Browsing by Author "Russ-Jara, Alissa L."

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    A user-centered evaluation of medication therapy management alerts for community pharmacists: Recommendations to improve usability and usefulness
    (Elsevier, 2021) Snyder, Margie E.; Adeoye-Olatunde, Omolola A.; Gernant, Stephanie A.; DiIulio, Julie; Jaynes, Heather A.; Doucette, William R.; Russ-Jara, Alissa L.; Medicine, School of Medicine
    Background: Community pharmacists provide comprehensive medication reviews (CMRs) through pharmacy contracts with medication therapy management (MTM) vendors. These CMRs are documented in the vendors' web-based MTM software platforms, which often integrate alerts to assist pharmacists in the detection of medication therapy problems. Understanding pharmacists' experiences with MTM alerts is critical to optimizing alert design for patient care. Objectives: The objectives of this study were to 1) assess the usability and usefulness of MTM alerts for MTM vendor-contracted community pharmacists and 2) generate recommendations for improving MTM alerts for use by community pharmacists. Methods: This was a convergent, parallel mixed-methods evaluation of data collected from 3 sources, with individual pharmacists contributing data to one or more sources: 1) community pharmacists' submissions of observational data about MTM alerts encountered during routine MTM provision, 2) videos of naturalistic usability testing of MTM alerts, and 3) semi-structured interviews to elicit pharmacists' perspectives on MTM alert usefulness and usability. MTM alert data submitted by pharmacists were summarized with descriptive statistics. Usability testing videos were analyzed to determine pharmacists' time spent on MTM alerts and to identify negative usability incidents. Interview transcripts were analyzed using a hybrid approach of deductive and inductive codes to identify emergent themes. Triangulation of data (i.e., determination of convergence/divergence in findings across all data sources) occurred through investigator discussion and identified overarching findings pertaining to key MTM alert challenges. These resulted in actionable recommendations to improve MTM alerts for use by community pharmacists. Results: Collectively, two and four overarching key challenges pertaining to MTM alert usability and usefulness, respectively, were identified, resulting in 15 actionable recommendations for improving the design of MTM alerts from a user-centered perspective. Conclusions: Recommendations are expected to inform enhanced MTM alert designs that can improve pharmacist efficiency, patient and prescriber satisfaction with MTM, and patient outcomes.
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    Care Coordination Strategies and Barriers during Medication Safety Incidents: a Qualitative, Cognitive Task Analysis
    (Springer, 2021) Russ-Jara, Alissa L.; Luckhurst, Cherie L.; Dismore, Rachel A.; Arthur, Karen J.; Ifeachor, Amanda P.; Militello, Laura G.; Glassman, Peter A.; Zillich, Alan J.; Weiner, Michael; Medicine, School of Medicine
    Background: Medication errors are prevalent in healthcare institutions worldwide, often arising from difficulties in care coordination among primary care providers, specialists, and pharmacists. Greater knowledge about care coordination surrounding medication safety incidents can inform efforts to improve patient safety. Objectives: To identify strategies that hospital and outpatient healthcare professionals (HCPs) use, and barriers encountered, when they coordinate care during a medication safety incident involving an adverse drug reaction, drug-drug interaction, or drug-renal concern. Design: We asked HCPs to complete a form whenever they encountered these incidents and intervened to prevent or mitigate patient harm. We stratified incidents across HCP roles and incident categories to conduct follow-up cognitive task analysis interviews with HCPs. Participants: We invited all physicians and pharmacists working in inpatient or outpatient care at a tertiary Veterans Affairs Medical Center. We examined 24 incidents: 12 from physicians and 12 from pharmacists, with a total of 8 incidents per category. Approach: Interviews were transcribed and analyzed via a two-stage inductive, qualitative analysis. In stage 1, we analyzed each incident to identify decision requirements. In stage 2, we analyzed results across incidents to identify emergent themes. Key results: Most incidents (19, 79%) were from outpatient care. HCPs relied on four main strategies to coordinate care: cognitive decentering; collaborative decision-making; back-up behaviors; and contingency planning. HCPs encountered four main barriers: role ambiguity and constraints, breakdowns (e.g., delays) in care, challenges related to the electronic health record, and factors that increased coordination complexity. Each strategy and barrier occurred across all incident categories and HCP groups. Pharmacists went to extra effort to ensure safety plans were implemented. Conclusions: Similar strategies and barriers were evident across HCP groups and incident types. Strategies for enhancing patient safety may be strengthened by deliberate organizational support. Some barriers could be addressed by improving work systems.
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    Clinicians' use of Health Information Exchange technologies for medication reconciliation in the U.S. Department of Veterans Affairs: a qualitative analysis
    (Springer Nature, 2024-10-08) Snyder, Margie E.; Nguyen, Khoa A.; Patel, Himalaya; Sanchez, Steven L.; Traylor, Morgan; Robinson, Michelle J.; Damush, Teresa M.; Taber, Peter; Mixon, Amanda S.; Fan, Vincent S.; Savoy, April; Dismore, Rachel A.; Porter, Brian W.; Boockvar, Kenneth S.; Haggstrom, David A.; Locke, Emily R.; Gibson, Bryan S.; Byerly, Susan H.; Weiner, Michael; Russ-Jara, Alissa L.; Medicine, School of Medicine
    Background: Medication reconciliation is essential for optimizing medication use. In part to promote effective medication reconciliation, the Department of Veterans Affairs (VA) invested substantial resources in health information exchange (HIE) technologies. The objectives of this qualitative study were to characterize VA clinicians' use of HIE tools for medication reconciliation in their clinical practice and to identify facilitators and barriers. Methods: We recruited inpatient and outpatient prescribers (physicians, nurse practitioners, physician assistants) and pharmacists at four geographically distinct VA medical centers for observations and interviews. Participants were observed as they interacted with HIE or medication reconciliation tools during routine work. Participants were interviewed about clinical decision-making pertaining to medication reconciliation and use of HIE tools, and about barriers and facilitators to use of the tools. Qualitative data were analyzed via inductive and deductive approaches using a priori codes. Results: A total of 63 clinicians participated. Over half (58%) were female, and the mean duration of VA clinical experience was 7 (range 0-32) years. Underlying motivators for clinicians seeking data external to their VA medical center were having new patients, current patients receiving care from an external institution, and clinicians' concerns about possible medication discrepancies among institutions. Facilitators for using HIE software were clinicians' familiarity with the HIE software, clinicians' belief that medication information would be available within HIE, and their confidence in the ability to find HIE medication-related data of interest quickly. Six overarching barriers to HIE software use for medication coordination included visual clutter and information overload within the HIE display; challenges with HIE interface navigation; lack of integration between HIE and other electronic health record interfaces, necessitating multiple logins and application switching; concerns with the dependability of HIE medication information; unfamiliarity with HIE tools; and a lack of HIE data from non-VA facilities. Conclusions: This study is believed to be the first to qualitatively characterize clinicians' HIE use with respect to medication reconciliation. Results inform recommendations to optimize HIE use for medication management activities. We expect that healthcare organizations and software vendors will be able to apply the findings to develop more effective and usable HIE information displays.
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    Human Factors and Ergonomics Methods for Pharmacy Research and Clinical Practice
    (Elsevier, 2021) Holden, Richard J.; Abebe, Ephrem; Russ-Jara, Alissa L.; Chui, Michelle A.; Medicine, School of Medicine
    Background: Human factors and ergonomics (HFE) is a scientific and practical human-centered discipline that studies and improves human performance in sociotechnical systems. HFE in pharmacy promotes the human-centered design of systems to support individuals and teams performing medication-related work. Objective: To review select HFE methods well suited to address pharmacy challenges, with examples of their application in pharmacy. Methods: We define the scope of HFE methods in pharmacy as applications to pharmacy settings, such as inpatient or community pharmacies, as well as medication-related phenomena such as medication safety, adherence, or deprescribing. We identify and present seven categories of HFE methods suited to widespread use for pharmacy research and clinical practice. Results: Categories of HFE methods applicable to pharmacy include work system analysis; task analysis; workload assessment; medication safety and error analysis; user-centered and participatory design; usability evaluation; and physical ergonomics. HFE methods are used in three broad phases of human-centered design and evaluation: study; design; and evaluation. The most robust applications of HFE methods involve the combination of HFE methods across all three phases. Two cases illustrate such a comprehensive application of HFE: one case of medication package, label, and information design and a second case of human-centered design of a digital decision aid for medication safety. Conclusions: Pharmacy, including the places where pharmacy professionals work and the multistep process of medication use across people and settings, can benefit from HFE. This is because pharmacy is a human-centered sociotechnical system with an existing tradition of studying and analyzing the present state, designing solutions to problems, and evaluating those solutions in laboratory or practice settings. We conclude by addressing common concerns about the implementation of HFE methods and urge the adoption of HFE methods in pharmacy.
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    A mixed-methods study of pharmacy instructors' early experiences with a teaching electronic medical record
    (Elsevier, 2021-09) Adeoye-Olatunde, Omolola A.; Vlashyn, Olga O.; Illingworth Plake, Kimberly S.; Woodyard, Jamie L.; Weber, Zachary A.; Litzelman, Debra K.; Russ-Jara, Alissa L.; Medicine, School of Medicine
    Introduction As use of electronic medical records (EMRs) increases in healthcare, multiple accreditation organizations recommend training future clinicians on EMRs as part of the academic curriculum. Therefore, some pharmacy programs now utilize an academic EMR. Our objective was to examine pharmacy instructors' early experiences with a commercially available teaching EMR (tEMR) in order to identify current and future priorities along with benefits and barriers to academic EMR use in pharmacy education. Methods We conducted semi-structured interviews and a web-based survey with pharmacy instructors. Interview and survey data analyses consisted of hybrid inductive/deductive approaches to coding data and descriptive statistics, respectively. We mapped themes to the Pharmacists' Patient Care Process (PPCP). Results Seven instructors participated in interviews, and 10 completed the survey. We identified 25 interview themes that were generally congruent with survey responses. A noted benefit of the tEMR was providing a large repository of real-life patient data. Instructors' current priorities for tEMR activities primarily aligned with “collect,” “assess,” and “plan” steps of the PPCP. One reported barrier was insufficient training regarding the tEMR capabilities. Instructors offered innovative ideas for future academic EMR use, including pharmacokinetics, incident reporting, and longitudinal cases. Conclusions Study findings are most applicable to pharmacy programs in the early stages of academic EMR adoption. We identified opportunities for pharmacy programs to facilitate innovative, future use of academic EMRs, including curriculum planning, so pharmacy students gain experience using EMR functions for each PPCP step and develop more advanced EMR skills.
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    Organizational conditions that influence work engagement and burnout: A qualitative study of mental health workers
    (American Psychological Association, 2021) Rollins, Angela L.; Eliacin, Johanne; Russ-Jara, Alissa L.; Monroe-Devita, Maria; Wasmuth, Sally; Flanagan, Mindy E.; Morse, Gary A.; Leiter, Michael; Salyers, Michelle P.; Psychology, School of Science
    Objective: Clinician burnout in healthcare is extensive and of growing concern. In mental health and rehabilitation settings, research on interventions to improve burnout and work engagement is limited and rarely addresses organizational drivers of burnout. This study sought to elaborate on the organizational influence of burnout and work engagement in mental health. Methods: We randomly selected 40 mental health clinicians and managers who were participating in a burnout intervention and conducted semi-structured interviews to understand their views of organizational conditions impacting burnout and work engagement. Data were analyzed using a thematic analytical approach. Results: Analyses yielded three major themes where organizational contexts might reduce burnout and increase work engagement: (a) a work culture that prioritizes person-centered care over productivity and other performance metrics, (b) robust management skills and practices to overcome bureaucracy, and (c) opportunities for employee professional development and self-care. Participants also referenced three levels of the organizational context that they believed influenced burnout and work engagement: front-line supervisors and program managers, organizational executive leadership, and the larger health system. Conclusions and Implications for Practice: Findings point to several possible targets of intervention at various organizational levels that could guide the field toward more effective ways to reduce burnout and improve work engagement.
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    Strategies prescribers and pharmacists use to identify and mitigate adverse drug reactions in inpatient and outpatient care: a cognitive task analysis at a US Veterans Affairs Medical Center
    (BMJ, 2022-02-21) Nguyen, Khoa Anh; Militello, Laura G.; Ifeachor, Amanda; Arthur, Karen J.; Glassman, Peter A.; Zillich, Alan J.; Weiner, Michael; Russ-Jara, Alissa L.; Medicine, School of Medicine
    Objective: To develop a descriptive model of the cognitive processes used to identify and resolve adverse drug reactions (ADRs) from the perspective of healthcare providers in order to inform future informatics efforts SETTING: Inpatient and outpatient care at a tertiary care US Veterans Affairs Medical Center. Participants: Physicians, nurse practitioners and pharmacists who report ADRs. Outcomes: Descriptive model and emerging themes from interviews. Results: We conducted critical decision method interviews with 10 physicians and 10 pharmacists. No nurse practitioners submitted ADR incidents. We generated a descriptive model of an ADR decision-making process and analysed emerging themes, categorised into four stages: detection of potential ADR, investigation of the problem's cause, risk/benefit consideration, and plan, action and follow-up. Healthcare professionals (HCPs) relied on several confirmatory or disconfirmatory cues to detect and investigate potential ADRs. Evaluating risks and benefits of related medications played an essential role in HCPs' pursuits of solutions CONCLUSIONS: This study provides an illustrative model of how HCPs detect problems and make decisions regarding ADRs. The design of supporting technology for potential ADR problems should align with HCPs' real-world cognitive strategies, to assist fully in detecting and preventing ADRs for patients.