health record; immersion crystallization facilitated analysis of the qualitative data. Nearly all pediatricians were unfamiliar with expert recommendations; however, all participants reported using growth charts and providing nutrition and physical activity counseling. Most participants wanted easy access to educational materials they could print for patients. The majority of participants were in favor of an electronic alert to identify obese patients, remind clinicians of current guidelines, and facilitate ordering, believing it would help standardize care. Concerns included "alert fatigue," distraction, and disruption of workflow. Suggestions for future electronic functions included tailored educational materials and physical activity resources customized by patient address.

Separate may not be equal: A preliminary investigation of clinical correlates of electronic psychiatric record accessibility in academic medical centers

PubMed Central

Kozubal, Dana E.; Samus, Quincy M.; Bakare, Aishat A.; Trecker, Carrilin C.; Wong, Hei-Wah; Guo, Huiying; Cheng, Jeffrey; Allen, Paul X.; Mayer, Lawrence S.; Jamison, Kay R.; Kaplin, Adam I.

2014-01-01

Objectives Electronic Medical Records (EMR) have the potential to improve the coordination of healthcare in this country, yet the field of psychiatry has lagged behind other medical disciplines in its adoption of EMR. Methods Psychiatrists at 18 of the top US hospitals completed an electronic survey detailing whether their psychiatric records were stored electronically and accessible to non-psychiatric physicians. Electronic hospital records and accessibility statuses were correlated with patient care outcomes obtained from the University Health System Consortium Clinical Database available for 13 of the 18 top US hospitals. Results 44% of hospitals surveyed maintained most or all of their psychiatric records electronically and 28% made psychiatric records accessible to non-psychiatric physicians; only 22% did both. Compared with hospitals where psychiatric records were not stored electronically, the average 7-day readmission rate of psychiatric patients was significantly lower at hospitals with psychiatric EMR (5.1% vs. 7.0%, p = .040). Similarly, the 14 and 30-day readmission rates at hospitals where psychiatric records were accessible to non-psychiatric physicians were lower than those of their counterparts with non-accessible records (5.8% vs. 9.5%, p = .019, 8.6% vs. 13.6%, p = .013, respectively). The 7, 14, and 30-day readmission rates were significantly lower in hospitals where psychiatric records were both stored electronically and made accessible than at hospitals where records were either not electronic or not accessible (4% vs 6.6%, 5.8% vs 9.1%, 8.9 vs 13%, respectively, all with p = 0.045). Conclusions Having psychiatric EMR that were accessible to non-psychiatric physicians correlated with improved clinical care as measured by lower readmission rates specific for psychiatric patients. PMID:23266060

Environmental factors associated with primary care access among urban older adults.

PubMed

Ryvicker, Miriam; Gallo, William T; Fahs, Marianne C

2012-09-01

Disparities in primary care access and quality impede optimal chronic illness prevention and management for older adults. Although research has shown associations between neighborhood attributes and health, little is known about how these factors - in particular, the primary care infrastructure - inform older adults' primary care use. Using geographic data on primary care physician supply and surveys from 1260 senior center attendees in New York City, we examined factors that facilitate and hinder primary care use for individuals living in service areas with different supply levels. Supply quartiles varied in primary care use (visit within the past 12 months), racial and socio-economic composition, and perceived neighborhood safety and social cohesion. Primary care use did not differ significantly after controlling for compositional factors. Individuals who used a community clinic or hospital outpatient department for most of their care were less likely to have had a primary care visit than those who used a private doctor's office. Stratified multivariate models showed that within the lowest-supply quartile, public transit users had a higher odds of primary care use than non-transit users. Moreover, a higher score on the perceived neighborhood social cohesion scale was associated with a higher odds of primary care use. Within the second-lowest quartile, nonwhites had a lower odds of primary care use compared to whites. Different patterns of disadvantage in primary care access exist that may be associated with - but not fully explained by - local primary care supply. In lower-supply areas, racial disparities and inadequate primary care infrastructure hinder access to care. However, accessibility and elder-friendliness of public transit, as well as efforts to improve social cohesion and support, may facilitate primary care access for individuals living in low-supply areas. Copyright © 2012 Elsevier Ltd. All rights reserved.

Exploring patients' perceptions of accessing electronic health records: Innovation in healthcare.

PubMed

Wass, Sofie; Vimarlund, Vivian; Ros, Axel

2017-04-01

The more widespread implementation of electronic health records has led to new ways of providing access to healthcare information, allowing patients to view their medical notes, test results, medicines and so on. In this article, we explore how patients perceive the possibility to access their electronic health record online and whether this influences patient involvement. The study includes interviews with nine patients and a survey answered by 56 patients. Our results show that patients perceive healthcare information to be more accessible and that electronic health record accessibility improves recall, understanding and patient involvement. However, to achieve the goal of involving patients as active decision-makers in their own treatment, electronic health records need to be fully available and test results, referrals and information on drug interactions need to be offered. As patient access to electronic health records spreads, it is important to gain a deeper understanding of how documentation practices can be changed to serve healthcare professionals and patients.

Creation of an Internal Teledermatology Store-and-Forward System in an Existing Electronic Health Record

PubMed Central

Carter, Zachary A.; Goldman, Shauna; Anderson, Kristen; Li, Xiaxiao; Hynan, Linda S.; Chong, Benjamin F.

2017-01-01

Importance External store-and-forward (SAF) teledermatology systems operate separately from the primary health record and have many limitations, including care fragmentation, inadequate communication among clinicians, and privacy and security concerns, among others. Development of internal SAF workflows within existing electronic health records (EHRs) should be the standard for large health care organizations for delivering high-quality dermatologic care, improving access, and capturing other telemedicine benchmark data. Epic EHR software (Epic Systems Corporation) is currently one of the most widely used EHR system in the United States, and development of a successful SAF workflow within it is needed. Objectives To develop an SAF teledermatology workflow within the Epic system, the existing EHR system of Parkland Health and Hospital System (Dallas, Texas), assess its effectiveness in improving access to care, and validate its reliability; and to evaluate the system’s ability to capture meaningful outcomes. Design, Setting, and Participants Electronic consults were independently evaluated by 2 board-certified dermatologists, who provided diagnoses and treatment plans to primary care physicians (PCPs). Results were compared with in-person referrals from May to December 2013 from the same clinic (a community outpatient clinic in a safety-net public hospital system). Patients were those 18 years or older with dermatologic complaints who would have otherwise been referred to dermatology clinic. Main Outcomes and Measures Median time to evaluation; percentage of patients evaluated by a dermatologist through either teledermatology or in-person compared with the previous year. Results Seventy-nine teledermatology consults were placed by 6 PCPs from an outpatient clinic between May and December 2014; 57 (74%) were female and their mean (SD) age was 47.0 (12.4) years. Teledermatology reduced median time to evaluation from 70.0 days (interquartile range [IQR], 33.25-83.0 days) to 0.5 days (IQR, 0.172-0.94 days) and median time to treatment from 73.5 to 3.0 days compared with in-person dermatology visits. Overall, a greater percentage of patients (120 of 144 [83.3%]) were evaluated by a dermatologist through either teledermatology or in-person during the 2014 study period compared with the previous year (111 of 173 [64.2%]). Primary care physicians followed management recommendations 93% of the time. Conclusions and Relevance Epic-based SAF teledermatology can improve access to dermatologic care in a public safety-net hospital setting. We hope that the system will serve as a model for other health care organizations wanting to create SAF teledermatology workflows within the Epic EHR system. PMID:28423156

Brazil's National Program for Improving Primary Care Access and Quality (PMAQ)

PubMed Central

Harris, Matthew J.; Rocha, Marcia Gomes

2017-01-01

Despite some remarkable achievements, there are several challenges facing Brazil's Family Health Strategy (FHS), including expanding access to primary care and improving its quality. These concerns motivated the development of the National Program for Improving Primary Care Access and Quality (PMAQ). Although voluntary, the program now includes nearly 39 000 FHS teams in the country and has led to a near doubling of the federal investment in primary care in its first 2 rounds. In this article, we introduce the PMAQ and advance several recommendations to ensure that it continues to improve primary care access and quality in Brazil. PMID:28252498

[Primary Health Care in the coordination of health care networks: an integrative review].

PubMed

Rodrigues, Ludmila Barbosa Bandeira; Silva, Patricia Costa Dos Santos; Peruhype, Rarianne Carvalho; Palha, Pedro Fredemir; Popolin, Marcela Paschoal; Crispim, Juliane de Almeida; Pinto, Ione Carvalho; Monroe, Aline Aparecida; Arcêncio, Ricardo Alexandre

2014-02-01

Health systems organized in health care networks and coordinated by Primary Health Care can contribute to an improvement in clinical quality with a positive impact on health outcomes and user satisfaction (by improving access and resolubility) and a reduction in the costs of local health systems. Thus, the scope of this paper is to analyze the scientific output about the evidence, potential, challenges and prospects of Primary Health Care in the coordination of Health Care Networks. To achieve this, the integrative review method was selected covering the period between 2000 and 2011. The databases selected were Medline (Medical Literature Analysis and Retrieval System online), Lilacs (Latin American Literature in Health Sciences) and SciELO (Scientific Electronic Library Online). Eighteen articles fulfilled the selection criteria. It was seen that the potential impacts of primary care services supersede the inherent weaknesses. However, the results revealed the need for research with a higher level of classification of the scientific evidence about the role of Primary Healh Care in the coordination of Health Care Networks.

Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis

PubMed Central

Whittaker, William; Anselmi, Laura; Lau, Yiu-Shing; Bower, Peter; Checkland, Katherine; Elvey, Rebecca; Stokes, Jonathan

2016-01-01

Background Health services across the world increasingly face pressures on the use of expensive hospital services. Better organisation and delivery of primary care has the potential to manage demand and reduce costs for hospital services, but routine primary care services are not open during evenings and weekends. Extended access (evening and weekend opening) is hypothesized to reduce pressure on hospital services from emergency department visits. However, the existing evidence-base is weak, largely focused on emergency out-of-hours services, and analysed using a before-and after-methodology without effective comparators. Methods and Findings Throughout 2014, 56 primary care practices (346,024 patients) in Greater Manchester, England, offered 7-day extended access, compared with 469 primary care practices (2,596,330 patients) providing routine access. Extended access included evening and weekend opening and served both urgent and routine appointments. To assess the effects of extended primary care access on hospital services, we apply a difference-in-differences analysis using hospital administrative data from 2011 to 2014. Propensity score matching techniques were used to match practices without extended access to practices with extended access. Differences in the change in “minor” patient-initiated emergency department visits per 1,000 population were compared between practices with and without extended access. Populations registered to primary care practices with extended access demonstrated a 26.4% relative reduction (compared to practices without extended access) in patient-initiated emergency department visits for “minor” problems (95% CI -38.6% to -14.2%, absolute difference: -10,933 per year, 95% CI -15,995 to -5,866), and a 26.6% (95% CI -39.2% to -14.1%) relative reduction in costs of patient-initiated visits to emergency departments for minor problems (absolute difference: -£767,976, -£1,130,767 to -£405,184). There was an insignificant relative reduction of 3.1% in total emergency department visits (95% CI -6.4% to 0.2%). Our results were robust to several sensitivity checks. A lack of detailed cost reporting of the running costs of extended access and an inability to capture health outcomes and other health service impacts constrain the study from assessing the full cost-effectiveness of extended access to primary care. Conclusions The study found that extending access was associated with a reduction in emergency department visits in the first 12 months. The results of the research have already informed the decision by National Health Service England to extend primary care access across Greater Manchester from 2016. However, further evidence is needed to understand whether extending primary care access is cost-effective and sustainable. PMID:27598248

48 CFR 352.239-73 - Electronic information and technology accessibility.

Code of Federal Regulations, 2013 CFR

2013-10-01

... technology accessibility. 352.239-73 Section 352.239-73 Federal Acquisition Regulations System HEALTH AND... Clauses 352.239-73 Electronic information and technology accessibility. (a) As prescribed in 339.201-70(a), the Contracting Officer shall insert the following provision: Electronic and Information Technology...

48 CFR 352.239-73 - Electronic information and technology accessibility.

Code of Federal Regulations, 2012 CFR

2012-10-01

... technology accessibility. 352.239-73 Section 352.239-73 Federal Acquisition Regulations System HEALTH AND... Clauses 352.239-73 Electronic information and technology accessibility. (a) As prescribed in 339.201-70(a), the Contracting Officer shall insert the following provision: Electronic and Information Technology...

48 CFR 352.239-73 - Electronic information and technology accessibility.

Code of Federal Regulations, 2014 CFR

2014-10-01

... technology accessibility. 352.239-73 Section 352.239-73 Federal Acquisition Regulations System HEALTH AND... Clauses 352.239-73 Electronic information and technology accessibility. (a) As prescribed in 339.201-70(a), the Contracting Officer shall insert the following provision: Electronic and Information Technology...

48 CFR 352.239-73 - Electronic information and technology accessibility.

Code of Federal Regulations, 2011 CFR

2011-10-01

... technology accessibility. 352.239-73 Section 352.239-73 Federal Acquisition Regulations System HEALTH AND... Clauses 352.239-73 Electronic information and technology accessibility. (a) As prescribed in 339.201-70(a), the Contracting Officer shall insert the following provision: Electronic and Information Technology...

48 CFR 352.239-73 - Electronic information and technology accessibility.

Code of Federal Regulations, 2010 CFR

2010-10-01

... technology accessibility. 352.239-73 Section 352.239-73 Federal Acquisition Regulations System HEALTH AND... Clauses 352.239-73 Electronic information and technology accessibility. (a) As prescribed in 339.201-70(a), the Contracting Officer shall insert the following provision: Electronic and Information Technology...

New Jersey: Libraries and the Information Superhighway.

ERIC Educational Resources Information Center

Livingstone, John H.

1996-01-01

Describes New Jersey libraries' specific goals for providing the public with electronic access to bibliographic data and government information as well as electronic interlibrary loan and document delivery. Other highlights include results of a public library survey concerning electronic access to information, dial-in access to online public…

Accessing Electronic Journals.

ERIC Educational Resources Information Center

McKay, Sharon Cline

1999-01-01

Discusses issues librarians need to consider when providing access to electronic journals. Topics include gateways; index and abstract services; validation and pay-per-view; title selection; integration with OPACs (online public access catalogs)or Web sites; paper availability; ownership versus access; usage restrictions; and services offered…

Evaluation of sealing ability of Biodentine™ and mineral trioxide aggregate in primary molars using scanning electron microscope: A randomized controlled in vitro trial.

PubMed

Samuel, Allwyn; Asokan, Sharath; Geetha Priya, P R; Thomas, Seby

2016-01-01

The aim of this study was to compare the sealing ability of mineral trioxide aggregate (MTA) and Biodentine™ when used to repair the furcal perforations in primary molars using scanning electron microscope (SEM). The study sample comprised forty recently extracted primary molars. These teeth were placed in a 5.25% sodium hypochlorite solution for 24 h and washed with tap water. Access cavities were made using a round bur in high-speed handpiece. Perforations were made in the center of the floor of the pulpal chamber using a 0.5 mm round bur. The teeth were randomly assigned into two experimental groups based on the material used to seal the perforation: Group A - MTA and Group B - Biodentine™. The packed materials were allowed to set for 24 h. The samples were sectioned longitudinally and the extent of marginal adaptation was measured by SEM. Wilcoxon-signed rank test was used for statistical analysis using SPSS software. All teeth exhibited microleakage, but Biodentine™ showed significantly less leakage (0.149) compared to MTA (0.583). Based on the results of this study, Biodentine™ showed lesser microleakage compared to MTA and thus may be a good alternative to MTA.

Patient-reported access to primary care in Ontario: effect of organizational characteristics.

PubMed

Muggah, Elizabeth; Hogg, William; Dahrouge, Simone; Russell, Grant; Kristjansson, Elizabeth; Muldoon, Laura; Devlin, Rose Anne

2014-01-01

To describe patient-reported access to primary health care across 4 organizational models of primary care in Ontario, and to explore how access is associated with patient, provider, and practice characteristics. Cross-sectional survey. One hundred thirty-seven randomly selected primary care practices in Ontario using 1 of 4 delivery models (fee for service, established capitation, reformed capitation, and community health centres). Patients included were at least 18 years of age, were not severely ill or cognitively impaired, were not known to the survey administrator, had consenting providers at 1 of the participating primary care practices, and were able to communicate in English or French either directly or through a translator. Patient-reported access was measured by a 4-item scale derived from the previously validated adult version of the Primary Care Assessment Tool. Questions were asked about physician availability during and outside of regular office hours and access to health information via telephone. Responses to the scale were normalized, with higher scores reflecting greater patient-reported access. Linear regressions were used to identify characteristics independently associated with access to care. Established capitation model practices had the highest patient-reported access, although the difference in scores between models was small. Our multilevel regression model identified several patient factors that were significantly (P = .05) associated with higher patient-reported access, including older age, female sex, good-to-excellent self-reported health, less mental health disability, and not working. Provider experience (measured as years since graduation) was the only provider or practice characteristic independently associated with improved patient-reported access. This study adds to what is known about access to primary care. The study found that established capitation models outperformed all the other organizational models, including reformed capitation models, independent of provider and practice variables save provider experience. This suggests that the capitation models might provide better access to care and that it might take time to realize the benefits of organizational reforms.

Designing a system for patients controlling providers' access to their electronic health records: organizational and technical challenges.

PubMed

Leventhal, Jeremy C; Cummins, Jonathan A; Schwartz, Peter H; Martin, Douglas K; Tierney, William M

2015-01-01

Electronic health records (EHRs) are proliferating, and financial incentives encourage their use. Applying Fair Information Practice principles to EHRs necessitates balancing patients' rights to control their personal information with providers' data needs to deliver safe, high-quality care. We describe the technical and organizational challenges faced in capturing patients' preferences for patient-controlled EHR access and applying those preferences to an existing EHR. We established an online system for capturing patients' preferences for who could view their EHRs (listing all participating clinic providers individually and categorically-physicians, nurses, other staff) and what data to redact (none, all, or by specific categories of sensitive data or patient age). We then modified existing data-viewing software serving a state-wide health information exchange and a large urban health system and its primary care clinics to allow patients' preferences to guide data displays to providers. Patients could allow or restrict data displays to all clinicians and staff in a demonstration primary care clinic, categories of providers (physicians, nurses, others), or individual providers. They could also restrict access to all EHR data or any or all of five categories of sensitive data (mental and reproductive health, sexually transmitted diseases, HIV/AIDS, and substance abuse) and for specific patient ages. The EHR viewer displayed data via reports, data flowsheets, and coded and free text data displayed by Google-like searches. Unless patients recorded restrictions, by default all requested data were displayed to all providers. Data patients wanted restricted were not displayed, with no indication they were redacted. Technical barriers prevented redacting restricted information in free textnotes. The program allowed providers to hit a "Break the Glass" button to override patients' restrictions, recording the date, time, and next screen viewed. Establishing patient-control over EHR data displays was complex and required ethical, clinical, database, and programming expertise and difficult choices to overcome technical and health system constraints. Assessing patients' preferences for access to their EHRs and applying them in clinical practice requires wide-ranging technical, clinical, and bioethical expertise, to make tough choices to overcome significant technical and organization challenges.

Enabling Scientists: Serving Sci-Tech Library Users with Disabilities.

ERIC Educational Resources Information Center

Coonin, Bryna

2001-01-01

Discusses how librarians in scientific and technical libraries can contribute to an accessible electronic library environment for users with disabilities to ensure independent access to information. Topics include relevant assistive technologies; creating accessible Web pages; monitoring accessibility of electronic databases; preparing accessible…

Rising Expectations: Access to Biomedical Information

PubMed Central

Lindberg, D. A. B.; Humphreys, B. L.

2008-01-01

Summary Objective To provide an overview of the expansion in public access to electronic biomedical information over the past two decades, with an emphasis on developments to which the U.S. National Library of Medicine contributed. Methods Review of the increasingly broad spectrum of web-accessible genomic data, biomedical literature, consumer health information, clinical trials data, and images. Results The amount of publicly available electronic biomedical information has increased dramatically over the past twenty years. Rising expectations regarding access to biomedical information were stimulated by the spread of the Internet, the World Wide Web, advanced searching and linking techniques. These informatics advances simplified and improved access to electronic information and reduced costs, which enabled inter-organizational collaborations to build and maintain large international information resources and also aided outreach and education efforts The demonstrated benefits of free access to electronic biomedical information encouraged the development of public policies that further increase the amount of information available. Conclusions Continuing rapid growth of publicly accessible electronic biomedical information presents tremendous opportunities and challenges, including the need to ensure uninterrupted access during disasters or emergencies and to manage digital resources so they remain available for future generations. PMID:18587496

Why high tech needs high touch: Supporting continuity of community primary health care.

PubMed

Meyer, Ellenore D; Hugo, Johannes F M; Marcus, Tessa S; Molebatsi, Rebaone; Komana, Kabelo

2018-06-21

 Integrated care through community-oriented primary care (COPC) deployed through municipal teams of community health workers (CHWs) has been part of health reform in South Africa since 2011. The role of COPC and integration of information and communication technology (ICT) information to improve patient health and access to care, require a better understanding of patient social behaviour. Aim: The study sought to understand how COPC with CHWs visiting households offering health education can support antenatal follow-up and what the barriers for access to care would be. Method: A mixed methodological approach was followed. Quantitative patient data were recorded on an electronic health record-keeping system. Qualitative data collection was performed through interviews of the COPC teams at seven health posts in Mamelodi and telephonic patient interviews. Interviews were analysed according to themes and summarised as barriers to access care from a social and community perspective. Results: An integrated COPC approach increased the number of traceable pregnant women followed up at home from 2016 - 2017. Wrong addresses or personal identification were given at the clinic because of fear of being denied care. Allocating patients correctly to a ward-based outreach team (WBOT) proved to be a challenge as many patients did not know their street address. Conclusion: Patient health data available to a health worker on a smartphone as part of COPC improve patient traceability and follow-up at home making timely referral possible. Health system developments that support patient care on community level could strengthen patient health access and overall health.

Patients’ perceptions of access to primary care

PubMed Central

Premji, Kamila; Ryan, Bridget L.; Hogg, William E.; Wodchis, Walter P.

2018-01-01

Abstract Objective To gain a more comprehensive understanding of patients’ perceptions of access to their primary care practice and how these relate to patient characteristics. Design Cross-sectional study. Setting Ontario. Participants Adult primary care patients in Ontario (N = 1698) completing the Quality and Costs of Primary Care (QUALICOPC) Patient Experiences Survey. Main outcome measures Responses to 11 access-related survey items, analyzed both individually and as a Composite Access Score (CAS). Results The mean (SD) CAS was 1.78 (0.16) (the highest possible CAS was 2 and the lowest was 1). Most patients (68%) waited more than 1 day for their appointment. By far most (96%) stated that it was easy to obtain their appointment and that they obtained that appointment as soon as they wanted to (87%). There were no statistically significant relationships between CAS and sex, language fluency, income, education, frequency of emergency department use, or chronic disease status. A higher CAS was associated with being older and being born in Canada, better self-reported health, and increased frequency of visits to a doctor. Conclusion Despite criticisms of access to primary care, this study found that Ontario patients belonging to primary care practices have favourable impressions of their access. There were few statistically significant relationships between patient characteristics and access, and these relationships appeared to be weak. PMID:29540392

A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide.

PubMed

Liddy, Clare; Moroz, Isabella; Mihan, Ariana; Nawar, Nikhat; Keely, Erin

2018-06-21

Electronic consultation (eConsult) is an asynchronous electronic communication tool allowing primary care providers to obtain a specialist consultant's expert opinion in a timely manner, thereby offering a potential solution to excessive wait times for specialist care, which remain a serious concern in many countries. Our 2014 review of eConsult services demonstrated feasibility and high acceptability among patients and providers. However, gaps remain in knowledge regarding eConsult's impact on system costs and patient outcomes. Following the PRISMA guidelines, we conducted a systematic review in May 2017 of English and French literature on OVID Medline, EMBASE, ERIC, and CINAHL databases, examining all studies on eConsult services published since our previous review. The Quadruple Aim Framework was used to synthesize outcomes. Articles reporting on the impact of eConsult on access, patient safety and satisfaction, utilization rates, clinical workflow, and continuing medical education were analyzed using a narrative synthesis approach. The initial search yielded 1,021 results, 50 of which were included on abstract and received a quality assessment and full text review. Of these, 43 were included in our final analysis. Results demonstrated the worldwide presence of eConsult services in North America and countries beyond, including Brazil, Australia, Spain, and The Netherlands. The breadth of specialty services offered has greatly expanded beyond dermatology and includes cardiology, nephrology, and hematology among others. Overall impact on access measures, acceptability, cost, and provider satisfaction remain positive. There is limited research on population health outcomes of morbidity and mortality. The availability of eConsult services has spread both geographically and in terms of specialty services offered. By allowing for a greater population to be served, access to care is being improved; however, long-term impact should continue to be assessed with a focus on patient safety, morbidity, mortality, and cost effectiveness metrics.

Telemedicine and security. Confidentiality, integrity, and availability: a Canadian perspective.

PubMed

Jennett, P; Watanabe, M; Igras, E; Premkumar, K; Hall, W

1996-01-01

The health care system is undergoing major reform, characterized by organized delivery systems (regionalization, decentralization, devolution, etc); shifts in care delivery sites; changing health provider roles; increasing consumer responsibilities; and accountability. Rapid advances in information technology and telecommunications have led to a new type of information infrastructure which can play a major role in this reform. Compatible health information systems are now being integrated and connected across institutional, regional, and sectorial boundaries. In the near future, these information systems will readily be accessed and shared by health providers, researchers, policy makers, health consumers, and the public. SECURITY is a critical characteristic of any health information system. This paper will address three fields associated with SECURITY: confidentiality, integrity, and availability. These will be defined and examined as they relate to specific aspects of Telemedicine, such as electronic integrated records and clinical databases; electronic transfer of documents; as well as data storage and disposal. The guiding principles, standards, and safeguards being considered and put in place to ensure that telemedicine information intrastructures can protect and benefit all stakeholders' rights and needs in both primary and secondary uses of information will be reviewed. Implemented, proposed, and tested institutional, System, and Network solutions will be discussed; for example, encryption-decryption methods; data transfer standards; individual and terminal access and entry I.D. and password levels; smart card access and PIN number control; data loss prevention strategies; interference alerts; information access keys; algorithm safeguards; and active marketing to users of standards and principles. Issues such as policy, implementation, and ownership will be addressed.

A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield.

PubMed

Ulloa, Jesus G; Russell, Marika D; Chen, Alice Hm; Tuot, Delphine S

2017-06-23

Electronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. Little is known about their impact on the efficiency of specialty care delivery, in particular surgical yield (percent of ambulatory visits resulting in a scheduled surgical case). Retrospective cohort of a random selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures (herniorrhaphy, cholecystectomy, anorectal procedures) in 2014. Electronic consultation requests were reviewed for the presence/absence of consult domains: symptom acuity/severity, diagnostic evaluation, concurrent medical conditions, and attempted diagnosis. Logic regression was used to examine the association between completeness of consult requests and scheduling an ambulatory clinic visit. Surgical yield was also calculated, as was the percentage of patients requiring unanticipated healthcare visits. In 2014, 1743 electronic consultations were submitted to general surgery. Among the 150 abstracted, the presence of consult domains ranged from 49% to 99%. Consult completeness was not associated with greater likelihood of scheduling an ambulatory visit. Seventy-six percent of consult requests (114/150) were scheduled for a clinic appointment and surgical yield was 46%; without an eConsult system, surgical yield would have been 35% (p=0.07). Among patients not scheduled for a clinic visit (n=36), 4 had related unanticipated emergency department visits. Econsult systems can be used to safely optimize the surgical yield of a safety-net general surgery service.

10 CFR 2.1007 - Access.

Code of Federal Regulations, 2011 CFR

2011-01-01

... to Proceedings for the Issuance of Licenses for the Receipt of High-Level Radioactive Waste at a Geologic Repository § 2.1007 Access. (a)(1) A system to provide electronic access to the Licensing Support...-license application phase. (2) A system to provide electronic access to the Licensing Support Network...

10 CFR 2.1007 - Access.

Code of Federal Regulations, 2012 CFR

2012-01-01

... to Proceedings for the Issuance of Licenses for the Receipt of High-Level Radioactive Waste at a Geologic Repository § 2.1007 Access. (a)(1) A system to provide electronic access to the Licensing Support...-license application phase. (2) A system to provide electronic access to the Licensing Support Network...

Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review

PubMed Central

2016-01-01

Background People who are homeless encounter barriers to primary care despite having greater needs for health care, on average, than people who are not homeless. We evaluated the effectiveness of interventions to improve access to primary care for people who are homeless. Methods We performed a systematic review to identify studies in English published between January 1, 1995, and July 8, 2015, comparing interventions to improve access to a primary care provider with usual care among people who are homeless. The outcome of interest was access to a primary care provider. The risk of bias in the studies was evaluated, and the quality of the evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. Results From a total of 4,047 citations, we identified five eligible studies (one randomized controlled trial and four observational studies). With the exception of the randomized trial, the risk of bias was considered high in the remaining studies. In the randomized trial, people who were homeless, without serious mental illness, and who received either an outreach intervention plus clinic orientation or clinic orientation alone, had improved access to a primary care provider compared with those receiving usual care. An observational study that compared integration of primary care and other services for people who are homeless with usual care did not observe any difference in access to a primary care provider between the two groups. A small observational study showed improvement among participants with a primary care provider after receiving an intervention consisting of housing and supportive services compared with the period before the intervention. The quality of the evidence was considered moderate for both the outreach plus clinic orientation and clinic orientation alone, and low to very low for the other interventions. Despite limitations, the literature identified reports of interventions developed to overcome barriers in access to primary care in people who are homeless. The interventions studied are complex and include multiple components that are consistent with proposed dimensions of access to care (availability, affordability, and acceptability). Conclusions Our systematic review of the literature identified various types of interventions that seek to improve access to primary care by attempting to address barriers to care encountered by people who are homeless. Moderate-quality evidence indicates that orientation to clinic services (either alone or combined with outreach) improves access to a primary care provider in adults who are homeless, without serious mental illness, and living in urban centres. PMID:27099645

Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review.

PubMed

2016-01-01

People who are homeless encounter barriers to primary care despite having greater needs for health care, on average, than people who are not homeless. We evaluated the effectiveness of interventions to improve access to primary care for people who are homeless. We performed a systematic review to identify studies in English published between January 1, 1995, and July 8, 2015, comparing interventions to improve access to a primary care provider with usual care among people who are homeless. The outcome of interest was access to a primary care provider. The risk of bias in the studies was evaluated, and the quality of the evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. From a total of 4,047 citations, we identified five eligible studies (one randomized controlled trial and four observational studies). With the exception of the randomized trial, the risk of bias was considered high in the remaining studies. In the randomized trial, people who were homeless, without serious mental illness, and who received either an outreach intervention plus clinic orientation or clinic orientation alone, had improved access to a primary care provider compared with those receiving usual care. An observational study that compared integration of primary care and other services for people who are homeless with usual care did not observe any difference in access to a primary care provider between the two groups. A small observational study showed improvement among participants with a primary care provider after receiving an intervention consisting of housing and supportive services compared with the period before the intervention. The quality of the evidence was considered moderate for both the outreach plus clinic orientation and clinic orientation alone, and low to very low for the other interventions. Despite limitations, the literature identified reports of interventions developed to overcome barriers in access to primary care in people who are homeless. The interventions studied are complex and include multiple components that are consistent with proposed dimensions of access to care (availability, affordability, and acceptability). Our systematic review of the literature identified various types of interventions that seek to improve access to primary care by attempting to address barriers to care encountered by people who are homeless. Moderate-quality evidence indicates that orientation to clinic services (either alone or combined with outreach) improves access to a primary care provider in adults who are homeless, without serious mental illness, and living in urban centres.

76 FR 39263 - Antidumping and Countervailing Duty Proceedings: Electronic Filing Procedures; Administrative...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-06

... resulting from the Department's implementation of an electronic filing and documents management program... regulations that is entitled ``IA ACCESS Handbook On Electronic Filing Procedures'' (``IA ACCESS Handbook... management program named Import Administration Antidumping and Countervailing Duty Centralized Electronic...

10 CFR 2.1007 - Access.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Licenses for the Receipt of High-Level Radioactive Waste at a Geologic Repository § 2.1007 Access. (a)(1) A system to provide electronic access to the Licensing Support Network shall be provided at the... provide electronic access to the Licensing Support Network shall be provided at the NRC Web site, http...

10 CFR 2.1007 - Access.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Licenses for the Receipt of High-Level Radioactive Waste at a Geologic Repository § 2.1007 Access. (a)(1) A system to provide electronic access to the Licensing Support Network shall be provided at the... provide electronic access to the Licensing Support Network shall be provided at the NRC Web site, http...

A pilot study of the feasibility of an Internet-based electronic Outpatient Cardiac Rehabilitation (eOCR) program in rural primary care.

PubMed

Clark, Robyn A; Tideman, Phillip; Tirimacco, Rosy; Wanguhu, Ken; Poulsen, Vanessa; Simpson, Paul; Duncan, Mitch J; Van Itallie, Anetta; Corry, Kelly; Vandelanotte, Corneel; Mummery, W Kerry

2013-05-01

Interventions that facilitate access to cardiac rehabilitation and secondary prevention programs are in demand. This pilot study used a mixed methods design to evaluate the feasibility of an Internet-based, electronic Outpatient Cardiac Rehabilitation (eOCR). Patients who had suffered a cardiac event and their case managers were recruited from rural primary practices. Feasibility was evaluated in terms of the number of patients enrolled and patient and case manager engagement with the eOCR website. Four rural general practices, 16 health professionals (cardiologists, general practitioners, nurses and allied health) and 24 patients participated in the project and 11 (46%) completed the program. Utilisation of the website during the 105 day evaluation period by participating health professionals was moderate to low (mean of 8.25 logins, range 0-28 logins). The mean login rate for patients was 16 (range 1-77 logins), mean time from first login to last (days using the website) was 51 (range 1-105 days). Each patient monitored at least five risk factors and read at least one of the secondary prevention articles. There was low utilisation of other tools such as weekly workbooks and discussion boards. It was important to evaluate how an eOCR website would be used within an existing healthcare setting. These results will help to guide the implementation of future internet based cardiac rehabilitation programs considering barriers such as access and appropriate target groups of participants. Crown Copyright © 2012. Published by Elsevier B.V. All rights reserved.

[Web accessibility of Internet appointment scheduling in primary care].

PubMed

Casasola Balsells, Luis Alejandro; Guerra González, Juan Carlos; Casasola Balsells, María Araceli; Pérez Chamorro, Vicente Antonio

2017-12-16

To assess the accessibility level of Internet appointment scheduling in primary care and the fulfilment of the requirements of Spanish legislation. Descriptive study of the accessibility of 18 web sites corresponding to the autonomic health services responsible for Internet appointment scheduling for primary health care services. The level of web accessibility was evaluated by means of five automated tools. Only six websites self-declared to be in compliance with level AA of WCAG 2.0. The level of web accessibility according to the legal requirements in Spain is low. The evaluation tools identified the main errors to be corrected. Most of the autonomic health services responsible for Internet appointment scheduling in primary care need to improve their level of web accessibility and ensure that it complies with Spanish legislation. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Evaluating the accessibility and utility of HIV-related point-of-care diagnostics for maternal health in rural South Africa: a study protocol

PubMed Central

Mashamba-Thompson, T P; Drain, P K; Sartorius, B

2016-01-01

Introduction Poor healthcare access is a major barrier to receiving antenatal care and a cause of high maternal mortality in South Africa (SA). ‘Point-of-care’ (POC) diagnostics is a powerful emerging healthcare approach to improve healthcare access. This study focuses on evaluating the accessibility and utility of POC diagnostics for maternal health in rural SA primary healthcare (PHC) clinics in order to generate a model framework of implementation of POC diagnostics in rural South African clinics. Method and analyses We will use several research methods, including a systematic review, quasi-experiments, survey, key informant interviews and audits. We will conduct a systematic review and experimental study to determine the impact of POC diagnostics on maternal health. We will perform a cross-sectional case study of 100 randomly selected rural primary healthcare clinics in KwaZulu-Natal to measure the context and patterns of POC diagnostics access and usage by maternal health providers and patients. We will conduct interviews with relevant key stakeholders to determine the reasons for POC deficiencies regarding accessibility and utility of HIV-related POC diagnostics for maternal health. We will also conduct a vertical audit to investigate all the quality aspects of POC diagnostic services including diagnostic accuracy in a select number of clinics. On the basis of information gathered, we will propose a model framework for improved implementation of POC diagnostics in rural South African public healthcare clinics. Statistical (Stata-13) and thematic (NVIVO) data analysis will be used in this study. Ethics and dissemination The study protocol was approved by the Ethics Committee of the University of KwaZulu-Natal (BE 484/14) and the KwaZulu-Natal Department of Health based on the Helsinki Declaration (HRKM 40/15). Findings of this study will be disseminated electronically and in print. They will be presented to conferences related to HIV/AIDS, diagnostics, maternal health and strengthening of health systems. PMID:27354074

Electronic communications and home blood pressure monitoring (e-BP) study: design, delivery, and evaluation framework.

PubMed

Green, Beverly B; Ralston, James D; Fishman, Paul A; Catz, Sheryl L; Cook, Andrea; Carlson, Jim; Tyll, Lynda; Carrell, David; Thompson, Robert S

2008-05-01

Randomized controlled trials have provided unequivocal evidence that treatment of hypertension decreases mortality and major disability from cardiovascular disease; however, blood pressure remains inadequately treated in most affected individuals. This large gap continues despite the facts that more than 90% of adults with hypertension have health insurance, and hypertension is the leading cause of visits to the doctor. New approaches are needed to improve hypertension care. The Electronic Communications and Home Blood Pressure Monitoring (e-BP) study is a three-arm randomized controlled trial designed to determine whether care based on the Chronic Care Model and delivered over the Internet improves hypertension care. The primary study outcomes are systolic, diastolic, and blood pressure control; secondary outcomes are medication adherence, patient self-efficacy, satisfaction and quality of life, and healthcare utilization and costs. Hypertensive patients receiving care at Group Health medical centers are eligible if they have uncontrolled blood pressure on two screening visits and access to the Web and an e-mail address. Study participants are randomly assigned to three intervention groups: (a) usual care; (b) home blood pressure monitoring receipt and proficiency training on its use and the Group Health secure patient website (with secure e-mail access to their healthcare provider, access to a shared medical record, prescription refill and other services); or (c) this plus pharmacist care management (collaborative care management between the patient, the pharmacist, and the patient's physician via a secure patient website and the electronic medical record). We will determine whether a new model of patient-centered care that leverages Web communications, self-monitoring, and collaborative care management improves hypertension control. If this model proves successful and cost-effective, similar interventions could be used to improve the care of large numbers of patients with uncontrolled hypertension.

48 CFR 1352.239-71 - Electronic and information technology.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Electronic and information technology. As prescribed in 48 CFR 1339.270(a), insert the following provision: Electronic and Information Technology (APR 2010) (a) To be considered eligible for award, offerors must propose electronic and information technology (EIT) that meet the applicable Access Board accessibility...

48 CFR 1352.239-71 - Electronic and information technology.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Electronic and information technology. As prescribed in 48 CFR 1339.270(a), insert the following provision: Electronic and Information Technology (APR 2010) (a) To be considered eligible for award, offerors must propose electronic and information technology (EIT) that meet the applicable Access Board accessibility...

48 CFR 1352.239-71 - Electronic and information technology.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Electronic and information technology. As prescribed in 48 CFR 1339.270(a), insert the following provision: Electronic and Information Technology (APR 2010) (a) To be considered eligible for award, offerors must propose electronic and information technology (EIT) that meet the applicable Access Board accessibility...

48 CFR 1352.239-71 - Electronic and information technology.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Electronic and information technology. As prescribed in 48 CFR 1339.270(a), insert the following provision: Electronic and Information Technology (APR 2010) (a) To be considered eligible for award, offerors must propose electronic and information technology (EIT) that meet the applicable Access Board accessibility...

Overview of emerging nonvolatile memory technologies

PubMed Central

2014-01-01

Nonvolatile memory technologies in Si-based electronics date back to the 1990s. Ferroelectric field-effect transistor (FeFET) was one of the most promising devices replacing the conventional Flash memory facing physical scaling limitations at those times. A variant of charge storage memory referred to as Flash memory is widely used in consumer electronic products such as cell phones and music players while NAND Flash-based solid-state disks (SSDs) are increasingly displacing hard disk drives as the primary storage device in laptops, desktops, and even data centers. The integration limit of Flash memories is approaching, and many new types of memory to replace conventional Flash memories have been proposed. Emerging memory technologies promise new memories to store more data at less cost than the expensive-to-build silicon chips used by popular consumer gadgets including digital cameras, cell phones and portable music players. They are being investigated and lead to the future as potential alternatives to existing memories in future computing systems. Emerging nonvolatile memory technologies such as magnetic random-access memory (MRAM), spin-transfer torque random-access memory (STT-RAM), ferroelectric random-access memory (FeRAM), phase-change memory (PCM), and resistive random-access memory (RRAM) combine the speed of static random-access memory (SRAM), the density of dynamic random-access memory (DRAM), and the nonvolatility of Flash memory and so become very attractive as another possibility for future memory hierarchies. Many other new classes of emerging memory technologies such as transparent and plastic, three-dimensional (3-D), and quantum dot memory technologies have also gained tremendous popularity in recent years. Subsequently, not an exaggeration to say that computer memory could soon earn the ultimate commercial validation for commercial scale-up and production the cheap plastic knockoff. Therefore, this review is devoted to the rapidly developing new class of memory technologies and scaling of scientific procedures based on an investigation of recent progress in advanced Flash memory devices. PMID:25278820

Overview of emerging nonvolatile memory technologies.

PubMed

Meena, Jagan Singh; Sze, Simon Min; Chand, Umesh; Tseng, Tseung-Yuen

2014-01-01

Nonvolatile memory technologies in Si-based electronics date back to the 1990s. Ferroelectric field-effect transistor (FeFET) was one of the most promising devices replacing the conventional Flash memory facing physical scaling limitations at those times. A variant of charge storage memory referred to as Flash memory is widely used in consumer electronic products such as cell phones and music players while NAND Flash-based solid-state disks (SSDs) are increasingly displacing hard disk drives as the primary storage device in laptops, desktops, and even data centers. The integration limit of Flash memories is approaching, and many new types of memory to replace conventional Flash memories have been proposed. Emerging memory technologies promise new memories to store more data at less cost than the expensive-to-build silicon chips used by popular consumer gadgets including digital cameras, cell phones and portable music players. They are being investigated and lead to the future as potential alternatives to existing memories in future computing systems. Emerging nonvolatile memory technologies such as magnetic random-access memory (MRAM), spin-transfer torque random-access memory (STT-RAM), ferroelectric random-access memory (FeRAM), phase-change memory (PCM), and resistive random-access memory (RRAM) combine the speed of static random-access memory (SRAM), the density of dynamic random-access memory (DRAM), and the nonvolatility of Flash memory and so become very attractive as another possibility for future memory hierarchies. Many other new classes of emerging memory technologies such as transparent and plastic, three-dimensional (3-D), and quantum dot memory technologies have also gained tremendous popularity in recent years. Subsequently, not an exaggeration to say that computer memory could soon earn the ultimate commercial validation for commercial scale-up and production the cheap plastic knockoff. Therefore, this review is devoted to the rapidly developing new class of memory technologies and scaling of scientific procedures based on an investigation of recent progress in advanced Flash memory devices.

Role of Geography and Nurse Practitioner Scope-of-Practice in Efforts to Expand Primary Care System Capacity: Health Reform and the Primary Care Workforce.

PubMed

Graves, John A; Mishra, Pranita; Dittus, Robert S; Parikh, Ravi; Perloff, Jennifer; Buerhaus, Peter I

2016-01-01

Little is known about the geographic distribution of the overall primary care workforce that includes both physician and nonphysician clinicians--particularly in areas with restrictive nurse practitioner scope-of-practice laws and where there are relatively large numbers of uninsured. We investigated whether geographic accessibility to primary care clinicians (PCCs) differed across urban and rural areas and across states with more or less restrictive scope-of-practice laws. An observational study. 2013 Area Health Resource File (AHRF) and US Census Bureau county travel data. The measures included percentage of the population in low-accessibility, medium-accessibility, and high-accessibility areas; number of geographically accessible primary care physicians (PCMDs), nurse practitioners (PCNPs), and physician assistants (PCPAs) per 100,000 population; and number of uninsured per PCC. We found divergent patterns in the geographic accessibility of PCCs. PCMDs constituted the largest share of the workforce across all settings, but were relatively more concentrated within urban areas. Accessibility to nonphysicians was highest in rural areas: there were more accessible PCNPs per 100,000 population in rural areas of restricted scope-of-practice states (21.4) than in urban areas of full practice states (13.9). Despite having more accessible nonphysician clinicians, rural areas had the largest number of uninsured per PCC in 2012. While less restrictive scope-of-practice states had up to 40% more PCNPs in some areas, we found little evidence of differences in the share of the overall population in low-accessibility areas across scope-of-practice categorizations. Removing restrictive scope-of-practice laws may expand the overall capacity of the primary care workforce, but only modestly in the short run. Additional efforts are needed that recognize the locational tendencies of physicians and nonphysicains.

SU-E-T-240: Design and Implement of An Electronic Records Function for Treatment Plan Checked Meeting

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Q

Purpose: To replace the paper records, we designed an electronic records function for plan checked meeting in our in-house developed radiotherapy information management system(RTIMS). Methods: Since 2007, the RTIMS has been developed on a database and web service of Apache+PHP+MySQL, and almost all computers and smartphones could access the RTIMS through IE browser, to input, search, count, and print the data. In 2012, we also established an radiation therapy case conference multi-media system(RTCCMMS) based on Windows Remote Desktop feature. Since 2013, we have carried out the treatment plan checked meeting of the physics division in every afternoon for about halfmore » an hour. In 2014, we designed an electronic records function, which includes a meeting information record and a checked plan record. And the meeting record includes the following items: meeting date, name, place, length, status, attendee, content, etc. The plan record includes the followings: meeting date, meeting name, patient ID, gender, age, patient name, course, plan, purpose, position, technique, CTsim type, plan type, primary doctor, other doctor, primary physicist, other physicist, difficulty, quality, score, opinion, status, note, etc. Results: In the past year, the electronic meeting records function has been successfully developed and implemented in the division, and it could be accessed from an smartphone. Almost all items have the corresponding pull-down menu selection, and each option would try to intelligently inherit default value from the former record or other form. According to the items, we could do big data mining to the input data. It also has both Chinese and English two versions. Conclusion: It was demonstrated to be user-friendly and was proven to significantly improve the clinical efficiency and quality of treatment plan. Since the RTIMS is an in-house developed system, more functions can be added or modified to further enhance its potentials in research and clinical practice. Project supported by the National Natural Science Foundation of China (Grant No.81101694)« less

Effects of Home Access to Active Videogames on Child Self-Esteem, Enjoyment of Physical Activity, and Anxiety Related to Electronic Games: Results from a Randomized Controlled Trial.

PubMed

Abbott, Rebecca A; Smith, Anne J; Howie, Erin K; Pollock, Clare; Straker, Leon

2014-08-01

Active-input videogames could provide a useful conduit for increasing physical activity by improving a child's self-confidence, physical activity enjoyment, and reducing anxiety. Therefore this study evaluated the impact of (a) the removal of home access to traditional electronic games or (b) their replacement with active-input videogames, on child self-perception, enjoyment of physical activity, and electronic game use anxiety. This was a crossover, randomized controlled trial, conducted over a 6-month period in participants' family homes in metropolitan Perth, Australia, from 2007 to 2010. Children 10-12 years old were recruited through school and community media. Of 210 children who were eligible, 74 met inclusion criteria, and 8 withdrew, leaving 66 children (33 girls) for analysis. A counterbalanced randomized order of three conditions sustained for 8 weeks each: No home access to electronic games, home access to traditional electronic games, and home access to active-input electronic games. Perception of self-esteem (Harter's Self Perception Profile for Children), enjoyment of physical activity (Physical Activity Enjoyment Scale questionnaire), and anxiety toward electronic game use (modified Loyd and Gressard Computer Anxiety Subscale) were assessed. Compared with home access to traditional electronic games, neither removal of all electronic games nor replacement with active-input games resulted in any significant change to child self-esteem, enjoyment of physical activity, or anxiety related to electronic games. Although active-input videogames have been shown to be enjoyable in the short term, their ability to impact on psychological outcomes is yet to be established.

A survey of World Wide Web use in middle-aged and older adults.

PubMed

Morrell, R W; Mayhorn, C B; Bennett, J

2000-01-01

We conducted a survey to document World Wide Web use patterns in middle-aged (ages 40-59), young-old (ages 60-74), and old-old adults (ages 75-92). We conducted this survey of 550 adults 40 years old and over in southeastern Michigan, and the overall response rate was approximately 71%. The results suggested that (a) there are distinct age and demographic differences in individuals who use the Web; (b) middle-aged and older Web users are similar in their use patterns; (c) the two primary predictors for not using the Web are lack of access to a computer and lack of knowledge about the Web; (d) old-old adults have the least interest in using the Web compared with middle-aged and young-old adults; and (e) the primary content areas in learning how to use the Web are learning how to use electronic mail and accessing health information and information about traveling for pleasure. This research may serve as a preliminary attempt to ascertain the issues that must be faced in order to increase use of the World Wide Web in middle-aged and older adults.

Spatial Access to Primary Care Providers in Appalachia

PubMed Central

Donohoe, Joseph; Marshall, Vince; Tan, Xi; Camacho, Fabian T.; Anderson, Roger T.; Balkrishnan, Rajesh

2016-01-01

Purpose: The goal of this research was to examine spatial access to primary care physicians in Appalachia using both traditional access measures and the 2-step floating catchment area (2SFCA) method. Spatial access to care was compared between urban and rural regions of Appalachia. Methods: The study region included Appalachia counties of Pennsylvania, Ohio, Kentucky, and North Carolina. Primary care physicians during 2008 and total census block group populations were geocoded into GIS software. Ratios of county physicians to population, driving time to nearest primary care physician, and various 2SFCA approaches were compared. Results: Urban areas of the study region had shorter travel times to their closest primary care physician. Provider to population ratios produced results that varied widely from one county to another because of strict geographic boundaries. The 2SFCA method produced varied results depending on the distance decay weight and variable catchment size techniques chose. 2SFCA scores showed greater access to care in urban areas of Pennsylvania, Ohio, and North Carolina. Conclusion: The different parameters of the 2SFCA method—distance decay weights and variable catchment sizes—have a large impact on the resulting spatial access to primary care scores. The findings of this study suggest that using a relative 2SFCA approach, the spatial access ratio method, when detailed patient travel data are unavailable. The 2SFCA method shows promise for measuring access to care in Appalachia, but more research on patient travel preferences is needed to inform implementation. PMID:26906524

Toward an Experimental Quantum Chemistry: Exploring a New Energy Partitioning.

PubMed

Rahm, Martin; Hoffmann, Roald

2015-08-19

Following the work of L. C. Allen, this work begins by relating the central chemical concept of electronegativity with the average binding energy of electrons in a system. The average electron binding energy, χ̅, is in principle accessible from experiment, through photoelectron and X-ray spectroscopy. It can also be estimated theoretically. χ̅ has a rigorous and understandable connection to the total energy. That connection defines a new kind of energy decomposition scheme. The changing total energy in a reaction has three primary contributions to it: the average electron binding energy, the nuclear-nuclear repulsion, and multielectron interactions. This partitioning allows one to gain insight into the predominant factors behind a particular energetic preference. We can conclude whether an energy change in a transformation is favored or resisted by collective changes to the binding energy of electrons, the movement of nuclei, or multielectron interactions. For example, in the classical formation of H2 from atoms, orbital interactions dominate nearly canceling nuclear-nuclear repulsion and two-electron interactions. While in electron attachment to an H atom, the multielectron interactions drive the reaction. Looking at the balance of average electron binding energy, multielectron, and nuclear-nuclear contributions one can judge when more traditional electronegativity arguments can be justifiably invoked in the rationalization of a particular chemical event.

48 CFR 401.170 - Electronic access to regulatory information.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Electronic access to... AGRICULTURE GENERAL AGRICULTURE ACQUISITION REGULATION SYSTEM Purpose, Authority, Issuance 401.170 Electronic... guidance in electronic form. The Internet address for the Procurement Homepage is URL http://www.usda.gov...

48 CFR 401.170 - Electronic access to regulatory information.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Electronic access to... AGRICULTURE GENERAL AGRICULTURE ACQUISITION REGULATION SYSTEM Purpose, Authority, Issuance 401.170 Electronic... guidance in electronic form. The Internet address for the Procurement Homepage is URL http://www.usda.gov...

48 CFR 401.170 - Electronic access to regulatory information.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Electronic access to... AGRICULTURE GENERAL AGRICULTURE ACQUISITION REGULATION SYSTEM Purpose, Authority, Issuance 401.170 Electronic... guidance in electronic form. The Internet address for the Procurement Homepage is URL http://www.usda.gov...

48 CFR 401.170 - Electronic access to regulatory information.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Electronic access to... AGRICULTURE GENERAL AGRICULTURE ACQUISITION REGULATION SYSTEM Purpose, Authority, Issuance 401.170 Electronic... guidance in electronic form. The Internet address for the Procurement Homepage is URL http://www.usda.gov...

Is palliative care support associated with better quality end-of-life care indicators for patients with advanced cancer? A retrospective cohort study

PubMed Central

Ziegler, Lucy E; Craigs, Cheryl L; West, Robert M; Carder, Paul; Hurlow, Adam; Millares-Martin, Pablo; Hall, Geoff; Bennett, Michael I

2018-01-01

Objectives This study aimed to establish the association between timing and provision of palliative care (PC) and quality of end-of-life care indicators in a population of patients dying of cancer. Setting This study uses linked cancer patient data from the National Cancer Registry, the electronic medical record system used in primary care (SystmOne) and the electronic medical record system used within a specialist regional cancer centre. The population resided in a single city in Northern England. Participants Retrospective data from 2479 adult cancer decedents who died between January 2010 and February 2012 were registered with a primary care provider using the SystmOne electronic health record system, and cancer was certified as a cause of death, were included in the study. Results Linkage yielded data on 2479 cancer decedents, with 64.5% who received at least one PC event. Decedents who received PC were significantly more likely to die in a hospice (39.4% vs 14.5%, P<0.005) and less likely to die in hospital (23.3% vs 40.1%, P<0.05), and were more likely to receive an opioid (53% vs 25.2%, P<0.001). PC initiated more than 2 weeks before death was associated with avoiding a hospital death (≥2 weeks, P<0.001), more than 4 weeks before death was associated with avoiding emergency hospital admissions and increased access to an opioid (≥4 weeks, P<0.001), and more than 33 weeks before death was associated with avoiding late chemotherapy (≥33 weeks, no chemotherapy P=0.019, chemotherapy over 4 weeks P=0.007). Conclusion For decedents with advanced cancer, access to PC and longer duration of PC were significantly associated with better end-of-life quality indicators. PMID:29386222

Growing health partnerships in rural and remote communities: what drives the joint efforts of primary schools and universities in maintaining service learning partnerships?

PubMed

Kirby, Sue; Held, Fabian P; Jones, Debra; Lyle, David

2018-01-10

Aim This study explored the partnership between universities and local primary schools to deliver a classroom-based paediatric communication impairment service provided by undergraduate speech pathology students. It aimed to understand how partnerships work to facilitate programme replication. The partners included universities sending students on rural clinical placement, local host academic units and primary schools who worked together to provide paediatric speech and language services in primary schools in three sites in Australia. Rural and remote communities experience poorer health outcomes because of chronic workforce shortages, social disadvantage and high Aboriginality, poor access to services and underfunding. The study was in twofold: qualitative analysis of data from interviews/focus group with the partners in the university and education sectors, and quantitative social network analysis of data from an electronic survey of the partners. Findings Factors supporting partnerships were long-term, work and social relationships, commitment to community, trust and an appetite for risk-taking. We postulate that these characteristics are more likely to exist in rural communities.

41 CFR 102-76.80 - What is required if the costs of alterations to provide an accessible path of travel to an...

Code of Federal Regulations, 2010 CFR

2010-07-01

... to provide an accessible path of travel to an altered area containing a primary function are... accessible path of travel to an altered area containing a primary function are disproportionate to the costs... exceeding 20 percent of the costs of the alterations to the primary function area. Priority should be given...

41 CFR 102-76.80 - What is required if the costs of alterations to provide an accessible path of travel to an...

Code of Federal Regulations, 2012 CFR

2012-01-01

... to provide an accessible path of travel to an altered area containing a primary function are... accessible path of travel to an altered area containing a primary function are disproportionate to the costs... exceeding 20 percent of the costs of the alterations to the primary function area. Priority should be given...

41 CFR 102-76.80 - What is required if the costs of alterations to provide an accessible path of travel to an...

Code of Federal Regulations, 2013 CFR

2013-07-01

... to provide an accessible path of travel to an altered area containing a primary function are... accessible path of travel to an altered area containing a primary function are disproportionate to the costs... exceeding 20 percent of the costs of the alterations to the primary function area. Priority should be given...

41 CFR 102-76.80 - What is required if the costs of alterations to provide an accessible path of travel to an...

Code of Federal Regulations, 2011 CFR

2011-01-01

... to provide an accessible path of travel to an altered area containing a primary function are... accessible path of travel to an altered area containing a primary function are disproportionate to the costs... exceeding 20 percent of the costs of the alterations to the primary function area. Priority should be given...

41 CFR 102-76.80 - What is required if the costs of alterations to provide an accessible path of travel to an...

Code of Federal Regulations, 2014 CFR

2014-01-01

... to provide an accessible path of travel to an altered area containing a primary function are... accessible path of travel to an altered area containing a primary function are disproportionate to the costs... exceeding 20 percent of the costs of the alterations to the primary function area. Priority should be given...

Knowledge retrieval as one type of knowledge-based decision support in medicine: results of an evaluation study.

PubMed

Haux, R; Grothe, W; Runkel, M; Schackert, H K; Windeler, H J; Winter, A; Wirtz, R; Herfarth, C; Kunze, S

1996-04-01

We report on a prospective, prolective observational study, supplying information on how physicians and other health care professionals retrieve medical knowledge on-line within the Heidelberg University Hospital information system. Within this hospital information system, on-line access to medical knowledge has been realised by installing a medical knowledge server in the range of about 24 GB and by providing access to it by health care professional workstations in wards, physicians' rooms, etc. During the study, we observed about 96 accesses per working day. The main group of health care professionals retrieving medical knowledge were physicians and medical students. Primary reasons for its utilisation were identified as support for the users' scientific work (50%), own clinical cases (19%), general medical problems (14%) and current clinical problems (13%). Health care professionals had accesses to medical knowledge bases such as MEDLINE (79%), drug bases ('Rote Liste', 6%), and to electronic text books and knowledge base systems as well. Sixty-five percent of accesses to medical knowledge were judged to be successful. In our opinion, medical knowledge retrieval can serve as a first step towards knowledge processing in medicine. We point out the consequences for the management of hospital information systems in order to provide the prerequisites for such a type of knowledge retrieval.

Literacy Infrastructure, Access to Books, and the Implementation of the School Literacy Movement in Primary Schools in Indonesia

NASA Astrophysics Data System (ADS)

Laksono, K.; Retnaningdyah, P.

2018-01-01

Literacy Infrastructure and access to books are the foundation of literacy activity. Indonesia has regulations from the Ministry of Education and Culture requiring that 15 minutes should be used each day before the learning begins to read books other than textbooks. However, many schools are not yet obeying this requirement. The purposes of this study are to describe the literacy infrastructure in primary schools in Indonesia, to analyze access to books in primary schools, to explain the School Literacy Movement implementation, and to identify issues around the implementation of reading strategies in a context in which there is limited access to books. The questionnaire and interview study were conducted in 30 primary schools in East Java, Indonesia. The study concluded that the literacy infrastructure and access to books in 30 primary schools are below standard, but the school community enthusiastically implements the objectives of the School Literacy Movement. Many primary schools are already implementing good many reading strategies although there are some problems related to teacher competence.

Review and analysis of the Mental Health Nurse Incentive Program.

PubMed

Happell, Brenda; Platania-Phung, Chris

2017-09-04

Objective The aim of the present study was to review and synthesise research on the Mental Health Nurse Incentive Program (MHNIP) to ascertain the benefits and limitations of this initiative for people with mental illness, general practitioners, mental health nurses and the wider community. Methods An electronic and manual search was made of the research literature for MHNIP in May 2017. Features of studies, including cohorts and findings, were tabulated and cross-study patterns in program processes and outcomes were closely compared. Results Seventeen reports of primary research data have been released. Triangulation of data from different cohorts, regions and design show that the program has been successful on the primary objectives of increased access to primary mental health care, and has received positive feedback from all major stakeholders. Although the program has been broadly beneficial to consumer health, there are inequities in access for people with mental illness. Conclusions The MHNIP greatly benefits the health of people with mental illness. Larger and more representative sampling of consumers is needed, as well as intensive case studies to provide a more comprehensive and effective understanding of the benefits and limitations of the program as it evolves with the establishment of primary health networks. What is known about the topic? The MHNIP is designed to increase access to mental health care in primary care settings such as general practice clinics. Studies have reported favourable views about the program. However, research is limited and further investigation is required to demonstrate the strengths and limitations of the program. What does this paper add? All studies reviewed reported that the MHNIP had positive implications for people with severe and persistent mental illness. Qualitative research has been most prevalent for mental health nurse views and research on Health of the Nation Outcome Scale scores for recipients of the program. There is more research on system dimensions than on person-centred care. Mental health consumers, carers and families have been neglected in the establishment, engagement and evaluation of the MHNIP. What are the implications for practitioners? A more systematic, national-level research program into the MHNIP is required that is centred more on the experiences of people with mental illness.

Not Near Enough: Racial and Ethnic Disparities in Access to Nearby Behavioral Health Care and Primary Care

PubMed Central

VanderWielen, Lynn M.; Gilchrist, Emma C.; Nowels, Molly A.; Petterson, Stephen M.; Rust, George; Miller, Benjamin F.

2016-01-01

Background Racial, ethnic, and geographical health disparities have been widely documented in the United States. However, little attention has been directed towards disparities associated with integrated behavioral health and primary care services. Methods Access to behavioral health professionals among primary care physicians was examined using multinomial logistic regression analyses with 2010 National Plan and Provider Enumeration System, American Medical Association Physician Masterfile, and American Community Survey data. Results Primary care providers practicing in neighborhoods with higher percentages of African Americans and Hispanics were less likely to have geographically proximate behavioral health professionals. Primary care providers in rural areas were less likely to have geographically proximate behavioral health professionals. Conclusion Neighborhood-level factors are associated with access to nearby behavioral health and primary care. Additional behavioral health professionals are needed in racial/ ethnic minority neighborhoods and rural areas to provide access to behavioral health services, and to progress toward more integrated primary care. PMID:26320931

Health information technology workforce needs of rural primary care practices.

PubMed

Skillman, Susan M; Andrilla, C Holly A; Patterson, Davis G; Fenton, Susan H; Ostergard, Stefanie J

2015-01-01

This study assessed electronic health record (EHR) and health information technology (HIT) workforce resources needed by rural primary care practices, and their workforce-related barriers to implementing and using EHRs and HIT. Rural primary care practices (1,772) in 13 states (34.2% response) were surveyed in 2012 using mailed and Web-based questionnaires. EHRs or HIT were used by 70% of respondents. Among practices using or intending to use the technology, most did not plan to hire new employees to obtain EHR/HIT skills and even fewer planned to hire consultants or vendors to fill gaps. Many practices had staff with some basic/entry, intermediate and/or advanced-level skills, but nearly two-thirds (61.4%) needed more staff training. Affordable access to vendors/consultants who understand their needs and availability of community college and baccalaureate-level training were the workforce-related barriers cited by the highest percentages of respondents. Accessing the Web/Internet challenged nearly a quarter of practices in isolated rural areas, and nearly a fifth in small rural areas. Finding relevant vendors/consultants and qualified staff were greater barriers in small and isolated rural areas than in large rural areas. Rural primary care practices mainly will rely on existing staff for continued implementation and use of EHR/HIT systems. Infrastructure and workforce-related barriers remain and must be overcome before practices can fully manage patient populations and exchange patient information among care system partners. Efforts to monitor adoption of these skills and ongoing support for continuing education will likely benefit rural populations. © 2014 National Rural Health Association.

The use of online information resources by nurses.

PubMed

Wozar, Jody A; Worona, Paul C

2003-04-01

Based on the results of an informal needs assessment, the Usage of Online Information Resources by Nurses Project was designed to provide clinical nurses with accurate medical information at the point of care by introducing them to existing online library resources through instructional classes. Actual usage of the resources was then monitored for a set period of time. A two-hour hands-on class was developed for interested nurses. Participants were instructed in the content and use of several different online resources. A special Web page was designed for this project serving as an access point to the resources. Using a password system and WebTrends trade mark software, individual participant's usage of the resources was monitored for a thirty-day period following the class. At the end of the thirty days, usage results were tabulated, and participants were sent general evaluation forms. Eight participants accessed the project page thirty-nine times in a thirty-day period. The most accessed resource was Primary Care Online (PCO), accessed thirty-three times. PCO was followed by MD Consult (17), Ovid (8), NLM resources (5), and electronic journals (1). The individual with the highest usage accessed the project page thirteen times. Practicing clinical nurses will use online medical information resources if they are first introduced to them and taught how to access and use them. Health sciences librarians can play an important role in providing instruction to this often overlooked population.

Entrustable professional activities in post-licensure training in primary care pediatrics: Necessity, development and implementation of a competency-based post-graduate curriculum.

PubMed

Fehr, Folkert; Weiß-Becker, Christoph; Becker, Hera; Opladen, Thomas

2017-01-01

There is an absence of broad-based and binding curricular requirements for structured competency-based post-graduate medical training in Germany, and thus no basis for comparing the competencies of physicians undergoing training in a medical specialty ( Ärzte im Weiterbildung ). In response, the German Society of Primary Care Pediatrics' working group on post-graduate education (DGAAP) has identified realistic entrustable professional activities (EPAs) in primary care, defined their number, scope and content, selected competency domains, specified required knowledge and skills, and described appropriate assessment methods. These guidelines are referred to as PaedCompenda and can be accessed electronically by educators in pediatric medicine; the use and effectiveness of these guidelines are monitored by the German Association for Medical Education's committee on post-graduate education (GMA). Teaching and training in pediatric medicine should take EPAs into consideration. To accomplish this, phases dedicated to primary care should be integrated into formal medical specialty training. Primary care pediatrics must enhance the sites where such training takes place into learning environments that prepare physicians trainees and turn the practicing specialists into mentoring educators.

Pandora's electronic box: GPs reflect upon email communication with their patients.

PubMed

Goodyear-Smith, Felicity; Wearn, Andy; Everts, Hans; Huggard, Peter; Halliwell, Joan

2005-01-01

Global access to information technology has increased dramatically in the past decade, with electronic health care changing medical practice. One example for general practitioners (GPs) is communication with patients via electronic mail (email). GPs face issues regarding e-communication with patients, including how and when it should it be used. The study aims were to assess the extent that GPs communicate with patients by email and explore their attitudes to this mode of communication. Design--telephone interview survey. Setting--primary care, largest urban and suburban area in New Zealand (NZ). Subjects--randomly selected GPs from the Auckland region. Main outcome measure--description of email use; analysis of issues by telephone survey. Data analysed using SPSS-12 and by thematic content analysis. At data saturation, 80 GPs had been interviewed. The majority (68%) had not used email with patients. Only 4% used it regularly. However, there was strong interest in this method. Perceived advantages were the ability to communicate at a distance and time convenient to both doctor and patient; communication where disability affected traditional methods; information-giving (for example, web links); passing on normal results. Identified problems involved inequity of access; linking of electronic data; security; unsuitability for some topics; medico-legal concerns; time; remuneration. Study sample closely mirrored current NZ GP population. Although few GPs emailed with patients, many might once barriers are addressed. GPs had a collective view of the appropriate boundaries for email communication, routine tasks and the transmission of information. GPs would encourage professional debate regarding guidelines for good practice, managing demand and remuneration.

The role of a bus network in access to primary health care in Metropolitan Auckland, New Zealand.

PubMed

Rocha, C M; McGuire, S; Whyman, R; Kruger, E; Tennant, M

2015-09-01

Background: This study examined the spatial accessibility of the population of metropolitan Auckland, New Zealand to the bus network, to connect them to primary health providers, in this case doctors (GP) and dentists. Analysis of accessibility by ethnic identity and socio-economic status were also carried out, because of existing health inequalities along these dimensions. The underlying hypothesis was that most people would live within easy reach of primary health providers, or easy bus transport to such providers. An integrated geographic model of bus transport routes and stops, with population and primary health providers (medical. and dental practices) was developed and analysed. Although the network of buses in metropolitan Auckland is substantial and robust it was evident that many people live more than 150 metres from a stop. Improving the access to bus stops, particularly in areas of high primary health care need (doctors and dentists), would certainly be an opportunity to enhance spatial access in a growing metropolitan area.

Electronic health record use among cancer patients: Insights from the Health Information National Trends Survey.

PubMed

Strekalova, Yulia A

2017-04-01

Over 90% of US hospitals provide patients with access to e-copy of their health records, but the utilization of electronic health records by the US consumers remains low. Guided by the comprehensive information-seeking model, this study used data from the National Cancer Institute's Health Information National Trends Survey 4 (Cycle 4) and examined the factors that explain the level of electronic health record use by cancer patients. Consistent with the model, individual information-seeking factors and perceptions of security and utility were associated with the frequency of electronic health record access. Specifically, higher income, prior online information seeking, interest in accessing health information online, and normative beliefs were predictive of electronic health record access. Conversely, poorer general health status and lack of health care provider encouragement to use electronic health records were associated with lower utilization rates. The current findings provide theory-based evidence that contributes to the understanding of the explanatory factors of electronic health record use and suggest future directions for research and practice.

A normal incidence, high resolution X-ray telescope for solar coronal observations

NASA Technical Reports Server (NTRS)

Golub, L.

1985-01-01

The following major activities were advanced or completed: complete design of the entire telescope assembly and fabrication of all front-end components; specification of all rocket skin sections including bulkheads, feedthroughs and access door; fabrication, curing, and delivery of the large graphite-epoxy telescope tube; engineering analysis of the primary mirror vibration test was completed and a decision made to redesign the mirror attachment to a kinematic three-point mount; detail design of the camera control, payload and housekeeping electronics; and multilayer mirror flats with 2d spacings of 50 A and 60 A.

'The right direction'. Primary-care docs see promise in CMS' proposed pay for non face-to-face work.

PubMed

Robeznieks, Andis

2013-07-15

The CMS has proposed paying physicians for managing patients apart from face-to-face office visits. Among the details under consideration are requiring practices to use an electronic health-record system that supports access to care, care coordination, care management and communications. "It's a step in the right direction. The devil will be in the details and, if the burden of documentation is so high, people may choose not to spend their time doing it," says Dr. Matt Handley, physician and medical director for quality at the Group Health Cooperative.

Multilevel library instruction for emerging nursing roles.

PubMed

Francis, B W; Fisher, C C

1995-10-01

As new nursing roles emerge that involve greater decision making than in the past, added responsibility for outcomes and cost control, and increased emphasis on primary care, the information-seeking skills needed by nurses change. A search of library and nursing literature indicates that there is little comprehensive library instruction covering all levels of nursing programs: undergraduate, returning registered nurses, and graduate students. The University of Florida is one of the few places that has such a multilevel, course-integrated curriculum in place for all entrants into the nursing program. Objectives have been developed for each stage of learning. The courses include instruction in the use of the online public access catalog, printed resources, and electronic databases. A library classroom equipped with the latest technology enables student interaction with electronic databases. This paper discusses the program and several methods used to evaluate it.

The future of scientific communication in the earth sciences: The impact of the internet

NASA Astrophysics Data System (ADS)

Carr, Timothy R.; Buchanan, Rex C.; Adkins-Heljeson, Dana; Mettille, Thomas D.; Sorensen, Janice

1997-06-01

Publication on paper of research results following peer-review and editing has been the accepted means of scientific communication for several centuries. Today, the continued growth in the volume of scientific literature, the increased unit costs of archiving paper publications, and the rapidly increasing power and availability of electronic technology are creating tremendous pressures on traditional scientific communication. The earth sciences are not immune from these pressures, and the role of the traditional publication as the primary means of communication is rapidly changing. Electronic publications and network technology are radically altering the relationship between interpretative result and the underlying data. Earth science research institutions, including the Kansas Geological Survey, are experimenting with new forms of on-line publication that assure broad access to research and data and improve application of research results to societal problems.

Superior Patency of Upper Arm Arteriovenous Fistulae in High Risk Patients

PubMed Central

Chiulli, Larissa C; Vasilas, Penny; Dardik, Alan

2011-01-01

Background Despite an increased propensity to primary failure in forearm arteriovenous fistulae compared to upper arm fistulae, forearm fistulae remain the preferred primary access type for chronic hemodialysis patients. In a high risk patient population with multiple medical comorbidities associated with requirement for intravenous access we compared the rates of access failure in forearm and upper arm fistulae. Materials and Methods The records of all patients having primary native arteriovenous fistulae placed between 2004 and 2009 at the VA Connecticut Healthcare system were reviewed (n=118). Primary and secondary patency of upper arm and forearm fistulae were evaluated using Kaplan-Meier survival analysis. The effects of medical comorbidities on access patency were analyzed with Cox regression. Results The median time to primary failure of the vascular access was 0.288 years in the forearm group compared to 0.940 years in the upper arm group (p=0.028). Secondary patency was 52% at 4.9 years in upper arm fistulae compared to 52% at 1.1 years in the forearm group (p=0.036). There was no significant effect of patient comorbidities on fistula failure; however, there was a trend toward upper arm surgical site as a protective factor for primary fistula patency (Hazard Ratio=0.573, p=0.076). Conclusions In veterans needing hemodialysis, a high risk population with extensive comorbid factors often requiring intravascular access, upper arm fistulae are not only a viable option for primary vascular access, but are likely to be a superior option to classic forearm fistulae. PMID:21571318

Modulated Electron Emission by Scattering-Interference of Primary Electrons

NASA Astrophysics Data System (ADS)

Valeri, Sergio; di Bona, Alessandro

We review the effects of scattering-interference of the primary, exciting beam on the electron emission from ordered atomic arrays. The yield of elastically and inelastically backscattered electrons, Auger electrons and secondary electrons shows a marked dependence on the incidence angle of primary electrons. Both the similarity and the relative importance of processes experienced by incident and excident electrons are discussed. We also present recent studies of electron focusing and defocusing along atomic chains. The interplay between these two processes determines the in-depth profile of the primary electron intensity anisotropy. Finally, the potential for surface-structural studies and limits for quantitative analysis are discussed, in comparison with the Auger electron diffraction (AED) and photoelectron diffraction (PD) techniques.

Association between Enhanced Access Services in Pediatric Primary Care and Utilization of Emergency Departments: A National Parent Survey

PubMed Central

Zickafoose, Joseph S.; DeCamp, Lisa R.; Prosser, Lisa A.

2013-01-01

Objectives To measure the prevalence of enhanced access services in pediatric primary care and to assess whether enhanced access services are associated with lower emergency department (ED) utilization. Study design Internet-based survey of a national sample of parents (n=820, response rate 41%). We estimated the prevalence of reported enhanced access services and ED use in the prior 12 months. We then used multivariate negative binomial regression to assess associations between enhanced access services and ED use. Results The majority of parents reported access to advice by telephone during office hours (80%), same-day sick visits (79%), and advice by telephone outside office hours (54%). Fewer than one-half of parents reported access to their child’s primary care office on weekends (47%), after 5:00 pm on any night (23%), or by email (13%). Substantial proportions of parents reported that they did not know if these services were available (7-56%, depending on service). Office hours after 5:00 pm on ≥5 nights a week was the only service significantly associated with ED utilization in multivariate analysis (adjusted incidence rate ratio: 0.51 [95% CI 0.28-0.92]). Conclusions The majority of parents report enhanced access to their child’s primary care office during office hours, but many parents do not have access or do not know if they have access outside of regular office hours. Extended office hours may be the most effective practice change to reduce emergency department use. Primary care practices should prioritize the most effective enhanced access services and communicate existing services to families. PMID:23759421

Access to primary health care services for Indigenous peoples: A framework synthesis.

PubMed

Davy, Carol; Harfield, Stephen; McArthur, Alexa; Munn, Zachary; Brown, Alex

2016-09-30

Indigenous peoples often find it difficult to access appropriate mainstream primary health care services. Securing access to primary health care services requires more than just services that are situated within easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore how, if at all, these were addressed by Indigenous health care services. To be included in this framework synthesis papers must have presented findings focused on access to (factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary health care services. Findings were imported into NVivo and a framework analysis undertaken whereby findings were coded to and then thematically analysed using Levesque and colleague's accessibility framework. Issues relating to the cultural and social determinants of health such as unemployment and low levels of education influenced whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if not the direct involvement of, community members in identifying and then addressing health care needs. Indigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hamper Indigenous peoples from accessing health care. Findings of this synthesis also suggest that Levesque and colleague's accessibility framework should be broadened to include factors related to the health care system such as funding.

Nurse-led management of chronic disease in a residential care setting.

PubMed

Neylon, Julie

2015-11-01

Introduction of the advanced nurse practitioner (ANP) role has enabled nurses to develop their clinical knowledge and skills, providing greater service provision and improved access to healthcare services. It can also help with the challenges of providing care to an ageing population in primary care. This article reports on the evaluation of an ANP-led clinic in two residential care homes that provides annual reviews for chronic disease management (CDM). A mixed method approach was used to evaluate the service using clinical data obtained from the electronic patient record system and software and patient satisfaction questionnaires. The number of patients receiving CDM reviews in the homes increased as a result of the clinic. Completed satisfaction questionnaires further demonstrated patients' satisfaction and willingness to engage with the service. The service highlights the ANP's effectiveness in managing residential care home patients with chronic diseases and improving their access to healthcare services.

Benchmarks for effective primary care-based nursing services for adults with depression: a Delphi study.

PubMed

McIlrath, Carole; Keeney, Sinead; McKenna, Hugh; McLaughlin, Derek

2010-02-01

This paper is a report of a study conducted to identify and gain consensus on appropriate benchmarks for effective primary care-based nursing services for adults with depression. Worldwide evidence suggests that between 5% and 16% of the population have a diagnosis of depression. Most of their care and treatment takes place in primary care. In recent years, primary care nurses, including community mental health nurses, have become more involved in the identification and management of patients with depression; however, there are no appropriate benchmarks to guide, develop and support their practice. In 2006, a three-round electronic Delphi survey was completed by a United Kingdom multi-professional expert panel (n = 67). Round 1 generated 1216 statements relating to structures (such as training and protocols), processes (such as access and screening) and outcomes (such as patient satisfaction and treatments). Content analysis was used to collapse statements into 140 benchmarks. Seventy-three benchmarks achieved consensus during subsequent rounds. Of these, 45 (61%) were related to structures, 18 (25%) to processes and 10 (14%) to outcomes. Multi-professional primary care staff have similar views about the appropriate benchmarks for care of adults with depression. These benchmarks could serve as a foundation for depression improvement initiatives in primary care and ongoing research into depression management by nurses.

Child language interventions in public health: a systematic literature review.

PubMed

De Cesaro, Bruna Campos; Gurgel, Léia Gonçalves; Nunes, Gabriela Pisoni Canedo; Reppold, Caroline Tozzi

2013-01-01

Systematically review the literature on interventions in children's language in primary health care. One searched the electronic databases (January 1980 to March 2013) MEDLINE (accessed by PubMed), Scopus, Lilacs and Scielo. The search terms used were "child language", "primary health care", "randomized controlled trial" and "intervention studies" (in English, Portuguese and Spanish). There were included any randomized controlled trials that addressed the issues child language and primary health care. The analysis was based on the type of language intervention conducted in primary health care. Seven studies were included and used intervention strategies such as interactive video, guidance for parents and group therapy. Individuals of both genders were included in the seven studies. The age of the children participant in the samples of the articles included in this review ranged from zero to 11 years. These seven studies used approaches that included only parents, parents and children or just children. The mainly intervention in language on primary health care, used in randomized controlled trials, involved the use of interactional video. Several professionals, beyond speech and language therapist, been inserted in the language interventions on primary health care, demonstrating the importance of interdisciplinary work. None of the articles mentioned aspects related to hearing. There was scarcity of randomized controlled trials that address on language and public health, either in Brazil or internationally.

Use of the radial approach in primary angioplasty: results in 1029 consecutive patients and analyses in unfavorable subgroups.

PubMed

Hernández-Pérez, Francisco J; Blasco-Lobo, Ana; Goicolea, Leire; Muñiz-Lozano, Ana; Fernandez-Díaz, José A; Domínguez, José R; Goicolea-Ruigómez, Javier

2014-01-01

The transradial approach is associated with a reduction in vascular access-related complications after primary percutaneous coronary interventions. The purpose of this study was to examine the feasibility of the routine use of transradial access in primary angioplasty and to evaluate how it affects subgroups with less favorable characteristics. We analyzed 1029 consecutive patients with an ST-segment elevation acute coronary syndrome treated with primary angioplasty. Transradial access was the primary approach in 93.1% of the patients. The success rate of primary angioplasty was 95.9%, and 87.6% of the patients were event-free 30 days after the procedure. Crossover was required in 3.0% of the patients with primary transradial access, and this rate remained stable over the years. Predictors of the need for crossover were age older than 75 years (odds ratio=2.50, 95% confidence interval, 1.09-5.71; P=.03) and a history of ischemic heart disease (odds ratio=2.65; 95% confidence interval, 1.12-6.24; P=.02). Primary transfemoral access use was higher in women older than 75 years. Use of the transradial approach in this subgroup did not affect reperfusion time or the success of angioplasty, although there was a greater need for crossover (10.9% vs 2.6%; P=.006). Among patients in cardiogenic shock, the transradial approach was used in 51.5%; reperfusion times and angioplasty success rates were similar to those obtained with transfemoral access, but there was a greater need for crossover. Transradial access can be used safely and effectively in most primary angioplasty procedures. In older women and in patients in cardiogenic shock, there is a higher crossover requirement, with no detriment to reperfusion time. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review.

PubMed

Khanassov, Vladimir; Pluye, Pierre; Descoteaux, Sarah; Haggerty, Jeannie L; Russell, Grant; Gunn, Jane; Levesque, Jean-Frederic

2016-10-10

Access to community-based primary health care (hereafter, 'primary care') is a priority in many countries. Health care systems have emphasized policies that help the community 'get the right service in the right place at the right time'. However, little is known about organizational interventions in primary care that are aimed to improve access for populations in situations of vulnerability (e.g., socioeconomically disadvantaged) and how successful they are. The purpose of this scoping review was to map the existing evidence on organizational interventions that improve access to primary care services for vulnerable populations. Scoping review followed an iterative process. Eligibility criteria: organizational interventions in Organisation for Economic Cooperation and Development (OECD) countries; aiming to improve access to primary care for vulnerable populations; all study designs; published from 2000 in English or French; reporting at least one outcome (avoidable hospitalization, emergency department admission, or unmet health care needs). Main bibliographic databases (Medline, Embase, CINAHL) and team members' personal files. One researcher selected relevant abstracts and full text papers. Theory-driven synthesis: The researcher classified included studies using (i) the 'Patient Centered Access to Healthcare' conceptual framework (dimensions and outcomes of access to primary care), and (ii) the classification of interventions of the Cochrane Effective Practice and Organization of Care. Using pattern analysis, interventions were mapped in accordance with the presence/absence of 'dimension-outcome' patterns. Out of 8,694 records (title/abstract), 39 studies with varying designs were included. The analysis revealed the following pattern. Results of 10 studies on interventions classified as 'Formal integration of services' suggested that these interventions were associated with three dimensions of access (approachability, availability and affordability) and reduction of hospitalizations (four/four studies), emergency department admissions (six/six studies), and unmet healthcare needs (five/six studies). These 10 studies included seven non-randomized studies, one randomized controlled trial, one quantitative descriptive study, and one mixed methods study. Our results suggest the limited breadth of research in this area, and that it will be feasible to conduct a full systematic review of studies on the effectiveness of the formal integration of services to improve access to primary care services for vulnerable populations.

Racial/ethnic variation in devices used to access patient portals.

PubMed

Chang, Eva; Blondon, Katherine; Lyles, Courtney R; Jordan, Luesa; Ralston, James D

2018-01-01

We examined racial/ethnic variation in the devices used by patients to access medical records through an online patient portal. Retrospective, cross-sectional analysis. Using data from 318,700 adults enrolled in an integrated delivery system between December 2012 and November 2013, we examined: 1) online patient portal use that directly engages the electronic health record and 2) portal use over desktops/laptops only, mobile devices only, or both device types. The primary covariate was race/ethnicity (non-Hispanic white, black, Hispanic, and Asian). Other covariates included age, sex, primary language, and neighborhood-level income and education. Portal use and devices used were assessed with multiple and multinomial logistic models, respectively. From December 2012 to November 2013, 56% of enrollees used the patient portal. Of these portal users, 62% used desktops/laptops only, 6% used mobile devices only, and 32% used both desktops/laptops and mobile devices. Black, Hispanic, and Asian enrollees had significantly lower odds of portal use than whites. Black and Hispanic portal users also were significantly more likely to use mobile devices only (relative risk ratio, 1.73 and 1.44, respectively) and both device types (1.21 and 1.07, respectively) than desktops/laptops only compared with whites. Although racial/ethnic minority enrollees were less likely to access the online patient portal overall, a greater proportion of black and Hispanic users accessed the patient portal with mobile devices than did non-Hispanic white users. The rapid spread of mobile devices among racial/ethnic minorities may help reduce variation in online patient portal use. Mobile device use may represent an opportunity for healthcare organizations to further engage black and Hispanic enrollees in online patient portal use.

Ask the eConsultant: Improving access to haematology expertise using an asynchronous eConsult system.

PubMed

Fogel, Adam; Khamisa, Karima; Afkham, Amir; Liddy, Clare; Keely, Erin

2017-04-01

Introduction The Champlain BASE (Building Access to Specialists through eConsultation) eConsultation service was designed to address the limited access to specialist care in Canada, which can lead to long waiting times and, subsequently, negative patient outcomes. Our primary objective was to perform an in-depth analysis of the use, content, and perceived value of haematology electronic consults (eConsults) submitted by primary care providers (PCPs) to the eConsult service. Methods We conducted a cross-sectional study using descriptive statistics to examine post-eConsult surveys for PCPs and other collected data including PCP designation, time for specialist to complete the eConsult, specialist response time, perceived value of the eConsult by the PCP, and the need for a face-to-face referral following the eConsult. A medically-trained author reviewed all haematology eConsults from April 2011 to January 2015, and categorized them by clinical topic and question type using validated taxonomies. Results Haematology accounted for 436 out of 5601 (7.8%) total eConsults, making it the third most popular service utilized. In 66% of haematology eConsults, a face-to-face consultation was not needed. Anaemia, neutropenia, and hyperferritinemia were the most common clinical queries. Most eConsult question types concerned the management of haematological disorders or the interpretation of laboratory tests. Most eConsults were answered within three days, using less than 15 minutes of the specialists' time. PCPs highly valued the service. Discussion This initiative increases access to haematology care and has the potential to reduce the long waiting times for non-urgent traditional consultation, along with the benefit of cost savings to the healthcare system.

[Access control management in electronic health records: a systematic literature review].

PubMed

Carrión Señor, Inmaculada; Fernández Alemán, José Luis; Toval, Ambrosio

2012-01-01

This study presents the results of a systematic literature review of aspects related to access control in electronic health records systems, wireless security and privacy and security training for users. Information sources consisted of original articles found in Medline, ACM Digital Library, Wiley InterScience, IEEE Digital Library, Science@Direct, MetaPress, ERIC, CINAHL and Trip Database, published between January 2006 and January 2011. A total of 1,208 articles were extracted using a predefined search string and were reviewed by the authors. The final selection consisted of 24 articles. Of the selected articles, 21 dealt with access policies in electronic health records systems. Eleven articles discussed whether access to electronic health records should be granted by patients or by health organizations. Wireless environments were only considered in three articles. Finally, only four articles explicitly mentioned that technical training of staff and/or patients is required. Role-based access control is the preferred mechanism to deploy access policy by the designers of electronic health records. In most systems, access control is managed by users and health professionals, which promotes patients' right to control personal information. Finally, the security of wireless environments is not usually considered. However, one line of research is eHealth in mobile environments, called mHealth. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

Electronic Biomedical Literature Search for Budding Researcher

PubMed Central

Thakre, Subhash B.; Thakre S, Sushama S.; Thakre, Amol D.

2013-01-01

Search for specific and well defined literature related to subject of interest is the foremost step in research. When we are familiar with topic or subject then we can frame appropriate research question. Appropriate research question is the basis for study objectives and hypothesis. The Internet provides a quick access to an overabundance of the medical literature, in the form of primary, secondary and tertiary literature. It is accessible through journals, databases, dictionaries, textbooks, indexes, and e-journals, thereby allowing access to more varied, individualised, and systematic educational opportunities. Web search engine is a tool designed to search for information on the World Wide Web, which may be in the form of web pages, images, information, and other types of files. Search engines for internet-based search of medical literature include Google, Google scholar, Scirus, Yahoo search engine, etc., and databases include MEDLINE, PubMed, MEDLARS, etc. Several web-libraries (National library Medicine, Cochrane, Web of Science, Medical matrix, Emory libraries) have been developed as meta-sites, providing useful links to health resources globally. A researcher must keep in mind the strengths and limitations of a particular search engine/database while searching for a particular type of data. Knowledge about types of literature, levels of evidence, and detail about features of search engine as available, user interface, ease of access, reputable content, and period of time covered allow their optimal use and maximal utility in the field of medicine. Literature search is a dynamic and interactive process; there is no one way to conduct a search and there are many variables involved. It is suggested that a systematic search of literature that uses available electronic resource effectively, is more likely to produce quality research. PMID:24179937

Electronic biomedical literature search for budding researcher.

PubMed

Thakre, Subhash B; Thakre S, Sushama S; Thakre, Amol D

2013-09-01

Search for specific and well defined literature related to subject of interest is the foremost step in research. When we are familiar with topic or subject then we can frame appropriate research question. Appropriate research question is the basis for study objectives and hypothesis. The Internet provides a quick access to an overabundance of the medical literature, in the form of primary, secondary and tertiary literature. It is accessible through journals, databases, dictionaries, textbooks, indexes, and e-journals, thereby allowing access to more varied, individualised, and systematic educational opportunities. Web search engine is a tool designed to search for information on the World Wide Web, which may be in the form of web pages, images, information, and other types of files. Search engines for internet-based search of medical literature include Google, Google scholar, Scirus, Yahoo search engine, etc., and databases include MEDLINE, PubMed, MEDLARS, etc. Several web-libraries (National library Medicine, Cochrane, Web of Science, Medical matrix, Emory libraries) have been developed as meta-sites, providing useful links to health resources globally. A researcher must keep in mind the strengths and limitations of a particular search engine/database while searching for a particular type of data. Knowledge about types of literature, levels of evidence, and detail about features of search engine as available, user interface, ease of access, reputable content, and period of time covered allow their optimal use and maximal utility in the field of medicine. Literature search is a dynamic and interactive process; there is no one way to conduct a search and there are many variables involved. It is suggested that a systematic search of literature that uses available electronic resource effectively, is more likely to produce quality research.

The impact of electronic health records on workflow and financial measures in primary care practices.

PubMed

Fleming, Neil S; Becker, Edmund R; Culler, Steven D; Cheng, Dunlei; McCorkle, Russell; da Graca, Briget; Ballard, David J

2014-02-01

To estimate a commercially available ambulatory electronic health record's (EHR's) impact on workflow and financial measures. Administrative, payroll, and billing data were collected for 26 primary care practices in a fee-for-service network that rolled out an EHR on a staggered schedule from June 2006 through December 2008. An interrupted time series design was used. Staffing, visit intensity, productivity, volume, practice expense, payments received, and net income data were collected monthly for 2004-2009. Changes were evaluated 1-6, 7-12, and >12 months postimplementation. Data were accessed through a SQLserver database, transformed into SAS®, and aggregated by practice. Practice-level data were divided by full-time physician equivalents for comparisons across practices by month. Staffing and practice expenses increased following EHR implementation (3 and 6 percent after 12 months). Productivity, volume, and net income decreased initially but recovered to/close to preimplementation levels after 12 months. Visit intensity did not change significantly, and a secular trend offset the decrease in payments received. Expenses increased and productivity decreased following EHR implementation, but not as much or as persistently as might be expected. Longer term effects still need to be examined. © Health Research and Educational Trust.

A Mixed-Methods Study of Patient-Provider E-mail Content in a Safety-Net Setting

PubMed Central

Mirsky, Jacob B.; Tieu, Lina; Lyles, Courtney; Sarkar, Urmimala

2016-01-01

Objective To explore the content of patient-provider e-mails in a safety-net primary care clinic. Methods We conducted a content analysis using inductive and deductive coding of e-mail exchanges (n=31) collected from January through November of 2013. Participants were English-speaking adult patients with a chronic condition (or their caregivers) cared for at a single publicly-funded general internal medicine clinic and their primary care providers (attending general internist physicians, clinical fellows, internal medicine residents, and nurse practitioners). Results All e-mails were non-urgent. Patients included a medical update in 19% of all e-mails. Patients requested action in 77% of e-mails, and the most common requests overall were for action regarding medications or treatment (29%). Requests for information were less common (45% of e-mails). Patient requests (n=56) were resolved in 84% of e-mail exchanges, resulting in 63 actions. Conclusion Patients in safety-net clinics are capable of safely and effectively using electronic messaging for between-visit communication with providers. Practical Implications Safety-net systems should implement electronic communications tools as soon as possible to increase healthcare access and enhance patient involvement in their care. PMID:26332306

Extracellular Electron Transfer and Survival Strategies in Acid Mine Drainage Impacted Soils

NASA Astrophysics Data System (ADS)

Gorby, Y. A.; Senko, J.

2011-12-01

Acid mine drainage (AMD) is a prominent and increasing problem in the greater Appalachian region of the United States and throughout the world. Recognition of the importance of extracellular electron transfer (EET) in microbial communities has provided a fertile research environment for multidisciplinary collaborations to emerge and effectively address complex questions with important environmental implications. Our research focuses on the components, strategies and mechanisms of EET in soil systems impacted by AMD and extends to other biogeochemical systems typified by steep redox gradients. Organisms within acid mine drainage use Fe(II) as their primary electron donor and couple Fe(II) oxidation to the reduction of oxygen as the terminal electron acceptor. Biogenic minerals formed by this process completely encase microbes in think deposits that would seem to limit diffusion of both Fe(II) and O2 for access by the organisms. We have developed methods for catalytically removing biogenic minerals revealing microorganisms and a fine network of filamentous extracellular material. Here we present a status report of our efforts to characterize the molecular and electronic properties of these filaments and to address the hypothesis that at least some of these filaments are electrically conductive microbial nanowires that facilitate electron transfer reactions within this complex biogeochemical system.

Access of primary and secondary literature by health personnel in an academic health center: implications for open access*

PubMed Central

Steinberg, Ryan M.; Moorhead, Laura; O'Brien, Bridget; Willinsky, John

2013-01-01

Purpose: The research sought to ascertain the types and quantity of research evidence accessed by health personnel through PubMed and UpToDate in a university medical center over the course of a year in order to better estimate the impact that increasing levels of open access to biomedical research can be expected to have on clinical practice in the years ahead. Methods: Web log data were gathered from the 5,042 health personnel working in the Stanford University Hospitals (SUH) during 2011. Data were analyzed for access to the primary literature (abstracts and full-text) through PubMed and UpToDate and to the secondary literature, represented by UpToDate (research summaries), to establish the frequency and nature of literature consulted. Results: In 2011, SUH health personnel accessed 81,851 primary literature articles and visited UpToDate 110,336 times. Almost a third of the articles (24,529) accessed were reviews. Twenty percent (16,187) of the articles viewed were published in 2011. Conclusion: When it is available, health personnel in a clinical care setting frequently access the primary literature. While further studies are needed, this preliminary finding speaks to the value of the National Institutes of Health public access policy and the need for medical librarians and educators to prepare health personnel for increasing public access to medical research. PMID:23930091

A qualitative study on African immigrant and refugee families' experiences of accessing primary health care services in Manitoba, Canada: it's not easy!

PubMed

Woodgate, Roberta Lynn; Busolo, David Shiyokha; Crockett, Maryanne; Dean, Ruth Anne; Amaladas, Miriam R; Plourde, Pierre J

2017-01-09

Immigrant and refugee families form a growing proportion of the Canadian population and experience barriers in accessing primary health care services. The aim of this study was to examine the experiences of access to primary health care by African immigrant and refugee families. Eighty-three families originating from 15 African countries took part in multiple open ended interviews in western Canada. Qualitative data was collected in six different languages between 2013 and 2015. Data analysis involved delineating units of meaning from the data, clustering units of meaning to form thematic statements, and extracting themes. African immigrant and refugee families experienced challenges in their quest to access primary health care that were represented by three themes: Expectations not quite met, facing a new life, and let's buddy up to improve access. On the theme of expectations not quite met, families struggled to understand and become familiar with a new health system that presented with a number of barriers including lengthy wait times, a shortage of health care providers, high cost of medication and non-basic health care, and less than ideal care. On the theme of facing a new life, immigrant and refugee families talked of the difficulties of getting used to their new and unfamiliar environments and the barriers that impact their access to health care services. They talked of challenges related to transportation, weather, employment, language and cultural differences, and lack of social support in their quest to access health care services. Additionally, families expressed their lack of social support in accessing care. Privately sponsored families and families with children experienced even less social support. Importantly, in the theme of let's buddy up to improve access, families recommended utilizing networking approaches to engage and improve their access to primary health care services. African immigrant and refugee families experience barriers to accessing primary health care. To improve access, culturally relevant programs, collaborative networking approaches, and policies that focus on addressing social determinants of health are needed.

GUI-Based Document Access via SATCOMMS: Online Electronic Document Retrieval at the European Telecommunications Satellite Organization EUTELSAT.

ERIC Educational Resources Information Center

Burton, Adrian P.

1995-01-01

Discusses accessing online electronic documents at the European Telecommunications Satellite Organization (EUTELSAT). Highlights include off-site paper document storage, the document management system, benefits, the EUTELSAT Standard IBM Access software, implementation, the development process, and future enhancements. (AEF)

Can an online clinical data management service help in improving data collection and data quality in a developing country setting?

PubMed

Wildeman, Maarten A; Zandbergen, Jeroen; Vincent, Andrew; Herdini, Camelia; Middeldorp, Jaap M; Fles, Renske; Dalesio, Otilia; van der Donk, Emile; Tan, I Bing

2011-08-08

Data collection by electronic medical record (EMR) systems have been proven to be helpful in data collection for scientific research and in improving healthcare. For a multi-centre trial in Indonesia and the Netherlands a web based system was selected to enable all participating centres to easily access data. This study assesses whether the introduction of a clinical trial data management service (CTDMS) composed of electronic case report forms (eCRF) can result in effective data collection and treatment monitoring. Data items entered were checked for inconsistencies automatically when submitted online. The data were divided into primary and secondary data items. We analysed both the total number of errors and the change in error rate, for both primary and secondary items, over the first five month of the trial. In the first five months 51 patients were entered. The primary data error rate was 1.6%, whilst that for secondary data was 2.7% against acceptable error rates for analysis of 1% and 2.5% respectively. The presented analysis shows that after five months since the introduction of the CTDMS the primary and secondary data error rates reflect acceptable levels of data quality. Furthermore, these error rates were decreasing over time. The digital nature of the CTDMS, as well as the online availability of that data, gives fast and easy insight in adherence to treatment protocols. As such, the CTDMS can serve as a tool to train and educate medical doctors and can improve treatment protocols.

48 CFR 339.201-70 - Required provision and contract clause.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY Electronic and Information... provision in 352.239-73(a), Electronic and Information Technology Accessibility, in solicitations valued at... insert the clause in 352.239-73(b), Electronic and Information Technology Accessibility, in contracts and...

48 CFR 339.201-70 - Required provision and contract clause.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY Electronic and Information... provision in 352.239-73(a), Electronic and Information Technology Accessibility, in solicitations valued at... insert the clause in 352.239-73(b), Electronic and Information Technology Accessibility, in contracts and...

19 CFR 122.49d - Passenger Name Record (PNR) information.

Code of Federal Regulations, 2010 CFR

2010-04-01

...; DEPARTMENT OF THE TREASURY AIR COMMERCE REGULATIONS Aircraft Entry and Entry Documents; Electronic Manifest... request, provide Customs with electronic access to certain Passenger Name Record (PNR) information, as... access to requested PNR information, each air carrier must ensure that its electronic reservation...

48 CFR 339.201-70 - Required provision and contract clause.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICES SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY Electronic and Information... provision in 352.239-73(a), Electronic and Information Technology Accessibility, in solicitations valued at... insert the clause in 352.239-73(b), Electronic and Information Technology Accessibility, in contracts and...

48 CFR 339.201-70 - Required provision and contract clause.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SERVICES SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY Electronic and Information... provision in 352.239-73(a), Electronic and Information Technology Accessibility, in solicitations valued at... insert the clause in 352.239-73(b), Electronic and Information Technology Accessibility, in contracts and...

48 CFR 339.201-70 - Required provision and contract clause.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY Electronic and Information... provision in 352.239-73(a), Electronic and Information Technology Accessibility, in solicitations valued at... insert the clause in 352.239-73(b), Electronic and Information Technology Accessibility, in contracts and...

39 CFR 255.4 - Accessibility to electronic and information technology.

Code of Federal Regulations, 2010 CFR

2010-07-01

... technology. 255.4 Section 255.4 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION... AND INFORMATION TECHNOLOGY § 255.4 Accessibility to electronic and information technology. (a) In... burden, that the electronic and information technology the agency procures allows— (1) Individuals with...

Feasibility and acceptability of patient partnership to improve access to primary care for the physical health of patients with severe mental illnesses: an interactive guide.

PubMed

Pelletier, Jean-François; Lesage, Alain; Boisvert, Christine; Denis, Frédéric; Bonin, Jean-Pierre; Kisely, Steve

2015-09-14

Even in countries with universal healthcare systems, excess mortality rates due to physical chronic diseases in patients also suffering from serious mental illness like schizophrenia is such that their life expectancy could be lessened by up to 20 years. The possible explanations for this disparity include: unhealthy habits (i.e. smoking; lack of exercise); side-effects of psychotropic medication; delays in the detection or initial presentation leading to a more advanced disease at diagnosis; and inequity of access to services. The main objective of this paper is to explore the feasibility and acceptability of patient partnership for developing an interactive guide to improve access to primary care providers for chronic diseases management and health promotion among patients with severe mental illnesses. A participatory action research design was used to engage patients with mental illness as full research partners for a strategy for patient-oriented research in primary care for persons with schizophrenia who also have chronic physical illnesses. This strategy was also developed in partnership with a health and social services centre responsible for the health of the population of a territory with about 100,000 inhabitants in East-end Montreal, Canada. A new interactive guide was developed by patient research partners and used by 146 participating patients with serious mental illness who live on this territory, for them to be better prepared for their medical appointment with a General Practitioner by becoming more aware of their own physical condition. Patient research partners produced a series of 33 short videos depicting signs and symptoms of common chronic diseases and risk factors for the leading causes of mortality and study participants were able to complete the corresponding 33-item questionnaire on an electronic touch screen tablet. What proved to be most relevant in terms of interactivity was the dynamic that has developed among the study participants during the small group learning sessions, a training technique designed for healthcare professionals that was adapted for this project for, and with patient partners. This research has shown the feasibility and acceptability of patient partnership and patient-oriented research approaches to the R&D process of a new medical tool and intervention for patients with serious mental illness, and its acceptability for addressing inequity of this disadvantaged population in terms of access to primary care providers.

The Primary Care Electronic Library: RSS feeds using SNOMED-CT indexing for dynamic content delivery.

PubMed

Robinson, Judas; de Lusignan, Simon; Kostkova, Patty; Madge, Bruce; Marsh, A; Biniaris, C

2006-01-01

Rich Site Summary (RSS) feeds are a method for disseminating and syndicating the contents of a website using extensible mark-up language (XML). The Primary Care Electronic Library (PCEL) distributes recent additions to the site in the form of an RSS feed. When new resources are added to PCEL, they are manually assigned medical subject headings (MeSH terms), which are then automatically mapped to SNOMED-CT terms using the Unified Medical Language System (UMLS) Metathesaurus. The library is thus searchable using MeSH or SNOMED-CT. Our syndicate partner wished to have remote access to PCEL coronary heart disease (CHD) information resources based on SNOMED-CT search terms. To pilot the supply of relevant information resources in response to clinically coded requests, using RSS syndication for transmission between web servers. Our syndicate partner provided a list of CHD SNOMED-CT terms to its end-users, a list which was coded according to UMLS specifications. When the end-user requested relevant information resources, this request was relayed from our syndicate partner's web server to the PCEL web server. The relevant resources were retrieved from the PCEL MySQL database. This database is accessed using a server side scripting language (PHP), which enables the production of dynamic RSS feeds on the basis of Source Asserted Identifiers (CODEs) contained in UMLS. Retrieving resources using SNOMED-CT terms using syndication can be used to build a functioning application. The process from request to display of syndicated resources took less than one second. The results of the pilot illustrate that it is possible to exchange data between servers using RSS syndication. This method could be utilised dynamically to supply digital library resources to a clinical system with SNOMED-CT data used as the standard of reference.

Beyond the guidelines: challenges, controversies, and unanswered questions.

PubMed

Radix, Anita; Silva, Manel

2014-06-01

Transgender and gender-nonconforming youth have unique medical and psychosocial needs that frequently go unmet. For youth who wish to have their physical appearance congruent with their gender identity, treatment guidelines are available that advocate the use of gonadotropin-releasing hormone (GnRH) analogues (puberty blockers) and cross-sex hormone regimens. Although medical transition was once considered highly controversial, there is a mounting body of evidence that providing a supportive and affirming environment, as well as appropriate medical intervention, results in improved health outcomes. Primary care pediatricians may be unaware of current guidelines and consequently the need for treatment and/or timely referrals. Transgender youth often face other hurdles to initiation of therapy, including refusal of care and harassment in medical settings, denial of coverage by insurance plans, and the high cost of puberty blockers. Because transgender youth younger than 18 years depend on their families for medical decision making, they may be unable to access necessary medical treatment when parents do not support their transition plan. Medical transition impacts many aspects of the medical system, such as insurance coverage, billing, electronic health records, and preventive health care maintenance. These issues may become more apparent with the implementation of the Affordable Care Act (ACA) and increased use of electronic records and clinical decision support. The implementation of the ACA may also present new opportunities and protections for transgender individuals. Primary pediatricians are often the first providers families and youth reach out to for advice, and they can assist families with negotiating these complex medical, legal, social, and economic challenges and optimizing access to safe and appropriate health care services. Copyright 2014, SLACK Incorporated.

Measuring the patient experience in primary care

PubMed Central

Slater, Morgan; Kiran, Tara

2016-01-01

Abstract Objective To compare the characteristics and responses of patients completing a patient experience survey accessed online after e-mail notification or delivered in the waiting room using tablet computers. Design Cross-sectional comparison of 2 methods of delivering a patient experience survey. Setting A large family health team in Toronto, Ont. Participants Family practice patients aged 18 or older who completed an e-mail survey between January and June 2014 (N = 587) or who completed the survey in the waiting room in July and August 2014 (N = 592). Main outcome measures Comparison of respondent demographic characteristics and responses to questions related to access and patient-centredness. Results Patients responding to the e-mail survey were more likely to live in higher-income neighbourhoods (P = .0002), be between the ages of 35 and 64 (P = .0147), and be female (P = .0434) compared with those responding to the waiting room survey; there were no significant differences related to self-rated health. The differences in neighbourhood income were noted despite minimal differences between patients with and without e-mail addresses included in their medical records. There were few differences in responses to the survey questions between the 2 survey methods and any differences were explained by the underlying differences in patient demographic characteristics. Conclusion Our findings suggest that respondent demographic characteristics might differ depending on the method of survey delivery, and these differences might affect survey responses. Methods of delivering patient experience surveys that require electronic literacy might underrepresent patients living in low-income neighbourhoods. Practices should consider evaluating for nonresponse bias and adjusting for patient demographic characteristics when interpreting survey results. Further research is needed to understand how primary care practices can optimize electronic survey delivery methods to survey a representative sample of patients. PMID:27965350

Access control and privilege management in electronic health record: a systematic literature review.

PubMed

Jayabalan, Manoj; O'Daniel, Thomas

2016-12-01

This study presents a systematic literature review of access control for electronic health record systems to protect patient's privacy. Articles from 2006 to 2016 were extracted from the ACM Digital Library, IEEE Xplore Digital Library, Science Direct, MEDLINE, and MetaPress using broad eligibility criteria, and chosen for inclusion based on analysis of ISO22600. Cryptographic standards and methods were left outside the scope of this review. Three broad classes of models are being actively investigated and developed: access control for electronic health records, access control for interoperability, and access control for risk analysis. Traditional role-based access control models are extended with spatial, temporal, probabilistic, dynamic, and semantic aspects to capture contextual information and provide granular access control. Maintenance of audit trails and facilities for overriding normal roles to allow full access in emergency cases are common features. Access privilege frameworks utilizing ontology-based knowledge representation for defining the rules have attracted considerable interest, due to the higher level of abstraction that makes it possible to model domain knowledge and validate access requests efficiently.

Open-Access Electronic Textbooks: An Overview

ERIC Educational Resources Information Center

Ovadia, Steven

2011-01-01

Given the challenging economic climate in the United States, many academics are looking to open-access electronic textbooks as a way to provide students with traditional textbook content at a more financially advantageous price. Open access refers to "the free and widely available information throughout the World Wide Web. Once an article's…

Fast probe of local electronic states in nanostructures utilizing a single-lead quantum dot

PubMed Central

Otsuka, Tomohiro; Amaha, Shinichi; Nakajima, Takashi; Delbecq, Matthieu R.; Yoneda, Jun; Takeda, Kenta; Sugawara, Retsu; Allison, Giles; Ludwig, Arne; Wieck, Andreas D.; Tarucha, Seigo

2015-01-01

Transport measurements are powerful tools to probe electronic properties of solid-state materials. To access properties of local electronic states in nanostructures, such as local density of states, electronic distribution and so on, micro-probes utilizing artificial nanostructures have been invented to perform measurements in addition to those with conventional macroscopic electronic reservoirs. Here we demonstrate a new kind of micro-probe: a fast single-lead quantum dot probe, which utilizes a quantum dot coupled only to the target structure through a tunneling barrier and fast charge readout by RF reflectometry. The probe can directly access the local electronic states with wide bandwidth. The probe can also access more electronic states, not just those around the Fermi level, and the operations are robust against bias voltages and temperatures. PMID:26416582

Development of Electronic Resources across Networks in Thailand.

ERIC Educational Resources Information Center

Ratchatavorn, Phandao

2002-01-01

Discusses the development of electronic resources across library networks in Thailand to meet user needs, particularly electronic journals. Topics include concerns about journal access; limited budgets for library acquisitions of journals; and sharing resources through a centralized database system that allows Web access to journals via Internet…

How do primary care physicians seek answers to clinical questions? A literature review.

PubMed

Coumou, Herma C H; Meijman, Frans J

2006-01-01

The authors investigated the extent to which changes occurred between 1992 and 2005 in the ways that primary care physicians seek answers to clinical problems. What search strategies are used? How much time is spent on them? How do primary care physicians evaluate various search activities and information sources? Can a clinical librarian be useful to a primary care physician? Twenty-one original research papers and three literature reviews were examined. No systematic reviews were identified. Primary care physicians seek answers to only a limited number of questions about which they first consult colleagues and paper sources. This practice has basically not changed over the years despite the enormous increase in and better accessibility to electronic information sources. One of the major obstacles is the time it takes to search for information. Other difficulties primary care physicians experience are related to formulating an appropriate search question, finding an optimal search strategy, and interpreting the evidence found. Some studies have been done on the supporting role of a clinical librarian in general practice. However, the effects on professional behavior of the primary care physician and on patient outcome have not been studied. A small group of primary care physicians prefer this support to developing their own search skills. Primary care physicians have several options for finding quick answers: building a question-and-answer database, consulting filtered information sources, or using an intermediary such as a clinical librarian.

How do primary care physicians seek answers to clinical questions? A literature review

PubMed Central

Coumou, Herma C. H.; Meijman, Frans J.

2006-01-01

Objectives: The authors investigated the extent to which changes occurred between 1992 and 2005 in the ways that primary care physicians seek answers to clinical problems. What search strategies are used? How much time is spent on them? How do primary care physicians evaluate various search activities and information sources? Can a clinical librarian be useful to a primary care physician? Methods: Twenty-one original research papers and three literature reviews were examined. No systematic reviews were identified. Results: Primary care physicians seek answers to only a limited number of questions about which they first consult colleagues and paper sources. This practice has basically not changed over the years despite the enormous increase in and better accessibility to electronic information sources. One of the major obstacles is the time it takes to search for information. Other difficulties primary care physicians experience are related to formulating an appropriate search question, finding an optimal search strategy, and interpreting the evidence found. Some studies have been done on the supporting role of a clinical librarian in general practice. However, the effects on professional behavior of the primary care physician and on patient outcome have not been studied. A small group of primary care physicians prefer this support to developing their own search skills. Discussion: Primary care physicians have several options for finding quick answers: building a question-and-answer database, consulting filtered information sources, or using an intermediary such as a clinical librarian. PMID:16404470

Primary care: current problems and proposed solutions.

PubMed

Bodenheimer, Thomas; Pham, Hoangmai H

2010-05-01

In 2005, approximately 400,000 people provided primary medical care in the United States. About 300,000 were physicians, and another 100,000 were nurse practitioners and physician assistants. Yet primary care faces a growing crisis, in part because increasing numbers of U.S. medical graduates are avoiding careers in adult primary care. Sixty-five million Americans live in what are officially deemed primary care shortage areas, and adults throughout the United States face difficulty obtaining prompt access to primary care. A variety of strategies are being tried to improve primary care access, even without a large increase in the primary care workforce.

Evaluation of Access, a Primary Care Program for Indigent Patients: Inpatient and Emergency Room Utilization.

ERIC Educational Resources Information Center

Davidson, Richard A.; Giancola, Angela; Gast, Andrea; Ho, Janice; Waddell, Rhondda

2003-01-01

Evaluated the impact of Accessing Community Care through Eastside Social Services (ACCESS), a program that provided indigent patients with free primary care, on inpatient admissions, emergency room (ER) visits, and subsequent charges. Data on 19 people before and after program enrollment showed significant decreases in ER visits following…

Biodiversity informatics: managing and applying primary biodiversity data.

PubMed Central

Soberón, Jorge; Peterson, A Townsend

2004-01-01

Recently, advances in information technology and an increased willingness to share primary biodiversity data are enabling unprecedented access to it. By combining presences of species data with electronic cartography via a number of algorithms, estimating niches of species and their areas of distribution becomes feasible at resolutions one to three orders of magnitude higher than it was possible a few years ago. Some examples of the power of that technique are presented. For the method to work, limitations such as lack of high-quality taxonomic determination, precise georeferencing of the data and availability of high-quality and updated taxonomic treatments of the groups must be overcome. These are discussed, together with comments on the potential of these biodiversity informatics techniques not only for fundamental studies but also as a way for developing countries to apply state of the art bioinformatic methods and large quantities of data, in practical ways, to tackle issues of biodiversity management. PMID:15253354

Potential access to primary health care: what does the National Program for Access and Quality Improvement data show?

PubMed Central

Uchôa, Severina Alice da Costa; Arcêncio, Ricardo Alexandre; Fronteira, Inês Santos Estevinho; Coêlho, Ardigleusa Alves; Martiniano, Claudia Santos; Brandão, Isabel Cristina Araújo; Yamamura, Mellina; Maroto, Renata Melo

2016-01-01

Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fisher's exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%). Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000), availability (p=0.0000), coordination of care (p=0.0000), integration (p=0.0000) and supply (p=0.0000), verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil. PMID:26959332

32 CFR Appendix A to Part 651 - References

Code of Federal Regulations, 2014 CFR

2014-07-01

... publications and forms are accessible from a variety of sources through the use of electronic media or paper products. In most cases, electronic publications and forms that are associated with military organizations can be accessed at various address or web sites on the Internet. Since electronic addresses can...

32 CFR Appendix A to Part 651 - References

Code of Federal Regulations, 2012 CFR

2012-07-01

... publications and forms are accessible from a variety of sources through the use of electronic media or paper products. In most cases, electronic publications and forms that are associated with military organizations can be accessed at various address or web sites on the Internet. Since electronic addresses can...

32 CFR Appendix A to Part 651 - References

Code of Federal Regulations, 2013 CFR

2013-07-01

... publications and forms are accessible from a variety of sources through the use of electronic media or paper products. In most cases, electronic publications and forms that are associated with military organizations can be accessed at various address or web sites on the Internet. Since electronic addresses can...

77 FR 67203 - Privacy Act of 1974; Republication of Systems of Records Notices

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-08

... file folders and on electronic media. RETRIEVABILITY: Accessed by name, tag number, and/or permit... DISPOSING OF RECORDS IN THE SYSTEM: STORAGE: Records are maintained on electronic media. RETRIEVABILITY... electronic media. RETRIEVABILITY: Records are accessed by individual action file number or by the name of the...

76 FR 56503 - Agency Information Collection Activity (VSO Access to VHA Electronic Health Records) Under OMB...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-13

... power of attorney by veterans who have medical information recorded in VHA electronic health records... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0710] Agency Information Collection Activity (VSO Access to VHA Electronic Health Records) Under OMB Review AGENCY: Veterans Health Administration...

Considerations regarding the deployment of hypermedia at JSC

NASA Technical Reports Server (NTRS)

Kacmar, Charles J.

1993-01-01

Electronic documents and systems are becoming the primary means of managing information for ground and space operations at NASA. These documents will utilize hypertext and hypermedia technologies to aid users in structuring and accessing information. Documents will be composed of static and dynamic data consisting of user-defined annotations and hypermedia links. The report consists of three major sections. First, it provides an overview of hypermedia and surveys the use of hypermedia throughout JSC. Second, it briefly describes a prototypical hypermedia system that was developed in conjunction with this work. This system was constructed to demonstrate various hypermedia features and to serve as a platform for supporting the electronic documentation needs for the MIDAS system developed by the Intelligent Systems Branch of the Automation and Robotics Division (Pac92). Third, it discusses emerging hypermedia technologies which have either been untapped by vendors or present significant challenges to the Agency.

The future of scientific communication in the earth sciences: The impact of the internet

USGS Publications Warehouse

Carr, T.R.; Buchanan, R.C.; Adkins-Heljeson, D.; Mettille, T.D.; Sorensen, J.

1997-01-01

Publication on paper of research results following peer-review and editing has been the accepted means of scientific communication for several centuries. Today, the continued growth in the volume of scientific literature, the increased unit costs of archiving paper publications, and the rapidly increasing power and availability of electronic technology are creating tremendous pressures on traditional scientific communication. The earth sciences are not immune from these pressures, and the role of the traditional publication as the primary means of communication is rapidly changing. Electronic publications and network technology are radically altering the relationship between interpretative result and the underlying data. Earth science research institutions, including the Kansas Geological Survey, are experimenting with new forms of on-line publication that assure broad access to research and data and improve application of research results to societal problems. ?? 1997 Elsevier Science Ltd.

Cryo-FIB specimen preparation for use in a cartridge-type cryo-TEM.

PubMed

He, Jie; Hsieh, Chyongere; Wu, Yongping; Schmelzer, Thomas; Wang, Pan; Lin, Ying; Marko, Michael; Sui, Haixin

2017-08-01

Cryo-electron tomography (cryo-ET) is a well-established technique for studying 3D structural details of subcellular macromolecular complexes and organelles in their nearly native context in the cell. A primary limitation of the application of cryo-ET is the accessible specimen thickness, which is less than the diameters of almost all eukaryotic cells. It has been shown that focused ion beam (FIB) milling can be used to prepare thin, distortion-free lamellae of frozen biological material for high-resolution cryo-ET. Commercial cryosystems are available for cryo-FIB specimen preparation, however re-engineering and additional fixtures are often essential for reliable results with a particular cryo-FIB and cryo-transmission electron microscope (cryo-TEM). Here, we describe our optimized protocol and modified instrumentation for cryo-FIB milling to produce thin lamellae and subsequent damage-free cryotransfer of the lamellae into our cartridge-type cryo-TEM. Published by Elsevier Inc.

The relationship between electronic gaming machine accessibility and police-recorded domestic violence: A spatio-temporal analysis of 654 postcodes in Victoria, Australia, 2005-2014.

PubMed

Markham, Francis; Doran, Bruce; Young, Martin

2016-08-01

An emerging body of research has documented an association between problem gambling and domestic violence in a range of study populations and locations. Yet little research has analysed this relationship at ecological scales. This study investigates the proposition that gambling accessibility and the incidence of domestic violence might be linked. The association between police-recorded domestic violence and electronic gaming machine accessibility is described at the postcode level. Police recorded family incidents per 10,000 and domestic-violence related physical assault offenses per 10,000 were used as outcome variables. Electronic gaming machine accessibility was measured as electronic gaming machines per 10,000 and gambling venues per 100,000. Bayesian spatio-temporal mixed-effects models were used to estimate the associations between gambling accessibility and domestic violence, using annual postcode-level data in Victoria, Australia between 2005 and 2014, adjusting for a range of covariates. Significant associations of policy-relevant magnitudes were found between all domestic violence and EGM accessibility variables. Postcodes with no electronic gaming machines were associated with 20% (95% credibility interval [C.I.]: 15%, 24%) fewer family incidents per 10,000 and 30% (95% C.I.: 24%, 35%) fewer domestic-violence assaults per 10,000, when compared with postcodes with 75 electronic gaming machine per 10,000. The causal relations underlying these associations are unclear. Quasi-experimental research is required to determine if reducing gambling accessibility is likely to reduce the incidence of domestic violence. Copyright © 2016 Elsevier Ltd. All rights reserved.

48 CFR 401.170 - Electronic access to regulatory information.

Code of Federal Regulations, 2010 CFR

2010-10-01

... access to regulatory information. The USDA Departmental Administration Procurement Homepage provides... guidance in electronic form. The Internet address for the Procurement Homepage is URL http://www.usda.gov...

Keeping Current: The Digital Divide: Can School Library Media Specialists Help Build the Bridge?

ERIC Educational Resources Information Center

Barron, Daniel D.

2000-01-01

Discusses the growth of electronic commerce as well as electronic education and suggests ways that schools and public libraries can help overcome inequity of access. Highlights include access to the Internet and computers; educational levels; Blacks; race and ethnic origin; rural access; use of the Internet; and income. (LRW)

Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study.

PubMed

O'Donnell, Patrick; Tierney, Edel; O'Carroll, Austin; Nurse, Diane; MacFarlane, Anne

2016-12-03

The involvement of patients and the public in healthcare has grown significantly in recent decades and is documented in health policy documents internationally. Many benefits of involving these groups in primary care planning have been reported. However, these benefits are rarely felt by those considered marginalised in society and they are often excluded from participating in the process of planning primary care. It has been recommended to employ suitable approaches, such as co-operative and participatory initiatives, to enable marginalised groups to highlight their priorities for care. This Participatory Learning and Action (PLA) research study involved 21 members of various marginalised groups who contributed their views about access to primary care. Using a series of PLA techniques for data generation and co-analysis, we explored barriers and facilitators to primary healthcare access from the perspective of migrants, Irish Travellers, homeless people, drug users, sex workers and people living in deprivation, and identified their priorities for action with regard to primary care provision. Four overarching themes were identified: the home environment, the effects of the 'two-tier' healthcare system on engagement, healthcare encounters, and the complex health needs of many in those groups. The study demonstrates that there are many complicated personal and structural barriers to accessing primary healthcare for marginalised groups. There were shared and differential experiences across the groups. Participants also expressed shared priorities for action in the planning and running of primary care services. Members of marginalised groups have shared priorities for action to improve their access to primary care. If steps are taken to address these, there is scope to impact on more than one marginalised group and to address the existing health inequities.

The association between EHRs and care coordination varies by team cohesion.

PubMed

Graetz, Ilana; Reed, Mary; Shortell, Stephen M; Rundall, Thomas G; Bellows, Jim; Hsu, John

2014-02-01

To examine whether primary care team cohesion changes the association between using an integrated outpatient-inpatient electronic health record (EHR) and clinician-rated care coordination across delivery sites. Self-administered surveys of primary care clinicians in a large integrated delivery system, collected in 2005 (N=565), 2006 (N=678), and 2008 (N=626) during the staggered implementation of an integrated EHR (2005-2010), including validated questions on team cohesion. Using multivariable regression, we examined the combined effect of EHR use and team cohesion on three dimensions of care coordination across delivery sites: access to timely and complete information, treatment agreement, and responsibility agreement. Among clinicians working in teams with higher cohesion, EHR use was associated with significant improvements in reported access to timely and complete information (53.5 percent with EHR vs. 37.6 percent without integrated-EHR), agreement on treatment goals (64.3 percent vs. 50.6 percent), and agreement on responsibilities (63.9 percent vs. 55.2 percent, all p<.05). We found no statistically significant association between use of the integrated-EHR and reported care coordination in less cohesive teams. The association between EHR use and reported care coordination varied by level of team cohesion. EHRs may not improve care coordination in less cohesive teams. © Health Research and Educational Trust.

Capitation funding of primary health organisations in New Zealand: are enrolled populations being funded according to need?

PubMed

Langton, Jennifer; Crampton, Peter

2008-04-18

To determine whether the three main funding formulas for Primary Health Organisations achieved a stated aim of the Primary Health Care Strategy to fund enrolled populations according to need. National data were obtained from the Ministry of Health for a 12-month period beginning in April 2004: these included demographic characteristics of the enrolled Primary Health Organisation population, plus rates tables for: First-Contact Services, Services to Improve Access, and Health Promotion. Funding for Access and Interim practices for four-quarters was calculated for each of these three funding streams. Analysis of the demographic characteristics of Access and Interim practices was undertaken. Maori and Pacific peoples made up a greater proportion of the Access population than the Interim, had higher rates of deprivation than the non-Maori/non-Pacific population, and demonstrated a younger age distribution. The first quarter (April 2004-June 2004) showed there was preferential funding for Access PHOs and in particular high-needs groups. In quarter two, this level of preferential funding had diminished, coinciding with the introduction of increased government funding for all Interim enrolees aged 65 and over. The greater funding for Access enrolees was notably eroded with the introduction of Access-level funding for those aged 65+ in Interim PHOs. Since these data were analysed all remaining Interim age groups have shifted to Access-level funding, benefiting non-Maori /non-Pacific in Interim PHOs. The rapid shift to Access-level funding for First Contact Services has seen a continued erosion of the redistributive effect of the original needs-based formulas. A system cannot be considered equitable if some members of society are not realising their health potential, and financing of primary care should remain redistributive until such a time as this objective is attained.

Accessible Electronic and Information Technology

EPA Pesticide Factsheets

This Policy establishes EPA's responsibilities and procedures for making its Electronic and Information Technology (EIT) products accessible to all people, including people with disabilities, in accordance with Section 508 of the Rehabilitation Act.

Public Funding of Primary Education in Kenya: Recent Tends, Challenges, and Implications for the Future.

ERIC Educational Resources Information Center

Mukudi, Edith

1999-01-01

Kenyan primary education is plagued by problems of high attrition and gender and regional disparities in access and achievement. Poverty, institutionalized corruption, and declining public funding are primary factors. More funding is needed for teacher salaries, infrastructure development, and improved educational access. (Contains 23 references.)…

Electronic surveillance and using administrative data to identify healthcare associated infections.

PubMed

Gastmeier, Petra; Behnke, Michael

2016-08-01

Traditional surveillance of healthcare associated infections (HCAI) is time consuming and error-prone. We have analysed literature of the past year to look at new developments in this field. It is divided into three parts: new algorithms for electronic surveillance, the use of administrative data for surveillance of HCAI, and the definition of new endpoints of surveillance, in accordance with an automatic surveillance approach. Most studies investigating electronic surveillance of HCAI have concentrated on bloodstream infection or surgical site infection. However, the lack of important parameters in hospital databases can lead to misleading results. The accuracy of administrative coding data was poor at identifying HCAI. New endpoints should be defined for automatic detection, with the most crucial step being to win clinicians' acceptance. Electronic surveillance with conventional endpoints is a successful method when hospital information systems implemented key changes and enhancements. One requirement is the access to systems for hospital administration and clinical databases.Although the primary source of data for HCAI surveillance is not administrative coding data, these are important components of a hospital-wide programme of automated surveillance. The implementation of new endpoints for surveillance is an approach which needs to be discussed further.

29 CFR 14.22 - Availability of classified information to persons not employed by the Department of Labor.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Officer. (b) Access to Top Secret material. Access to Top Secret Information within the primary organizational units of the DOL by employees of other Federal agencies must be approved in advance by the Top Secret Control Officer of the primary organizational unit. (c) Access to Secret and Confidential...

Readiness for the Patient-Centered Medical Home: Structural Capabilities of Massachusetts Primary Care Practices

PubMed Central

Friedberg, Mark W.; Safran, Dana G.; Coltin, Kathryn L.; Dresser, Marguerite

2008-01-01

Background The Patient-Centered Medical Home (PCMH), a popular model for primary care reorganization, includes several structural capabilities intended to enhance quality of care. The extent to which different types of primary care practices have adopted these capabilities has not been previously studied. Objective To measure the prevalence of recommended structural capabilities among primary care practices and to determine whether prevalence varies among practices of different size (number of physicians) and administrative affiliation with networks of practices. Design Cross-sectional analysis. Participants One physician chosen at random from each of 412 primary care practices in Massachusetts was surveyed about practice capabilities during 2007. Practice size and network affiliation were obtained from an existing database. Measurements Presence of 13 structural capabilities representing 4 domains relevant to quality: patient assistance and reminders, culture of quality, enhanced access, and electronic health records (EHRs). Main Results Three hundred eight (75%) physicians responded, representing practices with a median size of 4 physicians (range 2–74). Among these practices, 64% were affiliated with 1 of 9 networks. The prevalence of surveyed capabilities ranged from 24% to 88%. Larger practice size was associated with higher prevalence for 9 of the 13 capabilities spanning all 4 domains (P < 0.05). Network affiliation was associated with higher prevalence of 5 capabilities (P < 0.05) in 3 domains. Associations were not substantively altered by statistical adjustment for other practice characteristics. Conclusions Larger and network-affiliated primary care practices are more likely than smaller, non-affiliated practices to have adopted several recommended capabilities. In order to achieve PCMH designation, smaller non-affiliated practices may require the greatest investments. Electronic supplementary material The online version of this article (doi:10.1007/s11606-008-0856-x) contains supplementary material, which is available to authorized users. PMID:19050977

22 CFR 503.9 - Electronic records.

Code of Federal Regulations, 2012 CFR

2012-04-01

... electronically by accessing the BBG's Home Page via the Internet at http://www.ibb.gov. To set up an appointment to view such records in hard copy or to access the Internet via the BBG's computer, please contact... copying, both electronically via the Internet and in hard copy, those records that have been previously...

22 CFR 503.9 - Electronic records.

Code of Federal Regulations, 2013 CFR

2013-04-01

... electronically by accessing the BBG's Home Page via the Internet at http://www.ibb.gov. To set up an appointment to view such records in hard copy or to access the Internet via the BBG's computer, please contact... copying, both electronically via the Internet and in hard copy, those records that have been previously...

22 CFR 503.9 - Electronic records.

Code of Federal Regulations, 2014 CFR

2014-04-01

... electronically by accessing the BBG's Home Page via the Internet at http://www.ibb.gov. To set up an appointment to view such records in hard copy or to access the Internet via the BBG's computer, please contact... copying, both electronically via the Internet and in hard copy, those records that have been previously...

Individuals with Access and Functional Needs

MedlinePlus

... online tool helps people locate and access their electronic health records from a variety of sources. Plan ... Social Security or other regular benefits, switching to electronic payments is a simple, significant way to protect ...

Brain imaging before primary lung cancer resection: a controversial topic.

PubMed

Hudson, Zoe; Internullo, Eveline; Edey, Anthony; Laurence, Isabel; Bianchi, Davide; Addeo, Alfredo

2017-01-01

International and national recommendations for brain imaging in patients planned to undergo potentially curative resection of non-small-cell lung cancer (NSCLC) are variably implemented throughout the United Kingdom [Hudson BJ, Crawford MB, and Curtin J et al (2015) Brain imaging in lung cancer patients without symptoms of brain metastases: a national survey of current practice in England Clin Radiol https://doi.org/10.1016/j.crad.2015.02.007]. However, the recommendations are not based on high-quality evidence and do not take into account cost implications and local resources. Our aim was to determine local practice based on historic outcomes in this patient cohort. This retrospective study took place in a regional thoracic surgical centre in the United Kingdom. Pathology records for all patients who had undergone lung resection with curative intent during the time period January 2012-December 2014 were analysed in October 2015. Electronic pathology and radiology reports were accessed for each patient and data collected about their histological findings, TNM stage, resection margins, and the presence of brain metastases on either pre-operative or post-operative imaging. From the dates given on imaging, we calculated the number of days post-resection that the brain metastases were detected. 585 patients were identified who had undergone resection of their lung cancer. Of these, 471 had accessible electronic radiology records to assess for the radiological evidence of brain metastases. When their electronic records were evaluated, 25/471 (5.3%) patients had radiological evidence of brain metastasis. Of these, five patients had been diagnosed with a brain metastasis at initial presentation and had undergone primary resection of the brain metastasis followed by resection of the lung primary. One patient had been diagnosed with both a primary lung and a primary bowel adenocarcinoma; on review of the case, it was felt that the brain metastasis was more likely to have originated from the bowel cancer. One had been clinically diagnosed with a cerebral abscess while the radiology had been reported as showing a metastatic deposit. Of the remaining 18/471 (3.8%) patients who presented with brain metastases after their surgical resection, 12 patients had adenocarcinoma, four patients had squamous cell carcinoma, one had basaloid, and one had large-cell neuroendocrine. The mean number of days post-resection that the brain metastases were identified was 371 days, range 14-1032 days, median 295 days (date of metastases not available for two patients). The rate of brain metastases identified in this study was similar to previous studies. This would suggest that preoperative staging of the central nervous system may change the management pathway in a small group of patients. However, for this group of patients, the change would be significant either sparing them non-curative surgery or allowing aggressive management of oligometastatic disease. Therefore, we would recommend pre-operative brain imaging with MRI for all patients undergoing potentially curative lung resection.

Considering disparities: How do nurse practitioner regulatory policies, access to care, and health outcomes vary across four states?

PubMed

Sonenberg, Andréa; Knepper, Hillary J

Health disparities persist among morbidity and mortality rates in the United States. Contributing significantly to these disparities are the ability to pay for health care (largely, access to health insurance) and access to, and capacity of, the primary care health workforce. This article examines key determinants of health (DOH) including demographics, public and regulatory policies, health workforce capacity, and primary health outcomes of four states of the United States. The context of this study is the potential association among health care disparities and myriad DOH, among them, the restrictive nurse practitioner (NP) scope of practice (SOP) regulatory environment, which are documented to influence access to care and health outcomes. This descriptive study explores current NP SOP regulations, access to primary care, and health outcomes of key chronic disease indicators-diabetes, hypertension, and obesity in Alabama, Colorado, Mississippi, and Utah. These states represent both the greatest disparity in chronic disease health outcomes (obesity, diabetes, and hypertension) and the greatest difference in modernization of their NP SOP laws. The Affordable Care Act has greatly expanded access to health care. However, it is estimated that 23 million Americans, 7% of its total population, will remain uninsured by 2019. Restrictive and inconsistent NP SOP policies may continue to contribute to health workforce capacity and population health disparities across the country, with particular concern for primary care indicators. The study findings bring into question whether states with more restrictive NP SOP regulations impact access to primary care, which may in turn influence population health outcomes. These findings suggest the need for further research. NPs are essential for meeting the increasing demands of primary care in the United States, and quality-of-care indicator research supports their use. Copyright © 2016 Elsevier Inc. All rights reserved.

Publishing Accessible Materials on the Web and CD-ROM.

ERIC Educational Resources Information Center

Federal Resource Center for Special Education, Washington, DC.

While it is generally simple to make electronic content accessible, it is also easy inadvertently to make it inaccessible. This guide covers the many formats of electronic documents and points out what to keep in mind and what procedures to follow to make documents accessible to all when disseminating information via the World Wide Web and on…

The Primary Care Electronic Library (PCEL) five years on: open source evaluation of usage.

PubMed

Robinson, Judas; de Lusignan, Simon; Kostkova, Patty

2005-01-01

The Primary Care Electronic Library (PCEL) is a collection of indexed and abstracted internet resources. PCEL contains a directory of quality-assured internet material with associated search facilities. PCEL has been indexed, using metadata and established taxonomies. Site development requires an understanding of usage; this paper reports the use of open source tools to evaluate usage. This evaluation was conducted during a six-month period of development of PCEL. To use open source to evaluate changes in usage of an electronic library. We defined data we needed for analysis; this included: page requests, visits, unique visitors, page requests per visit, geographical location of users, NHS users, chronological information about users and resources used. During the evaluation period, page requests increased from 3500 to 10,000; visits from 1250 to 2300; and unique visitors from 750 to 1500. Up to 83% of users come from the UK, 15% were NHS users. The page requests of NHS users are slowly increasing but not as fast as requests by other users in the UK. PCEL is primarily used Monday to Friday, 9 a.m. to 5 p.m. Monday is the busiest day with use lessening through the week. NHS users had a different list of top ten resources accessed than non-NHS users, with only four resources appearing in both. Open source tools provide useful data which can be used to evaluate online resources. Improving the functionality of PCEL has been associated with increased use.

Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou, China

PubMed Central

Zeng, Jiazhi; Shi, Leiyu; Zou, Xia; Chen, Wen; Ling, Li

2015-01-01

Objectives China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants’ experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China. Methods The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool—Adult Short Version (PCAT-AS), representing 10 primary care domains was used to collect information on migrants’ quality of primary care experiences. These domains include first contact (utilization), first contact (accessibility), ongoing care, coordination (referrals), coordination (information systems), comprehensiveness (services available), comprehensiveness (services provided), family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients’ perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores. Results After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49) reported the highest PCAT total scores, followed by municipal hospitals (25.02), community health centers/community health stations (24.24), and township health centers/rural health stations (24.18). Tertiary hospital users reported significantly better performance in first contact (utilization), first contact (accessibility), coordination (information system), comprehensiveness (service available), and cultural competence. Community health center/community health station users reported significantly better experience in the community orientation domain. Township health center/rural health station users expressed significantly better experience in the ongoing care domain. There were no statistically significant differences across settings in the ongoing care, comprehensiveness (services provided), and family-centeredness domains. Multiple linear regression models showed that factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P<0.001). Conclusions This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care. PMID:26474161

Access to Education in Bangladesh: Country Analytic Review of Primary and Secondary School

ERIC Educational Resources Information Center

Ahmed, Manzoor; Ahmed, Kazi Saleh; Khan, Nurul Islam; Ahmed, Romij

2007-01-01

This country analytical review examines the key issues in access to and participation in primary and secondary education in Bangladesh, with a special focus on areas and dimensions of exclusion. Against a background of overall progress, particularly in closing the gender gap in primary and secondary enrollment, the research applies a conceptual…

Using Wearable Computers in Shuttle Processing: A Feasibility Study

NASA Technical Reports Server (NTRS)

Centeno, Martha A.; Correa, Daisy; Groh-Hammond, Marcia

2001-01-01

Shuttle processing operations are performed following prescribed instructions compiled in a Work Authorization Document (WAD). Until very recently, WADs were printed so that they could be properly executed, including the buy off of each and every step by the appropriate authorizing agent. However, with the development of EPICs, Maximo, and PeopleSoft applications, some of these documents are now available in electronic format; hence, it is possible for technicians and engineers to access them on line and buy off the steps electronically. To take full advantage of these developments, technicians need access to such documents at the point of job execution. Body wearable computers present an opportunity to develop a WAD delivery system that enables access while preserving technician's mobility, safety levels, and quality of work done. The primary objectives of this project were to determine if body wearable computers are a feasible delivery system for WADs. More specifically, identify and recommend specific brands of body wearable computers readily available on the market. Thus, this effort has field-tested this technology in two areas of shuttle processing, and it has examined the usability of the technology. Results of two field tests and a Human Factors Usability Test are presented. Section 2 provides a description of the body wearable computer technology. Section 3 presents the test at the Space Shuttle Main Engine (SSME) Shop. Section 4 presents the results of the integration test at the Solid Rocket Boosters Assembly and Refurbishing Facility (SRBARF). Section 5 presents the results of the usability test done at the Operations Support Building (OSB).

Epilepsy in Ireland: towards the primary-tertiary care continuum.

PubMed

Varley, Jarlath; Delanty, Norman; Normand, Charles; Coyne, Imelda; McQuaid, Louise; Collins, Claire; Boland, Michael; Grimson, Jane; Fitzsimons, Mary

2010-01-01

Epilepsy is a chronic neurological disease affecting people of every age, gender, race and socio-economic background. The diagnosis and optimal management relies on contribution from a number of healthcare disciplines in a variety of healthcare settings. To explore the interface between primary care and specialist epilepsy services in Ireland. Using appreciative inquiry, focus groups were held with healthcare professionals (n=33) from both primary and tertiary epilepsy specialist services in Ireland. There are significant challenges to delivering a consistent high standard of epilepsy care in Ireland. The barriers that were identified are: the stigma of epilepsy, unequal access to care services, insufficient human resources, unclear communication between primary-tertiary services and lack of knowledge. Improving the management of people with epilepsy requires reconfiguration of the primary-tertiary interface and establishing clearly defined roles and formalised clinical pathways. Such initiatives require resources in the form of further education and training and increased usage of information communication technology (ICT). Epilepsy services across the primary-tertiary interface can be significantly enhanced through the implementation of a shared model of care underpinned by an electronic patient record (EPR) system and information communication technology (ICT). Better chronic disease management has the potential to halt the progression of epilepsy with ensuing benefits for patients and the healthcare system. Copyright 2009 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Computational Model Tracking Primary Electrons, Secondary Electrons, and Ions in the Discharge Chamber of an Ion Engine

NASA Technical Reports Server (NTRS)

Mahalingam, Sudhakar; Menart, James A.

2005-01-01

Computational modeling of the plasma located in the discharge chamber of an ion engine is an important activity so that the development and design of the next generation of ion engines may be enhanced. In this work a computational tool called XOOPIC is used to model the primary electrons, secondary electrons, and ions inside the discharge chamber. The details of this computational tool are discussed in this paper. Preliminary results from XOOPIC are presented. The results presented include particle number density distributions for the primary electrons, the secondary electrons, and the ions. In addition the total number of a particular particle in the discharge chamber as a function of time, electric potential maps and magnetic field maps are presented. A primary electron number density plot from PRIMA is given in this paper so that the results of XOOPIC can be compared to it. PRIMA is a computer code that the present investigators have used in much of their previous work that provides results that compare well to experimental results. PRIMA only models the primary electrons in the discharge chamber. Modeling ions and secondary electrons, as well as the primary electrons, will greatly increase our ability to predict different characteristics of the plasma discharge used in an ion engine.

Accessible Electronic and Information Technology: Standards, Procedures, and Guidance

EPA Pesticide Factsheets

Defines electronic and information technology (EIT), and the technical and functional performance criteria for EIT to comply with Section 508 accessibility standards. Includes EPA procedures for EIT approval, 508 complaints, and undue burden justification.

An Introduction to Services Accessible on the Internet.

ERIC Educational Resources Information Center

Giguere, Marlene

1992-01-01

Provides an overview of the INTERNET and INTERNET services of interest to libraries, including electronic mail, bulletin boards, electronic publishing, online public access catalogs and databases, and downloaded texts and software. (16 references) (MES)

Gender and access in the African school

NASA Astrophysics Data System (ADS)

Adams, Milton N.; Kruppenbach, Susan E.

1987-12-01

The educational system in major parts of Africa, where post-primary enrolment rates are the lowest in the world, is treated in this article. In particular, female access patterns to formal education in Botswana, Liberia, Niger and Somalia are compared. One primary conclusion reached by the authors is that enrolment levels are linked with general economic development. Factors leading to the comparatively high rate of females having gained access to a primary level of education on the one hand, and a very low rate of post-primary enrolment on the other, are discussed and the following issues are touched on: the marginal link between school expansion policies and actual female enrolment, and their predominance in the urban sector.

Electronic access to scientific nursing knowledge: the Virginia Henderson International Nursing Library.

PubMed

Graves, J R

2001-02-01

To inform oncology nurses about the electronic knowledge resources offered by the Sigma Theta Tau International Virginia Henderson International Nursing Library. Published articles and research studies. Clinical nursing research dissemination has been seriously affected by publication bias. The Virginia Henderson International Nursing Library has introduced both a new publishing paradigm for research and a new knowledge indexing strategy for improving electronic access to research knowledge (findings). The ability of oncology nursing to evolve, as an evidence-based practice, is largely dependent on access to research findings.

EARS: Electronic Access to Reference Service.

PubMed Central

Weise, F O; Borgendale, M

1986-01-01

Electronic Access to Reference Service (EARS) is a front end to the Health Sciences Library's electronic mail system, with links to the online public catalog. EARS, which became operational in September 1984, is accessed by users at remote sites with either a terminal or microcomputer. It is menu-driven, allowing users to request: a computerized literature search, reference information, a photocopy of a journal article, or a book. This paper traces the history of EARS and discusses its use, its impact on library staff and services, and factors that influence the diffusion of new technology. PMID:3779167

EARS: Electronic Access to Reference Service.

PubMed

Weise, F O; Borgendale, M

1986-10-01

Electronic Access to Reference Service (EARS) is a front end to the Health Sciences Library's electronic mail system, with links to the online public catalog. EARS, which became operational in September 1984, is accessed by users at remote sites with either a terminal or microcomputer. It is menu-driven, allowing users to request: a computerized literature search, reference information, a photocopy of a journal article, or a book. This paper traces the history of EARS and discusses its use, its impact on library staff and services, and factors that influence the diffusion of new technology.

Learners on the Superhighway? Access to Learning via Electronic Communications. Winston Churchill Fellowship Report.

ERIC Educational Resources Information Center

Yeomans, Keith

Policymakers and practitioners in electronic communication and education in the United States and Canada were interviewed to identify those policies, strategies, and models of good practice used to increase access to learning via electronic communications that are relevant to the United Kingdom and Europe. Information was gathered from 5 experts…

Accessibility and Use of Web-Based Electronic Resources by Physicians in a Psychiatric Institution in Nigeria

ERIC Educational Resources Information Center

Oduwole, Adebambo Adewale; Oyewumi, Olatundun

2010-01-01

Purpose: This study aims to examine the accessibility and use of web-based electronic databases on the Health InterNetwork Access to Research Initiative (HINARI) portal by physicians in the Neuropsychiatric Hospital, Aro--a psychiatry health institution in Nigeria. Design/methodology/approach: Collection of data was through the use of a three-part…

A future for primary care for the Greek population.

PubMed

Groenewegen, Peter P; Jurgutis, Arnoldas

2013-01-01

Greece is hit hard by the state debt crisis. This calls for comprehensive reforms to restore sustainable and balanced growth. Healthcare is one of the public sectors needing reform. The European Union (EU) Task Force for Greece asked the authors to assess the situation of primary care and to make recommendations for reform. Primary healthcare is especially relevant in that it might increase the efficiency of the healthcare system, and improve access to good quality healthcare. Assessment of the state of primary care in Greece was made on the basis of existing literature, site visits in primary care and consultations with stakeholders. The governance of primary care (and healthcare in general) is fragmented. There is no system of gatekeeping or patient lists. Private payments (formal and informal) are high. There are too many physicians, but too few general practitioners and nurses, and they are unevenly spread across the country. As a consequence, there are problems of access, continuity, co-ordination and comprehensiveness of primary care. The authors recommend the development of a clear vision and development strategy for strengthening primary care. Stepped access to secondary care should be realised through the introduction of mandatory referrals. Primary care should be accessible through the lowest possible out-of-pocket payments. The roles of purchaser and provider of care should be split. Quality of care should be improved through development of clinical guidelines and quality indicators. The education of health professionals should put more emphasis on primary care and medical specialists working in primary care should be (re-)trained to acquire the necessary competences to satisfy the job descriptions to be developed for primary care professionals. The advantages of strong primary care should be communicated to patients and the wider public.

Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study.

PubMed

Bello, Aminu K; Molzahn, Anita E; Girard, Louis P; Osman, Mohamed A; Okpechi, Ikechi G; Glassford, Jodi; Thompson, Stephanie; Keely, Erin; Liddy, Clare; Manns, Braden; Jinda, Kailash; Klarenbach, Scott; Hemmelgarn, Brenda; Tonelli, Marcello

2017-03-02

We assessed stakeholder perceptions on the use of an electronic consultation system (e-Consult) to improve the delivery of kidney care in Alberta. We aim to identify acceptability, barriers and facilitators to the use of an e-Consult system for ambulatory kidney care delivery. This was a qualitative focus group study using a thematic analysis design. Eight focus groups were held in four locations in the province of Alberta, Canada. In total, there were 72 participants in two broad stakeholder categories: patients (including patients' relatives) and providers (including primary care physicians, nephrologists, other care providers and policymakers). The e-Consult system was generally acceptable across all stakeholder groups. The key barriers identified were length of time required for referring physicians to complete the e-Consult due to lack of integration with current electronic medical records, and concerns that increased numbers of requests might overwhelm nephrologists and lead to a delayed response or an unsustainable system. The key facilitators identified were potential improvement of care coordination, dissemination of best practice through an educational platform, comprehensive data to make decisions without the need for face-to-face consultation, timely feedback to primary care providers, timeliness/reduced delays for patients' rapid triage and identification of cases needing urgent care and improved access to information to facilitate decision-making in patient care. Stakeholder perceptions regarding the e-Consult system were favourable, and the key barriers and facilitators identified will be considered in design and implementation of an acceptable and sustainable electronic consultation system for kidney care delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Shaping the Values of Youth: Sunday School Books in 19th Century America

Science.gov Websites

develop accessible digital/electronic collections, unfortunately, not all are. The MSU Libraries are able to provide remediated, accessible versions of digital/electronic library documents to library users

The Impact of Electronic Health Records on Workflow and Financial Measures in Primary Care Practices

PubMed Central

Fleming, Neil S; Becker, Edmund R; Culler, Steven D; Cheng, Dunlei; McCorkle, Russell; da Graca, Briget; Ballard, David J

2014-01-01

Objective To estimate a commercially available ambulatory electronic health record’s (EHR’s) impact on workflow and financial measures. Data Sources/Study Setting Administrative, payroll, and billing data were collected for 26 primary care practices in a fee-for-service network that rolled out an EHR on a staggered schedule from June 2006 through December 2008. Study Design An interrupted time series design was used. Staffing, visit intensity, productivity, volume, practice expense, payments received, and net income data were collected monthly for 2004–2009. Changes were evaluated 1–6, 7–12, and >12 months postimplementation. Data Collection/Extraction Methods Data were accessed through a SQLserver database, transformed into SAS®, and aggregated by practice. Practice-level data were divided by full-time physician equivalents for comparisons across practices by month. Principal Findings Staffing and practice expenses increased following EHR implementation (3 and 6 percent after 12 months). Productivity, volume, and net income decreased initially but recovered to/close to preimplementation levels after 12 months. Visit intensity did not change significantly, and a secular trend offset the decrease in payments received. Conclusions Expenses increased and productivity decreased following EHR implementation, but not as much or as persistently as might be expected. Longer term effects still need to be examined. PMID:24359533

Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine.

PubMed

Tai-Seale, Ming; Olson, Cliff W; Li, Jinnan; Chan, Albert S; Morikawa, Criss; Durbin, Meg; Wang, Wei; Luft, Harold S

2017-04-01

Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians' use of time. We used data on physicians' time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients' EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine consists of activities such as communicating with patients through a secure patient portal, responding to patients' online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine. Staffing and scheduling in the physician's office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts. Project HOPE—The People-to-People Health Foundation, Inc.

Optimising the use of observational electronic health record data: Current issues, evolving opportunities, strategies and scope for collaboration.

PubMed

Liaw, Siaw-Teng; Powell-Davies, Gawaine; Pearce, Christopher; Britt, Helena; McGlynn, Lisa; Harris, Mark F

2016-03-01

With increasing computerisation in general practice, national primary care networks are mooted as sources of data for health services and population health research and planning. Existing data collection programs - MedicinesInsight, Improvement Foundation, Bettering the Evaluation and Care of Health (BEACH) - vary in purpose, governance, methodologies and tools. General practitioners (GPs) have significant roles as collectors, managers and users of electronic health record (EHR) data. They need to understand the challenges to their clinical and managerial roles and responsibilities. The aim of this article is to examine the primary and secondary use of EHR data, identify challenges, discuss solutions and explore directions. Representatives from existing programs, Medicare Locals, Local Health Districts and research networks held workshops on the scope, challenges and approaches to the quality and use of EHR data. Challenges included data quality, interoperability, fragmented governance, proprietary software, transparency, sustainability, competing ethical and privacy perspectives, and cognitive load on patients and clinicians. Proposed solutions included effective change management; transparent governance and management of intellectual property, data quality, security, ethical access, and privacy; common data models, metadata and tools; and patient/community engagement. Collaboration and common approaches to tools, platforms and governance are needed. Processes and structures must be transparent and acceptable to GPs.

41 CFR 102-76.70 - When are the costs of alterations to provide an accessible path of travel to an altered area...

Code of Federal Regulations, 2013 CFR

2013-07-01

... alterations to provide an accessible path of travel to an altered area containing a primary function... to an altered area containing a primary function disproportionate to the costs of the overall... area containing a primary function are disproportionate to the costs of the overall alterations when...

41 CFR 102-76.70 - When are the costs of alterations to provide an accessible path of travel to an altered area...

Code of Federal Regulations, 2010 CFR

2010-07-01

... alterations to provide an accessible path of travel to an altered area containing a primary function... to an altered area containing a primary function disproportionate to the costs of the overall... area containing a primary function are disproportionate to the costs of the overall alterations when...

41 CFR 102-76.70 - When are the costs of alterations to provide an accessible path of travel to an altered area...

Code of Federal Regulations, 2014 CFR

2014-01-01

... alterations to provide an accessible path of travel to an altered area containing a primary function... to an altered area containing a primary function disproportionate to the costs of the overall... area containing a primary function are disproportionate to the costs of the overall alterations when...

41 CFR 102-76.70 - When are the costs of alterations to provide an accessible path of travel to an altered area...

Code of Federal Regulations, 2012 CFR

2012-01-01

... alterations to provide an accessible path of travel to an altered area containing a primary function... to an altered area containing a primary function disproportionate to the costs of the overall... area containing a primary function are disproportionate to the costs of the overall alterations when...

41 CFR 102-76.70 - When are the costs of alterations to provide an accessible path of travel to an altered area...

Code of Federal Regulations, 2011 CFR

2011-01-01

... alterations to provide an accessible path of travel to an altered area containing a primary function... to an altered area containing a primary function disproportionate to the costs of the overall... area containing a primary function are disproportionate to the costs of the overall alterations when...

Are low income patients receiving the benefits of electronic health records? A statewide survey.

PubMed

Butler, Matthew J; Harootunian, Gevork; Johnson, William G

2013-06-01

There are concerns that physicians serving low-income, Medicaid patients, in the United States are less likely to adopt electronic health records and, if so, that Medicaid patients will be denied the benefits from electronic health record use. This study seeks to determine whether physicians treating Medicaid patients were less likely to have adopted electronic health records. Physician surveys completed during physicians' license renewal process in Arizona were merged with the physician licensing data and Medicaid administrative claims data. Survey responses were received from 50.7 percent (6,780 out of 13,380) of all physicians practicing in Arizona. Physician survey responses were used to identify whether the physician used electronic health records and the degree to which the physician exchanged electronic health records with other health-care providers. Medicaid claims data were used to identify which physicians provided health care to Medicaid beneficiaries. The primary outcome of interest was whether Medicaid providers were more or less likely to have adopted electronic health records. Logistic regression analysis was used to estimate average marginal effects. In multivariate analysis, physicians with 20 or more Medicaid patients during the survey cycle were 4.1 percent more likely to use an electronic health record and 5.2 percent more likely to be able to transmit electronic health records to at least one health-care provider outside of their practice. These effects increase in magnitude when the analysis is restricted to solo practice physicians This is the first study to find a pro-Medicaid gap in electronic health record adoption suggesting that the low income patients served by Arizona's Health Care Cost Containment System are not at a disadvantage with regard to electronic health record access and that Arizona's model of promoting electronic health record adoption merits further study.

Family physicians' ability to perform population management is associated with adoption of other aspects of the patient-centered medical home.

PubMed

Ottmar, Jessica; Blackburn, Brenna; Phillips, Robert L; Peterson, Lars E; Jaén, Carlos Roberto

2015-04-01

The patient-centered medical home (PCMH) model is considered a promising approach to improving population health, but how elements of these advanced practice models relate to population health capability is unknown. To measure associations between family physicians' performance of population management with PCMH components, a cross-sectional survey was conducted with physicians accessing the American Board of Family Medicine Web site in 2011. Bivariate analysis and logistic regression tested associations between physician and practice demographics and specific PCMH features. The primary outcome was performance of population management. The final sample included 3855 physicians, 37.3% of whom reported performing population management. Demographic characteristics significantly associated with greater use of population management were female sex and graduation from an international medical school. PCMH components that remained associated with population management after adjustment were access to clinical case managers (odds ratio [OR]=2.01, 95% confidence interval [95% CI]: 1.69, 2.39), behavioral health collaboration (OR=1.49, 95% CI: 1.26, 1.77), having an electronic health record that supports meaningful use (OR=1.47, 95% CI: 1.25, 1.74), recent participation in a quality improvement project (OR=2.47, 95% CI: 2.12, 2.89), and routine measurement of patient difficulty securing an appointment (OR=2.87, 95% CI: 2.45, 3.37). Performance of population management was associated with several PCMH elements and resources not present in traditional primary care offices. Attention to these elements likely will enhance delivery of population management services in primary care.

Insurance Type and Access to Health Care Providers and Appointments Under the Affordable Care Act.

PubMed

Alcalá, Héctor E; Roby, Dylan H; Grande, David T; McKenna, Ryan M; Ortega, Alexander N

2018-02-01

Millions of adults have gained insurance through the Affordable Care Act (ACA). However, disparities in access to care persist. This study examined differences in access to primary and specialty care among patients insured by private individual market insurance plans (both on-exchange and off-exchange) and Medicaid compared with those with employer-sponsored insurance. Using data from the 2014 and 2015 California Health Interview Survey, logistic regression analyses were used to calculate the odds of being unable to access primary care providers, access specialty care providers and receive a needed doctor's appointment in a timely manner, with insurance type serving as the independent variable. Interaction terms examined if the expiration of the ACA's optional Medicaid primary care fee increase in 2014 modified any of these associations. Findings showed poorer access to providers among those insured through Medicaid and the individual market (whether purchased through the state's health insurance exchange or off-exchange) relative to employer-based insurance. Poor access to primary care providers was seen among private coverage purchased via exchanges, relative to private coverage purchased on the individual market. In addition, findings showed that reduction of Medicaid fees coincided with reduced ability to see primary care providers. However, a similar trend was seen among those with employer-based coverage, which suggests that this change may not be attributable to reductions in Medicaid fees. Despite ACA-related gains in insurance coverage, those with on-exchange and off-exchange individual private insurance plans and Medicaid encounter more barriers to care than those with employer-based insurance.

Sequence-Based Identification of a Zoophilic Strain of Trichophyton interdigitale in a Rare Case of Tinea Blepharo-Ciliaris Associated with Tinea Barbae.

PubMed

Buruiana, Adrian M; Mihali, Ciprian V; Popescu, Cristina

2015-12-01

Impaired hair at blepharo-ciliaris area by dermatophytes is a rare clinical entity. This infection is often misdiagnosed or underdiagnosed, being mistakenly referred to as an infection of bacterial origin. Herein, we present a rare case of tinea blepharo-ciliaris associated with tinea barbae in an adult male. Considering the two lesions of the patient, mycological examination was performed by phenotypic methods, including environmental electronic scanning microscopy. Trichophyton interdigitale zoophilic strain was identified as the etiological agent by direct examination of the hair, primary culture analysis of the developed colonies and PCR sequencing of the ITS1 region of the rDNA gene. Homology search showed 100% similarity with T. interdigitale (GenBank accession number: KC595993), Arthroderma vanbreuseghemii (GenBank accession number: JQ407190) and zoophilic strain of T. interdigitale (GenBank accession number: AY062119.1.). Four weeks of oral and local treatment with itraconazole (100 mg twice a day) and fluconazole 0.3% (eyedrops) induced complete remission. To our knowledge, this is the first report of tinea blepharo-ciliaris associated with tinea barbae in Romania.

The contribution of dietitians to the primary health care workforce.

PubMed

Howatson, Alexandra; Wall, Clare R; Turner-Benny, Petrina

2015-12-01

Dietetic intervention is effective in the management of nutrition-related conditions and their comorbidities. New Zealand has an increasing need for primary and preventive health care to reduce the burden of non-communicable disease. To review the recent evidence of effectiveness of dietetic intervention in primary health care on health and wider economic outcomes. Health benefits and cost benefits of employing dietitians to perform nutrition intervention in the primary health care setting are evaluated in the areas of obesity in conjunction with diabetes and cardiovascular disease, and malnutrition in older adults. An electronic literature search of four scientific databases, websites of major dietetic associations and high-impact nutrition and dietetic journals was conducted. Randomised controlled trials and non-randomised studies conducted from 2000 to 2014 were included. Dietetic intervention demonstrates statistically and clinically significant impacts on health outcomes in the areas of obesity, cardiovascular disease, diabetes, and malnutrition in older adults, when compared to usual care. Dietitians working in primary health care can also have significant economic benefits, potentially saving the health care system NZ$5.50-$99 for every NZ$1 spent on dietetic intervention. New Zealand must look to new models of health care provision that are not only patient-centred but are also cost-effective. This review demonstrates that dietitians in primary health care can improve patients' health and quality of life. Increasing the number of dietitians working in primary health care has the potential to make quality nutrition care accessible and affordable for more New Zealanders.

“Nothing About Me Without Me”: An Interpretative Review of Patient Accessible Electronic Health Records

PubMed Central

Callahan, Ryan; Sevdalis, Nick; Mayer, Erik K; Darzi, Ara

2015-01-01

Background Patient accessible electronic health records (PAEHRs) enable patients to access and manage personal clinical information that is made available to them by their health care providers (HCPs). It is thought that the shared management nature of medical record access improves patient outcomes and improves patient satisfaction. However, recent reviews have found that this is not the case. Furthermore, little research has focused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers. Objective We provide a systematic review of reviews of the impact of giving patients record access from both a patient and HCP point of view. The review covers a broad range of outcome measures, including patient safety, patient satisfaction, privacy and security, self-efficacy, and health outcome. Methods A systematic search was conducted using Web of Science to identify review articles on the impact of PAEHRs. Our search was limited to English-language reviews published between January 2002 and November 2014. A total of 73 citations were retrieved from a series of Boolean search terms including “review*” with “patient access to records”. These reviews went through a novel scoring system analysis whereby we calculated how many positive outcomes were reported per every outcome measure investigated. This provided a way to quantify the impact of PAEHRs. Results Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well as HCPs were found but eight were included for the analysis of outcome measures. We found mixed outcomes across both patient and HCP groups, with approximately half of the reviews showing positive changes with record access. Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered. Nurses are more likely than physicians to gain time efficiencies by using a PAEHR system with the main concern from physicians being the security of the PAEHRs. Conclusions This review implements a novel scoring system, which shows there is a lack of rigorous empirical testing that separates the effect of record access from other existing disease management programs. Current research is too targeted within certain clinical groups’ needs, and although there are positive signs for the adoption of PAEHRs, there is currently insufficient evidence about the effect of PAEHRs on health outcomes for patients or HCPs. PMID:26123476

EASI: An electronic assistant for scientific investigation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schur, A.; Feller, D.; DeVaney, M.

1991-09-01

Although many automated tools support the productivity of professionals (engineers, managers, architects, secretaries, etc.), none specifically address the needs of the scientific researcher. The scientist's needs are complex and the primary activities are cognitive rather than physical. The individual scientist collects and manipulates large data sets, integrates, synthesizes, generates, and records information. The means to access and manipulate information are a critical determinant of the performance of the system as a whole. One hindrance in this process is the scientist's computer environment, which has changed little in the last two decades. Extensive time and effort is demanded from the scientistmore » to learn to use the computer system. This paper describes how chemists' activities and interactions with information were abstracted into a common paradigm that meets the critical requirement of facilitating information access and retrieval. This paradigm was embodied in EASI, a working prototype that increased the productivity of the individual scientific researcher. 4 refs., 2 figs., 1 tab.« less

Electronic Access to Information: A New Service Paradigm. Proceedings from a Symposium (July 23-24, 1993, Palo Alto, California).

ERIC Educational Resources Information Center

Chiang, Win-Shin S., Ed.; Elkington, Nancy E., Ed.

The Research Libraries Group (RLG) hosted a symposium to explore opportunities for cooperative action--to take advantage of technology and to improve electronic access to information--particularly in the RLG context, and to develop strategies for making the most effective use of technology and electronic information in support of research and…

Do Open Access Electronic Theses and Dissertations Diminish Publishing Opportunities in the Social Sciences and Humanities? Findings from a 2011 Survey of Academic Publishers

ERIC Educational Resources Information Center

Ramirez, Marisa L.; Dalton, Joan T.; McMillan, Gail; Read, Max; Seamans, Nancy H.

2013-01-01

An increasing number of higher education institutions worldwide are requiring submission of electronic theses and dissertations (ETDs) by graduate students and are subsequently providing open access to these works in online repositories. Faculty advisors and graduate students are concerned that such unfettered access to their work could diminish…

How primary health care staff working in rural and remote areas access skill development and expertise to support health promotion practice.

PubMed

McFarlane, Kathryn A; Judd, Jenni; Wapau, Hylda; Nichols, Nina; Watt, Kerrianne; Devine, Sue

2018-05-01

Health promotion is a key component of comprehensive primary health care. Health promotion approaches complement healthcare management by enabling individuals to increase control over their health. Many primary healthcare staff have a role to play in health promotion practice, but their ability to integrate health promotion into practice is influenced by their previous training and experience. For primary healthcare staff working in rural and remote locations, access to professional development can be limited by what is locally available and prohibitive in terms of cost for travel and accommodation. This study provides insight into how staff at a large north Queensland Aboriginal community controlled health service access skill development and health promotion expertise to support their work. A qualitative exploratory study was conducted. Small group and individual semi-structured interviews were conducted with staff at Apunipima Cape York Health Council (n=9). A purposive sampling method was used to recruit participants from a number of primary healthcare teams that were more likely to be involved in health promotion work. Both on-the-ground staff and managers were interviewed. All participants were asked how they access skill development and expertise in health promotion practice and what approaches they prefer for ongoing health promotion support. The interviews were transcribed verbatim and analysed thematically. All participants valued access to skill development, advice and support that would assist their health promotion practice. Skill development and expertise in health promotion was accessed from a variety of sources: conferences, workshops, mentoring or shared learning from internal and external colleagues, and access to online information and resources. With limited funds and limited access to professional development locally, participants fostered external and internal organisational relationships to seek in-kind advice and support. Irrespective of where the advice came from, it needed to be applicable to work with Aboriginal and Torres Strait Islander remote communities. To improve health outcomes in rural and remote communities, the focus on health promotion and prevention approaches must be strengthened. Primary healthcare staff require ongoing access to health promotion skill development and expertise to increase their capacity to deliver comprehensive primary health care. Practice-based evidence from staff working in the field provides a greater understanding of how skill development and advice are accessed. Many of these strategies can be formalised through organisational plans and systems, which would ensure that a skilled health promotion workforce is sustained.

Factors that impact access to ongoing health care for First Nation children with a chronic condition.

PubMed

Coombes, Julieann; Hunter, Kate; Mackean, Tamara; Holland, Andrew J A; Sullivan, Elizabeth; Ivers, Rebecca

2018-06-14

Access to multidisciplinary health care services for First Nation children with a chronic condition is critical for the child's health and well-being, but disparities and inequality in health care systems have been almost impossible to eradicate for First Nation people globally. The objective of this review is to identify the factors that impact access and ongoing care for First Nation children globally with a chronic condition. An extensive systematic search was conducted of nine electronic databases to identify primary studies that explored factors affecting access to ongoing services for First Nation children with a chronic disease or injury. Due to the heterogeneity of included studies the Mixed Method Appraisal Tool (MMAT) was used to assess study quality. A total of six studies from Australia, New Zealand and Canada were identified and included in this review. Four studies applied qualitative approaches using in-depth semi structured interviews, focus groups and community fora. Two of the six studies used quantitative approaches. Facilitators included the utilisation of First Nation liaison workers or First Nation Health workers. Key barriers that emerged included lack of culturally appropriate health care, distance, language and cultural barriers, racism, the lack of incorporation of First Nation workers in services, financial difficulties and transport issues. There are few studies that have identified positive factors that facilitate access to health care for First Nation children. There is an urgent need to develop programs and processes to facilitate access to appropriate health care that are inclusive of the cultural needs of First Nation children.

Accessibility and use of Primary Health Care: how conclusive is the social-economical situation in Antwerp?

PubMed

Philips, H; Rotthier, P; Meyvis, L; Remmen, R

2015-04-01

The percentage of households that delays medical assistance due to financial reasons is slowly increasing. Moreover, some groups of the population do not ever find their way to primary health care and end up unnecessarily in the emergency department or with specialists. This study wants to examine how primary health care can be made accessible to these groups. In this study, we aim to discover whether in a city such as Antwerp primary health care is accessible to everyone. The statistics were collected from the Health Care Survey done by the Welfare Services Antwerp in cooperation with the City of Antwerp. The questions were asked in three different ways: a postal questionnaire, a telephone questionnaire and a face-to-face interview. We determined that people who live on social welfare delay medical help due to financial reasons more frequently than the global Antwerp population. They often do not have a regular general practitioner (GP). Especially single parents, house-wives and house-husbands, job-seekers, incapacitated people unable to work, unskilled workers and foreigners are among the vulnerable groups where accessibility to primary health care is a concern. If we hope to improve the accessibility of primary health care, we must first and foremost inform the above-mentioned groups of the insurability and how this is applied. When this is fulfilled, it will be easier for the GP to receive this vulnerable group within the primary care system, so that the help of specialized care, which is often unnecessary, can be reduced.

Improving access to urologists through an electronic consultation service

PubMed Central

Witherspoon, Luke; Liddy, Clare; Afkham, Amir; Keely, Erin; Mahoney, John

2017-01-01

Introduction Access to specialist services is limited by wait times and geographic availability. Champlain Building Access to Specialist Advice (BASE) has been implemented in our service region to facilitate access to specialists by primary care providers (PCPs). Through a secure web-based system, PCPs are able to send eConsults instead of requesting a formal in-office consultation. Methods Urology eConsults completed through the Champlain BASE service from March 2013 to January 2015 were analyzed. Each consult was characterized in regard to the type of question asked by the referring physician and the clinical content of the referral. Using the mandatory close-out surveys, we analyzed rates of referral avoidance, physician satisfaction, and overall impact on patient care. Results Of 190 eConsultations, 70% were completed in less than 10 minutes. The most common clinical questions related to the interpretation of imaging reports (16%) and tests to choose for investigating a condition (15%). The most common diagnoses were hematuria (13%) and renal mass (8%). In 35% of cases, referral to a urologist had originally been contemplated and was avoided. In 8% of cases, a PCP did not believe a consultation was initially needed, but a referral was ultimately initiated after the eConsultation. Conclusions Our study shows that although certain clinical presentations still require a formal in-person urological consultation, eConsultations can potentially reduce unnecessary clinic visits while identifying patients who may benefit from early urological consultation. Through both these mechanisms, we may improve timely access to urologists. PMID:28798830

Improving access to specialists in remote communities: a cross-sectional study and cost analysis of the use of eConsult in Nunavut.

PubMed

Liddy, Clare; McKellips, Fanny; Armstrong, Catherine Deri; Afkham, Amir; Fraser-Roberts, Leigh; Keely, Erin

2017-01-01

Residents of remote communities face inequities in access to specialists, excessive wait times, and poorly coordinated care. The Champlain BASE TM (Building Access to Specialists through eConsultation) service facilitates asynchronous communication between primary care providers (PCP) and specialists. The service was extended to several PCPs in Nunavut in 2014. To (1) describe the use of eConsult services in Nunavut, and (2) conduct a costing evaluation. A cross-sectional study and cost analysis of all eConsult cases submitted between August 2014 and April 2016. PCPs from Nunavut submitted 165 eConsult cases. The most popular specialties were dermatology (16%), cardiology (8%), endocrinology (7%), otolaryngology (7%), and obstetrics/gynaecology (7%). Specialists provided a response in a median of 0.9 days (IQR=0.3-3.0, range=0.01-15.02). In 35% of cases, PCPs were able to avoid the face-to-face specialist visits they had originally planned for their patients. Total savings associated with eConsult in Nunavut are estimated at $180,552.73 or $1,100.93 per eConsult. The eConsult service provided patients in Nunavut's remote communities with prompt access to specialist advice. The service's chief advantage in Canada's northern communities is its ability to offer electronic access to a breadth of specialties far greater than could be supported locally. Our findings suggest that a territory-wide adoption of eConsult would generate enormous savings.

Development of CPR security using impact analysis.

PubMed Central

Salazar-Kish, J.; Tate, D.; Hall, P. D.; Homa, K.

2000-01-01

The HIPAA regulations will require that institutions ensure the prevention of unauthorized access to electronically stored or transmitted patient records. This paper discusses a process for analyzing the impact of security mechanisms on users of computerized patient records through "behind the scenes" electronic access audits. In this way, those impacts can be assessed and refined to an acceptable standard prior to implementation. Through an iterative process of design and evaluation, we develop security algorithms that will protect electronic health information from improper access, alteration or loss, while minimally affecting the flow of work of the user population as a whole. PMID:11079984

The Sector-Wide Approach in Bangladesh Primary Education: A Critical View. CREATE Pathways to Access. Research Monograph No. 57

ERIC Educational Resources Information Center

Ahmed, Manzoor

2011-01-01

This monograph, in the CREATE Pathways to Access series, is about the modality of cooperation and programme management in primary education in Bangladesh, based specifically on the experience of the Second Primary Education Development Programme (PEDP II). It is not intended to be an assessment of PEDP II accomplishments, but key information and a…

Evaluation of spatial accessibility to primary healthcare using GIS

NASA Astrophysics Data System (ADS)

Jamtsho, S.; Corner, R. J.

2014-11-01

Primary health care is considered to be one of the most important aspects of the health care system in any country, which directly helps in improving the health of the population. Potential spatial accessibility is a very important component of the primary health care system. One technique for studying spatial accessibility is by computing a gravity-based measure within a geographic information system (GIS) framework. In this study, straight-line distances between the associated population clusters and the health facilities and the provider-to-population ratio were used to compute the spatial accessibility of the population clusters for the whole country. Bhutan has been chosen as the case study area because it is quite easy to acquire and process data for the whole country due to its small size and population. The spatial accessibility measure of the 203 sub-districts shows noticeable disparities in health care accessibility in this country with about only 19 sub-districts achieving good health accessibility ranking. This study also examines a number of different health accessibility policy scenarios which can assist in identifying the most effective health policy from amongst many probable planning scenarios. Such a health accessibility measuring system can be incorporated into an existing spatial health system in developing countries to facilitate the proper planning and equitable distribution of health resources.

Does improved access to diagnostic imaging results reduce hospital length of stay? A retrospective study

PubMed Central

2010-01-01

Background One year after the introduction of Information and Communication Technology (ICT) to support diagnostic imaging at our hospital, clinicians had faster and better access to radiology reports and images; direct access to Computed Tomography (CT) reports in the Electronic Medical Record (EMR) was particularly popular. The objective of this study was to determine whether improvements in radiology reporting and clinical access to diagnostic imaging information one year after the ICT introduction were associated with a reduction in the length of patients' hospital stays (LOS). Methods Data describing hospital stays and diagnostic imaging were collected retrospectively from the EMR during periods of equal duration before and one year after the introduction of ICT. The post-ICT period was chosen because of the documented improvement in clinical access to radiology results during that period. The data set was randomly split into an exploratory part used to establish the hypotheses, and a confirmatory part. The data was used to compare the pre-ICT and post-ICT status, but also to compare differences between groups. Results There was no general reduction in LOS one year after ICT introduction. However, there was a 25% reduction for one group - patients with CT scans. This group was heterogeneous, covering 445 different primary discharge diagnoses. Analyses of subgroups were performed to reduce the impact of this divergence. Conclusion Our results did not indicate that improved access to radiology results reduced the patients' LOS. There was, however, a significant reduction in LOS for patients undergoing CT scans. Given the clinicians' interest in CT reports and the results of the subgroup analyses, it is likely that improved access to CT reports contributed to this reduction. PMID:20819224

Spatial access disparities to primary health care in rural and remote Australia.

PubMed

McGrail, Matthew Richard; Humphreys, John Stirling

2015-11-04

Poor spatial access to health care remains a key issue for rural populations worldwide. Whilst geographic information systems (GIS) have enabled the development of more sophisticated access measures, they are yet to be adopted into health policy and workforce planning. This paper provides and tests a new national-level approach to measuring primary health care (PHC) access for rural Australia, suitable for use in macro-level health policy. The new index was constructed using a modified two-step floating catchment area method framework and the smallest available geographic unit. Primary health care spatial access was operationalised using three broad components: availability of PHC (general practitioner) services; proximity of populations to PHC services; and PHC needs of the population. Data used in its measurement were specifically chosen for accuracy, reliability and ongoing availability for small areas. The resultant index reveals spatial disparities of access to PHC across rural Australia. While generally more remote areas experienced poorer access than more populated rural areas, there were numerous exceptions to this generalisation, with some rural areas close to metropolitan areas having very poor access and some increasingly remote areas having relatively good access. This new index provides a geographically-sensitive measure of access, which is readily updateable and enables a fine granulation of access disparities. Such an index can underpin national rural health programmes and policies designed to improve rural workforce recruitment and retention, and, importantly, health service planning and resource allocation decisions designed to improve equity of PHC access.

Access to primary care for socio-economically disadvantaged older people in rural areas: A qualitative study.

PubMed

Ford, John A; Turley, Rachel; Porter, Tom; Shakespeare, Tom; Wong, Geoff; Jones, Andy P; Steel, Nick

2018-01-01

We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas. Using a community recruitment strategy, fifteen people over 65 years, living in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access. Older people's experience can be understood within the context of a patient perceived set of unwritten rules or social contract-an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes. Health professionals' described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system. Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service.

A normal incidence X-ray telescope sounding rocket payload

NASA Technical Reports Server (NTRS)

Golub, L.

1985-01-01

Progress is reported on the following major activities on the X-ray telescope: (1) complete design of the entire telescope assembly and fabrication of all front-end components was completed; (2) all rocket skin sections, including bulkheads, feedthroughs and access door, were specified; (3) fabrication, curing and delivery of the large graphite-epoxy telescope tube were completed; (4) an engineering analysis of the primary mirror vibration test was completed and a decision made to redesign the mirror attachment system to a kinematic three-point mount; (5) detail design of the camera control, payload and housekeeping electronics were completed; and (6) multilayer mirror plates with 2d spacings of 50 A and 60 A were produced.

Transferring information to an out-of-hours primary care service for patients with palliative care needs: an action research study to improve the use of handover forms.

PubMed

Asprey, Anthea; Richards, Suzanne H; Wright, Christine; Seamark, Clare; Seamark, David; Moxon, Jane

2013-01-01

To work with service users and providers to optimise the design and implementation of handover forms to support the transfer of information between daytime and out-of-hours primary care services for patients with palliative care needs. There is a need for improved informational continuity between daytime and out-of-hours primary care services for patients with palliative care needs. Research suggests that while handover forms are vital to ensure continuity of care, they remain underused for such patients. Audit work in an out-of-hours primary care service in South West England identified that their current system of handover forms was underused. An action research study consisting of two phases was undertaken. In phase one, the views of general practitioners and nurses working in the out-of-hours and daytime primary care services (29 health professionals) in Devon (population c.1.4 million) and patients with palliative care needs and their carers (8 participants) were investigated using qualitative interviews and focus group methods. Participants' views on the content and use of handover forms, and of the systems supporting their generation were sought. In phase two, additional feedback from the health professional stakeholder groups was collected and collaborative work undertaken with the out-of-hours service to implement recommendations emerging from the qualitative research. Findings Respondents identified variable use of handover forms and inconsistent practice in terms of: who was responsible for generating and updating forms; when and where they were discussed in primary care; the criteria used to define which patient needed a form; and the information forms should contain. There was uncertainty about how handover forms were used by the out-of-hours service and concerns about incomplete access to forms for certain groups of staff. An action plan to improve the existing system was developed. This included distribution of educational materials (desktop guide, newsletter) to key stakeholders, and the modification of information systems to facilitate the updating of messages and the accessibility of electronic records for previously under-served staff.

Testing, Testing...Managing Electronic Access in Disparate Times.

ERIC Educational Resources Information Center

Carrington, Bessie M.

1996-01-01

Duke University's Perkins Library (North Carolina) tests electronic resources and services for remote accessibility by examining capabilities on various platforms, operating systems, communications software, and World Wide Web browsers. Problems occur in establishing connections, screen display, navigation or retrieval, keyboard variations, and in…

Towards linking patients and clinical information: detecting UMLS concepts in e-mail.

PubMed

Brennan, Patricia Flatley; Aronson, Alan R

2003-01-01

The purpose of this project is to explore the feasibility of detecting terms within the electronic messages of patients that could be used to effectively search electronic knowledge resources and bring health information resources into the hands of patients. Our team is exploring the application of the natural language processing (NLP) tools built within the Lister Hill Center at the National Library of Medicine (NLM) to the challenge of detecting relevant concepts from the Unified Medical Language System (UMLS) within the free text of lay people's electronic messages (e-mail). We obtained a sample of electronic messages sent by patients participating in a randomized field evaluation of an internet-based home care support service to the project nurse, and we subjected elements of these messages to a series of analyses using several vocabularies from the UMLS Metathesaurus and the selected NLP tools. The nursing vocabularies provide an excellent starting point for this exercise because their domain encompasses patient's responses to health challenges. In successive runs we augmented six nursing vocabularies (NANDA Nursing Diagnosis, Nursing Interventions Classification, Nursing Outcomes Classification, Home Health Classification, Omaha System, and the Patient Care Data Set) with selected sets of clinical terminologies (International Classification of Primary Care; International Classification of Primary Care- American English; Micromedex DRUGDEX; National Drug Data File; Thesaurus of Psychological Terms; WHO Adverse Drug Reaction Terminology) and then additionally with either Medical Subject Heading (MeSH) or SNOMED International terms. The best performance was obtained when the nursing vocabularies were complemented with selected clinical terminologies. These findings have implications not only for facilitating lay people's access to electronic knowledge resources but may also be of assistance in developing new tools to aid in linking free text (e.g., clinical notes) to lexically complex knowledge resources such as those emerging from the Human Genome Project.

Obesity Increases the Risk of Primary Nonfunction and Early Access Loss, and Decreases Overall Patency in Patients Who Underwent Hemodialysis Reliable Outflow Device Placement.

PubMed

Naffouje, Samer A; Tzvetanov, Ivo; Bui, James T; Gaba, Ron; Bernardo, Karrel; Jeon, Hoonbae

2016-10-01

Hemodialysis reliable outflow (HeRO) catheters were introduced in 2008, and have been since providing a reliable alternative for hemodialysis patients who are deemed "access challenged." However, its outcomes have not been extensively investigated due to its relatively young age. Here, we report our 6-year single institution experience, and demonstrate the significant impact of obesity on HeRO graft outcomes, an aspect not previously studied in the literature. Patients who underwent HeRO graft placement at the University of Illinois Hospital between April 2009 and August 2015 were included retrospectively. Data were collected from patients' electronic medical records and analyzed using SPSS software. Thirty-three patients who underwent 34 HeRO catheter placements were included. Mean age was 47 ± 12 years, and mean body mass index (BMI) was 30.75 ± 10.22. Median follow-up was 635 days. Overall catheter-related complications were thrombosis (70.59%), infection (20.59%), arterial steal (8.82%), and pseudoaneurysms requiring intervention (8.82%). Overall primary and secondary patency rates after 6 and 12 months were 31.25%, 25%, 78.13%, and 71.86%, respectively. Primary nonfunction rate was 14.7%. Obese patients had significantly higher rate of primary nonfunction (38.46% vs. 0%, P = 0.0046), and relative risk 3.62 (95% confidence interval [CI] 2.01-6.52). They also had a significantly decreased rate of graft patency after 12 months (10.53% vs. 53.85%, P = 0.0227), leading to a relative risk of "early" graft loss within 1 year of 5.12 (95% CI 1.26-20.83). Overall median graft patency in obese patients was significantly shorter than that of nonobese patients (311 vs. 1295 days, P = 0.014). BMI, as a continuous variable, was a significant predictor of primary nonfunction (P = 0.046) and early graft loss (0.020) when tested against age, sex, race, and diabetes in a multivariate logistic regression analysis. HeRO catheters offer a reliable, and possibly the last, alternative in hemodialysis access-challenged patients. In our population, obesity was a significant risk factor for primary nonfunction, early graft loss, and a shorter overall graft patency. BMI, as a continuous variable, can serve as a predictor of primary nonfunction and early graft loss after adjustment for age, race, sex, and diabetes. Obesity's effect on HeRO catheters has not been amply addressed; therefore further prospective studies are warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

Biomass accessibility analysis using electron tomography

DOE PAGES

Hinkle, Jacob D.; Ciesielski, Peter N.; Gruchalla, Kenny; ...

2015-12-25

Substrate accessibility to catalysts has been a dominant theme in theories of biomass deconstruction. Furthermore, current methods of quantifying accessibility do not elucidate mechanisms for increased accessibility due to changes in microstructure following pretreatment.

Beam impingement angle effects on secondary electron emission characteristics of textured pyrolytic graphite

NASA Technical Reports Server (NTRS)

Curren, A. N.; Jensen, K. A.

1984-01-01

Experimentally determined values of true secondary electron emission and relative values of reflected primary electron yield for untreated and ion-textured pyrolytic graphite over a range of primary electron energy levels and electron beam impingement angles are presented. Information required to develop high efficiency multistage depressed collectors (MDC's) for microwave amplifier traveling-wave tubes for space communication and aircraft applications is provided. To attain the highest possible MDC efficiencies, the electrode surfaces must have low secondary electron emission characteristics. Pyrolytic graphite, a chemically vapor-deposited material, is a particularly promising candidate for this application. The pyrolytic graphite surfaces studied were tested over a range of primary electron beam energies and beam impingement angles from 200 to 2000 eV and direct (0 deg) to near-grazing angles (85 deg), respectively. Surfaces both parallel to and normal to the planes of material deposition were examined. The true secondary electron emission and reflected primary electron yield characteristics of the pyrolytic graphite surfaces are compared to those of sooted control surfaces.

A Pacific population's access to and use of health services in Dunedin.

PubMed

Sopoaga, Faafetai; Parkin, Lianne; Gray, Andrew

2012-10-26

Pacific peoples in New Zealand (mostly of Samoan, Tongan, or Cook Islands origin) have poor health compared to the total New Zealand population. Understanding their access to and use of health services is important in resolving this. A survey of Pacific peoples in Dunedin obtained information about their access to and use of health services. 372 questionnaires were analysed. Approximately one-quarter did not have a regular doctor or health service. At least 50% used hospital emergency services for non-urgent illnesses. Nearly two-thirds used a "walk-in" primary care service. A significant proportion of Pacific peoples did not have a regular GP or health service in Dunedin. It was surprising students were more likely to be in this category because student health services should be more affordable. A "walk-in" primary care facility has a role in the delivery of primary care services. Pacific organisations can assist primary care providers to encourage access to and the appropriate use of health services.

Clinician-patient E-mail communication: challenges for reimbursement.

PubMed

Komives, Eugenie M

2005-01-01

Clinicians are rapidly gaining experience with online clinician-patient consultation, and more tools are becoming available to support these efforts. In addition, we now have evidence that using electronic communication is cost-effective to payers and appealing to patients and providers. At present, there appear to be few barriers to the adoption of these solutions for practices that use other online services. Security concerns can easily be overcome by using programs described in this commentary. Larger and longer studies that evaluate the benefits and cost savings in more detail may help convince other payers and providers of the utility of the Web-based programs. More studies are needed to understand the effect of dinician-patient electronic communication on the costs of caring for chronic illness. When these solutions also include support tools, such as electronic prescribing, which could improve patient safety and quality of care, they should be encouraged. In their article entitled, "Electrons in Flight-Email between Doctors and Patients," Delbanco and Sands postulate that the future of e-communication in medicine will be integrated with a patient-controlled health record and will include secure synchronous and asynchronous communication, video conferencing and messaging, instant transcription into the written record, full-patient access to the record, translation into different languages, connectivity to multiple data sources, incorporation of multi-media educational materials. It-will also allow data from home-based diagnostic technology to be sent to clinicians. "Electronic communication will move medicine inexorably toward such transparency, enabling doctors and patients to share knowledge, responsibility, and decision-making more equally. We need to explore rapidly how this change will affect the quality of care for patients and the quality of life for doctors." The widespread dependence on Internet-based electronic communication to support a variety of commercial, educational, and entertainment needs and interests offers us an opportunity to develop innovative approaches to some long-standing problems-assuring the accessibility of clinicians to their patients and the effectiveness and timeliness of communication between them. It is exciting that we now have well-documented examples of how these new technologies can be used to enhance the quality of primary care practice in both large and small practice organizations.

The economics of electronic journals.

PubMed

Budd, K W

2000-01-01

High print journal subscription costs, access to desktop publishing software, and awareness of Internet capability are among several reasons that interest in the electronic publishing of scholarly journals is increasing rapidly. The economic considerations of electronic publishing are not as familiar, however, although the fingertip accessibility of electronic journals, and in some cases, the lack of subscription charges gives the impression that electronic journal publishing is a much less costly means of publishing. Such an impression receives qualified confirmation in this article as an overview of the costs of scholarly publishing is provided, and the costs of print and electronic journals are compared. Also addressed are ways to recover costs of publishing electronic journals, and predictions for the future of such journals.

The impact of primary health care on malaria morbidity - defining access by disease burden

PubMed Central

O’Meara, W.P.; Noor, A.; Gatakaa, H.; Tsofa, B.; McKenzie, F. E.; Marsh, K.

2009-01-01

Objectives The convergence of malaria endemicity and poor health care infrastructure has resulted in persistently high rates of malaria morbidity and mortality in many parts of sub-Saharan Africa. Primary care facilities are increasingly becoming the focal point for distribution of intervention strategies, but physical access to these facilities may limit the extent to which communities can be reached. Here we investigate the impact of travel time to primary care on the incidence of hospitalized malaria episodes in a rural district in Kenya. Methods The incidence of hospitalized malaria in a population under continuous demographic surveillance was recorded over three years. The time to travel to the nearest primary health care facility was calculated for every child between birth and five years of age and trends in incidence of hospitalized malaria as a function of travel time were evaluated. Results and conclusions We show that the incidence of hospitalized malaria more than doubled as travel time to the nearest primary care facility increased from ten minutes up to two hours. Good access to primary health facilities may reduce the burden of disease by as much as 66%. Our results highlight both the potential of the primary health care system in reaching those most at risk and reducing the disease burden, and that insufficient access is an important risk factor, one that may be inequitably distributed to the poorest households. PMID:19121148

Medicaid Expansion Produces Long-Term Impact on Insurance Coverage Rates in Community Health Centers

PubMed Central

Huguet, Nathalie; Hoopes, Megan J.; Angier, Heather; Marino, Miguel; Holderness, Heather; DeVoe, Jennifer E.

2017-01-01

Background:It is crucial to understand the impact of the Affordable Care Act (ACA). This study assesses changes in insurance status of patients visiting community health centers (CHCs) comparing states that expanded Medicaid to those that did not. Methods: Electronic health record data on 875,571 patients aged 19 to 64 years with ≥ 1 visit between 2012 and 2015 in 412 primary care CHCs in 9 expansion and 4 nonexpansion states. We assessed changes in rates of total, uninsured, Medicaid-insured, and privately insured primary care and preventive care visits; immunizations administered, and medications ordered. Results: Rates of uninsured visits decreased pre- to post-ACA, with greater drops in expansion (−57%) versus nonexpansion (−20%) states. Medicaid-insured visits increased 60% in expansion states while remaining unchanged in nonexpansion states. Privately insured visits were 2.7 times higher post-ACA in nonexpansion states with no increase in expansion states. Comparing 2015 with 2014: Uninsured visit rates continued to decrease in expansion (−28%) and nonexpansion states (−19%), Medicaid-insured rates did not significantly increase, and privately insured visits increased in nonexpansion states but did not change in expansion states. Conclusions: Medicaid expansion and subsidies to purchase private coverage likely increased the accessibility of health insurance for patients who had previously not been able to access coverage. PMID:28513249

Patient-Physician Web Messaging

PubMed Central

Liederman, Eric M; Lee, Jerry C; Baquero, Victor H; Seites, Paul G

2005-01-01

BACKGROUND Patients want electronic access to providers. Providers fear being overwhelmed by unreimbursed messages. OBJECTIVE Measure the effects of patient-physician web messaging on primary care practices. DESIGN/SETTING Retrospective analysis of 6 case and 9 control internal medicine (IM) and family practice (FP) physicians' message volume, and a survey of 5,971 patients' web messaging with 267 providers and staff in 16 community primary care clinics in the Sacramento, CA region. MEASUREMENTS AND MAIN RESULTS Case telephone volume was 18.2% lower (P =.002) and fell 6.50 times faster than control. Case total telephone plus web message volume was 13.7% lower (P =.025) and fell 5.84 times faster than control. Surveys were responded to by 40.3% (1,743/4,320) of patients and 61.4% (164/267) of providers and staff. Patients were overwhelmingly satisfied and providers and staff were generally satisfied; both found the system easy to use. Patient satisfaction correlated strongly with provider response time (Γ=0.557), and provider/staff satisfaction with computer skills (Γ=0.626) (Goodman-Kruskal Gamma [Γ] measure of ordinal association). CONCLUSIONS Secure web messaging improves on e-mail with encryption, access controls, message templates, customized message and prescription routing, knowledge content, and reimbursement. Further study is needed to determine whether reducing telephone traffic through the use of web messaging decreases provider interruptions and increases clinical efficiency during the workday. Satisfaction with web messaging may increase patient retention. PMID:15693928

Good progress for children coupled with recalcitrant inequalities for adults in New Zealand's journey towards Universal Health Coverage over the last decade.

PubMed

Matheson, Don; Reidy, Johanna; Tan, Lee; Carr, Julia

2015-05-29

This article explores how primary health care policy changes in New Zealand over the last decade have impacted on primary care access equity and avoidable hospital admissions. The national Ambulatory Sensitive Hospitalisations (ASH) data trends by age, ethnicity and area level deprivation were analysed in relation to the Primary Health Care policy initiatives for the period 2002 to 2014. Changes in primary care access over the decade have led to improvement in ASH indicators for parts of the population, but not for others. ASH rates decreased very significantly for children, especially in the 0-4 age group. These trends began in 2004, with decreases most marked for Pacific children, and those from the most deprived neighbourhoods. Inequalities in ASH rates for children between ethnic groups and levels of deprivation have substantially decreased. On the other hand, there has been a significant increase in ASH rates and inequalities for Pacific peoples in the 45 to 64 age group. Māori in the same age band show a modest reduction in ASH rates, with inequalities compared with the rest of the population remaining unchanged. Inequalities in ASH rates between 45-65 year olds living in different levels of deprivation remain large and unchanged, indicative of the recalcitrant nature of inequalities in primary care access for the adult population. Major policy initiatives undertaken by the government during this period have significantly affected primary care access. These include the New Zealand Health Strategy, the Primary Health Care Strategy, the creation of District Health Boards and Primary Health Organisations, and free care to under 6-year-olds. In the latter part of the decade, high-level target setting by successive Ministers is also affecting system performance. We conclude that the success in reducing inequality in access to primary care for children needs to be intensified, and the same principles applied to the adult population groups.

Access of Rural Girls to Primary Education in the Third World: State of Art, Obstacles, and Policy Recommendations.

ERIC Educational Resources Information Center

Safilios-Rothschild, Constantina

In the Third World, women's literacy and access to primary education lags behind that of men, and the situation is more accentuated for rural than for urban women. In general, rural women have lower literacy than rural men and than urban women. Because a considerable percentage of girls enrolled in primary school are over 14 years old, marriage,…

After-hours access to primary care practices linked with lower emergency department use and less unmet medical need.

PubMed

O'Malley, Ann S

2013-01-01

One goal of the Affordable Care Act is to improve patients' access to primary care and the coordination of that care. An important ingredient in achieving that goal is ensuring that patients have access to their primary care practice outside of regular business hours. This analysis of the 2010 Health Tracking Household Survey found that among people with a usual source of primary care, 40.2 percent reported that their practice offered extended hours, such as at night or on weekends. The analysis also found that one in five people who attempted after-hours contact with their primary care provider reported it was "very difficult" or "somewhat difficult" to reach a clinician. Those who reported less difficulty contacting a clinician after hours had significantly fewer emergency department visits (30.4 percent compared to 37.7 percent) and lower rates of unmet medical need (6.1 percent compared to 13.7 percent) than people who experienced more difficulty. The findings provide a valuable baseline on after-hours access, especially as patient-centered medical homes and accountable care organizations expand. Increasing support to primary care practices to offer or coordinate after-hours care may help reduce rates of emergency department use and unmet medical need.

Open access in the patient-centered medical home: lessons from the Veterans Health Administration.

PubMed

True, Gala; Butler, Anneliese E; Lamparska, Bozena G; Lempa, Michele L; Shea, Judy A; Asch, David A; Werner, Rachel M

2013-04-01

The Veterans Health Administration (VHA) has undertaken a 5-year initiative to transform to a patient-centered medical home model. An early focus of implementation was on creating open access, defined as continuity and capacity in primary care. We describe the impact of readiness for implementation on efforts of pilot teams to make changes to improve access and identify successful strategies used by early adopters to overcome barriers to change. A qualitative, formative evaluation of the first 18 months of implementation in one Veterans Integrated Service Network (VISN) spread across six states. Members of local implementation teams including administrators, primary care providers, and staff from primary care clinics located at 10 medical centers and 45 outpatient clinics. We conducted site visits during the first 6 months of implementation, observations at Learning Collaboratives, semi-structured interviews, and review of internal organizational documents. All data collection took place between April 2010 and December 2011. Early adopters employed various strategies to enhance access, with a focus on decreasing demand for face-to-face care, increasing supply of different types of primary care encounters, and improving clinic efficiencies. Our interviews with key contacts revealed three important areas where readiness for implementation (or lack thereof) had an impact on interventions to improve access: leadership engagement, staffing resources, and access to information and knowledge. Key factors related to readiness for implementation had an impact on which interventions pilot teams could put into place, as well as the viability and sustainability of access gains. Wide variations in interventions to improve access occurring across sites situated within one organization have important implications for efforts to measure the impact of enhanced access on patient outcomes, costs, and other systems-level indicators of the Medical Home.

Accessing Electronic Theses: Progress?

ERIC Educational Resources Information Center

Tennant, Roy

2000-01-01

Describes various ways by which universities provide access to their electronic theses and dissertations (ETDs), discussing UMI (University Microfilms International), XML (eXtensible Markup Language), and other formats. Discusses key leaders--national and international--in the ETD effort. Outlines the two main methods for locating ETDs. Presents a…

A physiological perspective on the origin and evolution of photosynthesis

PubMed Central

Martin, William F; Bryant, Donald A; Beatty, J Thomas

2017-01-01

Abstract The origin and early evolution of photosynthesis are reviewed from an ecophysiological perspective. Earth's first ecosystems were chemotrophic, fueled by geological H2 at hydrothermal vents and, required flavin-based electron bifurcation to reduce ferredoxin for CO2 fixation. Chlorophyll-based phototrophy (chlorophototrophy) allowed autotrophs to generate reduced ferredoxin without electron bifurcation, providing them access to reductants other than H2. Because high-intensity, short-wavelength electromagnetic radiation at Earth's surface would have been damaging for the first chlorophyll (Chl)-containing cells, photosynthesis probably arose at hydrothermal vents under low-intensity, long-wavelength geothermal light. The first photochemically active pigments were possibly Zn-tetrapyrroles. We suggest that (i) after the evolution of red-absorbing Chl-like pigments, the first light-driven electron transport chains reduced ferredoxin via a type-1 reaction center (RC) progenitor with electrons from H2S; (ii) photothioautotrophy, first with one RC and then with two, was the bridge between H2-dependent chemolithoautotrophy and water-splitting photosynthesis; (iii) photothiotrophy sustained primary production in the photic zone of Archean oceans; (iv) photosynthesis arose in an anoxygenic cyanobacterial progenitor; (v) Chl a is the ancestral Chl; and (vi), anoxygenic chlorophototrophic lineages characterized so far acquired, by horizontal gene transfer, RCs and Chl biosynthesis with or without autotrophy, from the architects of chlorophototrophy—the cyanobacterial lineage. PMID:29177446

Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region

PubMed Central

Odekunle, Florence Femi; Odekunle, Raphael Oluseun; Shankar, Srinivasan

2017-01-01

Poor health information system has been identified as a major challenge in the health-care system in many developing countries including sub-Saharan African countries. Electronic health record (EHR) has been shown as an important tool to improve access to patient information with attendance improved quality of care. However, EHR has not been widely implemented/adopted in sub-Saharan Africa. This study sought to identify factors that affect the adoption of an EHR in sub-Saharan Africa and strategies to improve its adoption in this region. A comprehensive literature search was conducted on three electronic databases: PubMed, Medline, and Google Scholar. Articles of interest were those published in English that contained information on factors that limit the adoption of an EHR as well as strategies that improve its adoption in sub-Saharan African countries. The available evidence indicated that there were many factors that hindered the widespread adoption of an EHR in sub-Saharan Africa. These were high costs of procurement and maintenance of the EHR system, lack of financial incentives and priorities, poor electricity supply and internet connectivity, and primary user’s limited computer skills. However, strategies such as implementation planning, financial supports, appropriate EHR system selection, training of primary users, and the adoption of the phased implementation process have been identified to facilitate the use of an EHR. Wide adoption of an EHR in sub-Saharan Africa region requires a lot more effort than what is assumed because of the current poor level of technological development, lack of required computer skills, and limited resources. PMID:29085270

Implementing electronic health records (EHRs): health care provider perceptions before and after transition from a local basic EHR to a commercial comprehensive EHR.

PubMed

Krousel-Wood, Marie; McCoy, Allison B; Ahia, Chad; Holt, Elizabeth W; Trapani, Donnalee N; Luo, Qingyang; Price-Haywood, Eboni G; Thomas, Eric J; Sittig, Dean F; Milani, Richard V

2018-06-01

We assessed changes in the percentage of providers with positive perceptions of electronic health record (EHR) benefit before and after transition from a local basic to a commercial comprehensive EHR. Changes in the percentage of providers with positive perceptions of EHR benefit were captured via a survey of academic health care providers before (baseline) and at 6-12 months (short term) and 12-24 months (long term) after the transition. We analyzed 32 items for the overall group and by practice setting, provider age, and specialty using separate multivariable-adjusted random effects logistic regression models. A total of 223 providers completed all 3 surveys (30% response rate): 85.6% had outpatient practices, 56.5% were >45 years old, and 23.8% were primary care providers. The percentage of providers with positive perceptions significantly increased from baseline to long-term follow-up for patient communication, hospital transitions - access to clinical information, preventive care delivery, preventive care prompt, preventive lab prompt, satisfaction with system reliability, and sharing medical information (P < .05 for each). The percentage of providers with positive perceptions significantly decreased over time for overall satisfaction, productivity, better patient care, clinical decision quality, easy access to patient information, monitoring patients, more time for patients, coordination of care, computer access, adequate resources, and satisfaction with ease of use (P < 0.05 for each). Results varied by subgroup. After a transition to a commercial comprehensive EHR, items with significant increases and significant decreases in the percentage of providers with positive perceptions of EHR benefit were identified, overall and by subgroup.

Specialty-care access for community health clinic patients: processes and barriers.

PubMed

Ezeonwu, Mabel C

2018-01-01

Community health clinics/centers (CHCs) comprise the US's core health-safety net and provide primary care to anyone who walks through their doors. However, access to specialty care for CHC patients is a big challenge. In this descriptive qualitative study, semistructured interviews of 37 referral coordinators of CHCs were used to describe their perspectives on processes and barriers to patients' access to specialty care. Analysis of data was done using content analysis. The process of coordinating care referrals for CHC patients is complex and begins with a provider's order for consultation and ends when the referring provider receives the specialist's note. Poverty, specialist and referral coordinator shortages, lack of insurance, insurance acceptability by providers, transport and clinic-location factors, lack of clinic-hospital affiliations, and poor communication between primary and specialty providers constitute critical barriers to specialty-care access for patients. Understanding the complexities of specialty-care coordination processes and access helps determine the need for comprehensive and uninterrupted access to quality health care for vulnerable populations. Guaranteed access to primary care at CHCs has not translated into improved access to specialty care. It is critical that effective policies be pursued to address the barriers and minimize interruptions in care, and to ensure continuity of care for all patients needing specialty care.

How does the social environment during life course embody in and influence the development of cancer?

PubMed

Chen, Ming; Zhu, Huiyun; Du, Yiqi; Yang, Geliang

2018-06-11

This review assessed the complex longitudinal processes involved in cancer etiology during life course to understand how the social inequality may be embodied in and influence cancer risk. A narrative literature review was performed with a keyword search conducted using PubMed, Scientific Electronic Library Online and Google. Three aspects of literatures were mainly included: social environmental mechanisms of cancer, life course of cancer development and social inequality of cancer risk. This review was complemented with manual searches of relevant journals and reference lists of primary articles. Social inequality is mostly embodied in genetic susceptibility and early childhood development, the duration and intensity of exposures and the access to medical resources, which influence the timing and accumulation of cancer risk during life course. The individuals with lower socioeconomic status are more likely to have higher cancer risk because of more frequency of timing and quantity of accumulation of adverse exposures and greater impact on epigenetic mechanisms. Primary prevention is the best prevention strategy to reduce cancer risk.

Scientific information repository assisting reflectance spectrometry in legal medicine.

PubMed

Belenki, Liudmila; Sterzik, Vera; Bohnert, Michael; Zimmermann, Klaus; Liehr, Andreas W

2012-06-01

Reflectance spectrometry is a fast and reliable method for the characterization of human skin if the spectra are analyzed with respect to a physical model describing the optical properties of human skin. For a field study performed at the Institute of Legal Medicine and the Freiburg Materials Research Center of the University of Freiburg, a scientific information repository has been developed, which is a variant of an electronic laboratory notebook and assists in the acquisition, management, and high-throughput analysis of reflectance spectra in heterogeneous research environments. At the core of the repository is a database management system hosting the master data. It is filled with primary data via a graphical user interface (GUI) programmed in Java, which also enables the user to browse the database and access the results of data analysis. The latter is carried out via Matlab, Python, and C programs, which retrieve the primary data from the scientific information repository, perform the analysis, and store the results in the database for further usage.

Computational Study of Primary Electrons in the Cusp Region of an Ion Engine's Discharge Chamber

NASA Technical Reports Server (NTRS)

Stueber, Thomas J. (Technical Monitor); Deshpande, Shirin S.; Mahalingam, Sudhakar; Menart, James A.

2004-01-01

In this work a computer code called PRIMA is used to study the motion of primary electrons in the magnetic cusp region of the discharge chamber of an ion engine. Even though the amount of wall area covered by the cusps is very small, the cusp regions are important because prior computational analyses have indicated that most primary electrons leave the discharge chamber through the cusps. The analysis presented here focuses on the cusp region only. The affects of the shape and size of the cusp region on primary electron travel are studied as well as the angle and location at which the electron enters the cusp region. These affects are quantified using the confinement length and the number density distributions of the primary electrons. In addition to these results comparisons of the results from PRIMA are made to experimental results for a cylindrical discharge chamber with two magnetic rings. These comparisons indicate the validity of the computer code called PRIMA.

From managing access to managing care: the impact of primary care on health care delivery organizations.

PubMed

Hickey, M E

1995-10-01

Professional "revenge of the nerds" is currently taking place, as managed care evolves generalist physicians into new professional prominence. Primary care physicians are finding themselves at the center of health care market reform as health plans, insurers, and other financing organizations turn to them as the key to cost control. In short supply, they are prospering financially from the demand. As the source of patients, they are gaining in prestige from specialists and hospitals who once demeaned them. But these newfound roles are only the initial steps in the transformation of the primary care practitioner. The change that the generalists are experiencing is essentially managing access to care, not truly managing care itself. There are large and crucial differences between managing access to care and actually managing care. These differences are, in many ways, a higher calling for primary care practitioners as they refocus attention on patient outcomes, which will in itself result in a lower resource utilization above and beyond the crude controlling of access. What those differences are, what new roles they require, and what impact they will have on organizations that either house or contract with primary care physicians will be the focus of this article.

The emergency data set for the German Electronic Health Card--which benefits can be expected?

PubMed

Born, Judith; Albert, Jürgen; Butz, Norbert; Loos, Stefan; Schenkel, Johannes; Gipp, Christoph; Juhra, Christian

2015-01-01

In order to improve access to pre-existing patient information in case of emergency, the German Electronic Health Card (EHC) is supposed to hold emergency data. As a basis, the German Medical Association developed an emergency data set, which provides the possibility to store information on prior diagnoses, medications, allergies and other emergency-relevant information. One main objective of the study is to evaluate the usefulness of the emergency data in specific emergency situations. Within a two-phase exploratory study, a total of 64 paper-based emergency data sets were completed by primary care physicians, and then were evaluated by clinicians, emergency physicians, and paramedics. Clinicians, emergency physicians as well as paramedics rated the emergency data set in more than 70% of the reviewed cases as very useful or useful. The greatest benefit was attributed to the information on diagnoses and medication. The implementation of an emergency data on the EHC has the potential to improve safety, quality and efficiency of emergency care.

Comparing Charge Transport in Oligonucleotides: RNA:DNA Hybrids and DNA Duplexes.

PubMed

Li, Yuanhui; Artés, Juan M; Qi, Jianqing; Morelan, Ian A; Feldstein, Paul; Anantram, M P; Hihath, Joshua

2016-05-19

Understanding the electronic properties of oligonucleotide systems is important for applications in nanotechnology, biology, and sensing systems. Here the charge-transport properties of guanine-rich RNA:DNA hybrids are compared to double-stranded DNA (dsDNA) duplexes with identical sequences. The conductance of the RNA:DNA hybrids is ∼10 times higher than the equivalent dsDNA, and conformational differences are determined to be the primary reason for this difference. The conductance of the RNA:DNA hybrids is also found to decrease more rapidly than dsDNA when the length is increased. Ab initio electronic structure and Green's function-based density of states calculations demonstrate that these differences arise because the energy levels are more spatially distributed in the RNA:DNA hybrid but that the number of accessible hopping sites is smaller. These combination results indicate that a simple hopping model that treats each individual guanine as a hopping site is insufficient to explain both a higher conductance and β value for RNA:DNA hybrids, and larger delocalization lengths must be considered.

Educating Girls: Strategies To Increase Access, Persistence, and Achievement.

ERIC Educational Resources Information Center

Tietjen, Karen; Prather, Cynthia, Ed.

This document reviews the interventions, such as policies, programs, and projects, that have been implemented by governments, donors, and other institutions to increase girls' access, persistence, and achievement at the primary school level. It examines both the formal system of primary education and nontraditional, alternative approaches to reach…

Providers' Access of Imaging Versus Only Reports: A System Log File Analysis.

PubMed

Jung, Hye-Young; Gichoya, Judy Wawira; Vest, Joshua R

2017-02-01

An increasing number of technologies allow providers to access the results of imaging studies. This study examined differences in access of radiology images compared with text-only reports through a health information exchange system by health care professionals. The study sample included 157,256 historical sessions from a health information exchange system that enabled 1,670 physicians and non-physicians to access text-based reports and imaging over the period 2013 to 2014. The primary outcome was an indicator of access of an imaging study instead of access of a text-only report. Multilevel mixed-effects regression models were used to estimate the association between provider and session characteristics and access of images compared with text-only reports. Compared with primary care physicians, specialists had an 18% higher probability of accessing actual images instead of text-only reports (β = 0.18; P < .001). Compared with primary care practice settings, the probability of accessing images was 4% higher for specialty care practices (P < .05) and 8% lower for emergency departments (P < .05). Radiologists, orthopedists, and neurologists accounted for 79% of all the sessions with actual images accessed. Orthopedists, radiologists, surgeons, and pulmonary disease specialists accessed imaging more often than text-based reports only. Consideration for differences in the need to access images compared with text-only reports based on the type of provider and setting of care are needed to maximize the benefits of image sharing for patient care. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Public housing relocations in Atlanta, Georgia, and declines in spatial access to safety net primary care

PubMed Central

Cooper, Hannah LF; Wodarski, Stephanie; Cummings, Janet; Hunter-Jones, Josalin; Karnes, Conny; Ross, Zev; Druss, Ben; Bonney, Loida E

2012-01-01

This analysis investigates changes in spatial access to safety-net primary care in a sample of US public housing residents relocating via the HOPE VI initiative from public housing complexes to voucher-subsidized rental units; substance misusers were oversampled. We used gravity-based models to measure spatial access to care, and used mixed models to assess pre-/post-relocation changes in access. Half the sample experienced declines in spatial access of ≥79.83%; declines did not vary by substance misuse status. Results suggest that future public housing relocation initiatives should partner with relocaters, particularly those in poor health, to help them find housing near safety-net clinics. PMID:23060002

[Use of indicators of geographical accessibility to primary health care centers in addressing inequities].

PubMed

De Pietri, Diana; Dietrich, Patricia; Mayo, Patricia; Carcagno, Alejandro; de Titto, Ernesto

2013-12-01

Characterize geographical indicators in relation to their usefulness in measuring regional inequities, identify and describe areas according to their degree of geographical accessibility to primary health care centers (PHCCs), and detect populations at risk from the perspective of access to primary care. Analysis of spatial accessibility using geographic information systems (GIS) involved three aspects: population without medical coverage, distribution of PHCCs, and the public transportation network connecting them. The development of indicators of demand (real, potential, and differential) and analysis of territorial factors affecting population mobility enabled the characterization of PHCCs with regard to their environment, thereby contributing to local and regional analysis and to the detection of different zones according to regional connectivity levels. Indicators developed in a GIS environment were very useful in analyzing accessibility to PHCCs by vulnerable populations. Zoning the region helped identify inequities by differentiating areas of unmet demand and fragmentation of spatial connectivity between PHCCs and public transportation.

The effect of tail stretching on the ionospheric accessibility of relativistic electron beam experiments

NASA Astrophysics Data System (ADS)

Willard, J.; Johnson, J.; Sanchez, E. R.; Kaganovich, I.; Greklek-McKeon, M.; Powis, T.

2017-12-01

New accelerator technologies have made it possible to install a lightweight electron beam accelerator onto small to medium satellites. Electron beams fired along the geomagnetic field would be able to carry energy flux into the ionosphere if they were fired into the loss cone, making these particles observable from the ground. Such an experiment would provide a way to accurately map field lines. One of the important challenges to utilizing this concept is understanding accessibility of these electrons to the ionosphere. While relativistic electron beams are generally more stable than lower energy beams, they are more sensitive to the effects of field-line curvature, which can significantly modify the loss cone [Porazik et al., 2014] making accessibility to the ionosphere sensitive to the launch angle with respect to the magnetic field. We examine the loss cone for 1 MeV electrons in a realistic magnetospheric geometry considering, in particular, the role of field-line stretching. To map the loss cone, we consider conservation of the first adiabatic invariant to second order in ρ/L using the asymptotic series derived by Gardner [Phys Fluids, 1966], which is valid on the midnight meridian. We investigate the loss cones for different magnetic field models controlled by a stretching parameter over the entire midnight meridian. We found that, because tail stretching increases field line curvature near the midplane but decreases curvature elsewhere, accessibility to the ionosphere is increased by tail stretching in regions above and below the midplane, although accessibility of particles passing through the midplane is reduced. This result implies that satellites armed with electron beam accelerators may be able to visibly affect the atmosphere from distances greater than previously anticipated.

Access to primary care for socio-economically disadvantaged older people in rural areas: A qualitative study

PubMed Central

Turley, Rachel; Porter, Tom; Shakespeare, Tom; Wong, Geoff; Jones, Andy P.; Steel, Nick

2018-01-01

Objective We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas. Methods Using a community recruitment strategy, fifteen people over 65 years, living in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access. Findings Older people’s experience can be understood within the context of a patient perceived set of unwritten rules or social contract–an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes. Health professionals’ described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system. Conclusion Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service. PMID:29509811

Early detection of cervical cancer according to the discourses of primary care midwives in Segovia, Spain.

PubMed

Otero, Laura; Sanz, Belén; Blasco, Teresa

2011-10-01

To analyze the discourses of primary care midwives on access to and utilization of the Cervical Cancer Prevention Program. A qualitative study was conducted in an area of low population density with a high proportion of rural population in Segovia, Spain, between 2008 and 2009. Semi-structured interviews were carried out. Ten primary care midwives were interviewed covering the 16 basic health districts of the city. Data analysis was based on grounded theory methodology. Access to and utilization of the Cervical Cancer Prevention Program was associated with attendance to midwife visits, women's experiences with cervical smears and their perception of risk of cervical cancer. Geographic distance to the health center, difficult access to immigrant women who have no health insurance, and being unaware of the program offered are some of the perceived barriers. Social exclusion is also perceived as a barrier of access to and utilization of the program. The recommendation to participate in the program made by the primary care physician was identified as the main facilitator. The midwives perceived inequalities in access to and utilization of the Cervical Cancer Prevention Program that are associated to individual characteristics of women, and contextual characteristics such as the geographical environment where they live and Program's infrastructure. There is inequality of access to care of underrepresented groups of women such as immigrant women and those residing in rural areas.

Electron-positron pair production by ultrarelativistic electrons in a soft photon field

NASA Technical Reports Server (NTRS)

Mastichiadis, A.; Marscher, A. P.; Brecher, K.

1986-01-01

The fully differential cross section for photon-electron pair production is integrated numerically over phase space. Results are obtained for the astrophysically interesting case in which the interaction between an ultrarelativistic electron and a soft photon results in electron-positron pair production. The positron spectrum is a function of the energies of both the photon and the electron, as well as the angle of interaction. It is found that the energy at which the positron distribution peaks is inversely proportional to the photon energy and independent of the electron energy. The positron spectrum is integrated once more over initial electron energies for a power-law energy distribution of primary electrons. The same procedure is repeated for the recoil particle; it is shown that the peak of the recoil energy distribution depends linearly on the energy of the primary electron. Finally, semianalytical expressions are obtained for the energy losses of the primary electrons.

Electronic information and clinical decision support for prescribing: state of play in Australian general practice

PubMed Central

Robertson, Jane; Moxey, Annette J; Newby, David A; Gillies, Malcolm B; Williamson, Margaret; Pearson, Sallie-Anne

2011-01-01

Background. Investments in eHealth worldwide have been mirrored in Australia, with >90% of general practices computerized. Recent eHealth incentives promote the use of up to date electronic information sources relevant to general practice with flexibility in mode of access. Objective. To determine GPs’ access to and use of electronic information sources and computerized clinical decision support systems (CDSSs) for prescribing. Methods. Semi-structured interviews were conducted with 18 experienced GPs and nine GP trainees in New South Wales, Australia in 2008. A thematic analysis of interview transcripts was undertaken. Results. Information needs varied with clinical experience, and people resources (specialists, GP peers and supervisors for trainees) were often preferred over written formats. Experienced GPs used a small number of electronic resources and accessed them infrequently. Familiarity from training and early clinical practice and easy access were dominant influences on resource use. Practice time constraints meant relevant information needed to be readily accessible during consultations, requiring integration or direct access from prescribing software. Quality of electronic resource content was assumed and cost a barrier for some GPs. Conclusions. The current Australian practice incentives do not prescribe which information resources GPs should use. Without integration into practice computing systems, uptake and routine use seem unlikely. CDSS developments must recognize the time pressures of practice, preference for integration and cost concerns. Minimum standards are required to ensure that high-quality information resources are integrated and regularly updated. Without standards, the anticipated benefits of computerization on patient safety and health outcomes will be uncertain. PMID:21109619

Electronic Reference Library: Silverplatter's Database Networking Solution.

ERIC Educational Resources Information Center

Millea, Megan

Silverplatter's Electronic Reference Library (ERL) provides wide area network access to its databases using TCP/IP communications and client-server architecture. ERL has two main components: The ERL clients (retrieval interface) and the ERL server (search engines). ERL clients provide patrons with seamless access to multiple databases on multiple…

Electronic Document Delivery: New Options for Libraries.

ERIC Educational Resources Information Center

Leach, Ronald G.; Tribble, Judith E.

1993-01-01

Examines commercial electronic document delivery services that are available to academic libraries. Highlights include collection development issues; criteria for selection and evaluation; remote access systems, including CARL UnCover 2, Faxon Finder and Faxon Xpress, ContentsFirst and ArticleFirst, and CitaDel; and on-site access systems,…

The University of Minnesota's Internet Gopher System: A Tool for Accessing Network-Based Electronic Information.

ERIC Educational Resources Information Center

Wiggins, Rich

1993-01-01

Describes the Gopher system developed at the University of Minnesota for accessing information on the Internet. Highlights include the need for navigation tools; Gopher clients; FTP (File Transfer Protocol); campuswide information systems; navigational enhancements; privacy and security issues; electronic publishing; multimedia; and future…

Under Lock and Key: Preventing Campus Theft of Electronic Equipment.

ERIC Educational Resources Information Center

Harrison, J. Phil

1996-01-01

A discussion of computer theft prevention on college campuses looks at a variety of elements in electronic equipment security, including the extent of the problem, physical antitheft products, computerized access, control of key access, alarm systems, competent security personnel, lighting, use of layers of protection, and increasing…

78 FR 76153 - Agency Information Collection Activities: Comment Request; Extension of an Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-16

... Notice of Information Collection for review; Electronic Bonds Online (eBonds) Access; OMB Control No... submitting the following information collection request for review and clearance in accordance [[Page 76154... information collection. (2) Title of the Form/Collection: Electronic Bonds Online (eBonds) Access. (3) Agency...

Internet Database Review: The FDA BBS.

ERIC Educational Resources Information Center

Tomaiuolo, Nicholas G.

1993-01-01

Describes the electronic bulletin board system (BBS) of the Food and Drug Administration (FDA) that is accessible through the Internet. Highlights include how to gain access; the menu-driven software; other electronic sources of FDA information; and adding value. Examples of the FDA BBS menu and the help screen are included. (LRW)

Electronic Portfolios.

ERIC Educational Resources Information Center

Purves, Alan C.

1996-01-01

Outlines three forms of electronic portfolio based on a student's work, a class project about a specific topic, and a class seminar on a broad topic. Discusses logistical problems of management, access, and cross-referencing; technical problems of input, access, and copying; and theoretical issues of the lack of realia, of ownership and copyright,…

Impact of an EHR-based diabetes management form on quality and outcomes of diabetes care in primary care practices.

PubMed

Herrin, Jeph; da Graca, Briget; Aponte, Phil; Stanek, H Greg; Cowling, Terianne; Fullerton, Cliff; Hollander, Priscilla; Ballard, David J

2015-01-01

Health information technology shows promise for improving chronic disease care. This study assessed the impact of a diabetes management form (DMF), accessible within an electronic health record. From 2007 to 2009, 2108 diabetes patients were seen in 20 primary care practices; 1103 visits involved use of the DMF in 2008. The primary outcome was "optimal care": HbA1c ≤8%, low-density lipoprotein (LDL) cholesterol <100 mg/dL, blood pressure <130/80 mm Hg, not smoking, and aspirin prescription in patients ≥40 years. After adjusting for number of visits, age, sex, and insulin use, DMF-exposed patients showed less improvement in attaining "optimal care" (estimated difference-in-difference [DID] = -2.06 percentage points; P < .001), LDL cholesterol (DID = -2.30; P = .023), blood pressure (DID = -3.05; P < .001), and total cholesterol (DID = -0.47; P = .004) targets. Documented microalbumin tests, aspirin prescription, and eye and foot exams increased more. Thus, DMF use was associated with smaller gains in achieving evidence-based targets, but greater improvement in documented delivery of care. © 2013 by the American College of Medical Quality.

Themes and Reform of Primary Health Care (RCAPS) in the city of Rio de Janeiro, Brazil.

PubMed

Soranz, Daniel; Pinto, Luiz Felipe; Penna, Gerson Oliveira

2016-05-01

During the period of 1990-2000, Rio de Janeiro was characterized by a limited supply of public and universal primary care services. In 2008, family health team coverage corresponded to 3.5% of the population, the lowest among capital cities. At the end of 2013, coverage reached more than 40% of Rio residents with teams comprised of doctors, nurses, practical nurses, community health agents, and health surveillance agents, in addition to oral health teams. This article describes and analyzes the main components of the Reform in Primary Health Care (RCAPS) implemented since 2009, focusing on three lines of action: administrative reform, organizational model, and model of care. A new organizational chart of the Municipal Health Secretary and a legal framework for a new results-based model were created. As for the model of care, the standardization of procedures and health activities for all units and the monthly assessment of clinical indicators of results of implanted electronic medical records were created. Experience has shown the feasibility of RCAPS, pointing to new challenges that will allow consolidation of the expansion of access, training of human resources, health communication, and a shift to a managerial results-driven model.

Pediatric asthma hospitalizations among urban minority children and the continuity of primary care.

PubMed

Utidjian, Levon H; Fiks, Alexander G; Localio, A Russell; Song, Lihai; Ramos, Mark J; Keren, Ron; Bell, Louis M; Grundmeier, Robert W

2017-12-01

To examine the effect of ambulatory health care processes on asthma hospitalizations. A retrospective cohort study using electronic health records was completed. Patients aged 2-18 years receiving health care from 1 of 5 urban practices between Jan 1, 2004 and Dec 31, 2008 with asthma documented on their problem list were included. Independent variables were modifiable health care processes in the primary care setting: (1) use of asthma controller medications; (2) regular assessment of asthma symptoms; (3) use of spirometry; (4) provision of individualized asthma care plans; (5) timely influenza vaccination; (6) access to primary healthcare; and (7) use of pay for performance physician incentives. Occurrence of one or more asthma hospitalizations was the primary outcome of interest. We used a log linear model (Poisson regression) to model the association between the factors of interest and number of asthma hospitalizations. 5,712 children with asthma were available for analysis. 96% of the children were African American. The overall hospitalization rate was 64 per 1,000 children per year. None of the commonly used asthma-specific indicators of high quality care were associated with fewer asthma hospitalizations. Children with documented asthma who experienced a lack of primary health care (no more than one outpatient visit at their primary care location in the 2 years preceding hospitalization) were at higher risk of hospitalization compared to those children with a greater number of visits (incidence rate ratio 1.39; 95% CI 1.09-1.78). In children with asthma, more frequent primary care visits are associated with reduced asthma hospitalizations.

Ethnicity and cardiovascular health inequalities in people with severe mental illnesses: protocol for the E-CHASM study.

PubMed

Das-Munshi, J; Ashworth, M; Gaughran, F; Hull, S; Morgan, C; Nazroo, J; Roberts, A; Rose, D; Schofield, P; Stewart, R; Thornicroft, G; Prince, M J

2016-04-01

People with severe mental illnesses (SMI) experience a 17- to 20-year reduction in life expectancy. One-third of deaths are due to cardiovascular disease. This study will establish the relationship of SMI with cardiovascular disease in ethnic minority groups (Indian, Pakistani, Bangladeshi, black Caribbean, black African and Irish), in the UK. E-CHASM is a mixed methods study utilising data from 1.25 million electronic patient records. Secondary analysis of routine patient records will establish if differences in cause-specific mortality, cardiovascular disease prevalence and disparities in accessing healthcare for ethnic minority people living with SMI exist. A nested qualitative study will be used to assess barriers to accessing healthcare, both from the perspectives of service users and providers. In primary care, 993,116 individuals, aged 18+, provided data from 186/189 (98 %) practices in four inner-city boroughs (local government areas) in London. Prevalence of SMI according to primary care records, ranged from 1.3-1.7 %, across boroughs. The primary care sample included Bangladeshi [n = 94,643 (10 %)], Indian [n = 6086 (6 %)], Pakistani [n = 35,596 (4 %)], black Caribbean [n = 45,013 (5 %)], black African [n = 75,454 (8 %)] and Irish people [n = 13,745 (1 %)]. In the secondary care database, 12,432 individuals with SMI over 2007-2013 contributed information; prevalent diagnoses were schizophrenia [n = 6805 (55 %)], schizoaffective disorders [n = 1438 (12 %)] and bipolar affective disorder [n = 4112 (33 %)]. Largest ethnic minority groups in this sample were black Caribbean [1432 (12 %)] and black African (1393 (11 %)). There is a dearth of research examining cardiovascular disease in minority ethnic groups with severe mental illnesses. The E-CHASM study will address this knowledge gap.

Bioengineered human acellular vessels for dialysis access in patients with end-stage renal disease: two phase 2 single-arm trials

PubMed Central

Lawson, Jeffrey H; Glickman, Marc H; Ilzecki, Marek; Jakimowicz, Tomasz; Jaroszynski, Andrzej; Peden, Eric K; Pilgrim, Alison J; Prichard, Heather L; Guziewicz, Malgorzata; Przywara, Stanisław; Szmidt, Jacek; Turek, Jakub; Witkiewicz, Wojciech; Zapotoczny, Norbert; Zubilewicz, Tomasz; Niklason, Laura E

2016-01-01

Summary Background For patients with end-stage renal disease who are not candidates for fistula, dialysis access grafts are the best option for chronic haemodialysis. However, polytetrafluoroethylene arteriovenous grafts are prone to thrombosis, infection, and intimal hyperplasia at the venous anastomosis. We developed and tested a bioengineered human acellular vessel as a potential solution to these limitations in dialysis access. Methods We did two single-arm phase 2 trials at six centres in the USA and Poland. We enrolled adults with end-stage renal disease. A novel bioengineered human acellular vessel was implanted into the arms of patients for haemodialysis access. Primary endpoints were safety (freedom from immune response or infection, aneurysm, or mechanical failure, and incidence of adverse events), and efficacy as assessed by primary, primary assisted, and secondary patencies at 6 months. All patients were followed up for at least 1 year, or had a censoring event. These trials are registered with ClinicalTrials.gov, NCT01744418 and NCT01840956. Findings Human acellular vessels were implanted into 60 patients. Mean follow-up was 16 months (SD 7·6). One vessel became infected during 82 patient-years of follow-up. The vessels had no dilatation and rarely had post-cannulation bleeding. At 6 months, 63% (95% CI 47–72) of patients had primary patency, 73% (57–81) had primary assisted patency, and 97% (85–98) had secondary patency, with most loss of primary patency because of thrombosis. At 12 months, 28% (17–40) had primary patency, 38% (26–51) had primary assisted patency, and 89% (74–93) had secondary patency. Interpretation Bioengineered human acellular vessels seem to provide safe and functional haemodialysis access, and warrant further study in randomised controlled trials. Funding Humacyte and US National Institutes of Health. PMID:27203778

Accessibility and use of primary healthcare for immigrants living in the Niagara Region.

PubMed

Lum, Irene D; Swartz, Rebecca H; Kwan, Matthew Y W

2016-05-01

Although the challenges of accessing and using primary healthcare for new immigrants to Canada have been fairly well documented, the focus has primarily been on large cities with significant immigrant populations. The experiences of immigrants living in smaller, less diverse urban centres remain largely unknown. The purpose of this study was to examine the lived experiences of immigrants living in a small urban centre with regards to the primary healthcare system. A total of 13 immigrants living in the Greater Niagara Region participated in semi-structured interviews. All interviews were recorded, transcribed, and then coded and analyzed for emergent themes using NVivo. Five factors were found to impact primary care access and use: lack of social contacts, lack of universal healthcare coverage during their initial arrival, language as a barrier, treatment preferences, and geographic distance to primary care. Overall findings suggest that immigrants moving to smaller areas such as the Niagara Region face similar barriers to primary care as those moving into large cities. Some barriers, however, appear to be specific to the context of smaller urban centres, further exacerbated by living in a small city due to a smaller immigrant population, fewer services for immigrants, and less diversity in practicing physicians. More research is required to understand the contextual factors inhibiting primary care access and use among immigrants moving to smaller urban centres, and determine effective strategies to overcome these barriers. Copyright © 2016 Elsevier Ltd. All rights reserved.

Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care

PubMed Central

Daker-White, Gavin; Hays, Rebecca; McSharry, Jennifer; Giles, Sally; Cheraghi-Sohi, Sudeh; Rhodes, Penny; Sanders, Caroline

2015-01-01

Objective Studies of patient safety in health care have traditionally focused on hospital medicine. However, recent years have seen more research located in primary care settings which have different features compared to secondary care. This study set out to synthesize published qualitative research concerning patient safety in primary care in order to build a conceptual model. Method Meta-ethnography, an interpretive synthesis method whereby third order interpretations are produced that best describe the groups of findings contained in the reports of primary studies. Results Forty-eight studies were included as 5 discrete subsets where the findings were translated into one another: patients’ perspectives of safety, staff perspectives of safety, medication safety, systems or organisational issues and the primary/secondary care interface. The studies were focused predominantly on issues seen to either improve or compromise patient safety. These issues related to the characteristics or behaviour of patients, staff or clinical systems and interactions between staff, patients and staff, or people and systems. Electronic health records, protocols and guidelines could be seen to both degrade and improve patient safety in different circumstances. A conceptual reading of the studies pointed to patient safety as a subjective feeling or judgement grounded in moral views and with potentially hidden psychological consequences affecting care processes and relationships. The main threats to safety appeared to derive from ‘grand’ systems issues, for example involving service accessibility, resources or working hours which may not be amenable to effective intervention by individual practices or health workers, especially in the context of a public health system. Conclusion Overall, the findings underline the human elements in patient safety primary health care. The key to patient safety lies in effective face-to-face communication between patients and health care staff or between the different staff involved in the care of an individual patient. Electronic systems can compromise safety when they override the opportunities for face-to-face communication. The circumstances under which guidelines or protocols are seen to either compromise or improve patient safety needs further investigation. PMID:26244494

Evaluating a complex model designed to increase access to high quality primary mental health care for under-served groups: a multi-method study.

PubMed

Dowrick, Christopher; Bower, Peter; Chew-Graham, Carolyn; Lovell, Karina; Edwards, Suzanne; Lamb, Jonathan; Bristow, Katie; Gabbay, Mark; Burroughs, Heather; Beatty, Susan; Waheed, Waquas; Hann, Mark; Gask, Linda

2016-02-17

Many people with mental distress are disadvantaged because care is not available or does not address their needs. In order to increase access to high quality primary mental health care for under-served groups, we created a model of care with three discrete elements: community engagement, primary care training and tailored wellbeing interventions. We have previously demonstrated the individual impact of each element of the model. Here we assess the effectiveness of the combined model in increasing access to and improving the quality of primary mental health care. We test the assumptions that access to the wellbeing interventions is increased by the presence of community engagement and primary care training; and that quality of primary mental health care is increased by the presence of community engagement and the wellbeing interventions. We implemented the model in four under-served localities in North-West England, focusing on older people and minority ethnic populations. Using a quasi-experimental design with no-intervention comparators, we gathered a combination of quantitative and qualitative information. Quantitative information, including referral and recruitment rates for the wellbeing interventions, and practice referrals to mental health services, was analysed descriptively. Qualitative information derived from interview and focus group responses to topic guides from more than 110 participants. Framework analysis was used to generate findings from the qualitative data. Access to the wellbeing interventions was associated with the presence of the community engagement and the primary care training elements. Referrals to the wellbeing interventions were associated with community engagement, while recruitment was associated with primary care training. Qualitative data suggested that the mechanisms underlying these associations were increased awareness and sense of agency. The quality of primary mental health care was enhanced by information gained from our community mapping activities, and by the offer of access to the wellbeing interventions. There were variable benefits from health practitioner participation in community consultative groups. We also found that participation in the wellbeing interventions led to increased community engagement. We explored the interactions between elements of a multilevel intervention and identified important associations and underlying mechanisms. Further research is needed to test the generalisability of the model. Current Controlled Trials, reference ISRCTN68572159 . Registered 25 February 2013.

Closing the Referral Loop: an Analysis of Primary Care Referrals to Specialists in a Large Health System.

PubMed

Patel, Malhar P; Schettini, Priscille; O'Leary, Colin P; Bosworth, Hayden B; Anderson, John B; Shah, Kevin P

2018-05-01

Ideally, a referral from a primary care physician (PCP) to a specialist results in a completed specialty appointment with results available to the PCP. This is defined as "closing the referral loop." As health systems grow more complex, regulatory bodies increase vigilance, and reimbursement shifts towards value, closing the referral loop becomes a patient safety, regulatory, and financial imperative. To assess the ability of a large health system to close the referral loop, we used electronic medical record (EMR)-generated data to analyze referrals from a large primary care network to 20 high-volume specialties between July 1, 2015 and June 30, 2016. The primary metric was documented specialist appointment completion rate. Explanatory analyses included documented appointment scheduling rate, individual clinic differences, appointment wait times, and geographic distance to appointments. Of the 103,737 analyzed referral scheduling attempts, only 36,072 (34.8%) resulted in documented complete appointments. Low documented appointment scheduling rates (38.9% of scheduling attempts lacked appointment dates), individual clinic differences in closing the referral loop, and significant differences in wait times and distances to specialists between complete and incomplete appointments drove this gap. Other notable findings include high variation in wait times among specialties and correlation between high wait times and low documented appointment completion rates. The rate of closing the referral loop in this health system is low. Low appointment scheduling rates, individual clinic differences, and patient access issues of wait times and geographic proximity explain much of the gap. This problem is likely common among large health systems with complex provider networks and referral scheduling. Strategies that improve scheduling, decrease variation among clinics, and improve patient access will likely improve rates of closing the referral loop. More research is necessary to determine the impact of these changes and other potential driving factors.

Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) for adults at risk for glaucoma: study rationale and design.

PubMed

Owsley, Cynthia; Rhodes, Lindsay A; McGwin, Gerald; Mennemeyer, Stephen T; Bregantini, Mary; Patel, Nita; Wiley, Demond M; LaRussa, Frank; Box, Dan; Saaddine, Jinan; Crews, John E; Girkin, Christopher A

2015-11-18

Primary open angle glaucoma is a chronic, progressive eye disease that is the leading cause of blindness among African Americans. Glaucoma progresses more rapidly and appears about 10 years earlier in African Americans as compared to whites. African Americans are also less likely to receive comprehensive eye care when glaucoma could be detected before irreversible blindness. Screening and follow-up protocols for managing glaucoma recommended by eye-care professional organizations are often not followed by primary eye-care providers, both ophthalmologists and optometrists. There is a pressing need to improve both the accessibility and quality of glaucoma care for African Americans. Telemedicine may be an effective solution for improving management and diagnosis of glaucoma because it depends on ocular imaging and tests that can be electronically transmitted to remote reading centers where tertiary care specialists can examine the results. We describe the Eye Care Quality and Accessibility Improvement in the Community project (EQUALITY), set to evaluate a teleglaucoma program deployed in retail-based primary eye care practices serving communities with a large percentage of African Americans. We conducted an observational, 1-year prospective study based in two Walmart Vision Centers in Alabama staffed by primary care optometrists. EQUALITY focuses on new or existing adult patients who are at-risk for glaucoma or already diagnosed with glaucoma. Patients receive dilated comprehensive examinations and diagnostic testing for glaucoma, followed by the optometrist's diagnosis and a preliminary management plan. Results are transmitted to a glaucoma reading center where ophthalmologists who completed fellowship training in glaucoma review results and provide feedback to the optometrist, who manages the care of the patient. Patients also receive eye health education about glaucoma and comprehensive eye care. Research questions include diagnostic and management agreement between providers, the impact of eye health education on patients' knowledge and adherence to follow-up and medication, patient satisfaction, program cost-effectiveness, and EQUALITY's impact on Walmart pharmacy prescription rates. As eye-care delivery systems in the US strive to improve quality while reducing costs, telemedicine programs including teleglaucoma initiatives such as EQUALITY could contribute toward reaching this goal, particularly among underserved populations at-risk for chronic blinding diseases.

Electron polar cap and the boundary of open geomagnetic field lines.

NASA Technical Reports Server (NTRS)

Evans, L. C.; Stone, E. C.

1972-01-01

A total of 333 observations of the boundary of the polar access region for electrons (energies greater than 530 keV) provides a comprehensive map of the electron polar cap. The boundary of the electron polar cap, which should occur at the latitude separating open and closed field lines, is consistent with previously reported closed field line limits determined from trapped-particle data. The boundary, which is sharply defined, seems to occur at one of three discrete latitudes. Although the electron flux is generally uniform across the polar cap, a limited region of reduced access is observed about 10% of the time.

Advanced dental education programs: status and implications for access to care in California.

PubMed

Glassman, Paul

2012-01-01

Primary care residencies in dentistry include general practice residency and advanced education in general dentistry--collectively known as postdoctoral general--dentistry and pediatric dentistry. These primary care programs are the most likely to serve underserved populations during the training experience. An expansion of primary care dental residency positions in California has the potential to positively impact access to care in California. However, there are significant political and financial barriers to realizing this potential.

A registry-based randomized trial comparing radial and femoral approaches in women undergoing percutaneous coronary intervention: the SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women) trial.

PubMed

Rao, Sunil V; Hess, Connie N; Barham, Britt; Aberle, Laura H; Anstrom, Kevin J; Patel, Tejan B; Jorgensen, Jesse P; Mazzaferri, Ernest L; Jolly, Sanjit S; Jacobs, Alice; Newby, L Kristin; Gibson, C Michael; Kong, David F; Mehran, Roxana; Waksman, Ron; Gilchrist, Ian C; McCourt, Brian J; Messenger, John C; Peterson, Eric D; Harrington, Robert A; Krucoff, Mitchell W

2014-08-01

This study sought to determine the effect of radial access on outcomes in women undergoing percutaneous coronary intervention (PCI) using a registry-based randomized trial. Women are at increased risk of bleeding and vascular complications after PCI. The role of radial access in women is unclear. Women undergoing cardiac catheterization or PCI were randomized to radial or femoral arterial access. Data from the CathPCI Registry and trial-specific data were merged into a final study database. The primary efficacy endpoint was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding or vascular complications requiring intervention. The primary feasibility endpoint was access site crossover. The primary analysis cohort was the subgroup undergoing PCI; sensitivity analyses were conducted in the total randomized population. The trial was stopped early for a lower than expected event rate. A total of 1,787 women (691 undergoing PCI) were randomized at 60 sites. There was no significant difference in the primary efficacy endpoint between radial or femoral access among women undergoing PCI (radial 1.2% vs. 2.9% femoral, odds ratio [OR]: 0.39; 95% confidence interval [CI]: 0.12 to 1.27); among women undergoing cardiac catheterization or PCI, radial access significantly reduced bleeding and vascular complications (0.6% vs. 1.7%; OR: 0.32; 95% CI: 0.12 to 0.90). Access site crossover was significantly higher among women assigned to radial access (PCI cohort: 6.1% vs. 1.7%; OR: 3.65; 95% CI: 1.45 to 9.17); total randomized cohort: (6.7% vs. 1.9%; OR: 3.70; 95% CI: 2.14 to 6.40). More women preferred radial access. In this pragmatic trial, which was terminated early, the radial approach did not significantly reduce bleeding or vascular complications in women undergoing PCI. Access site crossover occurred more often in women assigned to radial access. (SAFE-PCI for Women; NCT01406236). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Special requirements for electronic health record systems in ophthalmology.

PubMed

Chiang, Michael F; Boland, Michael V; Brewer, Allen; Epley, K David; Horton, Mark B; Lim, Michele C; McCannel, Colin A; Patel, Sayjal J; Silverstone, David E; Wedemeyer, Linda; Lum, Flora

2011-08-01

The field of ophthalmology has a number of unique features compared with other medical and surgical specialties regarding clinical workflow and data management. This has important implications for the design of electronic health record (EHR) systems that can be used intuitively and efficiently by ophthalmologists and that can promote improved quality of care. Ophthalmologists often lament the absence of these specialty-specific features in EHRs, particularly in systems that were developed originally for primary care physicians or other medical specialists. The purpose of this article is to summarize the special requirements of EHRs that are important for ophthalmology. The hope is that this will help ophthalmologists to identify important features when searching for EHR systems, to stimulate vendors to recognize and incorporate these functions into systems, and to assist federal agencies to develop future guidelines regarding meaningful use of EHRs. More broadly, the American Academy of Ophthalmology believes that these functions are elements of good system design that will improve access to relevant information at the point of care between the ophthalmologist and the patient, will enhance timely communications between primary care providers and ophthalmologists, will mitigate risk, and ultimately will improve the ability of physicians to deliver the highest-quality medical care. Proprietary or commercial interest disclosure may be found after the references. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Building a Foundation to Reduce Health Inequities: Routine Collection of Sociodemographic Data in Primary Care.

PubMed

Pinto, Andrew D; Glattstein-Young, Gabriela; Mohamed, Anthony; Bloch, Gary; Leung, Fok-Han; Glazier, Richard H

2016-01-01

Detailed data on social determinants of health can facilitate the identification of inequities in access to health care. We report on a sociodemographic data collection tool used in a family medicine clinic. Four major health organizations in Toronto collaborated to identify a set of 14 questions that covered a range of social determinants of health. These were translated into 13 languages. This survey was self-administered using an electronic tablet to a convenience sample of 407 patients in the waiting room of a primary care clinic. Data were uploaded directly to the electronic medical record. The rate of valid responses provided for each question was high, ranging from 84% to 100%. The questions with the highest number of patients selecting "do not know" and "prefer not to answer" pertained to disabilities and income. Patients reported finding the process acceptable. In subsequent implementation across 5 clinics, 10,536 patients have been surveyed; only 724 (6.9%) declined to participate. Collecting data on social determinants of health through a self-administered survey, and linking them to a patient's chart, is feasible and acceptable. A modified survey is now administered to all patients. Such data are already being used to identify health inequities, develop novel interventions, and evaluate their impact on health outcomes. © Copyright 2016 by the American Board of Family Medicine.

Provider Perspectives about Latino Patients: Determinants of Care and Implications for Treatment

ERIC Educational Resources Information Center

Valdez, Carmen R.; Dvorscek, Michael J.; Budge, Stephanie L.; Esmond, Sarah

2011-01-01

Primary care settings are the gateway through which the majority of Latinos access care for their physical and mental health concerns. This study explored the perspectives of primary care providers concerning their Latino patients, in particular issues affecting their patients' access to and utilization of services. Interviews were conducted with…

News from ESO Archive Services: Next Generation Request Handler and Data Access Delegation

NASA Astrophysics Data System (ADS)

Fourniol, N.; Lockhart, J.; Suchar, D.; Tacconi-Garman, L. E.; Moins, C.; Bierwirth, T.; Eglitis, P.; Vuong, M.; Micol, A.; Delmotte, N.; Vera, I.; Dobrzycki, A.; Forchì, V.; Lange, U.; Sogni, F.

2012-09-01

We present the new ESO Archive services which improve the electronic data access via the Download Manager and also provide PIs with the option to delegate data access to their collaborators via the Data Access Control.

[Multidimensional assessment of public health care services for adolescents in Chile].

PubMed

Williams, Catalina de T; Poblete, Fernando A; Baldrich, Francisca A

2012-09-01

Adolescents are an especially vulnerable age group in terms of behavioral issues and require skilled teams in health centers. To assess the quality of health services provided to teenage users in Primary Health Care. A study of multiple cases was carried out in two family health centers in Puente Alto, Chile. Health services delivered to adolescents were evaluated from the provider's perspective, through qualitative design of focus groups and interviews to the care teams at each centre. For technical quality, comparing electronic records of two tracer conditions (prenatal care and depression) with technical standards established by Delphi methodology and from teenage users perspective, through a survey of service satisfaction. In both centers, providers perceived a lack of training in adolescent care, a deficient preventive approach and a limited access to care. The technical evaluation showed an inappropriate recording of both tracer conditions. The instrument used to assess user satisfaction survey was reliable and showed that the best perceived issue was medical care and treatment, and the least perceived, was the access to the services. Professionals working in these health care facilities, feel unprepared to provide comprehensive approach to adolescents. The surveyed teenagers complained of limited access to care. Therefore this age group continues to be as a non-priority group for health care.

A comparative cost analysis of an integrated military telemental health-care service.

PubMed

Grady, Brian J

2002-01-01

The National Naval Medical Center, Bethesda, Maryland, integrated telemental health care into its primary behavioral health-care outreach service in 1998. To date, there have been over 1,800 telemental health visits, and the service encounters approximately 100 visits per month at this time. The objective of this study was to compare and contrast the costs to the beneficiary, the medical system, and the military organization as a whole via one of the four methods currently employed to access mental health care from remotely located military medical clinics. The four methods include local access via the military's civilian health maintenance organization (HMO) network, patient travel to the military treatment facility, military mental health specialists' travel to the remote clinic (circuit riding) and TeleMental Healthcare (TMH). Interactive video conferencing, phone, electronic mail, and facsimile were used to provide telemental health care from a military treatment facility to a remote military medical clinic. The costs of health-care services, equipment, patient travel, lost work time, and communications were tabulated and evaluated. While the purpose of providing telemental healthcare services was to improve access to mental health care for our beneficiaries at remote military medical clinics, it became apparent that this could be done at comparable or reduced costs.

An enhanced two-step floating catchment area (E2SFCA) method for measuring spatial accessibility to primary care physicians.

PubMed

Luo, Wei; Qi, Yi

2009-12-01

This paper presents an enhancement of the two-step floating catchment area (2SFCA) method for measuring spatial accessibility, addressing the problem of uniform access within the catchment by applying weights to different travel time zones to account for distance decay. The enhancement is proved to be another special case of the gravity model. When applying this enhanced 2SFCA (E2SFCA) to measure the spatial access to primary care physicians in a study area in northern Illinois, we find that it reveals spatial accessibility pattern that is more consistent with intuition and delineates more spatially explicit health professional shortage areas. It is easy to implement in GIS and straightforward to interpret.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ponomarenko, N. S.; Poluektov, O. G.; Bylina, E. J.

High-field electron paramagnetic resonance (HF EPR) has been employed to investigate the primary electron donor electronic structure of Blastochloris viridis heterodimer mutant reaction centers (RCs). In these mutants the amino acid substitution His(M200)Leu or His(L173)Leu eliminates a ligand to the primary electron donor, resulting in the loss of a magnesium in one of the constituent bacteriochlorophylls (BChl). Thus, the native BChl/BChl homodimer primary donor is converted into a BChl/bacteriopheophytin (BPhe) heterodimer. The heterodimer primary donor radical in chemically oxidized RCs exhibits a broadened EPR line indicating a highly asymmetric distribution of the unpaired electron over both dimer constituents. Observed tripletmore » state EPR signals confirm localization of the excitation on the BChl half of the heterodimer primary donor. Theoretical simulation of the triplet EPR lineshapes clearly shows that, in the case of mutants, triplet states are formed by an intersystem crossing mechanism in contrast to the radical pair mechanism in wild type RCs. Photooxidation of the mutant RCs results in formation of a BPhe anion radical within the heterodimer pair. The accumulation of an intradimer BPhe anion is caused by the substantial loss of interaction between constituents of the heterodimer primary donor along with an increase in the reduction potential of the heterodimer primary donor D/D{sup +} couple. This allows oxidation of the cytochrome even at cryogenic temperatures and reduction of each constituent of the heterodimer primary donor individually. Despite a low yield of primary donor radicals, the enhancement of the semiquinone-iron pair EPR signals in these mutants indicates the presence of kinetically viable electron donors.« less

Double Bind: Primary Caregivers of Children with Special Health Care Needs and Their Access to Leave Benefits

PubMed Central

Chung, Paul J.; Garfield, Craig F.; Elliott, Marc N.; Vestal, Katherine D.; Klein, David J.; Schuster, Mark A.

2013-01-01

Objective Family leave benefits are a critical tool allowing parents to miss work to care for their ill children. We examined whether access to benefits varies by level of childcare responsibilities among employed parents of children with special health care needs (CSHCN). Methods We conducted telephone interviews with three successive cohorts of employed parents of CSHCN, randomly sampled from a California children’s hospital. At Wave 1 (November 2003 to January 2004) we conducted 372 parent interviews. At Wave 2 (November 2005 to January 2006) we conducted 396 parent interviews. At Wave 3 (November 2007 to December 2008) we conducted 393 parent interviews. We pooled these samples for bivariate and multivariate regression analyses, using wave indicators and sample weights. Results Parents with more childcare responsibilities (primary caregivers) reported less access to sick leave/vacation (65% vs. 82%, P<.001), access to paid leave outside of sick leave/vacation (41% vs. 51%, P<.05), and FMLA eligibility (2890025; vs. 44%, P<.001) than secondary caregivers. Part-time employment and female gender largely explained two of the three associations between more childcare responsibilities and less access to leave benefits. Even in the context of part-time employment, however, primary caregivers were just as likely as secondary caregivers both to miss work due to their child’s illness and to report being unable to miss work when they needed to. Conclusions Due in part to employment and gender differences, leave benefits among parents of CSHCN are skewed away from primary caregivers and toward secondary caregivers. Thus, primary caregivers may face particularly difficult choices between employment and childcare responsibilities. Reducing this disparity in access to benefits may improve health for CSHCN and their families. PMID:23477748

Transradial primary angioplasty and stenting in Indian patients with acute myocardial infarction: acute results and 6-month follow-up.

PubMed

Ranjan, Alok; Patel, Tejas M; Shah, Sanjay C; Malhotra, Hemant; Patel, Rajni; Vayada, Nishith; Pothiwala, Rasesh; Fonseca, Keith; Tanwar, Narendra S

2005-01-01

Coronary angioplasty and stent implantation is effective as primary intervention in acute myocardial infarction. Because of fewer puncture site complications and improved patient comfort, transradial access has been increasingly used as an alternative to transfemoral access for percutaneous coronary interventions. We studied 103 patients (94 men, 9 women: mean age 52.5 +/- 11.96 years) with a diagnosis of acute myocardial infarction (<12 hours after onset), who underwent primary percutaneous coronary intervention. Transradial access was used in all patients with a normal Allen's test and transfemoral access was used additionally only if intra-aortic balloon counterpulsation was required. Follow-up duration was 6 months. Transradial access was successfully achieved in all patients. Radial artery cannulation took <2 min in more than 85% patients. During percutaneous coronary intervention, cannulation to balloon inflation times and total procedure times were 11.3 +/- 5.2 min and 19.9 +/- 10.8 min, respectively. Stents were implanted in 99 (96.1%) patients andplain balloon angioplastywas performed in 3.9%. The primary success rate was 98.1%, with no major bleeding complications. Total length of hospitalization averaged 2.4 +/- 0.8 days. In-hospital major adverse clinical events rate was 5.9%. Six-month clinical follow-up was achieved for 84 (86.6%) patients. Six (7.1%) patients died during follow-up. Follow-up coronary angiography was performed in 22 (26.2%) patients. After 6 months, 7 patients required revascularizationof the target lesion. The rate of survival without myocardial infarction, bypass surgery or repeat coronary angioplasty was 88.5% at 6 months. Transradial access may represent a safe and feasible technique for performing primary percutaneous coronary intervention with good acute results and without major bleeding complications.

Specialty-care access for community health clinic patients: processes and barriers

PubMed Central

Ezeonwu, Mabel C

2018-01-01

Introduction Community health clinics/centers (CHCs) comprise the US’s core health-safety net and provide primary care to anyone who walks through their doors. However, access to specialty care for CHC patients is a big challenge. Materials and methods In this descriptive qualitative study, semistructured interviews of 37 referral coordinators of CHCs were used to describe their perspectives on processes and barriers to patients’ access to specialty care. Analysis of data was done using content analysis. Results The process of coordinating care referrals for CHC patients is complex and begins with a provider’s order for consultation and ends when the referring provider receives the specialist’s note. Poverty, specialist and referral coordinator shortages, lack of insurance, insurance acceptability by providers, transport and clinic-location factors, lack of clinic–hospital affiliations, and poor communication between primary and specialty providers constitute critical barriers to specialty-care access for patients. Conclusion Understanding the complexities of specialty-care coordination processes and access helps determine the need for comprehensive and uninterrupted access to quality health care for vulnerable populations. Guaranteed access to primary care at CHCs has not translated into improved access to specialty care. It is critical that effective policies be pursued to address the barriers and minimize interruptions in care, and to ensure continuity of care for all patients needing specialty care. PMID:29503559

The digital divide in public e-health: barriers to accessibility and privacy in state health department websites.

PubMed

West, Darrell M; Miller, Edward Alan

2006-08-01

State health departments have placed a tremendous amount of information, data, and services online in recent years. With the significant increase in online resources at official health sites, though, have come questions concerning equity of access and the confidentiality of electronic medical materials. This paper reports on an examination of public health department websites maintained by the 50 state governments. Using a content analysis of health department sites undertaken each year from 2000 to 2005, we investigate several dimensions of accessibility and privacy: readability levels, disability access, non-English accessibility, and the presence of privacy and security statements. We argue that although progress has been made at improving the accessibility and confidentiality of health department electronic resources, there remains much work to be done to ensure quality access for all Americans in the area of public e-health.

Do new and traditional models of primary care differ with regard to access?: Canadian QUALICOPC study.

PubMed

Miedema, Baukje; Easley, Julie; Thompson, Ashley E; Boivin, Antoine; Aubrey-Bassler, Kris; Katz, Alan; Hogg, William E; Breton, Mylaine; Francoeur, Danièle; Wong, Sabrina T; Wodchis, Walter P

2016-01-01

To examine access to primary care in new and traditional models using 2 dimensions of the concept of patient-centred access. An international survey examining the quality and costs of primary health care (the QUALICOPC study) was conducted in 2013 in Canada. This study adopted a descriptive cross-sectional survey method using data from practices across Canada. Each participating practice filled out the Family Physician Survey and the Practice Survey, and patients in each participating practice were asked to complete the Patient Experiences Survey. All 10 Canadian provinces. A total of 759 practices and 7172 patients. Independent t tests were conducted to examine differences between new and traditional models of care in terms of availability and accommodation, and affordability of care. Of the 759 practices, 407 were identified as having new models of care and 352 were identified as traditional. New models of care were distinct with respect to payment structure, opening hours, and having an interdisciplinary work force. Most participating practices were from large cities or suburban areas. There were few differences between new and traditional models of care regarding accessibility and accommodation in primary care. Patients under new models of care reported easier access to other physicians in the same practice, while patients from traditional models reported seeing their regular family physicians more frequently. There was no difference between the new and traditional models of care with regard to affordability of primary care. Patients attending clinics with new models of care reported that their physicians were more involved with them as a whole person than patients attending clinics based on traditional models did. Primary care access issues do not differ strongly between traditional and new models of care; however, patients in the new models of care believed that their physicians were more involved with them as people.

Cross-sectional study examining whether the extent of first-contact access to primary care differentially benefits those with certain personalities to receive preventive services

PubMed Central

Pandhi, Nancy; Schumacher, Jessica R; Thorpe, Carolyn T; Smith, Maureen A

2016-01-01

Objective The extent of first-contact access to primary care (ie, easy availability when needed) is associated with receiving recommended preventive services. Whether this access benefits patients at risk of preventive services underutilisation, such as those with certain personality characteristics, is unclear. Setting Secondary analysis of the 2003–2006 round of the Wisconsin Longitudinal Study. Participants 6975 respondents who reported a usual provider whose specialty was internal medicine or family medicine. Those reporting not visiting a medical provider in the past 12 months, and those who were uninsured were excluded. Primary outcome measures Receiving mammography, cholesterol testing and influenza vaccination. Adjusted predicted probabilities (aPP) of receiving these services were analysed stratified by personality characteristics overall, and if significant, then interacted with first-contact access. Results Lower conscientiousness as compared with higher conscientiousness predicted less of all 3 preventive services; mammography (aPP 80%; 95% CI (77% to 83%) vs aPP 85%; (95% CI 82% to 87%)), cholesterol testing (88%; (85% to 90%) vs 93% (91% to 94%), and influenza vaccination (62%; (59% to 64%) vs 66%; (63% to 68%)). Lower agreeableness as compared with higher agreeableness predicted less mammography (77%; (73% to 81%) vs 84%; (82% to 87%)) and less influenza vaccination (59%; (56% to 62%) vs 65%; (63% to 68%)). Lower extraversion predicted less cholesterol testing (88%; (86% to 91%) vs (92%; (90% to 94%)). Lower openness to experience predicted less influenza vaccination (59%; (56% to 63%) vs (68%; (65% to 70%)). For agreeableness, these differences in receiving preventive services did not persist when first-contact access to primary care was present. Conclusions Certain personality characteristics predicted receiving less preventive care services. For those with less agreeableness, improved first-contact access to primary care mitigated this effect. If these results are replicated in other studies, primary care offices seeking to improve population health through receiving preventive services should prioritise increasing their first-contact accessibility. PMID:26951211

LexisNexis

EPA Pesticide Factsheets

LexisNexis provides access to electronic legal and non-legal research databases to the Agency's attorneys, administrative law judges, law clerks, investigators, and certain non-legal staff (e.g. staff in the Office of Public Affairs). The agency requires access to the following types of electronic databases: Legal databases, Non-legal databases, Public Records databases, and Financial databases.

X-ray Photoelectron Spectroscopy Database (Version 4.1)

National Institute of Standards and Technology Data Gateway

SRD 20 X-ray Photoelectron Spectroscopy Database (Version 4.1) (Web, free access)   The NIST XPS Database gives access to energies of many photoelectron and Auger-electron spectral lines. The database contains over 22,000 line positions, chemical shifts, doublet splittings, and energy separations of photoelectron and Auger-electron lines.

Public Access to Electronic Federal Depository Information in Regional Depository Libraries.

ERIC Educational Resources Information Center

Ford, Stephanie

This study describes regional depository institutions, the organization of their document collections, the staffing of their documents departments, and factors relevant to their providing access to electronic government information. Surveys were sent to 53 regional depository libraries in March 1995. Forty-one of the 53 libraries responded (77%…

21 CFR 1300.03 - Definitions relating to electronic orders for controlled substances and electronic prescriptions...

Code of Federal Regulations, 2010 CFR

2010-04-01

... records on its servers. Audit trail means a record showing who has accessed an information technology... identity of the user as a prerequisite to allowing access to the information application. Authentication... information in a database. (4) Comparing the biometric data with data contained in one or more reference...

75 FR 75705 - Notice of Availability of the Models for Plant-Specific Adoption of Technical Specifications Task...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-06

..., Rockville, Maryland. NRC's Agencywide Documents Access and Management System (ADAMS): Publicly available documents created or received at the NRC are available electronically at the NRC's Electronic Reading Room... Specifications End States (BAW- 2441).'' TSTF-431, Revision 3, is available in the Agencywide Documents Access...

Managing Electronic Resources: A Survey of Current Practices in Academic Libraries.

ERIC Educational Resources Information Center

Shaw, Beth Hansen

This document reports results of an online survey that examined practices and procedures in the management of electronic resources in 65 academic library reference departments. Responses are related to: (1) student population; (2) library use by community people; (3) number of public access workstations, workstations with World Wide Web access,…

76 FR 72210 - Agency Information Collection Activities: Extension of an Information Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-22

... Notice of Information Collection Under Review; Electronic Bonds Online (eBonds) Access. The Department of... collection request for review and clearance in accordance with the Paperwork Reduction Act of 1995. The...) Title of the Form/Collection: Electronic Bonds Online (eBonds) Access; OMB Control No. 1653-0046. (3...

76 FR 22103 - The Consumer and Governmental Affairs Bureau Seeks Comment on “Need for Speed” Information for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-20

... to make informed choices among competing broadband Internet access services. According to the most... speed and performance required for the range of Internet applications consumers intend to use, and how... electronically using the Internet by accessing the Commission's Electronic Comment Filing System (ECFS): http...

Patients' willingness to pay for electronic communication with their general practitioner.

PubMed

Bergmo, Trine Strand; Wangberg, Silje Camilla

2007-06-01

Despite the common use of electronic communication in other aspects of everyday life, its use between patients and health care providers has been slow to diffuse. Possible explanations are security issues and lack of payment mechanisms. This study investigated how patients value secure electronic access to their general practitioner (GP). One hundred and ninety-nine patients were asked an open-ended willingness-to-pay (WTP) question as part of a randomised controlled trial. We compared the WTP values between two groups of respondents; one group had had the opportunity to communicate electronically with their GP for a year and the other group had not. Fifty-two percent of the total sample was willing to pay for electronic GP contact. The group of patients with access revealed a significantly lower WTP than the group without such access. Possible explanations are that the system had fewer benefits than expected, a presence of hypothetical bias or simply a preference for face-to-face encounters.

The Electronic Astrophysical Journal Letters Project

NASA Astrophysics Data System (ADS)

Dalterio, H. J.; Boyce, P. B.; Biemesderfer, C.; Warnock, A., III; Owens, E.; Fullton, J.

The American Astronomical Society has developed a comprehensive system for the electronic dissemination of refereed astronomical research results. Our current focus is the production of an electronic version of the Astrophysical Journal Letters. With the help of a recent National Science Foundation grant, we have developed a system that includes: LATEX-based manuscript preparation, electronic submission, peer review, production, development of a database of SGML-tagged manuscripts, collection of page charges and other fees, and electronic manuscript storage and delivery. Delivery options include World-Wide Web access through HTML browsers such as Mosaic and Netscape, an email gateway, and a stand-alone client accessible through astronomical software packages such as IRAF. Our goal is to increase the access and usefulness of the journal by providing enhanced features such as faster publication, advanced search capabilities, forward and backward referencing, links to underlying data and links to adjunct materials in a variety of media. We have based our journal on open standards and freely available network tools wherever possible.

GuiaTreeKey, a multi-access electronic key to identify tree genera in French Guiana.

PubMed

Engel, Julien; Brousseau, Louise; Baraloto, Christopher

2016-01-01

The tropical rainforest of Amazonia is one of the most species-rich ecosystems on earth, with an estimated 16000 tree species. Due to this high diversity, botanical identification of trees in the Amazon is difficult, even to genus, often requiring the assistance of parataxonomists or taxonomic specialists. Advances in informatics tools offer a promising opportunity to develop user-friendly electronic keys to improve Amazonian tree identification. Here, we introduce an original multi-access electronic key for the identification of 389 tree genera occurring in French Guiana terra-firme forests, based on a set of 79 morphological characters related to vegetative, floral and fruit characters. Its purpose is to help Amazonian tree identification and to support the dissemination of botanical knowledge to non-specialists, including forest workers, students and researchers from other scientific disciplines. The electronic key is accessible with the free access software Xper ², and the database is publicly available on figshare: https://figshare.com/s/75d890b7d707e0ffc9bf (doi: 10.6084/m9.figshare.2682550).

Secret Shoppers Find Access To Providers And Network Accuracy Lacking For Those In Marketplace And Commercial Plans.

PubMed

Haeder, Simon F; Weimer, David L; Mukamel, Dana B

2016-07-01

The adequacy of provider networks for plans sold through insurance Marketplaces established under the Affordable Care Act has received much scrutiny recently. Various studies have established that networks are generally narrow. To learn more about network adequacy and access to care, we investigated two questions. First, no matter the nominal size of a network, can patients gain access to primary care services from providers of their choice in a timely manner? Second, how does access compare to plans sold outside insurance Marketplaces? We conducted a "secret shopper" survey of 743 primary care providers from five of California's nineteen insurance Marketplace pricing regions in the summer of 2015. Our findings indicate that obtaining access to primary care providers was generally equally challenging both inside and outside insurance Marketplaces. In less than 30 percent of cases were consumers able to schedule an appointment with an initially selected physician provider. Information about provider networks was often inaccurate. Problems accessing services for patients with acute conditions were particularly troubling. Effectively addressing issues of network adequacy requires more accurate provider information. Project HOPE—The People-to-People Health Foundation, Inc.

Collections and Services for the Spanish-Speaking: Accessibility.

ERIC Educational Resources Information Center

Marquis, Solina Kasten

2003-01-01

Discusses making public library collections accessible to Spanish-speaking users and describes the consequences that can result from inattention to linguistic and cultural accessibility. Topics include cataloging issues and solutions; labeling; shelving; signage; electronic access; Spanish language training for staff; intercultural communication;…

The future SwissFEL facility - challenges from a radiation protection point of view

NASA Astrophysics Data System (ADS)

Strabel, Claudia; Fuchs, Albert; Galev, Roman; Hohmann, Eike; Lüscher, Roland; Musto, Elisa; Mayer, Sabine

2017-09-01

The Swiss Free Electron Laser is a new large-scale facility currently under construction at the Paul Scherrer Institute. Accessible areas surrounding the 720 m long accelerator tunnel, together with the pulsed time structure of the primary beam, lead to new challenges for ensuring that the radiation level in these areas remains in compliance with the legal constraints. For this purpose an online survey system based on the monitoring of the ambient dose rate arising from neutrons inside of the accelerator tunnel and opportunely calibrated to indicate the total dose rate outside of the tunnel, will be installed. The presented study provides a conceptual overview of this system, its underlying assumptions and measurements so far performed to validate its concept.

REPHLEX II: An information management system for the ARS Water Data Base

NASA Astrophysics Data System (ADS)

Thurman, Jane L.

1993-08-01

The REPHLEX II computer system is an on-line information management system which allows scientists, engineers, and other researchers to retrieve data from the ARS Water Data Base using asynchronous communications. The system features two phone lines handling baud rates from 300 to 2400, customized menus to facilitate browsing, help screens, direct access to information and data files, electronic mail processing, file transfers using the XMODEM protocol, and log-in procedures which capture information on new users, process passwords, and log activity for a permanent audit trail. The primary data base on the REPHLEX II system is the ARS Water Data Base which consists of rainfall and runoff data from experimental agricultural watersheds located in the United States.

Electronic theses and dissertations: a review of this valuable resource for nurse scholars worldwide.

PubMed

Goodfellow, L M

2009-06-01

A worldwide repository of electronic theses and dissertations (ETDs) could provide worldwide access to the most up-to-date research generated by masters and doctoral students. Until that international repository is established, it is possible to access some of these valuable knowledge resources. ETDs provide a technologically advanced medium with endless multimedia capabilities that far exceed the print and bound copies of theses and dissertations housed traditionally in individual university libraries. CURRENT USE: A growing trend exists for universities worldwide to require graduate students to submit theses or dissertations as electronic documents. However, nurse scholars underutilize ETDs, as evidenced by perusing bibliographic citation lists in many of the research journals. ETDs can be searched for and retrieved through several digital resources such as the Networked Digital Library of Theses and Dissertations (http://www.ndltd.org), ProQuest Dissertations and Theses (http://www.umi.com), the Australasian Digital Theses Program (http://adt.caul.edu.au/) and through individual university web sites and online catalogues. An international repository of ETDs benefits the community of nurse scholars in many ways. The ability to access recent graduate students' research electronically from anywhere in the world is advantageous. For scholars residing in developing countries, access to these ETDs may prove to be even more valuable. In some cases, ETDs are not available for worldwide access and can only be accessed through the university library from which the student graduated. Public access to university library ETD collections is not always permitted. Nurse scholars from both developing and developed countries could benefit from ETDs.

Measuring access to primary care appointments: a review of methods

PubMed Central

Jones, Wendy; Elwyn, Glyn; Edwards, Peter; Edwards, Adrian; Emmerson, Melody; Hibbs, Richard

2003-01-01

Background Patient access to primary care appointments is not routinely measured despite the increasing interest in this aspect of practice activity. The generation of standardised data (or benchmarks) for access could inform developments within primary care organisations and act as a quality marker for clinical governance. Logically the setting of targets should be based on a sound system of measurement. The practicalities of developing appropriate measures need debate. Therefore we aimed to search for and compare methods that have been published or are being developed to measure patient access to primary care appointments, with particular focus on finding methods using appointment system data. Method A search and review was made of the primary care literature from 1990 to 2001, which included an assessment of online resources (websites) and communication with recognised experts. The identified methods were assessed. Results The published literature in this specific area was not extensive but revealed emerging interest in the late 1990s. Two broad approaches to the measurement of waiting times to GP appointments were identified. Firstly, appointment systems in primary care organisations were analysed in differing ways to provide numerical data and, secondly, patient perceptions (reports) of access were evaluated using survey techniques. Six different methods were found which were based on appointment systems data. Conclusion The two approaches of either using patient questionnaires or appointment system data are methods that represent entirely different aims. The latter method when used to represent patient waiting times for 'routine' elective appointments seems to hold promise as a useful tool and this avoids the definitional problems that surround 'urgent' appointments. The purpose for which the data is being collected needs to be borne in mind and will determine the chosen methods of data retrieval and representation. PMID:12846934

Accelerating global access to plant diversity information.

PubMed

Lughadha, Eimear Nic; Miller, Chuck

2009-11-01

Botanic gardens play key roles in the development and dissemination of plant information resources. Drivers for change have included progress in information technology, growing public expectations of electronic access and international conservation policy. Great advances have been made in the quantity, quality and accessibility of plant information in digital form and the extent to which information from multiple providers can be accessed through a single portal. However, significant challenges remain to be addressed in making botanic gardens resources maximally accessible and impactful, not least the overwhelming volume of material which still awaits digitisation. The year 2010 represents an opportunity for botanic gardens to showcase their collaborative achievements in delivery of electronic plant information and reinforce their relevance to pressing environmental issues.

Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care.

PubMed

Prins, Marijn A; Verhaak, Peter F M; Smolders, Mirrian; Laurant, Miranda G H; van der Meer, Klaas; Spreeuwenberg, Peter; van Marwijk, Harm W J; Penninx, Brenda W J H; Bensing, Jozien M

2010-07-01

To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). Seven hundred and twenty-one patients with a current anxiety or depressive disorder, recruited from 67 general practitioners (GPs), were included. Diagnoses according to the Diagnostic and Statistic Manual of Mental Disorders, fourth edition (DSM-IV) were made using a structured and widely validated assessment. Socio-demographic and enabling characteristics, severity of symptoms, disability, (under treatment for) chronic somatic conditions, perceived need for care, beliefs and evaluations of care were measured by questionnaires. Actual care data were derived from electronic medical records. Criteria for guideline-concordant care were based on general practice guidelines, issued by the Dutch College of General Practitioners. Two hundred and eighty-one (39%) patients received guideline-concordant care. High education level, accessibility of care, comorbidity of anxiety and depression, and severity and disability scores were positively associated with receiving guideline-concordant care in univariate analyses. In multivariate multi-level logistic regression models, significant associations with the clinical need factors disappeared. Positive evaluations of accessibility of care increased the chance (OR = 1.31; 95%-CI = 1.05-1.65; p = 0.02) of receiving guideline-concordant care, as well as perceiving any need for medication (OR = 2.99; 95%-CI = 1.84-4.85; p < 0.001), counseling (OR = 2.25; 95%-CI = 1.29-3.95; p = 0.005) or a referral (OR = 1.83; 95%-CI = 1.09-3.09; p = 0.02). A low educational level decreased the odds (OR = 0.33; 95%-CI = 0.11-0.98; p = 0.04) of receiving guideline-concordant care. This study shows that education level, accessibility of care and patients' perceived needs for care are more strongly associated with the delivery of guideline-concordant care for anxiety or depression than clinical need factors. Initiatives to improve GPs' communication skills around mental health issues, and to improve recognition of people suffering from anxiety disorders, could increase the number of patients receiving treatment for depression and anxiety in primary care.

Scholarly Electronic Full-Text Publications via the Internet: Issues and Impacts

NASA Technical Reports Server (NTRS)

Kosmin, Linda J.

1999-01-01

On-line access to complete texts of scholarly journal articles, conference papers, and books is facilitated by rapidly developing World-wide Web Internet access and capabilities. Meanwhile, print publications continue to be produced and read in spite of the proliferation of many networked electronic publications. The purpose of this presentation is to highlight fundamental issues impacting stakeholder groups, as the trend continues towards migration from paper to affordable ubiquitous networked full-text publications. Librarians, publishers, authors and end-users have various viewpoints, interests, and concerns. There are many issues challenging all stakeholder groups. For instance, all share concerns about administering copyright compliance and enforcing fair use. Uncontrollable electronic downstreaming could result in infringed copyright, while limiting a publisher's entitled revenue stream. Moreover, metered fee-based access may hamper scholarly information research. And, self-authoring on the Internet without peer filtering could lead to information clutter. Many related issues challenge librarians in particular. Among these are rising journal subscription prices, regardless if offered in print or electronic. Some electronic offerings are independent of print, others supplement or duplicate print; several publishers presently require subscribing to print in order to access electronic. Furthermore, numbers of publications are n'ow being marketed via the Internet directly to end-users, which can be viewed as encouraging users to bypass the traditional library. A key issue challenging publishers today is the rapidly expanding electronic user base that is demanding delivery of added-value full-text to desktop computers. Also of growing concern appears to be the decline in print sales to libraries, thereby reducing traditional revenue stream potential. Nowadays, publishers are more hesitant about investing in the production of publications geared toward small niche subjects, since these tend to require higher pricing and carry limited sales potential. Both electronic and print publications necessitate similar editorial, production, operating, and marketing dollars. Tradeoffs owing to delivery format difference do not necessarily mean less dollars need to be spent. Authors wishing to publish books are facing a decline in the role of scholarly monographs in electronic media. However, they are witnessing increased roles of electronic preprints and electronic journal articles. Moreover, the Internet fosters self-publishing without peer monitoring or formal review. Issues challenging end-users include electronic barriers to peer-reviewed formal published works (i.e., fee-based subscriptions to journal literature vs. traditional free-library concept). This often means password only access or IP address controlled site-licensed access. Also, in an uncontrolled Internet environment, sometimes there is a blurring of publication authorship/ownership, as various pieces of publications are cut/pasted into/re-posted on various, disconnected Web searchable home pages.

Electronic Journals, the Internet, and Scholarly Communication.

ERIC Educational Resources Information Center

Kling, Rob; Callahan, Ewa

2003-01-01

Examines the role of the Internet in supporting scholarly communication via electronic journals. Topics include scholarly electronic communication; a typology of electronic journals; models of electronic documents and scholarly communication forums; publication speed; costs; pricing; access and searching; citations; interactivity; archiving and…

Accessibility, Textbooks, and Access Services

ERIC Educational Resources Information Center

Kahler, Janice E.

2017-01-01

Putting access in Access Services is the goal. The Course Reserves unit is the place. Textbooks are the focus. Electronic technologies are the future. Patron-centric services will be our standard. Access to textbooks by all patrons will be the achievement. Course Reserves located in Library West at the University of Florida George A. Smathers…

The SciELO Open Access: A Gold Way from the South

ERIC Educational Resources Information Center

Packer, Abel L.

2009-01-01

Open access has long emphasized access to scholarly materials. However, open access can also mean access to the means of producing visible and recognized journals. This issue is particularly important in developing and emergent countries. The SciELO (Scientific Electronic Library On-line) project, first started in Brazil and, shortly afterward, in…

Assessing Impacts on Unplanned Hospitalisations of Care Quality and Access Using a Structural Equation Method: With a Case Study of Diabetes

PubMed Central

Congdon, Peter

2016-01-01

Background: Enhanced quality of care and improved access are central to effective primary care management of long term conditions. However, research evidence is inconclusive in establishing a link between quality of primary care, or access, and adverse outcomes, such as unplanned hospitalisation. Methods: This paper proposes a structural equation model for quality and access as latent variables affecting adverse outcomes, such as unplanned hospitalisations. In a case study application, quality of care (QOC) is defined in relation to diabetes, and the aim is to assess impacts of care quality and access on unplanned hospital admissions for diabetes, while allowing also for socio-economic deprivation, diabetes morbidity, and supply effects. The study involves 90 general practitioner (GP) practices in two London Clinical Commissioning Groups, using clinical quality of care indicators, and patient survey data on perceived access. Results: As a single predictor, quality of care has a significant negative impact on emergency admissions, and this significant effect remains when socio-economic deprivation and morbidity are allowed. In a full structural equation model including access, the probability that QOC negatively impacts on unplanned admissions exceeds 0.9. Furthermore, poor access is linked to deprivation, diminished QOC, and larger list sizes. Conclusions: Using a Bayesian inference methodology, the evidence from the analysis is weighted towards negative impacts of higher primary care quality and improved access on unplanned admissions. The methodology of the paper is potentially applicable to other long term conditions, and relevant when care quality and access cannot be measured directly and are better regarded as latent variables. PMID:27598184

Assessing Impacts on Unplanned Hospitalisations of Care Quality and Access Using a Structural Equation Method: With a Case Study of Diabetes.

PubMed

Congdon, Peter

2016-09-01

Enhanced quality of care and improved access are central to effective primary care management of long term conditions. However, research evidence is inconclusive in establishing a link between quality of primary care, or access, and adverse outcomes, such as unplanned hospitalisation. This paper proposes a structural equation model for quality and access as latent variables affecting adverse outcomes, such as unplanned hospitalisations. In a case study application, quality of care (QOC) is defined in relation to diabetes, and the aim is to assess impacts of care quality and access on unplanned hospital admissions for diabetes, while allowing also for socio-economic deprivation, diabetes morbidity, and supply effects. The study involves 90 general practitioner (GP) practices in two London Clinical Commissioning Groups, using clinical quality of care indicators, and patient survey data on perceived access. As a single predictor, quality of care has a significant negative impact on emergency admissions, and this significant effect remains when socio-economic deprivation and morbidity are allowed. In a full structural equation model including access, the probability that QOC negatively impacts on unplanned admissions exceeds 0.9. Furthermore, poor access is linked to deprivation, diminished QOC, and larger list sizes. Using a Bayesian inference methodology, the evidence from the analysis is weighted towards negative impacts of higher primary care quality and improved access on unplanned admissions. The methodology of the paper is potentially applicable to other long term conditions, and relevant when care quality and access cannot be measured directly and are better regarded as latent variables.

Lessons about So-Called "Difficult" Patients from the UK Controversy over Patient Access to Electronic Health Records.

PubMed

Lucivero, Federica

2017-04-01

Increasing numbers of patients have direct access to their electronic health records (EHRs). Proponents of direct access argue that it empowers patients by making them more informed and offering them more control over their health and care. According to some proponents of patients' access to EHRs, clinicians' concerns about potential negative implications are grounded in a form of paternalism that protects clinicians' authority. This paper draws upon narratives from patients in the United Kingdom (UK) who have access to their EHRs and suggests strategies for moving beyond these controversies between proponents and critics of the system. It additionally shows that the very organizational, procedural, and technological infrastructure that promises patients' increased access to records can also exacerbate some patients' "difficult" behaviors. © 2017 American Medical Association. All Rights Reserved.

Why do patients seek primary medical care in emergency departments? An ethnographic exploration of access to general practice

PubMed Central

Brangan, Emer; Wye, Lesley; Checkland, Kath; Lasserson, Daniel; Morris, Richard; Tammes, Peter; Purdy, Sarah

2017-01-01

Objectives To describe how processes of primary care access influence decisions to seek help at the emergency department (ED). Design Ethnographic case study combining non-participant observation, informal and formal interviewing. Setting Six general practitioner (GP) practices located in three commissioning organisations in England. Participants and methods Reception areas at each practice were observed over the course of a working week (73 hours in total). Practice documents were collected and clinical and non-clinical staff were interviewed (n=19). Patients with recent ED use, or a carer if aged 16 and under, were interviewed (n=29). Results Past experience of accessing GP care recursively informed patient decisions about where to seek urgent care, and difficulties with access were implicit in patient accounts of ED use. GP practices had complicated, changeable systems for appointments. This made navigating appointment booking difficult for patients and reception staff, and engendered a mistrust of the system. Increasingly, the telephone was the instrument of demand management, but there were unintended consequences for access. Some patient groups, such as those with English as an additional language, were particularly disadvantaged, and the varying patient and staff semantic of words like ‘urgent’ and ‘emergency’ was exacerbated during telephone interactions. Poor integration between in-hours and out-of-hours care and patient perceptions of the quality of care accessible at their GP practice also informed ED use. Conclusions This study provides important insight into the implicit role of primary care access on the use of ED. Discourses around ‘inappropriate’ patient demand neglect to recognise that decisions about where to seek urgent care are based on experiential knowledge. Simply speeding up access to primary care or increasing its volume is unlikely to alleviate rising ED use. Systems for accessing care need to be transparent, perceptibly fair and appropriate to the needs of diverse patient groups. PMID:28473509

Access, Quality, and Opportunity: A Case Study of Zambia Open Community Schools (ZOCS)

ERIC Educational Resources Information Center

Mwalimu, Michelle

2011-01-01

Community schools and other approaches to Alternative Primary Education or APE have increased access to primary education for underserved populations in Africa, Asia, and Latin America as a major goal of the Education for All (EFA) movement. In Zambia, a country where an estimated 20 percent of the basic education enrollment now attends community…

Language Barriers Impact Access to Services for Children with Autism Spectrum Disorders.

PubMed

St Amant, Helaine G; Schrager, Sheree M; Peña-Ricardo, Carolina; Williams, Marian E; Vanderbilt, Douglas L

2018-02-01

Racial and ethnic disparities in accessing health care have been described in children with autism spectrum disorder (ASD). In a retrospective chart review of 152 children with ASD, children of parents whose primary language was English were significantly more likely to have both social skills and communication goals within their individualized education plan (IEP) compared to children of parents whose primary language was not English. Additionally, children of primary English speakers received significantly more hours of direct services from their state disability program. After controlling for demographic covariates, findings suggest that language barriers may negatively affect parents' abilities to access health care services for their child with ASD. Acculturation factors must therefore be considered when analyzing disparities in autism.

Ex vivo accuracy of an apex locator using digital signal processing in primary teeth.

PubMed

Leonardo, Mário Roberto; da Silva, Lea Assed Bezerra; Nelson-Filho, Paulo; da Silva, Raquel Assed Bezerra; Lucisano, Marília Pacífico

2009-01-01

The purpose of this study was to evaluate ex vivo the accuracy an electronic apex locator during root canal length determination in primary molars. One calibrated examiner determined the root canal length in 15 primary molars (total=34 root canals) with different stages of root resorption. Root canal length was measured both visually with the placement of a K-file 1 mm short of the apical foramen or the apical resorption bevel, and electronically using an electronic apex locator (Digital Signal Processing). Data were analyzed statistically using the intraclass correlation (ICC) test. Comparing the actual and electronic root canal length measurements in the primary teeth showed a high correlation (ICC=0.95). The Digital Signal Processing apex locator is useful and accurate for apex foramen location during root canal length measurement in primary molars.

The Role of Community Health Centers in Reducing Racial Disparities in Spatial Access to Primary Care.

PubMed

Seymour, Jane W; Polsky, Daniel E; Brown, Elizabeth J; Barbu, Corentin M; Grande, David

2017-07-01

Racial minorities are more likely to live in primary care shortage areas. We sought to understand community health centers' (CHCs) role in reducing disparities. We surveyed all primary care practices in an urban area, identified low access areas, and examined how CHCs influence spatial accessibility. Census tracts with higher rates of public insurance (≥40% vs <10%, odds ratio [OR] = 31.06, P < .001; 30-39% vs 10%, OR = 7.84, P = 0.001) were more likely to be near a CHC and those with moderate rates of uninsurance (10%-19% vs <10%, OR = 0.42, P = .045) were less likely. Racial composition was not associated with proximity. Tracts close to a CHC were less likely (OR = 0.11, P < .0001) to be in a low access area. This association did not differ based on racial composition. Although CHCs were more likely to be in areas with a greater fraction of racial minorities, location was more strongly influenced by public insurance rates. CHCs reduced the likelihood of being in low access areas but the effect did not vary by tract racial composition.

Diagnosis of primary ciliary dyskinesia: summary of the ERS Task Force report

PubMed Central

Lucas, Jane S.

2017-01-01

Key points Primary ciliary dyskinesia (PCD) is a genetically and clinically heterogeneous disease characterised by abnormal motile ciliary function. There is no “gold standard” diagnostic test for PCD. The European Respiratory Society (ERS) Task Force Guidelines for diagnosing PCD recommend that patients should be referred for diagnostic testing if they have several of the following features: persistent wet cough; situs anomalies; congenital cardiac defects; persistent rhinitis; chronic middle ear disease with or without hearing loss; or a history, in term infants, of neonatal upper and lower respiratory symptoms or neonatal intensive care admission. The ERS Task Force recommends that patients should be investigated in a specialist PCD centre with access to a range of complementary tests: nasal nitric oxide, high-speed video microscopy analysis and transmission electron microscopy. Additional tests including immunofluorescence labelling of ciliary proteins and genetic testing may also help determine the diagnosis. Educational aims This article is intended for primary and secondary care physicians interested in primary ciliary dyskinesia (PCD), i.e. those who identify patients for testing, and those involved in diagnosing and managing PCD patients. It aims: to inform readers about the new European Respiratory Society Task Force Guidelines for diagnosing patients with PCDto enable primary and secondary care physicians to: identify patients who need diagnostic testing; understand the diagnostic tests that their patients will undergo, the results of the tests and their limitations; and ensure that appropriate care is subsequently delivered. PMID:28894478

NLS Flight Simulation Laboratory (FSL) documentation

NASA Technical Reports Server (NTRS)

1995-01-01

The Flight Simulation Laboratory (FSL) Electronic Documentation System design consists of modification and utilization of the MSFC Integrated Engineering System (IES), translation of the existing FSL documentation to an electronic format, and generation of new drawings to represent the Engine Flight Simulation Laboratory design and implementation. The intent of the electronic documentation is to provide ease of access, local print/plot capabilities, as well as the ability to correct and/or modify the stored data by network users who are authorized to access this information.

Disparities in the access to primary healthcare in rural areas from the county of Iasi - Romania.

PubMed

Duma, Olga-Odetta; Roşu, Solange Tamara; Manole, M; Petrariu, F D; Constantin, Brânduşa

2014-01-01

To identify the factors that may conduct to various forms of social exclusion of the population from the primary healthcare and to analyze health disparities as population-specific differences in the access to primary healthcare in rural compared to urban residence areas from Iasi, the second biggest county, situated in the North--East region of Romania. This research is a type of inquiry-based opinion survey of the access to primary healthcare in rural compared to urban areas of the county of Iasi. Data were collected by face-to-face interviews. There were taken into account the socioeconomic status (education level in the adult population, employment status, family income, household size) and two temporal variables (the interval of time spent to arrive at the primary healthcare office as a marker for the geographical access and the waiting time for a consultation). The study group consisted of two samples, from rural and urban area, each of 150 patients, all ages, randomly selected, who were waiting at the family doctor's practice. The study has identified disparities related to a poor economic status assessed through the employed status ("not working" 15% in urban and of 20% in rural).The income calculated per member of family and divided in terciles has recorded significant differences for "high" (36.7% urban and 14.7% rural) and "low", respectively (14.6% urban and 56.6% rural). High household size with more than five members represented 22.6% of the total subjects in rural and 15.3% in urban areas. The assessment of the education level in the adult population (> 18 years) revealed that in the rural areas more than a half (56%) of the sample is placed in the category primary and secondary incomplete, whereas the value for secondary complete and postsecondary was 37.3%. The proportion of respondents in the urban areas who have post-secondary education is five times higher than those in rural areas (15.4% vs. 2.7%). The reduced geographical access assessed as the interval of time spent to arrive at the primary healthcare office revealed, on average, 25 minutes in urban versus 75 minutes in rural areas. The research outcomes highlight the fact that the population living in rural communities from the county of Iasi, are disadvantaged in accessing the primary health services, with negative consequences on the health status.

Beyond the Examination Room

PubMed Central

O'Malley, Ann S; Forrest, Christopher B

2002-01-01

OBJECTIVE To assess whether primary care performance of low-income women's primary care delivery sites is associated with the strength of their relationships with their physicians. DESIGN Random-digit-dial and targeted household telephone survey of a population-based sample. SETTING Washington, D.C. census tracts with ≥30% of households below 200% of federal poverty threshold. PARTICIPANTS Women over age 40 (N = 1,205), 82% of whom were African American. MEASUREMENTS AND MAIN RESULTS The response rate was 85%. Primary care performance was assessed using women's ratings of their systems' accessibility (organizational, geographic, and financial), continuity, comprehensiveness, and coordination. Respondents' ratings of trust in their physicians, communication with their physicians, and compassion shown by their physicians were used to operationalize the patient-physician relationship. Controlling for population and insurance characteristics, 4 primary care features were positively associated with women's trust in and communication with their physicians: continuity with a single clinician, organizational accessibility of the practice, comprehensive care, and coordination of specialty care services. Better organizational access, but not geographic or financial access, was associated with greater levels of trust, compassion, and communication (odds ratios [ORs], 3.2, 7.4, and 6.9, respectively; P≤ .01). Women who rated highest their doctor's ability to take care of all of their health care needs (highest level of comprehensiveness) had 11 times the odds of trusting their physician (P≤ .01) and 6 times the odds of finding their physicians compassionate and communicative (P≤ .01), compared to those with the lowest level of comprehensiveness. CONCLUSIONS Primary care delivery sites organized to be more accessible, to link patients with the same clinician for their visits, to provide for all of a woman's health care needs, and to coordinate specialty care services are associated with stronger relationships between low-income women and their physicians. Primary care systems that fail to emphasize these features of primary care may jeopardize the clinician-patient relationship and indirectly the quality of care and health outcomes. PMID:11903777

Scholarly Publishing's Evolving Landscape: Impact Metrics, Electronic-Only Journals, and Open Access in Journalism and Communication Research

ERIC Educational Resources Information Center

Antell, Karen; Foote, Joe S.; Foote, Jody Bales

2016-01-01

This study surveys the landscape of scholarly publishing, with particular emphasis on scholarly journals in the communication discipline, measuring the shift to electronic publishing in six selected disciplines and exploring two other important emerging topics: open-access publishing and new journal citation metrics. The goals are to inform…

Five Ways to Hack and Cheat with Bring-Your-Own-Device Electronic Examinations

ERIC Educational Resources Information Center

Dawson, Phillip

2016-01-01

Bring-your-own-device electronic examinations (BYOD e-exams) are a relatively new type of assessment where students sit an in-person exam under invigilated conditions with their own laptop. Special software restricts student access to prohibited computer functions and files, and provides access to any resources or software the examiner approves.…

A Correlational Analysis: Electronic Health Records (EHR) and Quality of Care in Critical Access Hospitals

ERIC Educational Resources Information Center

Khan, Arshia A.

2012-01-01

Driven by the compulsion to improve the evident paucity in quality of care, especially in critical access hospitals in the United States, policy makers, healthcare providers, and administrators have taken the advise of researchers suggesting the integration of technology in healthcare. The Electronic Health Record (EHR) System composed of multiple…

Bringing Up Gopher: Access to Local & Remote Electronic Resources for University Library Users.

ERIC Educational Resources Information Center

Brown, Melvin Marlo; And Others

Some of the administrative and organizational issues in creating a gopher, specifically a library gopher for university libraries, are discussed. In 1993 the Electronic Collections Task Force of the New Mexico State University library administration began to develop a library-based gopher system that would enable users to have unlimited access to…

78 FR 21100 - Low Enriched Uranium From France: Final Results of the Expedited Second Sunset Review of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-09

... received no response from the respondent interested parties, i.e., French uranium producers and exporters... Centralized Electronic Service System (IA ACCESS). IA ACCESS is available to registered users at http... the Internet at http://trade.gov/ia/ . The signed Decision Memorandum and electronic versions of the...

Internet Usage by Native Americans with Disabilities Living on American Indian Reservations in the Great Plains

ERIC Educational Resources Information Center

De Mars, AnnMaria

2010-01-01

It has been assumed that, due to limited Internet access, electronic media is an ineffective means for information dissemination to Native Americans with disabilities. In this investigation, we surveyed a sample of 467 households of Native Americans with disabilities living on Great Plains reservations regarding access to electronic resources. Of…

75 FR 57333 - Privacy Act of 1974; Republication of Systems of Records Notices

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-20

... file folders and on electronic media. RETRIEVABILITY: Accessed by name, tag number, and/or permit... file folders and on electronic media. RETRIEVABILITY: Records are accessed by name. SAFEGUARDS: Records... SYSTEM: 5 CFR 2634-2641, 5801; 5 U.S.C. 7351, 7353; Ethics in Government Act of 1978, as amended (5 U.S.C...

76 FR 30995 - Renewed and Amended Memorandum of Understanding (MOU) Assigning Environmental Responsibilities to...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-27

.... The public is invited to comment on any aspect of the proposed MOU, including the scope of..., between 9 a.m. and 5 p.m. (EST), Monday through Friday, except Federal holidays. Docket: For access to the... . SUPPLEMENTARY INFORMATION: Electronic Access An electronic copy of this notice may be downloaded using a...

Will Today's Electronic Journals Be Accessible in the 23rd Century: Issues in Long-Term Archiving (SIG STI, IFP)

ERIC Educational Resources Information Center

Lippert, Margaret

2000-01-01

This abstract of a planned session on access to scientific and technical journals addresses policy and standard issues related to long-term archives; digital archiving models; economic factors; hardware and software issues; multi-publisher electronic journal content integration; format considerations; and future data migration needs. (LRW)

Readiness for the Patient-Centered Medical Home: structural capabilities of Massachusetts primary care practices.

PubMed

Friedberg, Mark W; Safran, Dana G; Coltin, Kathryn L; Dresser, Marguerite; Schneider, Eric C

2009-02-01

The Patient-Centered Medical Home (PCMH), a popular model for primary care reorganization, includes several structural capabilities intended to enhance quality of care. The extent to which different types of primary care practices have adopted these capabilities has not been previously studied. To measure the prevalence of recommended structural capabilities among primary care practices and to determine whether prevalence varies among practices of different size (number of physicians) and administrative affiliation with networks of practices. Cross-sectional analysis. One physician chosen at random from each of 412 primary care practices in Massachusetts was surveyed about practice capabilities during 2007. Practice size and network affiliation were obtained from an existing database. Presence of 13 structural capabilities representing 4 domains relevant to quality: patient assistance and reminders, culture of quality, enhanced access, and electronic health records (EHRs). Three hundred eight (75%) physicians responded, representing practices with a median size of 4 physicians (range 2-74). Among these practices, 64% were affiliated with 1 of 9 networks. The prevalence of surveyed capabilities ranged from 24% to 88%. Larger practice size was associated with higher prevalence for 9 of the 13 capabilities spanning all 4 domains (P < 0.05). Network affiliation was associated with higher prevalence of 5 capabilities (P < 0.05) in 3 domains. Associations were not substantively altered by statistical adjustment for other practice characteristics. Larger and network-affiliated primary care practices are more likely than smaller, non-affiliated practices to have adopted several recommended capabilities. In order to achieve PCMH designation, smaller non-affiliated practices may require the greatest investments.

Health information technology interventions enhance care completion, engagement in HIV care and treatment, and viral suppression among HIV-infected patients in publicly funded settings.

PubMed

Shade, Starley B; Steward, Wayne T; Koester, Kimberly A; Chakravarty, Deepalika; Myers, Janet J

2015-04-01

The National HIV/AIDS Strategy (NHAS) emphasizes the use of technology to facilitate coordination of comprehensive care for people with HIV. We examined the effect of six health information technology (HIT) interventions in a Ryan White-funded Special Projects of National Significance (SPNS) on care completion services, engagement in HIV care, and viral suppression. Interventions included use of surveillance data to identify out-of-care individuals, extending access to electronic health records to support service providers, use of electronic laboratory ordering and prescribing, and development of a patient portal. Data from a sample of electronic patient records from each site were analyzed to assess changes in utilization of comprehensive care (prevention screening, support service utilization), engagement in primary HIV medical care (receipt of services and use of antiretroviral therapy), and viral suppression. We used weighted generalized estimating equations to estimate outcomes while accounting for the unequal contribution of data and differences in the distribution of patient characteristics across sites and over time. We observed statistically significant changes in the desired direction in comprehensive care utilization and engagement in primary care outcomes targeted by each site. Five of six sites experienced statistically significant increases in viral suppression. These results provide additional support for the use of HIT as a valuable tool for achieving the NHAS goal of providing comprehensive care for all people living with HIV. HIT has the potential to increase utilization of services, improve health outcomes for people with HIV, and reduce community viral load and subsequent transmission of HIV. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com For affiliation see end of article.

SIPP ACCESS: Information Tools Improve Access to National Longitudinal Panel Surveys.

ERIC Educational Resources Information Center

Robbin, Alice; David, Martin

1988-01-01

A computer-based, integrated information system incorporating data and information about the data, SIPP ACCESS systematically links technologies of laser disk, mainframe computer, microcomputer, and electronic networks, and applies relational technology to provide access to information about complex statistical data collections. Examples are given…

Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial

PubMed Central

Bendtsen, Preben; Müssener, Ulrika; Karlsson, Nadine; López-Pelayo, Hugo; Palacio-Vieira, Jorge; Colom, Joan; Gual, Antoni; Reynolds, Jillian; Wallace, Paul; Segura, Lidia; Anderson, Peter

2016-01-01

Objectives The objective of the present study was to explore whether the possibility of offering facilitated access to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increased the proportion of consulting adults who were screened and given brief advice. Design The study was a 12-week implementation study. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands, Poland and Sweden) were asked to screen adults who attended the PHCU for risky drinking. Setting A total of 120 primary healthcare centres from 5 jurisdictions in Europe. Participants 746 individual providers (general practitioners, nurses or other professionals) participated in the study. Primary outcome Change in the proportion of patients screened and referred to eBI comparing a baseline 4-week preimplementation period with a 12-week implementation period. Results The possibility of referring patients to the eBI was not found to be associated with any increase in the proportion of patients screened. However, it was associated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole (p<0.05), mainly driven by a significant increase in brief intervention rates in England from 87% to 96% (p<0.01). The study indicated that staff displayed a low level of engagement in this new technology. Staff continued to offer face-to-face advice to a larger proportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among the referred patients; on average, 18% of the patients logged on to the website with a mean log-on rate across the different countries between 0.58% and 36.95%. Conclusions Referral to eBI takes nearly as much time as brief oral advice and might require more introduction and training before staff are comfortable with referring to eBI. Trial registration number NCT01501552; Post-results. PMID:27311902

Preventing obesity in infants: the Growing healthy feasibility trial protocol

PubMed Central

Denney-Wilson, Elizabeth; Laws, Rachel; Russell, Catherine Georgina; Ong, Kok-leong; Taki, Sarah; Elliot, Roz; Azadi, Leva; Lymer, Sharyn; Taylor, Rachael; Lynch, John; Crawford, David; Ball, Kylie; Askew, Deborah; Litterbach, Eloise Kate; J Campbell, Karen

2015-01-01

Introduction Early childhood is an important period for establishing behaviours that will affect weight gain and health across the life course. Early feeding choices, including breast and/or formula, timing of introduction of solids, physical activity and electronic media use among infants and young children are considered likely determinants of childhood obesity. Parents play a primary role in shaping these behaviours through parental modelling, feeding styles, and the food and physical activity environments provided. Children from low socio-economic backgrounds have higher rates of obesity, making early intervention particularly important. However, such families are often more difficult to reach and may be less likely to participate in traditional programs that support healthy behaviours. Parents across all socio-demographic groups frequently access primary health care (PHC) services, including nurses in community health services and general medical practices, providing unparalleled opportunity for engagement to influence family behaviours. One emerging and promising area that might maximise engagement at a low cost is the provision of support for healthy parenting through electronic media such as the Internet or smart phones. The Growing healthy study explores the feasibility of delivering such support via primary health care services. Methods This paper describes the Growing healthy study, a non-randomised quasi experimental study examining the feasibility of an intervention delivered via a smartphone app (or website) for parents living in socioeconomically disadvantaged areas, for promoting infant feeding and parenting behaviours that promote healthy rather than excessive weight gain. Participants will be recruited via their primary health care practitioner and followed until their infant is 9 months old. Data will be collected via web-based questionnaires and the data collected inherently by the app itself. Ethics and dissemination This study received approval from the University of Technology Sydney Ethics committee and will be disseminated via peer-reviewed publications and conference presentations. PMID:26621519

Preventing obesity in infants: the Growing healthy feasibility trial protocol.

PubMed

Denney-Wilson, Elizabeth; Laws, Rachel; Russell, Catherine Georgina; Ong, Kok-Leong; Taki, Sarah; Elliot, Roz; Azadi, Leva; Lymer, Sharyn; Taylor, Rachael; Lynch, John; Crawford, David; Ball, Kylie; Askew, Deborah; Litterbach, Eloise Kate; J Campbell, Karen

2015-11-30

Early childhood is an important period for establishing behaviours that will affect weight gain and health across the life course. Early feeding choices, including breast and/or formula, timing of introduction of solids, physical activity and electronic media use among infants and young children are considered likely determinants of childhood obesity. Parents play a primary role in shaping these behaviours through parental modelling, feeding styles, and the food and physical activity environments provided. Children from low socio-economic backgrounds have higher rates of obesity, making early intervention particularly important. However, such families are often more difficult to reach and may be less likely to participate in traditional programs that support healthy behaviours. Parents across all socio-demographic groups frequently access primary health care (PHC) services, including nurses in community health services and general medical practices, providing unparalleled opportunity for engagement to influence family behaviours. One emerging and promising area that might maximise engagement at a low cost is the provision of support for healthy parenting through electronic media such as the Internet or smart phones. The Growing healthy study explores the feasibility of delivering such support via primary health care services. This paper describes the Growing healthy study, a non-randomised quasi experimental study examining the feasibility of an intervention delivered via a smartphone app (or website) for parents living in socioeconomically disadvantaged areas, for promoting infant feeding and parenting behaviours that promote healthy rather than excessive weight gain. Participants will be recruited via their primary health care practitioner and followed until their infant is 9 months old. Data will be collected via web-based questionnaires and the data collected inherently by the app itself. This study received approval from the University of Technology Sydney Ethics committee and will be disseminated via peer-reviewed publications and conference presentations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Psychiatric Consultation at Your Fingertips: Descriptive Analysis of Electronic Consultation From Primary Care to Psychiatry.

PubMed

Lowenstein, Margaret; Bamgbose, Olusinmi; Gleason, Nathaniel; Feldman, Mitchell D

2017-08-04

Mental health problems are commonly encountered in primary care, with primary care providers (PCPs) experiencing challenges referring patients to specialty mental health care. Electronic consultation (eConsult) is one model that has been shown to improve timely access to subspecialty care in a number of medical subspecialties. eConsults generally involve a PCP-initiated referral for specialty consultation for a clinical question that is outside their expertise but may not require an in-person evaluation. Our aim was to describe the implementation of eConsults for psychiatry in a large academic health system. We performed a content analysis of the first 50 eConsults to psychiatry after program implementation. For each question and response, we coded consults as pertaining to diagnosis and/or management as well as categories of medication choice, drug side effects or interactions, and queries about referrals and navigating the health care system. We also performed a chart review to evaluate the timeliness of psychiatrist responses and PCP implementation of recommendations. Depression was the most common consult template selected by PCPs (20/50, 40%), followed by the generic template (12/50, 24%) and anxiety (8/50, 16%). Most questions (49/50, 98%) pertained primarily to management, particularly for medications. Psychiatrists commented on both diagnosis (28/50, 56%) and management (50/50, 100%), responded in an average of 1.4 days, and recommended in-person consultation for 26% (13/50) of patients. PCPs implemented psychiatrist recommendations 76% (38/50) of the time. For the majority of patients, psychiatrists provided strategies for ongoing management in primary care without an in-person evaluation, and PCPs implemented most psychiatrist recommendations. eConsults show promise as one means of supporting PCPs to deliver mental health care to patients with common psychiatric disorders. ©Margaret Lowenstein, Olusinmi Bamgbose, Nathaniel Gleason, Mitchell D Feldman. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 04.08.2017.

Primary Care Collaborative Memory Clinics: Building Capacity for Optimized Dementia Care.

PubMed

Lee, Linda; Hillier, Loretta M; Molnar, Frank; Borrie, Michael J

2017-01-01

Increasingly, primary care collaborative memory clinics (PCCMCs) are being established to build capacity for person-centred dementia care. This paper reflects on the significance of PCCMCs within the system of care for older adults, supported with data from ongoing evaluation studies. Results highlight timelier access to assessment with a high proportion of patients being managed in primary care within a person-centred approach to care. Enhancing primary care capacity for dementia care with interprofessional and collaborative care will strengthen the system's ability to respond to increasing demands for service and mitigate the growth of wait times to access geriatric specialist assessment.

Impact of health literacy, accessibility and coordination of care on patient's satisfaction with primary care in Germany.

PubMed

Altin, Sibel Vildan; Stock, Stephanie

2015-10-22

Although health policy makers call for the transformation of health care organizations to health literacy responsive ones, there is limited evidence on the care experiences of patients with limited health literacy skills (HL) in respect to health care quality. We explored if HL and patient-reported experiences regarding access to care and support in care-coordination in primary care organizations (PCO) have an impact on patients satisfaction with the care received by their personal general practitioner (GP). A nationwide representative survey was administered in a random sample of 1125 German adults. Binary logistic regression analyses were performed to determine whether HL and perceived access to and coordination of care were associated with satisfaction with care received in primary care adjusting for demographics and health status. In the unadjusted as well as adjusted model, better accessibility of the primary care practice (β= 1.858; 2.032 p < 0.001) frequent support in care coordination by the general practitioner (β = 2.680; 2.820 p < 0.001) as well as sufficient HL (β = 0.888; 1.228 p < 0.05) were independent predictors of a higher satisfaction with care received in the general practice. German adults with sufficient HL and positive experiences regarding care coordination and access to care are more satisfied with care received by their personal general practitioner. This result is from major importance for primary care organizations intending to transform their processes and structures to respond to the health literacy needs of their patients more effectively.

Ethical, legal, and social implications of incorporating genomic information into electronic health records.

PubMed

Hazin, Ribhi; Brothers, Kyle B; Malin, Bradley A; Koenig, Barbara A; Sanderson, Saskia C; Rothstein, Mark A; Williams, Marc S; Clayton, Ellen W; Kullo, Iftikhar J

2013-10-01

The inclusion of genomic data in the electronic health record raises important ethical, legal, and social issues. In this article, we highlight these challenges and discuss potential solutions. We provide a brief background on the current state of electronic health records in the context of genomic medicine, discuss the importance of equitable access to genome-enabled electronic health records, and consider the potential use of electronic health records for improving genomic literacy in patients and providers. We highlight the importance of privacy, access, and security, and of determining which genomic information is included in the electronic health record. Finally, we discuss the challenges of reporting incidental findings, storing and reinterpreting genomic data, and nondocumentation and duty to warn family members at potential genetic risk.

Shaping the Electronic Library--The UW-Madison Approach.

ERIC Educational Resources Information Center

Dean, Charles W., Ed.; Frazier, Ken; Pope, Nolan F.; Gorman, Peter C.; Dentinger, Sue; Boston, Jeanne; Phillips, Hugh; Daggett, Steven C.; Lundquist, Mitch; McClung, Mark; Riley, Curran; Allan, Craig; Waugh, David

1998-01-01

This special theme section describes the University of Wisconsin-Madison's experience building its Electronic Library. Highlights include integrating resources and services; the administrative framework; the public electronic library, including electronic publishing capability and access to World Wide Web-based and other electronic resources;…

[Management of open access gastrointestinal endoscopy and quality of care: collaboration between an improvement team and primary care].

PubMed

Sebastián Domingo, Juan José; Sánchez Sánchez, Clara; Galve Royo, Eugenio; Mendi Metola, Carolina; Valdepérez Torrubia, Javier

2012-02-01

To create an improvement team within a healthcare quality improvement project of the Government of Aragon (Spain), aimed at increasing the quality of care and suitability of the indications of gastrointestinal endoscopy in the open access endoscopy system of a secondary hospital in Aragon. The team developed a consensus document indicating how to use oral endoscopy and colonoscopy correctly, and held information and training sessions with all the primary care physicians involved in this area. Sector I health centers and Royo Villanova Hospital, in Zaragoza. The team consisted of a gastroenterologist and three primary care physicians and, from the outset received the support of the primary care administration and management in the health area. Inappropriate use of endoscopy, particularly colonoscopy, was reduced from 20% to 11.6%. Significant savings were achieved in health costs. The endoscopy waiting list was reduced. The quality of care and the safety of patients undergoing these examinations improved. Training of primary care physicians in these procedures was enhanced, and coordination between primary and specialized was implemented. To ensure efficient running of an open access gastrointestinal endoscopy system, an interdisciplinary improvement team and the full involvement of the primary care staff managing this resource are required. Copyright © 2011 Elsevier España, S.L. All rights reserved.

Assessment of access to primary health care among children and adolescents hospitalized due to avoidable conditions.

PubMed

Ferrer, Ana Paula Scoleze; Grisi, Sandra Josefina Ferraz Ellero

2016-09-01

Hospitalizations for ambulatory care-sensitive conditions (HACSC) are considered an indicator of the effectiveness of primary health care (PHC). High rates of HACSC represent problems in the access or the quality of health care. In Brazil, HACSC rates are high and there are few studies on the factors associated with it. To evaluate the access to PHC offered to children and adolescents hospitalized due to ACSC and analyze the conditioning factors. Cross-sectional study with a quantitative and qualitative approach. Five hundred and one (501) users (guardians/caregivers) and 42 professionals of PHC units were interviewed over one year. Quantitative data were obtained using Primary Care Assessment Tool validated in Brazil (PCATool-Brazil), while qualitative data were collected by semi-structured interview. The independent variables were: age, maternal education, family income, type of diagnosis, and model of care offered, and the dependent variables were access and its components (accessibility and use of services). Sixty-five percent (65.2%) of hospitalizations were ACSC. From the perspective of both users and professionals, access and its components presented low scores. Age, type of diagnosis, and model of care affected the results. The proportion of HACSC was high in this population. Access to services is inappropriate due to: barriers to access, appreciation of the emergency services, and attitude towards health needs. Professional attitudes and opinions reinforce inadequate ideas of users reflecting on the pattern of service use.

[Minimum Standards for the Spatial Accessibility of Primary Care: A Systematic Review].

PubMed

Voigtländer, S; Deiters, T

2015-12-01

Regional disparities of access to primary care are substantial in Germany, especially in terms of spatial accessibility. However, there is no legally or generally binding minimum standard for the spatial accessibility effort that is still acceptable. Our objective is to analyse existing minimum standards, the methods used as well as their empirical basis. A systematic literature review was undertaken of publications regarding minimum standards for the spatial accessibility of primary care based on a title word and keyword search using PubMed, SSCI/Web of Science, EMBASE and Cochrane Library. 8 minimum standards from the USA, Germany and Austria could be identified. All of them specify the acceptable spatial accessibility effort in terms of travel time; almost half include also distance(s). The travel time maximum, which is acceptable, is 30 min and it tends to be lower in urban areas. Primary care is, according to the identified minimum standards, part of the local area (Nahbereich) of so-called central places (Zentrale Orte) providing basic goods and services. The consideration of means of transport, e. g. public transport, is heterogeneous. The standards are based on empirical studies, consultation with service providers, practical experiences, and regional planning/central place theory as well as on legal or political regulations. The identified minimum standards provide important insights into the effort that is still acceptable regarding spatial accessibility, i. e. travel time, distance and means of transport. It seems reasonable to complement the current planning system for outpatient care, which is based on provider-to-population ratios, by a gravity-model method to identify places as well as populations with insufficient spatial accessibility. Due to a lack of a common minimum standard we propose - subject to further discussion - to begin with a threshold based on the spatial accessibility limit of the local area, i. e. 30 min to the next primary care provider for at least 90% of the regional population. The exceeding of the threshold would necessitate a discussion of a health care deficit and in line with this a potential need for intervention, e. g. in terms of alternative forms of health care provision. © Georg Thieme Verlag KG Stuttgart · New York.

Poor Affordability and Low Access to Primary Education with Special Reference to Eastern Uttar Pradesh: Reflections from DISE Data

ERIC Educational Resources Information Center

Sulochana, Rosy

2015-01-01

"Access to basic education" continues to be a matter of serious concern in India. While the quantitative expansion of the system appears to be very impressive, the achievement of the goal of universalisation of primary education has still remained elusive. This is because the government continues its celebration through reflecting on…

The role of public health in providing primary care for the medically underserved.

PubMed Central

Sundwall, D N; Tavani, C

1991-01-01

Strategies designed to meet the health care needs of Americans should include the issues of access as well as financing. And primary care and clinical preventive services should receive as much national attention as acute care and long-term care. The public health system at the Federal, State, and local levels with its mandate to assure conditions in which people can be healthy must also be incorporated into the national debate. Publicly funded infrastructures for delivering primary health care have become a significant element of assuring access at the community level. This paper examines the expanding role of public health in assuring access to the delivery of primary health care and clinical preventive services to vulnerable populations within the larger issue of who should have access to care and how it should be made available. Special attention is paid to the part played by the Health Resources and Services Administration (HRSA) of the Public Health Service, which, in the Federal fiscal year that began on October 1, 1989, administered some $1.8 billion worth of programs for health care of targeted populations and for the support of training in the health professions. PMID:1899936

Patient information: confidentiality and the electronic record.

PubMed

Griffith, Richard

The rise of the electronic record now allows nurses to access a large archive of patient information that was more difficult to obtain when records consisted of manually held paper files. There have been several instances where curiosity and, occasionally, more malicious motivations have led nurses to access these records and read the notes of a celebrity or a person they know. In this article, Richard Griffith considers whether nurses' accessing and reading of the record of someone who is not in their care is in breach of their duty of confidentiality.

10 CFR 2.1007 - Access.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Access. 2.1007 Section 2.1007 Energy NUCLEAR REGULATORY COMMISSION RULES OF PRACTICE FOR DOMESTIC LICENSING PROCEEDINGS AND ISSUANCE OF ORDERS Procedures Applicable... Geologic Repository § 2.1007 Access. (a)(1) A system to provide electronic access to the Licensing Support...

Workplace learning through collaboration in primary healthcare: A BEME realist review of what works, for whom and in what circumstances: BEME Guide No. 46.

PubMed

Mertens, Fien; de Groot, Esther; Meijer, Loes; Wens, Johan; Gemma Cherry, Mary; Deveugele, Myriam; Damoiseaux, Roger; Stes, Ann; Pype, Peter

2018-02-01

Changes in healthcare practice toward more proactive clinical, organizational and interprofessional working require primary healthcare professionals to learn continuously from each other through collaboration. This systematic review uses realist methodology to consolidate knowledge on the characteristics of workplace learning (WPL) through collaboration by primary healthcare professionals. Following several scoping searches, five electronic bibliographic databases were searched from January 1990 to December 2015 for relevant gray and published literature written in English, French, German and Dutch. Reviewers worked in pairs to identify relevant articles. A set of statements, based on the findings of our scoping searches, was used as a coding tree to analyze the papers. Interpretation of the results was done in alternating pairs, discussed within the author group and triangulated with stakeholders' views. Out of 6930 references, we included 42 publications that elucidated who, when, how and what primary healthcare professionals learn through collaboration. Papers were both qualitative and quantitative in design, and focused largely on WPL of collaborating general practitioners and nurses. No striking differences between different professionals within primary healthcare were noted. Professionals were often unaware of the learning that occurs through collaboration. WPL happened predominantly through informal discussions about patient cases and modeling for other professionals. Any professionals could both learn and facilitate others' learning. Outcomes were diverse, but contextualized knowledge seemed to be important. Primary care professionals' WPL is multifaceted. Existing social constructivist and social cognitivist learning theories form a framework from which to interpret these findings. Primary care policy makers and managers should ensure that professionals have access to protected time, earmarked for learning. Time is required for reflection, to learn new ways of interaction and to develop new habits within clinical practice.

Improving access to primary mental health care for Australian children.

PubMed

Bassilios, Bridget; Nicholas, Angela; Reifels, Lennart; King, Kylie; Spittal, Matthew J; Fletcher, Justine; Pirkis, Jane

2016-11-01

This study examines the uptake by children aged predominantly 0-11 years of an Australian primary mental health service - the Access to Allied Psychological Services programme - which began in 2001. In particular, it considers access to, and use of, the child component of Access to Allied Psychological Services, the Child Mental Health Service, introduced in 2010. Using routinely collected programme data from a national minimum dataset and regional population data, we conducted descriptive and regression analysis to examine programme uptake, predictors of service reach and consumer- and treatment-based characteristics of service. Between 2003 and 2013, 18,631 referrals for children were made and 75,178 sessions were scheduled via Access to Allied Psychological Services, over 50% of which were via the Child Mental Health Service in its first 3 years of operation. The rate of referrals for children to the Child Mental Health Service was associated with the rate of Access to Allied Psychological Services referrals for consumers aged 12+ years. The Child Mental Health Service has increased services provided within the Access to Allied Psychological Services programme for children with emotional and behavioural issues and their families, and is potentially filling a service gap in the area of prevention and early intervention for children who have significant levels of need but are unable to access other mental health services. Our findings are policy-relevant for other developed countries with a similar primary mental health care system that are considering means of improving service access by children. © The Royal Australian and New Zealand College of Psychiatrists 2016.

Patient-Centered Appointment Scheduling Using Agent-Based Simulation

PubMed Central

Turkcan, Ayten; Toscos, Tammy; Doebbeling, Brad N.

2014-01-01

Enhanced access and continuity are key components of patient-centered care. Existing studies show that several interventions such as providing same day appointments, walk-in services, after-hours care, and group appointments, have been used to redesign the healthcare systems for improved access to primary care. However, an intervention focusing on a single component of care delivery (i.e. improving access to acute care) might have a negative impact other components of the system (i.e. reduced continuity of care for chronic patients). Therefore, primary care clinics should consider implementing multiple interventions tailored for their patient population needs. We collected rapid ethnography and observations to better understand clinic workflow and key constraints. We then developed an agent-based simulation model that includes all access modalities (appointments, walk-ins, and after-hours access), incorporate resources and key constraints and determine the best appointment scheduling method that improves access and continuity of care. This paper demonstrates the value of simulation models to test a variety of alternative strategies to improve access to care through scheduling. PMID:25954423

Primary radical yields in pulse irradiated alkaline aqueous solution

NASA Technical Reports Server (NTRS)

Fielden, E. M.; Hart, E. J.

1969-01-01

Primary radical yields of hydrated electrons, H atoms, and OH radicals are determined by measuring hydrated electron formation following a 4 microsecond pulse of X rays. The pH dependence of free radical yields beyond pH 12 is determined by observation of the hydrated electrons.

Factors Associated With Access to HIV Testing and Primary Care Among Migrants Living in Europe: Cross-Sectional Survey.

PubMed

Fakoya, Ibidun; Álvarez-Del Arco, Débora; Copas, Andrew J; Teixeira, Bryan; Block, Koen; Gennotte, Anne-Francoise; Volny-Anne, Alain; Bil, Janneke P; Touloumi, Giota; Del Amo, Julia; Burns, Fiona M

2017-11-06

There is a heavy and disproportionate burden of human immunodeficiency virus (HIV) infection among migrant communities living in Europe. Despite this, the published evidence related to HIV testing, prevention, and treatment needs for migrants is sparse. The aim of this study was to identify the factors associated with access to primary care and HIV testing among migrant groups living in Europe. A Web-based survey (available in 14 languages) was open to all people aged 18 years and older, living outside their country of birth in the World Health Organization (WHO) European area. Community organizations in 9 countries promoted the survey to migrant groups, focusing on those at a higher risk of HIV (sub-Saharan Africans, Latin Americans, gay or bisexual men, and people who inject drugs). Multivariable analysis examined factors associated with access to primary care and previous history of an HIV test. In total, 559 women, 395 heterosexual men, and 674 gay or bisexual men were included in the analysis, and 68.1% (359/527) of women, 59.5% (220/371) of heterosexual men, and 89.6% (596/664) of gay or bisexual men had tested for HIV. Low perceived risk was the reason given for not testing by 62.3% (43/69) of gay or bisexual men and 83.3% (140/168) of women and heterosexual men who reported never having tested for HIV. Access to primary care was >60% in all groups. Access to primary care was strongly positively associated with living in Northern Europe compared with Southern Europe (women: adjusted odds ratio, aOR 34.56 [95% CI 11.58-101]; heterosexual men: aOR 6.93 [95% CI 2.49-19.35], and gay or bisexual men: aOR 2.53 [95% CI 1.23-5.19]), whereas those with temporary residency permits were less likely to have access to primary care (women: aOR 0.41 [95% CI 0.21-0.80] and heterosexual men: aOR 0.24 [95% CI 0.10-0.54] only). Women who had experience of forced sex (aOR 3.53 [95% CI 1.39-9.00]) or postmigration antenatal care (aOR 3.07 [95% CI 1.55-6.07]) were more likely to have tested for HIV as were heterosexual men who had access to primary care (aOR 3.13 [95% CI 1.58-6.13]) or reported "Good" health status (aOR 2.94 [95% CI 1.41-5.88]). Access to primary care is limited by structural determinants such as immigration and health care policy, which varies across Europe. For those migrants who can access primary care and other health services, missed opportunities for HIV testing remain a barrier to earlier testing and diagnosis for migrants in Europe. Clinicians should be aware of these potential structural barriers to HIV testing as well as low perception of HIV risk in migrant groups. ©Ibidun Fakoya, Débora Álvarez-del Arco, Andrew J Copas, Bryan Teixeira, Koen Block, Anne-Francoise Gennotte, Alain Volny-Anne, Janneke P Bil, Giota Touloumi, Julia del Amo, Fiona M Burns. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 06.11.2017.

A Previsit Screening Checklist Improves Teamwork and Access to Preventive Services in a Medical Home Serving Low-Income Adolescent and Young Adult Patients.

PubMed

Allende-Richter, Sophie H; Johnson, Sydney T; Maloyan, Mariam; Glidden, Patricia; Rice, Kerrilynn; Epee-Bounya, Alexandra

2018-06-01

Publicly insured adolescents and young adults experience significant obstacles in accessing primary care services. As a result, they often present to their medical appointments with multiple unmet needs, adding time and complexity to the visit. The goal of this project was to optimize team work and access to primary care services among publicly insured adolescents and young adults attending an urban primary care clinic, using a previsit screening checklist to identify patient needs and delegate tasks within a care team to coordinate access to health services at the time of the visit. We conducted an interventional quality improvement initiative in a PDSA (Plan-Do-Study-Act) cycle format; 291 patients, 13 to 25 years old were included in the study over an 8-months period. The majority of patients were receptive to the previsit screening checklist; 85% of services requested were provided; nonclinician staff felt more involved in patient care; and providers' satisfaction increased.

The Electronic Journal of Information Technology in Construction (ITcon): An Open Access Journal Using an Un-Paid, Volunteer-Based Organization

ERIC Educational Resources Information Center

Björk, Bo-Christer; Turk, Žiga

2006-01-01

Introduction: This case study is based on the experiences with the Electronic Journal of Information Technology in Construction (ITcon), founded in 1995. Development: This journal is an example of a particular category of open access journals, which use neither author charges nor subscriptions to finance their operations, but rely largely on…

75 FR 1533 - Airworthiness Directives; The Boeing Company Model 747-200F, 747-200C, 747-400, 747-400D, and 747...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-12

... frames, upper deck floor beams, electronic bay access door cutout, nose wheel well, and main entry doors... intervals for certain airplanes. This AD results from fatigue tests and analysis that identified additional... frames, upper deck floor beams, electronic bay access door cutout, nose wheel well, and main entry doors...

Evaluating Microcomputer Access Technology for Use by Visually Impaired Students.

ERIC Educational Resources Information Center

Ruconich, Sandra

1984-01-01

The article outlines advantages and limitations of five types of access to microcomputer technology for visually impaired students: electronic braille, paper braille, Optacon, synthetic speech, and enlarged print. Additional considerations in access decisions are noted. (CL)

Reforming primary health care: is New Zealand's primary health care strategy achieving its early goals?

PubMed

Cumming, Jacqueline; Mays, Nicholas; Gribben, Barry

2008-11-06

In 2001, the New Zealand government introduced its Primary Health Care Strategy (PHCS), aimed at strengthening the role of primary health care, in order to improve health and to reduce inequalities in health. As part of the Strategy, new funding was provided to reduce the fees that patients pay when they use primary health care services in New Zealand, to improve access to services and to increase service use. In this article, we estimate the impact of the new funding on general practitioner and practice nurse visit fees paid by patients and on consultation rates. The analyses involved before-and-after monitoring of fees and consultation rates in a random sample of 99 general practices and covered the period from June 2001 (pre-Strategy) to mid-2005. Fees fell particularly in Access (higher need, higher per capita funded) practices over time for doctor and nurse visits. Fees increased over time for many in Interim (lower need, lower per capita funded) practices, but they fell for patients aged 65 years and over as new funding was provided for this age group. There were increases in consultation rates across almost all age, funding model (Access or Interim), socio-demographic and ethnic groups. Increases were particularly high in Access practices. The Strategy has resulted in lower fees for primary health care for many New Zealanders, and consultation rates have also increased over the past few years. However, fees have not fallen by as much as expected in government policy given the amount of extra public money spent since there are limited requirements for practices to reduce patients' fees in line with increases in public funding for primary care.

Reforming primary health care: is New Zealand's primary health care strategy achieving its early goals?

PubMed Central

Cumming, Jacqueline; Mays, Nicholas; Gribben, Barry

2008-01-01

Background In 2001, the New Zealand government introduced its Primary Health Care Strategy (PHCS), aimed at strengthening the role of primary health care, in order to improve health and to reduce inequalities in health. As part of the Strategy, new funding was provided to reduce the fees that patients pay when they use primary health care services in New Zealand, to improve access to services and to increase service use. In this article, we estimate the impact of the new funding on general practitioner and practice nurse visit fees paid by patients and on consultation rates. The analyses involved before-and-after monitoring of fees and consultation rates in a random sample of 99 general practices and covered the period from June 2001 (pre-Strategy) to mid-2005. Results Fees fell particularly in Access (higher need, higher per capita funded) practices over time for doctor and nurse visits. Fees increased over time for many in Interim (lower need, lower per capita funded) practices, but they fell for patients aged 65 years and over as new funding was provided for this age group. There were increases in consultation rates across almost all age, funding model (Access or Interim), socio-demographic and ethnic groups. Increases were particularly high in Access practices. Conclusion The Strategy has resulted in lower fees for primary health care for many New Zealanders, and consultation rates have also increased over the past few years. However, fees have not fallen by as much as expected in government policy given the amount of extra public money spent since there are limited requirements for practices to reduce patients' fees in line with increases in public funding for primary care. PMID:18990236

Do Patients Who Access Clinical Information on Patient Internet Portals Have More Primary Care Visits?

PubMed

Leveille, Suzanne G; Mejilla, Roanne; Ngo, Long; Fossa, Alan; Elmore, Joann G; Darer, Jonathan; Ralston, James D; Delbanco, Tom; Walker, Jan

2016-01-01

As health care costs alarm the nation and the debate increases about the impact of health information technologies, patients are reviewing their medical records increasingly through secure Internet portals. Important questions remain about the impact of portal use on office visits. To evaluate whether use of patient Internet portals to access records is associated with increased primary care utilization. A prospective cohort study. Primary care patients registered on patient Internet portals, within an integrated health system serving rural Pennsylvania and an academic medical center in Boston. Frequency of "clinical portal use" (days/2 mo intervals over 2 y) included secure messaging about clinical issues and viewing laboratory and radiology findings. In year 2, a subset of patients also gained access to their primary care doctor's visit notes. The main outcome was number of primary care office visits. In the first 2 months of the 2-year period, 14% of 44,951 primary care patients engaged in clinical portal use 2 or more days per month, 31% did so 1 day per month, and the remainder had no clinical portal use. Overall, adjusted for age, sex, and chronic conditions, clinical portal use was not associated with subsequent office visits. Fewer than 0.1% of patients engaged in high levels of clinical portal use (31 or more login days in 2 mo) that were associated with 1 or more additional visits in the subsequent 2 months (months 3 and 4). However, the reverse was true: office visits led to subsequent clinical portal use. Similar trends were observed among patients with or without access to visit notes. Patients turn to their portals following visits, but clinical portal use does not contribute to an increase in primary care visits.

Some old drugs improve late primary patency rate of native arteriovenous fistulas in hemodialysis patients.

PubMed

Righetti, Marco; Ferrario, GianMichele; Serbelloni, Paola; Milani, Silvana; Tommasi, Adalberto

2009-01-01

Vascular access failure causes 20% of all hospitalizations of dialysis patients. Native arteriovenous fistulas, the best type of dialysis vascular access, have a 1-year primary patency rate that is extremely variable, ranging 40-80%. Neointimal hyperplasia is the most important cause of arteriovenous fistula late primary dysfunction. In recent years the arteriovenous fistula late primary patency rate has not improved because of the increase of old uremic patients with a high number of comorbidities and the lack of new therapeutic interventions. Therefore, we performed a long-term case-control study to analyze which factors or drugs may affect native arteriovenous fistula late primary patency rate in 60 incident hemodialysis patients. The arteriovenous fistula late primary patency rate was 75.1% after 12 months, 58.5% after 24 months, and 50% after 987 days. Homocysteine levels during follow-up had a significant direct association with vascular access failure (event vs. event-free 28.5+/-1.9 vs. 22.3+/-1.2 micromol/L, p<0.01). Folate values had a trend toward an inverse relationship with arteriovenous fistula failure (event vs. event-free 11.5+/-1.2 vs. 14.6 vs. 1.1 ng/mL, p=0.06). Patients treated with folic acid and/or statin had an arteriovenous fistula late primary patency rate significantly higher than patients without folic acid and statin therapy, respectively, 81.7% vs. 66% after 1 year and 71.5% vs. 39.1% after 2 years (p=0.02). Many other factors were not associated with vascular access failure. Statin and homocysteine-lowering folic acid therapy is associated with prolonged arteriovenous fistula survival. It is important to perform randomized trials to verify our observation.

Conversion of school nurse policy and procedure manual to electronic format.

PubMed

Randall, Joellyn; Knee, Rachel; Galemore, Cynthia

2006-10-01

Policy and procedure manuals are essential to establishing standards of practice and ensuring quality of care to students and families. The Olathe District Schools (Kansas) Technology Department created the Virtual File Cabinet to provide online access to employee policies, school board policies, forms, and other documents. A task force of school nurses was formed to convert the nursing department's policies, procedures, protocols, and forms from hard copy to electronic format and make them available on the district's Virtual File Cabinet. Having the policy and procedure manuals in electronic format allows for quick access and ease in updating information, thereby guaranteeing the school nurses have access to the most current information. Cost savings were realized by reducing the amount of paper and staff time needed to copy, collate, and assemble materials.

Biomedical information @ the speed of light: implementing desktop access to publishers' resources at the Paterson Institute for Cancer Research.

PubMed

Glover, S W

2001-06-01

Shortly after midnight every Thursday morning, a list server in Massachusetts delivers an electronic table of contents message to the Kostoris Medical Library at the Paterson Institute for Cancer Research in Manchester, UK. The messageins details of the latest edition of the New England Journal of Medicine, complete with hyperlinks to the full text of the content online. Publishers' electronic current awareness services have been integrated into the dissemination process of the Library service to enhance the speed of communication and access to full text content. As a means of promoting electronic journal use, a system of e-mail delivery coupled with fast Internet access has allowed a migration from paper-based current awareness alerting to a seamless online product.

Database Access Systems.

ERIC Educational Resources Information Center

Dalrymple, Prudence W.; Roderer, Nancy K.

1994-01-01

Highlights the changes that have occurred from 1987-93 in database access systems. Topics addressed include types of databases, including CD-ROMs; enduser interface; database selection; database access management, including library instruction and use of primary literature; economic issues; database users; the search process; and improving…

Electronic Journals in Academic Libraries: A Comparison of ARL and Non-ARL Libraries.

ERIC Educational Resources Information Center

Shemberg, Marian; Grossman, Cheryl

1999-01-01

Describes a survey dealing with academic library provision of electronic journals and other electronic resources that compared ARL (Association of Research Libraries) members to non-ARL members. Highlights include full-text electronic journals; computers in libraries; online public access catalogs; interlibrary loan and electronic reserves; access…

78 FR 17781 - Transportation Worker Identification Credential (TWIC)-Reader Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

...In this Notice of Proposed Rulemaking (NPRM), the Coast Guard proposes to require owners and operators of certain vessels and facilities regulated by the Coast Guard to use electronic readers designed to work with the Transportation Worker Identification Credential (TWIC) as an access control measure. This NPRM also proposes additional requirements associated with electronic TWIC readers, including recordkeeping requirements for those owners and operators required to use an electronic TWIC reader, and security plan amendments to incorporate TWIC requirements. The TWIC program, including the proposed TWIC reader requirements in this rule, is an important component of the Coast Guard's multi-layered system of access control requirements and other measures designed to enhance maritime security. This rulemaking action, once final, would build upon existing Coast Guard regulations designed to ensure that only individuals who hold a TWIC are granted unescorted access to secure areas at those locations. The Coast Guard has already promulgated regulations pursuant to the Maritime Transportation Security Act of 2002 (MTSA) that require mariners and other individuals to obtain a TWIC and present it for inspection by security personnel prior to gaining access to such secure areas. By requiring certain vessels and facilities to perform TWIC inspections using electronic TWIC readers, this rulemaking would further enhance security at those locations. This rulemaking would also implement the Security and Accountability For Every Port Act of 2006 electronic TWIC reader requirements.

Tablet computers in support of rural and frontier clinical practice.

PubMed

Anderson, Chad; Henner, Terry; Burkey, Jake

2013-11-01

Healthcare organizations are increasingly faced with an environment in which they must implement health information systems to achieve higher standards for efficiency and quality of care while at the same time being asked to provide needed services with fewer resources. This is particularly challenging for rural health systems where access to resources is often more limited. This study investigates the potential value of iPad tablets for enhancing health services delivery by primary care physicians in rural Nevada. Five physicians from rural Nevada were selected to receive iPads and funding for apps that would enhance their medical practices. Following a year of use, data was gathered on each physician's actual use and perceived value of the iPads. A case study approach was taken using both an online survey and semi-structured phone interviews to collect case data. Use and perceived usefulness of the iPad was mixed but generally positive with some physicians utilizing it much more than others. The iPads were primarily used by the physicians to access medical information through online resources (e.g. Epocrates and UpToDate) for reference and diagnostic purposes, although they were also used for some interaction with patients. All felt that resources available through the iPad were limited and that better applications would improve the usefulness of the iPad, particularly in regard to graphical and video content suitable to sharing with patients. Physicians in this study felt that the iPad could fill a need between smartphones and desktops, which were their primary technology tools prior to receiving the iPad, but that useful medical applications and resources are currently limited for the iPad. In particular, better graphical and video content would improve the usefulness of the iPad as a tool for patient interactions. Apps that store content locally would serve to mitigate inconsistent internet access that is still common in rural settings, increasing the usefulness of the iPad in that context. Tablets like the iPad also have potential for use in accessing the electronic medical record systems that are increasingly being implemented in rural hospitals and healthcare facilities. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

29 CFR 33.11 - Communications.

Code of Federal Regulations, 2010 CFR

2010-07-01

... beneficiaries by telephone, telecommunications devices for deaf persons (TDDs), or equally effective... about accessible facilities. The international symbol for accessibility shall be used at each primary...

Electronic Ramp to Success: Designing Campus Web Pages for Users with Disabilities.

ERIC Educational Resources Information Center

Coombs, Norman

2002-01-01

Discusses key issues in addressing the challenge of Web accessibility for people with disabilities, including tools for Web authoring, repairing, and accessibility validation, and relevant legal issues. Presents standards for Web accessibility, including the Section 508 Standards from the Federal Access Board, and the World Wide Web Consortium's…

76 FR 8802 - On Behalf of the Accessibility Committee of the Federal CIO Council (29 U.S.C. 794d); Listening...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-15

...) requires federal agencies to buy and use electronic and information technology (EIT) that is accessible. On... improving the acquisition and implementation of accessible technology. In order to better understand the... information technology (EIT) accessible to people with disabilities. Inaccessible technology interferes with...

Freedom of the Press vs. Public Access.

ERIC Educational Resources Information Center

Schmidt, Benno C., Jr.

This book surveys the implications of freedom of the press for a constitutionally rooted public right of access to electronic and print media. Part one provides general perspectives on access to the media, including discussions of access in relation to the Supreme Court, to First Amendment history and theory, to current perceptions of the press,…

The Health IT Regional Extension Center Program: evolution and lessons for health care transformation.

PubMed

Lynch, Kimberly; Kendall, Mat; Shanks, Katherine; Haque, Ahmed; Jones, Emily; Wanis, Maggie G; Furukawa, Michael; Mostashari, Farzad

2014-02-01

Assess the Regional Extension Center (REC) program's progress toward its goal of supporting over 100,000 providers in small, rural, and underserved practices to achieve meaningful use (MU) of an electronic health record (EHR). Data collected January 2010 through June 2013 via monitoring and evaluation of the 4-year REC program. Descriptive study of 62 REC programs. Primary data collected from RECs were merged with nine other datasets, and descriptive statistics of progress by practice setting and penetration of targeted providers were calculated. RECs recruited almost 134,000 primary care providers (PCPs), or 44 percent of the nation's PCPs; 86 percent of these were using an EHR with advanced functionality and almost half (48 percent) have demonstrated MU. Eighty-three percent of Federally Qualified Health Centers and 78 percent of the nation's Critical Access Hospitals were participating with an REC. RECs have made substantial progress in assisting PCPs with adoption and MU of EHRs. This infrastructure supports small practices, community health centers, and rural and public hospitals to use technology for care delivery transformation and improvement. © Health Research and Educational Trust.

Apgar score and dental caries risk in the primary dentition of five year olds.

PubMed

Sanders, A E; Slade, G D

2010-09-01

Conditions in utero and early life underlie risk for several childhood disorders. This study tested the hypothesis that the Apgar score predicted dental caries in the primary dentition. A retrospective cohort study conducted in 2003 examined associations between conditions at birth and early life with dental caries experience at five years. Dental examination data for a random sample of five-year-old South Australian children were obtained from School Dental Service electronic records. A questionnaire mailed to the parents obtained information about neonatal status at delivery (five-minute Apgar score, birthweight, plurality, gestational age) and details about birth order, weaning, and behavioural, familial and sociodemographic characteristics. Of the 1398 sampled children with a completed questionnaire (response rate=64.6%), 1058 were singleton term deliveries among whom prevalence of dental caries was 40.1%. In weighted log-binomial regression analysis, children with an Apgar score of <=8 relative to a score of 9-10 had greater probability of dental caries in the primary dentition after adjusting for sociodemographic and behavioural covariates and water fluoridation concentration (adjusted PR=1.47, 95% CI=1.11, 1.95). Readily accessible markers of early life, such as the Apgar score, may guide clinicians in identifying children at potentially heightened risk for dental caries and aid decision-making in allocating preventive services.

Job satisfaction and perceived autonomy for nurse practitioners working in nurse-managed health centers.

PubMed

Pron, Ann Linguiti

2013-04-01

More primary care providers are needed to deliver health care to Americans living in poverty and those soon to be insured under the Affordable Care Act. Nurse practitioners (NPs) in nurse-managed health centers (NMHCs) are poised to meet this need. This research study examined the characteristics of NPs working in NMHCs and measured job satisfaction and perceived level of autonomy. No studies about job satisfaction or autonomy for NPs working in NMHCs had been previously reported. This descriptive, quantitative study surveyed primary care NPs working in NMHCs that are part of the National Nursing Centers Consortium (NNCC). NP e-mail addresses were obtained from NNCC center directors. Of 198 NPs invited to the electronic survey, 99 completed the Misener Nurse Practitioner Job Satisfaction Scale, demographic questionnaire, questions about perceived autonomy, and whether they would recommend working in an NMHC. Participants came from 16 states and 46 NMHCs. NPs working in NMHCs have job satisfaction, perceive their role as autonomous, and are satisfied with the autonomy they have. NMHCs can provide access to primary health care for many Americans. More NPs may choose employment in NMHCs for job satisfaction and autonomy. ©2012 The Author(s) Journal compilation ©2012 American Association of Nurse Practitioners.

Multi-physics modelling contributions to investigate the atmospheric cosmic rays on the single event upset sensitivity along the scaling trend of CMOS technologies.

PubMed

Hubert, G; Regis, D; Cheminet, A; Gatti, M; Lacoste, V

2014-10-01

Particles originating from primary cosmic radiation, which hit the Earth's atmosphere give rise to a complex field of secondary particles. These particles include neutrons, protons, muons, pions, etc. Since the 1980s it has been known that terrestrial cosmic rays can penetrate the natural shielding of buildings, equipment and circuit package and induce soft errors in integrated circuits. Recently, research has shown that commercial static random access memories are now so small and sufficiently sensitive that single event upsets (SEUs) may be induced from the electronic stopping of a proton. With continued advancements in process size, this downward trend in sensitivity is expected to continue. Then, muon soft errors have been predicted for nano-electronics. This paper describes the effects in the specific cases such as neutron-, proton- and muon-induced SEU observed in complementary metal-oxide semiconductor. The results will allow investigating the technology node sensitivity along the scaling trend. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Electronic Journal Market Overview in 1997: Part 1--The Publishers.

ERIC Educational Resources Information Center

Machovec, George S.

1997-01-01

Provides an overview of the electronic journal market and focuses on publishers doing innovative projects. Discusses predominate market models; publishers and the Internet; issues surrounding electronic journals: pricing, security, electronic page layout, copyright, backfile availability, reliability, and accessibility. Highlights selected…

Making Microcomputers Accessible to Blind Persons.

ERIC Educational Resources Information Center

Ruconich, Sandra K.; And Others

1986-01-01

The article considers advantages and limitations of tactile, auditory, and visual means of microcomputer access for blind students. Discussed are electronic braille, paper braille, the Optacon, synthesized speech, and enlarged print. Improved multimedia access technology is predicted for the future. (Author/DB)

Accessibility | NREL

Science.gov Websites

electronic and information technologies accessible to individuals with disabilities in accordance with Section 508 of the Rehabilitation Act (29 U.S.C. 794d), as amended in 1998. Contact us with feedback or concerns related to the accessibility of this website.

The TULIP Project.

ERIC Educational Resources Information Center

Gusack, Nancy, Ed.; And Others

1995-01-01

Contains 11 articles that describe different university access systems designed and built to provide access to journals via The University Licensing Program (TULIP), a science journal access project, involving Elsevier Science Publishing and major universities. The project produced insights to help with future electronic information delivery…

Optical observations of Magnetosphere-Ionosphere coupling: Inter-hemispheric electron reflections within pulsating aurora

NASA Astrophysics Data System (ADS)

Samara, M.; Michell, R.; Khazanov, G. V.; Grubbs, G. A., II

2017-12-01

Magnetosphere-Ionosphere coupling is exhibited in reflected primary and secondary electrons which constitute the second step in the formation of the total precipitating electron distribution. While they have largely been missing from the current theoretical studies of particle precipitation, ground based observations point to the existence of a reflected electron population. We present evidence that pulsating aurora is caused by electrons bouncing back and forth between the two hemispheres. This means that these electrons are responsible for some of the total light in the aurora, a possibility that has largely been ignored in theoretical models. Pulsating auroral events imaged optically at high time resolution present direct observational evidence in agreement with the inter-hemispheric electron bouncing predicted by the SuperThermal Electron Trans-port (STET) model. Immediately following each of the `pulsation-on' times are equally spaced, and subsequently fainter pulsations, which can be explained by the primary precipitating electrons reflecting upwards from the ionosphere, traveling to the opposite hemisphere, and reflecting upwards again. The high time-resolution of these data, combined with the short duration of the `pulsation-on' time ( 1 s) and the relatively long spacing between pulsations ( 6 to 9 s) made it possible to observe the faint optical pulses caused by the reflected electrons coming from the opposite hemisphere. These results are significant and have broad implications because they highlight that the formation of the auroral electron distributions within regions of diffuse and pulsating aurora contain contributions from reflected primary and secondary electrons. These processes can ultimately lead to larger fluxes than expected when considering only the primary injection of magnetospheric electrons.

A Monte Carlo study of primary electron production inside photoconductors for digital mammography and indications of material suitability

NASA Astrophysics Data System (ADS)

Sakellaris, T.; Spyrou, G.; Panayiotakis, G.; Tzanakos, G.

2010-08-01

Materials like a-Se, a-As2Se3, GaSe, GaAs, Ge, CdTe, CdZnTe, Cd0.8Zn0.2Te, ZnTe, PbO, TlBr, PbI2 and HgI2 are possible photoconductors for direct conversion digital mammography detectors. The physical characteristics of primary electrons, such as their number, energies, direction angles and spatial distributions, strongly affect the characteristics of the final signal and hence image quality. In previous work, a Monte Carlo model has been developed that simulates the generation of primary electrons inside these materials for x-ray spectra in the mammographic energy range. Using this model the energy, angular and spatial distributions of primary electrons have been studied. For the case of CdTe, CdZnTe, Cd0.8Zn0.2Te and ZnTe, an investigation was also made concerning the dependence of the primary electron production on the incident x-ray energy. In this paper, this investigation has been extended to include the rest of the photoconducting materials. The investigation is realized studying the number of primary electrons produced along with the escaping of photons (both incident and fluorescent) and the number of fluorescent photons emitted for 39 monoenergetic x-ray spectra with energies between 2 and 40 keV. The information obtained from the overall investigation of the primary signal in the various photoconductors gives some good indications of the suitability of PbI2 and HgI2.

Access to leave benefits for primary caregivers of children with special health care needs: a double bind.

PubMed

Chung, Paul J; Garfield, Craig F; Elliott, Marc N; Vestal, Katherine D; Klein, David J; Schuster, Mark A

2013-01-01

Family leave benefits are a key tool that allow parents to miss work to care for their ill children. We examined whether access to benefits varies by level of childcare responsibilities among employed parents of children with special health care needs (CSHCN). We conducted telephone interviews with 3 successive cohorts of employed parents of CSHCN, randomly sampled from a California children's hospital. At Wave 1 (November 2003 to January 2004), we conducted 372 parent interviews. At Wave 2 (November 2005 to January 2006), we conducted 396 parent interviews. At Wave 3 (November 2007 to January 2008), we conducted 393 parent interviews. We pooled these samples for bivariate and multivariate regression analyses by using wave indicators and sample weights. Parents with more childcare responsibilities (primary caregivers) reported less access to sick leave/vacation (65% vs 82%, P < .001), access to paid leave outside of sick leave/vacation (41% vs 51%, P < .05), and eligibility for Family and Medical Leave Act benefits (28% vs 44%, P < .001) than secondary caregivers. Part-time employment and female gender largely explained 2 of the 3 associations between more childcare responsibilities and less access to leave benefits. Even in the context of part-time employment, however, primary caregivers were just as likely as secondary caregivers both to miss work due to their child's illness and to report being unable to miss work when they needed to. Due in part to employment and gender differences, leave benefits among parents of CSHCN are skewed away from primary caregivers and toward secondary caregivers. Thus, primary caregivers may face particularly difficult choices between employment and childcare responsibilities. Reducing this disparity in access to benefits may improve the circumstances of CSHCN and their families. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

A patient-centered electronic tool for weight loss outcomes after Roux-en-Y gastric bypass.

PubMed

Wood, G Craig; Benotti, Peter; Gerhard, Glenn S; Miller, Elaina K; Zhang, Yushan; Zaccone, Richard J; Argyropoulos, George A; Petrick, Anthony T; Still, Christopher D

2014-01-01

BACKGROUND. Current patient education and informed consent regarding weight loss expectations for bariatric surgery candidates are largely based on averages from large patient cohorts. The variation in weight loss outcomes illustrates the need for establishing more realistic weight loss goals for individual patients. This study was designed to develop a simple web-based tool which provides patient-specific weight loss expectations. METHODS. Postoperative weight measurements after Roux-en-Y gastric bypass (RYGB) were collected and analyzed with patient characteristics known to influence weight loss outcomes. Quantile regression was used to create expected weight loss curves (25th, 50th, and 75th %tile) for the 24 months after RYGB. The resulting equations were validated and used to develop web-based tool for predicting weight loss outcomes. RESULTS. Weight loss data from 2986 patients (2608 in the primary cohort and 378 in the validation cohort) were included. Preoperative body mass index (BMI) and age were found to have a high correlation with weight loss accomplishment (P < 0.0001 for each). An electronic tool was created that provides easy access to patient-specific, 24-month weight loss trajectories based on initial BMI and age. CONCLUSIONS. This validated, patient-centered electronic tool will assist patients and providers in patient teaching, informed consent, and postoperative weight loss management.

eC3--a modern telecommunications matrix for cervical cancer prevention in Zambia.

PubMed

Parham, Groesbeck P; Mwanahamuntu, Mulindi H; Pfaendler, Krista S; Sahasrabuddhe, Vikrant V; Myung, Daniel; Mkumba, Gracilia; Kapambwe, Sharon; Mwanza, Bianca; Chibwesha, Carla; Hicks, Michael L; Stringer, Jeffrey S A

2010-07-01

Low physician density, undercapacitated laboratory infrastructures, and limited resources are major limitations to the development and implementation of widely accessible cervical cancer prevention programs in sub-Saharan Africa. We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector cervical cancer prevention program in Zambia, one of the world's poorest countries. Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients, and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of "electronic cervical cancer control" bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring, evaluation, and continued education of primary health care providers, patient education, and medical records documentation. The electronic cervical cancer control system uses appropriate technology to bridge the gap between screening and diagnosis, thereby facilitating the conduct of "screen-and-treat" programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus-based screening approaches and wireless telemedicine communications.

Patient experience of access to primary care: identification of predictors in a national patient survey.

PubMed

Kontopantelis, Evangelos; Roland, Martin; Reeves, David

2010-08-28

The 2007/8 GP Access Survey in England measured experience with five dimensions of access: getting through on the phone to a practice, getting an early appointment, getting an advance appointment, making an appointment with a particular doctor, and surgery opening hours. Our aim was to identify predictors of patient satisfaction and experience with access to English primary care. 8,307 English general practices were included in the survey (of 8,403 identified). 4,922,080 patients were randomly selected and contacted by post and 1,999,523 usable questionnaires were returned, a response rate of 40.6%. We used multi-level logistic regressions to identify patient, practice and regional predictors of patient satisfaction and experience. After controlling for all other factors, younger people, and people of Asian ethnicity, working full time, or with long commuting times to work, reported the lowest levels of satisfaction and experience of access. For people in work, the ability to take time off work to visit the GP effectively eliminated the disadvantage in access. The ethnic mix of the local area had an impact on a patient's reported satisfaction and experience over and above the patient's own ethnic identity. However, area deprivation had only low associations with patient ratings. Responses from patients in small practices were more positive for all aspects of access with the exception of satisfaction with practice opening hours. Positive reports of access to care were associated with higher scores on the Quality and Outcomes Framework and with slightly lower rates of emergency admission. Respondents in London were the least satisfied and had the worst experiences on almost all dimensions of access. This study identifies a number of patient groups with lower satisfaction, and poorer experience, of gaining access to primary care. The finding that access is better in small practices is important given the increasing tendency for small practices to combine into larger units. Consideration needs to be given to ways of retaining these and other benefits of small practice size when primary care services are reconfigured. Differences between population groups (e.g. younger people, ethnic minorities) may be due to differences in actual care received or different response tendencies of different groups. Further analysis is needed to determine whether case-mix adjustment is required when comparing practices serving different populations.

Developing a mobile electronic D2B checklist for treatment of ST elevation myocardial infarction patients who need a primary coronary intervention.

PubMed

Lin, Hung-Jung; Hsu, Min-Huei; Huang, Chien-Cheng; Liu, Chung-Feng; Tan, Che-Kim; Chou, Shu-Lien; Huang, Shou-Yung; Chen, Chia-Jung

2015-04-01

ST elevation myocardial infarction (STEMI), one main type of acute myocardial infarction with high mortality, requires percutaneous coronary intervention (PCI) with balloon inflation. Current guidelines recommend a door-to-balloon (D2B) interval (i.e., starts with the patient's arrival in the emergency department and ends when PCI with a catheter guidewire and balloon inflation crosses the culprit lesion) of no more than 90 min. However, promptly implementing PCI requires coordinating various medical teams. Checklists can be used to ensure consistency and operating sequences when executing complex tasks in a clinical routine. Developing an effective D2B checklist would enhance the care of STEMI patients who need PCI. Mobile information and communication technologies have the potential to greatly improve communication, facilitate access to information, and eliminate duplicated documentation without the limitations of space and time. In a research project by the Chi Mei Medical Center, "Developing a Mobile Electronic D2B Checklist for Managing the Treatment of STEMI Patients Who Need Primary Coronary Intervention," a prototype version of a mobile checklist was developed. This study describes the research project and the four phases of the system development life cycle, comprising system planning and selection, analysis, design, and implementation and operation. Face-to-face interviews with 16 potential users were conducted and revealed highly positive user perception and use intention toward the prototype. Discussion and directions for future research are also presented.

Developing a Mobile Electronic D2B Checklist for Treatment of ST Elevation Myocardial Infarction Patients Who Need a Primary Coronary Intervention

PubMed Central

Lin, Hung-Jung; Hsu, Min-Huei; Huang, Chien-Cheng; Tan, Che-Kim; Chou, Shu-Lien; Huang, Shou-Yung; Chen, Chia-Jung

2015-01-01

Abstract ST elevation myocardial infarction (STEMI), one main type of acute myocardial infarction with high mortality, requires percutaneous coronary intervention (PCI) with balloon inflation. Current guidelines recommend a door-to-balloon (D2B) interval (i.e., starts with the patient's arrival in the emergency department and ends when PCI with a catheter guidewire and balloon inflation crosses the culprit lesion) of no more than 90 min. However, promptly implementing PCI requires coordinating various medical teams. Checklists can be used to ensure consistency and operating sequences when executing complex tasks in a clinical routine. Developing an effective D2B checklist would enhance the care of STEMI patients who need PCI. Mobile information and communication technologies have the potential to greatly improve communication, facilitate access to information, and eliminate duplicated documentation without the limitations of space and time. In a research project by the Chi Mei Medical Center, “Developing a Mobile Electronic D2B Checklist for Managing the Treatment of STEMI Patients Who Need Primary Coronary Intervention,” a prototype version of a mobile checklist was developed. This study describes the research project and the four phases of the system development life cycle, comprising system planning and selection, analysis, design, and implementation and operation. Face-to-face interviews with 16 potential users were conducted and revealed highly positive user perception and use intention toward the prototype. Discussion and directions for future research are also presented. PMID:25615278

The value of personal health records for chronic disease management: what do we know?

PubMed

Tenforde, Mark; Jain, Anil; Hickner, John

2011-05-01

Electronic personal health records (PHRs) allow patients access to their medical records, self-management tools, and new avenues of communication with their health care providers. They will likely become a valuable component of the primary care Patient-centered Medical Home model. Primary care physicians, who manage the majority of chronic disease, will use PHRs to help patients manage their diabetes and other chronic diseases requiring continuity of care and enhanced information flow between patient and physician. In this brief report, we explore the evidence for the value of PHRs in chronic disease management. We used a comprehensive review of MEDLINE articles published in English between January 2000 and September 2010 on personal health records and related search terms. Few published articles have described PHR programs designed for use in chronic disease management or PHR adoption and attitudes in the context of chronic disease management. Only three prospective randomized trials have evaluated the benefit of PHR use in chronic disease management, all in diabetes care. These trials showed small improvements in some but not all diabetes care measures. All three trials involved additional interventions, making it difficult to determine the influence of patient PHR use in improved outcomes. The evidence remains sparse to support the value of PHR use for chronic disease management. With the current policy focus on meaningful use of electronic and personal health records, it is crucial to investigate and learn from new PHR products so as to maximize the clinical value of this tool.

Use of Electronic Health Records in Disaster Response: The Experience of Department of Veterans Affairs After Hurricane Katrina

PubMed Central

Brown, Steven H.; Fischetti, Linda F.; Graham, Gail; Bates, Jack; Lancaster, Anne E.; McDaniel, David; Gillon, Joseph; Darbe, Melody; Kolodner, Robert M.

2007-01-01

Objectives. We describe electronic health data use by the Department of Veterans Affairs (VA) in the month after Katrina, including supporting technologies, the extent and nature of information accessed, and lessons learned. Methods. We conducted a retrospective study using cross-sectional panels of data collected sequentially over time. Results. By September 30, 2005, clinical data were accessed electronically for at least 38% (14941 of 39910) of patients cared for prior to Hurricane Katrina by New Orleans–area VA medical facilities. Approximately 1000 patients per day had data accessed during the month following Hurricane Katrina, a rate approximately two thirds of pre-Katrina values. Health care data were transmitted to more than 200 sites in 48 states and to at least 2300 users. Conclusions. The VA electronic health records supported continuity of care for evacuated veterans after Katrina. Our findings suggest that pharmacy and laboratory computerization alone will not be sufficient for future disaster support systems. PMID:17413082

Digital Savings: A Study of Academic Libraries Finds that Going from Print to Electronic Journals Can Save Money, if It's Done Right, but Challenges Remain

ERIC Educational Resources Information Center

Schonfeld, Roger C.; Fenton, Eileen Gifford

2005-01-01

Without question, the ongoing transition from print to electronic periodicals has challenged librarians to rethink their strategies. While some effects of this change have been immediately apparent--greater breadth of material, easier access, exposure to new sources, publisher package deals, and open access--the broader outcomes on library…

Specialist outreach clinics in primary care and rural hospital settings.

PubMed

Gruen, R L; Weeramanthri, T S; Knight, S E; Bailie, R S

2004-01-01

Specialist medical practitioners have conducted clinics in primary care and rural hospital settings for a variety of reasons in many different countries. Such clinics have been regarded as an important policy option for increasing the accessibility and effectiveness of specialist services and their integration with primary care services. To undertake a descriptive overview of studies of specialist outreach clinics and to assess the effectiveness of specialist outreach clinics on access, quality, health outcomes, patient satisfaction, use of services, and costs. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialised register (March 2002), the Cochrane Controlled Trials Register (CCTR) (Cochrane Library Issue 1, 2002), MEDLINE (including HealthStar) (1966 to May 2002), EMBASE (1988 to March 2002), CINAHL (1982 to March 2002), the Primary-Secondary Care Database previously maintained by the Centre for Primary Care Research in the Department of General Practice at the University of Manchester, a collection of studies from the UK collated in "Specialist Outreach Clinics in General Practice" (Roland 1998), and the reference lists of all retrieved articles. Randomised trials, controlled before and after studies and interrupted time series analyses of visiting specialist outreach clinics in primary care or rural hospital settings, either providing simple consultations or as part of complex multifaceted interventions. The participants were patients, specialists, and primary care providers. The outcomes included objective measures of access, quality, health outcomes, satisfaction, service use, and cost. Four reviewers working in pairs independently extracted data and assessed study quality. 73 outreach interventions were identified covering many specialties, countries and settings. Nine studies met the inclusion criteria. Most comparative studies came from urban non-disadvantaged populations in developed countries. Simple 'shifted outpatients' styles of specialist outreach were shown to improve access, but there was no evidence of impact on health outcomes. Specialist outreach as part of more complex multifaceted interventions involving collaboration with primary care, education or other services was associated with improved health outcomes, more efficient and guideline-consistent care, and less use of inpatient services. The additional costs of outreach may be balanced by improved health outcomes. This review supports the hypothesis that specialist outreach can improve access, outcomes and service use, especially when delivered as part of a multifaceted intervention. The benefits of simple outreach models in urban non-disadvantaged settings seem small. There is a need for good comparative studies of outreach in rural and disadvantaged settings where outreach may confer most benefit to access and health outcomes.

Impact of arterial access site on outcomes after primary percutaneous coronary intervention: prespecified subgroup analysis from the EUROMAX trial.

PubMed

Hamon, Martial; Coste, Pierre; Van't Hof, Arnoud; Ten Berg, Jurrien; Clemmensen, Peter; Tabone, Xavier; Benamer, Hakim; Kristensen, Steen D; Cavallini, Claudio; Marzocchi, Antonio; Hamm, Christian; Kanic, Vojko; Bernstein, Debra; Anthopoulos, Prodromos; Deliargyris, Efthymios N; Steg, Philippe Gabriel

2015-06-01

In European Ambulance Acute Coronary Syndrome Angiography (EUROMAX), bivalirudin improved 30-day clinical outcomes with reduced major bleeding compared with heparins plus optional glycoprotein IIb/IIIa inhibitors. We assessed whether choice of access site (radial or femoral) had an impact on 30-day outcomes and whether it interacted with the benefit of bivalirudin. In EUROMAX, choice of arterial access was left to operator discretion. Overall, 47% of patients underwent radial and 53% femoral access. Baseline risk was higher in the femoral access group. Unadjusted proportions for the primary outcome (death or noncoronary artery bypass graft protocol major bleeding at 30 days) were lower with radial access, however, without differences in major or major plus minor bleeding proportions. After multivariable adjustment, ischemic outcomes were no longer different between access site groups, except for a lower risk of stroke in radial patients. Bivalirudin was associated with lower proportions of the primary outcome in both the radial (odds ratio, 0.58; 95% CI, 0.33-1.03; P=0.058) and the femoral groups (odds ratio, 0.59; 95% CI, 0.37-0.93; P=0.022; interaction P=0.97). Bleeding was significantly lower in the bivalirudin group both in the radial- and femoral-treated patients but no significant difference was observed in ischemic outcomes. In multivariable analysis, bivalirudin emerged as the only independent predictor of reduced major bleeding (odds ratio, 0.45; 95% CI, 0.27-0.74; P=0.002). In this prespecified analysis from EUROMAX, radial access was preferred in lower risk patients and did not improve clinical outcomes. Bivalirudin was associated with less bleeding irrespective of access site. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01087723. © 2015 American Heart Association, Inc.

Does Technical Success of Angioplasty in Dysfunctional Hemodialysis Accesses Correlate with Access Patency?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sidhu, Arshdeep; Tan, Kong T.; Noel-Lamy, Maxime

2016-10-15

PurposeTo study if <30 % residual stenosis post angioplasty (PTA) correlates with primary access circuit patency, and if any variables predict technical success.Materials and MethodsA prospective observational study was performed between January 2009 and December 2012, wherein 76 patients underwent 154 PTA events in 56 prosthetic grafts (AVG) and 98 autogenous fistulas (AVF). Data collected included patient age, gender, lesion location and laterality, access type and location, number of prior interventions, and transonic flow rates pre- and postintervention. Impact of technical outcome on access patency was assessed. Univariate logistic regression was used to assess the impact of variables on technical success withmore » significant factors assessed with a multiple variable model.ResultsTechnical success rates of PTA in AVFs and AVGs were 79.6 and 76.7 %, respectively. Technical failures of PTA were associated with an increased risk of patency loss among circuits with AVFs (p < 0.05), but not with AVGs (p = 0.7). In AVFs, primary access patency rates between technical successes and failures at three and 6 months were 74.4 versus 61.9 % (p = 0.3) and 53.8 versus 23.8 % (p < 0.05), respectively. In AVGs, primary access patency rates between technical successes and failures at three and six months were 72.1 versus 53.9 % (p = 0.5) and 33.6 versus 38.5 % (p = 0.8), respectively. Transonic flow rates did not significantly differ among technically successful or failed outcomes at one or three months.ConclusionTechnical failures of PTA had a significant impact on access patency among AVFs with a trend toward poorer access patency within AVGs.« less

Does Technical Success of Angioplasty in Dysfunctional Hemodialysis Accesses Correlate with Access Patency?

PubMed

Sidhu, Arshdeep; Tan, Kong T; Noel-Lamy, Maxime; Simons, Martin E; Rajan, Dheeraj K

2016-10-01

To study if <30 % residual stenosis post angioplasty (PTA) correlates with primary access circuit patency, and if any variables predict technical success. A prospective observational study was performed between January 2009 and December 2012, wherein 76 patients underwent 154 PTA events in 56 prosthetic grafts (AVG) and 98 autogenous fistulas (AVF). Data collected included patient age, gender, lesion location and laterality, access type and location, number of prior interventions, and transonic flow rates pre- and postintervention. Impact of technical outcome on access patency was assessed. Univariate logistic regression was used to assess the impact of variables on technical success with significant factors assessed with a multiple variable model. Technical success rates of PTA in AVFs and AVGs were 79.6 and 76.7 %, respectively. Technical failures of PTA were associated with an increased risk of patency loss among circuits with AVFs (p < 0.05), but not with AVGs (p = 0.7). In AVFs, primary access patency rates between technical successes and failures at three and 6 months were 74.4 versus 61.9 % (p = 0.3) and 53.8 versus 23.8 % (p < 0.05), respectively. In AVGs, primary access patency rates between technical successes and failures at three and six months were 72.1 versus 53.9 % (p = 0.5) and 33.6 versus 38.5 % (p = 0.8), respectively. Transonic flow rates did not significantly differ among technically successful or failed outcomes at one or three months. Technical failures of PTA had a significant impact on access patency among AVFs with a trend toward poorer access patency within AVGs.

Comparison of Safety and Effectiveness Between Right Versus Left Radial Arterial Access in Primary Percutaneous Coronary Intervention for Acute ST Segment Elevation Myocardial Infarction.

PubMed

Elmahdy, Mahmoud Farouk; ElMaghawry, Mohamed; Hassan, Mohamed; Kassem, Hussien Heshmat; Said, Karim; Elfaramawy, Amr AbdelAziz

2017-01-01

Transradial approach (TRA) is now considered the standard of care in many centres for elective and primary percutaneous intervention (PCI). The use of the radial approach in ST segment elevation myocardial infarction (STEMI) patients has been associated with a significant reduction in major adverse cardiac events. However, it is still unclear if the side of radial access (right vs. left) has impact on safety and effectiveness of TRA in primary PCI. So this study was conducted to compare the safety, feasibility, and outcomes of right radial access (RRA) vs. left radial access (LRA) in the setting of primary PCI. We retrospectively analysed the data of 400 consecutive patients presenting to our institution with STEMI for whom primary PCIs were performed via RRA and LRA. Mean age of the whole studied population was 57±12.8 years, with male predominance (77.2%). There were 202 cases in the RRA group and 198 in the LRA group, with no significant difference in demographics and clinical characteristics for patients included in both groups. There was no significant difference in procedure success rate (97.5% for RRA vs. 98.4% for LRA; P=0.77). In addition, no significant difference between both approaches was observed in the contrast volume, number of catheters, fluoroscopy time (FT), needle-to-balloon time, post-procedure vascular complications, in hospital reinfarction, stroke/transient ischaemic attack (TIA) or death. Right radial access and LRA are equally safe and effective in the setting of primary PCI. Both approaches have a high success rate and comparable needle-to-balloon time. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Why do patients seek primary medical care in emergency departments? An ethnographic exploration of access to general practice.

PubMed

MacKichan, Fiona; Brangan, Emer; Wye, Lesley; Checkland, Kath; Lasserson, Daniel; Huntley, Alyson; Morris, Richard; Tammes, Peter; Salisbury, Chris; Purdy, Sarah

2017-05-04

To describe how processes of primary care access influence decisions to seek help at the emergency department (ED). Ethnographic case study combining non-participant observation, informal and formal interviewing. Six general practitioner (GP) practices located in three commissioning organisations in England. Reception areas at each practice were observed over the course of a working week (73 hours in total). Practice documents were collected and clinical and non-clinical staff were interviewed (n=19). Patients with recent ED use, or a carer if aged 16 and under, were interviewed (n=29). Past experience of accessing GP care recursively informed patient decisions about where to seek urgent care, and difficulties with access were implicit in patient accounts of ED use. GP practices had complicated, changeable systems for appointments. This made navigating appointment booking difficult for patients and reception staff, and engendered a mistrust of the system. Increasingly, the telephone was the instrument of demand management, but there were unintended consequences for access. Some patient groups, such as those with English as an additional language, were particularly disadvantaged, and the varying patient and staff semantic of words like 'urgent' and 'emergency' was exacerbated during telephone interactions. Poor integration between in-hours and out-of-hours care and patient perceptions of the quality of care accessible at their GP practice also informed ED use. This study provides important insight into the implicit role of primary care access on the use of ED. Discourses around 'inappropriate' patient demand neglect to recognise that decisions about where to seek urgent care are based on experiential knowledge. Simply speeding up access to primary care or increasing its volume is unlikely to alleviate rising ED use. Systems for accessing care need to be transparent, perceptibly fair and appropriate to the needs of diverse patient groups. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Commissioning and equity in primary care in Australia: Views from Primary Health Networks.

PubMed

Henderson, Julie; Javanparast, Sara; MacKean, Tamara; Freeman, Toby; Baum, Fran; Ziersch, Anna

2018-01-01

This paper reports findings from 55 stakeholder interviews undertaken in six Primary Health Networks (PHNs) in Australia as part of a study of the impact of population health planning in regional primary health organisations on service access and equity. Primary healthcare planning is currently undertaken by PHNs which were established in 2015 as commissioning organisations. This was a departure from the role of Medicare Locals, the previous regional primary health organisations which frequently provided services. This paper addresses perceptions of 23 senior staff, 11 board members and 21 members of clinical and community advisory councils or health priority groups from six case study PHNs on the impact of commissioning on equity. Participants view the collection of population health data as facilitating service access through redistributing services on the basis of need and through bringing objectivity to decision-making about services. Conversely, participants question the impact of the political and geographical context and population profile on capacity to improve service access and equity through service commissioning. Service delivery was seen as fragmented, the model is at odds with the manner in which Aboriginal Community Controlled Health Organisations (ACCHOs) operate and rural regions lack services to commission. As a consequence, reliance upon commissioning of services may not be appropriate for the Australian primary healthcare context. © 2017 John Wiley & Sons Ltd.

NASA Access Mechanism - Graphical user interface information retrieval system

NASA Technical Reports Server (NTRS)

Hunter, Judy F.; Generous, Curtis; Duncan, Denise

1993-01-01

Access to online information sources of aerospace, scientific, and engineering data, a mission focus for NASA's Scientific and Technical Information Program, has always been limited by factors such as telecommunications, query language syntax, lack of standardization in the information, and the lack of adequate tools to assist in searching. Today, the NASA STI Program's NASA Access Mechanism (NAM) prototype offers a solution to these problems by providing the user with a set of tools that provide a graphical interface to remote, heterogeneous, and distributed information in a manner adaptable to both casual and expert users. Additionally, the NAM provides access to many Internet-based services such as Electronic Mail, the Wide Area Information Servers system, Peer Locating tools, and electronic bulletin boards.

NASA access mechanism: Graphical user interface information retrieval system

NASA Technical Reports Server (NTRS)

Hunter, Judy; Generous, Curtis; Duncan, Denise

1993-01-01

Access to online information sources of aerospace, scientific, and engineering data, a mission focus for NASA's Scientific and Technical Information Program, has always been limited to factors such as telecommunications, query language syntax, lack of standardization in the information, and the lack of adequate tools to assist in searching. Today, the NASA STI Program's NASA Access Mechanism (NAM) prototype offers a solution to these problems by providing the user with a set of tools that provide a graphical interface to remote, heterogeneous, and distributed information in a manner adaptable to both casual and expert users. Additionally, the NAM provides access to many Internet-based services such as Electronic Mail, the Wide Area Information Servers system, Peer Locating tools, and electronic bulletin boards.

Increasing access to emergency contraception through online prescription requests.

PubMed

Averbach, Sarah; Wendt, Jacqueline Moro; Levine, Deborah K; Philip, Susan S; Klausner, Jeffrey D

2010-01-01

To describe a pilot program, Plan B Online Prescription Access, to provide easy access to prescriptions for emergency contraception via the Internet. We measured electronic prescriptions for Plan B (Duramed Pharmaceuticals, Cincinnati, Ohio) by month over time. Pharmacists faxed patient-generated prescriptions back to the Department of Public Health for confirmation. Despite no marketing, within the first 18 months of the program, 152 electronic prescriptions for Plan B were requested by 128 female San Francisco residents. Seventy-eight prescriptions were filled (51%) by pharmacists. If correctly marketed, online prescriptions for Plan B have the potential to be an effective means of increasing emergency contraception access in both urban and rural settings across the United States. Further user-acceptability studies are warranted.

CIDR

Science.gov Websites

Related Links & Resources Access and Applications Access Applications Example Applications Project Us -Privacy Policy -Site Map Search You are here: CIDR>Access and Applications> Deadlines NIH Program must submit an electronic application to NIH. Applications are continuously accepted and are

17 CFR 37.202 - Access requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... software vendor with impartial access to its market(s) and market services, including any indicative quote... electronic confirmation of their status as eligible contract participants, as defined by the Act and... participants and independent software vendors receiving comparable access to, or services from, the swap...

Accessibility to primary healthcare in the capital city of a northeastern state of Brazil: an evaluation of the results of a programme.

PubMed

Vieira-da-Silva, Ligia Maria; Chaves, Sonia Cristina Lima; Esperidião, Monique Azevedo; Lopes-Martinho, Rosana Machado

2010-12-01

Organisational barriers to primary healthcare are still relevant in developing countries. Although descriptive reports of some experiences focusing on improving accessibility have been published, few studies have evaluated specific interventions aimed at overcoming the organisational obstacles. To evaluate the results of a project designed to improve accessibility to healthcare services in Salvador, Bahia, Brazil. An evaluative, cross-sectional, ex post facto study that included a control group was carried out in a random sample of 710 users of 25 healthcare units of the primary municipal healthcare network. The association between the project implementation degree and outcome variables was measured by prevalence ratios (PR) and statistical inference was based on Taylor series 95% CIs. Better access to primary healthcare was found in units in which the intervention had been implemented than in those in which it had not been implemented, particularly with respect to reducing avoidable queues, the waiting time for scheduling a consultation (PR=0.23; 95% CI 0.15 to 0.34); the time of arrival in the queue (PR=0.16; 95% CI 0.09 to 0.31) and the introduction of a system for scheduling appointments by telephone (PR=0.76; 95% CI 0.70 to 0.83). Owing to the simplicity of the programme and the impact it achieved, it may be reproduced in other underdeveloped countries to improve access to healthcare services. In addition, some of the instruments may be used in routine programme evaluation.

Embedding online patient record access in UK primary care: a survey of stakeholder experiences.

PubMed

Pagliari, Claudia; Shand, Tim; Fisher, Brian

2012-05-01

To explore the integration of online patient Record Access within UK Primary Care, its perceived impacts on workload and service quality, and barriers to implementation. Mixed format survey of clinicians, administrators and patients. Telephone interviews with non-users. Primary care centres within NHS England that had offered online record access for the preceding year. Of the 57 practices initially agreeing to pilot the system, 32 had adopted it and 16 of these returned questionnaires. The 42 individual respondents included 14 practice managers, 15 clinicians and 13 patients. Follow-up interviews were conducted with one participant from 15 of the 25 non-adopter practices. Most professionals believed that the system is easy to integrate within primary care; while most patients found it easy to integrate within their daily lives. Professionals perceived no increase in the volume of patient queries or clinical consultations as a result of Record Access; indeed some believed that these had decreased. Most clinicians and patients believed that the service had improved mutual trust, communication, patients' health knowledge and health behaviour. Inhibiting factors included concerns about security, liability and resource requirements. Non-adoption was most frequently attributed to competing priorities, rather than negative beliefs about the service. Record access has an important role to play in supporting patient-focused healthcare policies in the UK and may be easily accommodated within existing services. Additional materials to facilitate patient recruitment, inform system set-up processes, and assure clinicians of their legal position are likely to encourage more widespread adoption.