Browsing by Author "Huffman, Monica"

Now showing 1 - 5 of 5
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    “I Don’t Want to Spend the Rest of my Life Only Going to a Gender Wellness Clinic”: Healthcare Experiences of Patients of a Comprehensive Transgender Clinic
    (Springer, 2022-10) Lee, Joy L.; Huffman, Monica; Rattray, Nicholas A.; Carnahan, Jennifer L.; Fortenberry, J. Dennis; Fogel, Janine M.; Weiner, Michael; Matthias, Marianne S.; Medicine, School of Medicine
    Background Transgender individuals are less likely to have had a primary care visit in the last year than cisgender individuals. While the importance of multidisciplinary clinics for transgender care has been established, little is known about the healthcare experiences of transgender patients with these clinics. Objective To describe how patients experience transgender clinics and how these experiences compare to those experiences in other settings. Participants Twenty-one adult patients of a gender health program. Design and Approach Semi-structured interviews of transgender patients. The interviews focused on two domains: healthcare experiences and relationships with healthcare providers. Key Results Overall, transgender patients expressed a need for healthcare services, particularly for primary care, that are partially met by the comprehensive care clinic model. Limitations in access included the lack of willing providers, where the patients live, and long wait times for appointments. Participants recounted a range of experiences, both positive and negative, with providers outside of the transgender clinic, but only positive experiences to share about providers from the transgender clinic. Conclusion Outside specialty transgender settings, many patients had negative experiences with providers who were unwilling or unable to provide care. This study speaks to the need for primary care providers who can and will treat transgender patients, as well as the need for healthcare spaces that feel safe to transgender patents. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07408-5.
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    Insecure messaging: how clinicians approach potentially problematic messages from patients
    (Oxford University Press, 2020-12-05) Lee, Joy L.; Matthias, Marianne S.; Huffman, Monica; Frankel, Richard M.; Weiner, Michael; Medicine, School of Medicine
    Objective: Secure messaging has become an integrated function of patient portals, but misuse of secure messaging by both patients and clinicians can lead to miscommunication and errors, such as overlooked urgent messages. We sought to uncover variations in clinician approaches and responses to messaging with patients. Methods: In this two-part study, 20 primary care clinicians (1) composed message responses to five hypothetical patient vignettes and messages and (2) were subsequently interviewed for their perspectives on appropriate circumstances for secure messaging. Messages and interviews were analyzed for themes. Results: Clinicians have different experiences with, and perceptions of, secure messaging. The messages the clinicians wrote were uniformly respectful, but differed in degrees of patient-centeredness and level of detail. None of the clinicians found their messaging workload to be unmanageable. From the interviews, we found divergent clinician perspectives about when to use secure messaging and how to respond to emotional content. Conclusion: Clinicians have different opinions about the appropriateness of secure messaging in response to specific medical issues. Our results noted a desire and need for greater guidance about secure messaging. This aspect of informatics education warrants greater attention in clinical practice. Practical implications: We summarize the types of issues raised by the participants yet to be addressed by existing guidelines. Further guidance from hospitals, professional societies, and other institutions that govern clinician behavior on the appropriateness and effectiveness of delivering care through secure messaging may aid clinicians and patients.
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    “I’m Not Gonna Pull the Rug out from under You”: Patient-Provider Communication about Opioid Tapering
    (Elsevier, 2017) Matthias, Marianne S.; Johnson, Nicole L.; Shields, Cleveland G.; Bair, Matthew J.; MacKie, Palmer; Huffman, Monica; Alexander, Stewart C.; Department of Medicine, School of Medicine
    In response to increases in harms associated with prescription opioids, opioid prescribing has come under greater scrutiny, leading many healthcare organizations and providers to consider or mandate opioid dose reductions (tapering) for patients with chronic pain. Communicating about tapering can be difficult, particularly for patients on long-term opioids who perceive benefits and are using their medications as prescribed. Given the importance of effective patient-provider communication for pain management and recent health system-level initiatives and provider practices to taper opioids, this study used qualitative methods to understand communication processes related to opioid tapering, to identify best practices and opportunities for improvement. Up to 3 clinic visits per patient were audio-recorded, and individual interviews were conducted with patients and their providers. Four major themes emerged: 1) Explaining—Patients needed to understand individualized reasons for tapering, beyond general, population-level concerns such as addiction potential; 2) Negotiating—Patients needed to have input, even if it was simply the rate of tapering; 3) Managing difficult conversations—When patients and providers did not reach a shared understanding, difficulties and misunderstandings arose; 4) Non-abandonment—Patients needed to know that their providers would not abandon them throughout the tapering process.
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    Management of Chronic Cough in Adult Primary Care: A Qualitative Study
    (Springer, 2021-09) Gowan, Tayler M.; Huffman, Monica; Weiner, Michael; Talib, Tasneem L.; Schelfhout, Jonathan; Weaver, Jessica; Griffith, Ashley; Doshi, Ishita; Dexter, Paul; Bali, Vishal; Medicine, School of Medicine
    This study is the first to describe, qualitatively, PCPs’ experiences evaluating and treating CC in adults. By interviewing clinicians, we sought to understand reasons for referrals, accessibility and use of clinical guidelines, confidence in evaluation and treatment, perceptions and attitudes, and desired resources. Findings may help in elucidating clinical decision-making and could indicate areas for improvement in dissemination and use of guidelines.
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    Qualitative Analysis of Team Communication with a Clinical Texting System at a Midwestern Academic Hospital
    (Thieme, 2022) Lee, Joy L.; Kara, Areeba; Huffman, Monica; Matthias, Marianne S.; Radecki, Bethany; Savoy, April; Schaffer, Jason T.; Weiner, Michael; Medicine, School of Medicine
    Background: Hospitals are increasingly replacing pagers with clinical texting systems that allow users to use smartphones to send messages while maintaining compliance for privacy and security. As more institutions adopt such systems, the need to understand the impact of such transitions on team communication becomes ever more significant. Methods: We conducted focus groups with hospitalists and individual interviews with nurses at one academic medical center in the Midwest. All interviews and focus groups were audiorecorded, transcribed, and deidentified for analysis. All transcripts and notes were independently read by two members of the research team and coded for themes. Results: Twenty-one hospitalists and eight nurses participated in the study. Although study participants spoke favorably of texting, they identified more dissatisfactions with texting than benefits. There were disagreements regarding appropriate texting practices both within and between the hospitalists and nurses. Conclusion: Despite the benefits of texting, there is room for improving team communication and understanding in the realm of clinical texting. A lack of shared understanding regarding when and how to use texting may require long-term solutions that address teamwork and appropriateness.