Search

In a primary care health clinic, providers before, after, and throughout their shifts retrieve archival patient information and document new empirical data from each patient encounter into an electronic medical record (EMR). This documentation, called charting, contributes to ever increasing workload and provider burnout. While a provider may not perceive it to be, "charting" is writing work, and the clinic is a writing space. In this article, we use the concept of writing stewardship to examine a needs analysis of workflow in a family health center. We argue that the addition of writing stewards would shift the burden of documentation practices to distribute writing throughout the clinic, not primarily on providers. The implications of this are twofold: first, that writing studies researchers can help clinics write more efficiently and, second, that patient outcomes improve as a result of improved clinical communication.

In a primary care health clinic, providers before, after, and throughout their shifts retrieve archival patient information and document new empirical data from each patient encounter into an electronic medical record (EMR). This documentation, called charting, contributes to ever increasing workload and provider burnout. While a provider may not perceive it to be, "charting" is writing work, and the clinic is a writing space. In this article, we use the concept of writing stewardship to examine a needs analysis of workflow in a family health center. We argue that the addition of writing stewards would shift the burden of documentation practices to distribute writing throughout the clinic, not primarily on providers. The implications of this are twofold: first, that writing studies researchers can help clinics write more efficiently and, second, that patient outcomes improve as a result of improved clinical communication. [ABSTRACT FROM AUTHOR]

Background: Use of Shared Decision-Making (SDM) and Decision Aids (DAs) has been encouraged but is not regularly implemented in primary care. The Office-Guidelines Applied to Practice (Office-GAP) intervention is an application of a previous model revised to address guidelines based care for low-income populations with diabetes and coronary heart disease (CHD).Objective: To evaluate Office-GAP Program feasibility and preliminary efficacy on medication use, patient satisfaction with physician communication and confidence in decision in low-income population with diabetes and coronary heart disease (CHD) in a Federally Qualified Healthcare Center (FQHC).Method: Ninety-five patients participated in an Office-GAP program. A quasi-experimental design study, over 6 months with 12-month follow-up. Office-GAP program integrates health literacy, communication skills education for patients and physicians, patient/physician decision support tools and SDM into routine care.Main Measures: 1) Implementation rates of planned program elements 2) Patient satisfaction with communication and confidence in decision, and 3) Medication prescription rates. We used the GEE method for hierarchical logistic models, controlling for confounding.Results: Feasibility of the Office-GAP program in the FQHC setting was established. We found significant increase in use of Aspirin/Plavix, statin and beta-blocker during follow-up compared to baseline: Aspirin OR 1.5 (95 % CI: 1.1, 2.2) at 3-months, 1.9 (1.3, 2.9) at 6-months, and 1.8 (1.2, 2.8) at 12-months. Statin OR 1.1 (1.0, 1.3) at 3-months and 1.5 (1.1, 2.2) at 12-months; beta-blocker 1.8 (1.1, 2.9) at 6-months and 12-months. Program elements were consistently used (≥ 98 % clinic attendance at training and tool used). Patient satisfaction with communication and confidence in decision increased.Conclusions: The use of Office-GAP program to teach SDM and use of DAs in real time was demonstrated to be feasible in FQHCs. It has the potential to improve satisfaction with physician communication and confidence in decisions and to improve medication use. The Office-GAP program is a brief, efficient platform for delivering patient and provider education in SDM and could serve as a model for implementing guideline based care for all chronic diseases in outpatient clinical settings. Further evaluation is needed to establish feasibility outside clinical study, reach, effectiveness and cost-effectiveness of this approach. [ABSTRACT FROM AUTHOR]