Internet Access and Electronic Communication Among Families in an Urban Pediatric Emergency Department

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

doi:10.1097/pec.0b013e318258ad76

Cited by 25 publications

(24 citation statements)

References 20 publications

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“…Saidinejad et al noted that half of caregivers in an urban underserved pediatric ED were interested in receiving discharge information electronically with e-mail being the preferred modality. 4 Similar mechanisms could be used to distribute clinic discharge information, follow-up reminders, or additional preventive or acute care-based anticipatory guidance. Digital platforms also offer the possibility of bidirectional communication, providing a means with which clinicians could respond efficiently to patient or family queries.…”

Section: Discussionmentioning

confidence: 99%

“…8,11,12 As an example, caregivers seeking care for their children in an inner-city ED were interested in receiving discharge information electronically. 4 An adult patient study demonstrated interest in having links to credible Web sites provided as part of their discharge paperwork. 18 Thus, medical providers could play an important role in connecting patients and families to credible resources.…”

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confidence: 99%

“…3 In 2009, 62% of caregivers presenting to an urban, academic pediatric emergency department (ED) reported home Internet access; social media use was also becoming prevalent with 60% using Facebook and 8% Twitter. 4 There has been a dramatic increase in Internet and social media usage to search for health-related information. [5][6][7] Caregivers are searching the Internet for answers to questions about their child' s health, often before seeking medical care.…”

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confidence: 99%

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Access to Digital Technology Among Families Coming to Urban Pediatric Primary Care Clinics

DeMartini¹,

Beck

Klein

et al. 2013

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Internet, smartphones, and online social media offer new platforms for health promotion and disease management. Few studies have evaluated the use of digital technology among families receiving care in an urban pediatric primary care setting.WHAT THIS STUDY ADDS: Caregivers in an urban pediatric primary care setting have access to and frequently use the Internet, smartphones, and online social media. These technologies may help reach a traditionally hard-to-reach population.abstract OBJECTIVE: Digital technologies offer new platforms for health promotion and disease management. Few studies have evaluated the use of digital technology among families receiving care in an urban pediatric primary care setting. METHODS:A self-administered survey was given to a convenience sample of caregivers bringing their children to 2 urban pediatric primary care centers in spring 2012. The survey assessed access to home Internet, e-mail, smartphone, and social media (Facebook and Twitter). A "digital technology" scale (0-4) quantified the number of available digital technologies and connections. Frequency of daily use and interest in receiving medical information digitally were also assessed. RESULTS:The survey was completed by 257 caregivers. The sample was drawn from a clinical population that was 73% African American and 92% Medicaid insured with a median patient age of 2.9 years (interquartile range 0.8-7.4). Eighty percent of respondents reported having Internet at home, and 71% had a smartphone. Ninety-one percent reported using e-mail, 78% Facebook, and 27% Twitter. Ninety-seven percent scored $1 on the digital technology scale; 49% had a digital technology score of 4. The digital technology score was associated with daily use of digital media in a graded fashion (P , .0001). More than 70% of respondents reported that they would use health care information supplied digitally if approved by their child' s medical provider.CONCLUSIONS: Caregivers in an urban pediatric primary care setting have access to and frequently use digital technologies. Digital connections may help reach a traditionally hard-to-reach population.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Access to Digital Technology Among Families Coming to Urban Pediatric Primary Care Clinics

DeMartini¹,

Beck

Klein

et al. 2013

Pediatrics

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“…Many underserved patients report high rates of Internet access and wanting to communicate with health providers via e-mail to enhance health care decisions. [76][77][78][79][80] Some patients may have concerns about trust and privacy that could be worsened by real or perceived stigma in visit notes. 71,74,81 For example, in a Veterans Affairs shared notes study, some patients took issue with the way their clinicians described them.…”

Section: Ehr: Patient Portals and Shared Visit Notesmentioning

confidence: 99%

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

et al. 2016

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Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dualminority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender (BLGBT^) racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.

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“…17 This affords opportunities for web-based tools to inform decision making regarding when and where to seek health care. We performed this pilot study to determine if a prototype SORT for Kids could be easily understood and used by parents and adult caregivers across a range of educational, racial, and ethnic backgrounds.…”

Section: Commentmentioning

confidence: 99%

Feasibility of Web-Based Self-Triage by Parents of Children With Influenza-Like Illness

Price¹,

Fagbuyi²,

Harris³

et al. 2013

JAMA Pediatr

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Importance: Self-triage using web-based decision support could be a useful way to encourage appropriate careseeking behavior and reduce health system surge in epidemics. However, the feasibility and safety of this strategy have not previously been evaluated.Objective: To assess the usability and safety of Strategy for Off-site Rapid Triage (SORT) for Kids, a webbased decision support tool designed to translate clinical guidance developed by the Centers for Disease Control and Prevention to help parents and adult caregivers determine if a child with influenza-like illness requires immediate care in an emergency department (ED).Design: Prospective pilot validation study conducted between February 8 and April 30, 2012. Staff who abstracted medical records and made follow-up calls were blinded to the SORT algorithm's assessment of the child's level of risk.Setting: Two pediatric emergency departments in the National Capital Region.Participants: Convenience sample of 294 parents and adult caregivers who were at least 18 years of age; able to read and speak English; and the parent or legal guardian of a child 18 years or younger presenting to 1 of 2 EDs with signs and symptoms meeting Centers for Disease Control and Prevention criteria for influenza-like illness.Intervention: Completion of the SORT for Kids survey.Main Outcome Measures: Caregiver ratings of the website's usability and the sensitivity of the underlying algorithm for identifying children who required immediate ED management of influenza-like illness, defined as receipt of 1 or more of 5 essential clinical services.Results: Ninety percent of participants reported that the website was "very easy" to understand and use. Ratings did not differ by respondent race, ethnicity, or educational attainment. Of the 15 patients whose initial ED visit met explicit criteria for clinical necessity, the Centers for Disease Control and Prevention algorithm classified 14 as high risk, resulting in an overall sensitivity of 93.3% (exact 95% CI, 68.1%-99.8%). Specificity of the algorithm was poor. Conclusions and Relevance:This pilot study suggests that web-based decision support to help parents and adult caregivers self-triage children with influenza-like illness is feasible. However, prospective refinement of the clinical algorithm is needed to improve its specificity without compromising patient safety.

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Internet Access and Electronic Communication Among Families in an Urban Pediatric Emergency Department

Abstract: 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.

Cited by 25 publications

References 20 publications

Access to Digital Technology Among Families Coming to Urban Pediatric Primary Care Clinics

Access to Digital Technology Among Families Coming to Urban Pediatric Primary Care Clinics

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

Feasibility of Web-Based Self-Triage by Parents of Children With Influenza-Like Illness

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