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BackgroundHealth emergencies disproportionally affect vulnerable populations. Digital tools can help primary care providers find, and reach, the right patients.AimTo evaluate whether digital interventions delivered directly to GPs’ clinical software were more effective at promoting primary care appointments during the COVID-19 pandemic than interventions delivered by post.Design and settingReal-world, non-randomised, interventional study involving GP practices in all Australian states.MethodIntervention material was developed to promote care coordination for vulnerable older veterans during the COVID-19 pandemic, and sent to GPs either digitally to the clinical practice software system or in the post. The intervention material included patient-specific information sent to GPs to support care coordination, and education material sent via post to veterans identified in the administrative claims database. To evaluate the impact of intervention delivery modalities on outcomes, the time to first appointment with the primary GP was measured; a Cox proportional hazards model was used, adjusting for differences and accounting for pre-intervention appointment numbers.ResultsThe intervention took place in April 2020, during the first weeks of COVID-19 social distancing restrictions in Australia. GPs received digital messaging for 51 052 veterans and postal messaging for 26 859 veterans. The digital group was associated with earlier appointments (adjusted hazard ratio 1.38 [1.34 to 1.41]).ConclusionData-driven digital solutions can promote care coordination at scale during national emergencies, opening up new perspectives for precision public-health initiatives.

Background Digital technologies can enable rapid targeted delivery of audit and feedback interventions at scale. Few studies have evaluated how mode of delivery affects clinical professional behavior change and none have assessed the feasibility of such an initiative at a national scale. Objective The aim of this study was to develop and evaluate the effect of audit and feedback by digital versus postal (letter) mode of delivery on primary care physician behavior. Methods This study was developed as part of the Veterans’ Medicines Advice and Therapeutics Education Services (MATES) program, an intervention funded by the Australian Government Department of Veterans’ Affairs that provides targeted education and patient-specific audit with feedback to Australian general practitioners, as well as educational material to veterans and other health professionals. We performed a cluster randomized controlled trial of a multifaceted intervention to reduce inappropriate gabapentinoid prescription, comparing digital and postal mode of delivery. All veteran patients targeted also received an educational intervention (postal delivery). Efficacy was measured using a linear mixed-effects model as the average number of gabapentinoid prescriptions standardized by defined daily dose (individual level), and number of veterans visiting a psychologist in the 6 and 12 months following the intervention. Results The trial involved 2552 general practitioners in Australia and took place in March 2020. Both intervention groups had a significant reduction in total gabapentinoid prescription by the end of the study period (digital: mean reduction of 11.2%, P=.004; postal: mean reduction of 11.2%, P=.001). We found no difference between digital and postal mode of delivery in reduction of gabapentinoid prescriptions at 12 months (digital: –0.058, postal: –0.058, P=.98). Digital delivery increased initiations to psychologists at 12 months (digital: 3.8%, postal: 2.0%, P=.02). Conclusions Our digitally delivered professional behavior change intervention was feasible, had comparable effectiveness to the postal intervention with regard to changes in medicine use, and had increased effectiveness with regard to referrals to a psychologist. Given the logistical benefits of digital delivery in nationwide programs, the results encourage exploration of this mode in future interventions.

Background: Medical practice research suggests that deficits in information exchange can have implications, such as misunderstandings and non-adherence to treatment. There has been little investigation into the implications of unanswered health-related questions in community pharmacy, especially for professional pharmacy practice and quality use of medicines. Aim: To investigate the frequency of consumers leaving community pharmacies with unanswered health-related questions, the nature of the unanswered questions and the impact on consumers. Method: Consumers exiting participating community pharmacies (convenience sample) were interviewed using a semi-structured tool to capture information on the frequency, nature and consequences of unanswered health-related questions. Data recorded from the interviews were thematically analysed. Results: Over the 5 week study period, of the 87 participants interviewed, 18 (20%) had come into the pharmacy with a health-related question and 6 (33%) left with their question unanswered. Of the 47 participants who were asked about past instances of unanswered questions, 7 (15%) reported incidents they could recall. The nature of the unanswered questions mainly focused on potential or perceived medicationrelated adverse effects, and information on which to select medicines or treatment. A number of unanswered questions were considered to have potential for negative health consequences if not followed up. Conclusion: On occasion, consumers leave community pharmacies with unanswered questions, which could have consequences for the quality use of medicines. Further research is needed to establish the prevalence and significance of unanswered health-related questions in community pharmacy. J Pharm Pract Res 2011; 41: 271-4.

Information Systems in the healthcare domain are seen as integral to improving quality and efficiency. However, the socio-technical nature of the healthcare domain makes it unusually difficult to successfully integrate people and information technology in such a way as to improve outcomes. During an information technology intervention to improve the process of medication management, we identified a number of sociotechnical factors relevant to our intervention, including: missing information, information granularity, the importance of information transferred by conversation, the impact of time constraints on information gathering and use, the influence of professional practice software, the nature of information technology use; and the notion of what systems should support ‘experts’. Our findings support the need for information technology to support natural human processes – not necessarily requiring sophisticated technology, but rather the ‘right’ technology. In an area such as healthcare, characterised by complex decision-making, uncertainty and involving highly trained professionals, we believe that designing decision support tools should take these factors into account, to ensure fit with health care-related work processes. Refereed/Peer-reviewed

Implementing health information systems (HIS) to support the healthcare process is subject to many challenges: behavioural, technical, and organisational. Developing these technological artefacts based on good understanding of such challenges, yields a system design capable of addressing implementation issues. Based on such understanding, we set off a development process to produce a metaphoric software tool to support health care practitioners in a hospital setting. The development of software adopting such approach explicitly considers the inclusion of users concerns, a crucial determinant for the successful implementation of any IS. The software design directly implemented the look and feel of a paper-based medical form used by targeted health care practitioners. This paper illustrates empirical research done in developing and evaluating a metaphoric software tool, and highlights important aspects of such approach in addressing the implementation process.

Medication management (MM) is a process used to ensure safe usage of medications, describing many tasks performed by groups of healthcare practitioners, including: processing large amounts of data, decision making; and coordination of involved professionals. The process poses risks for patient safety, many of which are serious. One way to enhance safety is by utilisation of IT to support various aspects of the process. However, despite the consensus about IT's positive influence on the safety of healthcare process in general, and MM in particular, successful implementation of IT in healthcare remains challenged by many factors, including social factors. This paper outlines the MM process and illustrates some IT tools used to support tasks of the process. It further describes limitations and implementation challenges of these IT tools. Finally, the article discusses social challenges and some approaches to address them Refereed/Peer-reviewed

Refereed/Peer-reviewed

PhD Doctorate Medication is vital in treating chronic disease. Increasing use of medication, however, can lead to (potentially preventable) medication-related adverse events. Medication management offers a means of addressing such adverse events and pharmacists have an important role in this solution, especially in terms of reviews of patient medication. Improved availability and sharing of patient-related information are critical factors in medication management, so that providing access to this information becomes a major factor in effective medication reviews. Although clinical decision support tools can significantly assist doctors in accessing relevant point-of-care information for greater patient safety, it has proven difficult to ensure the availability and appropriate structure of patient-related information for such support tools. These information access and input problems are further exacerbated by a lack of existing research into suitable decision support solutions for pharmacists. This research project explored the suitability of an essential information model to support an electronic document solution to support clinical documentation and allow effective communication between pharmacists and doctors for medication reviews. The project investigated whether this approach could improve safety, quality and efficiency in the medication review process; as well as more generally identifying factors influencing development and uptake of document-based support tools in the Health sector. The project used a qualitative Design Research approach and iterated through three scenarios. The first, information-rich, hospital scenario developed an information model of essential medication management components, which underpinned the development of a digital document prototype implemented using XForms technology. In the second scenario, accredited pharmacists evaluated the digital document to enable refinement of the information model and its associated digital document for the broader community context. The third scenario involved field studies which evaluated the digital document (and thus the underlying information model) within the community, assessing its contribution to quality, safety and efficiency throughout the medication review process. The investigation identified a number of themes which guided design and development of the prototype; and which appeared likely to have a broader impact on successful uptake of decision support tools. Missing information proved to be a constant and serious problem for health professionals although, in this project, it also became a way of determining the value of an information element and thus its inclusion in the information model. Conversation played a significant role in the hospital environment to help supply pharmacists information needs. Information granularity, the language of health professionals; and their time constraints were major factors influencing design. Health professionals extensive use of their personal knowledge also suggested decision support tools in this sector should be systems for experts rather than expert systems, i.e. the decision support tool and its users personal knowledge should complement one another. The results of this proof-of-concept project suggest practice improvement in medication management is possible, with perceived improvements in safety, quality and efficiency of the medication management process. These benefits, however, now need to be affirmed in larger field studies. The contributions of this research are two-fold: firstly, it is possible to develop a model of essential medication-related information which is succinct, relevant and can be understood and shared by health professionals in conjunction with the individuals personal knowledge. Secondly, a document metaphor is a natural fit with health professionals for representing and communicating information. Expressing this metaphor as digital document overcomes the main problems of paper-based documents sharing and communication; and the dynamic properties of digital documents assist in decision-making.

2005

2005

Refereed/Peer-reviewed Our research set out to investigate the potential for a beneficial technology intervention in the area of medication management – an area previously devoid of such support. We chose the design research (DR) method, based on its suitability to handle complexity as evidenced by its use in education and information systems-based research. Our intervention was based on two artefacts – an information model and its implementation as a digital document – which were well accepted by the trial participants. Based on our positive experience, we conclude that DR may very well be a useful and appropriate research approach for studying the application and impact of technology interventions in the health domain.