Browsing by Author "Sanner, Lindsey"
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Item Assessing the use of a clinical decision support tool for pain management in primary care(Oxford University Press, 2022-09-15) Apathy, Nate C.; Sanner, Lindsey; Adams, Meredith C.B.; Mamlin, Burke W.; Grout, Randall W.; Fortin, Saura; Hillstrom, Jennifer; Saha, Amit; Teal, Evgenia; Vest, Joshua R.; Menachemi, Nir; Hurley, Robert W.; Harle, Christopher A.; Mazurenko, Olena; Health Policy and Management, School of Public HealthObjective: Given time constraints, poorly organized information, and complex patients, primary care providers (PCPs) can benefit from clinical decision support (CDS) tools that aggregate and synthesize problem-specific patient information. First, this article describes the design and functionality of a CDS tool for chronic noncancer pain in primary care. Second, we report on the retrospective analysis of real-world usage of the tool in the context of a pragmatic trial. Materials and methods: The tool known as OneSheet was developed using user-centered principles and built in the Epic electronic health record (EHR) of 2 health systems. For each relevant patient, OneSheet presents pertinent information in a single EHR view to assist PCPs in completing guideline-recommended opioid risk mitigation tasks, review previous and current patient treatments, view patient-reported pain, physical function, and pain-related goals. Results: Overall, 69 PCPs accessed OneSheet 2411 times (since November 2020). PCP use of OneSheet varied significantly by provider and was highly skewed (site 1: median accesses per provider: 17 [interquartile range (IQR) 9-32]; site 2: median: 8 [IQR 5-16]). Seven "power users" accounted for 70% of the overall access instances across both sites. OneSheet has been accessed an average of 20 times weekly between the 2 sites. Discussion: Modest OneSheet use was observed relative to the number of eligible patients seen with chronic pain. Conclusions: Organizations implementing CDS tools are likely to see considerable provider-level variation in usage, suggesting that CDS tools may vary in their utility across PCPs, even for the same condition, because of differences in provider and care team workflows.Item The Challenges of Conducting Intrastate Policy Surveillance: A Methods Note on County and City Laws in Indiana(APHA, 2021-06) Sanner, Lindsey; Grant, Sean; Walter-McCabe, Heather; Silverman, Ross D.; Social and Behavioral Sciences, School of Public HealthPolicy surveillance is critical in examining the ways law functions as a structural and social determinant of health. To date, little policy surveillance research has focused on examining intrastate variations in the structure and health impact of laws. Intrastate policy surveillance poses unique methodological challenges because of the complex legal architecture within states and inefficient curation of local laws. We discuss our experience with these intrastate policy surveillance challenges in Indiana, a state with 92 counties and several populous cities, a complicated history of home rule, systemically underfunded local governments, and variations in demography, geography, and technology adoption. In our case study, we expended significant time and resources to obtain county and city ordinances through online code libraries, jurisdiction Web sites, and (most notably) visits to offices to scan documents ourselves. A concerted effort is needed to ensure that local laws of all kinds are stored online in organized, searchable, and open access systems. Such an effort is vital to achieve the aspirational goals of policy surveillance at the intrastate level.Item Community Behavioral Health Needs Assessment for Howard County(Richard M. Fairbanks School of Public Health, 2023-09) Greene, Marion; Sanner, Lindsey; King, HannahThis report describes the need for behavioral health services in Howard County and identifies the gaps that exist between service needs and service availability. Based on the findings, Community Fairbanks Behavioral Health – Howard will strategize on how to address these needs and gaps.Item Community Mental Health Needs Assessment Report for Marion County(Richard M. Fairbanks School of Public Health, 2023-06-23) Greene, Marion; Sanner, Lindsey; McNamee, CassidyThe purpose of this project was to conduct a community mental health needs assessment (CMHNA) specific to the services available for serious mental illness and substance use disorders across the lifespan in Marion County, Indiana. The CMHNA was developed in collaboration with Sandra Eskenazi Mental Health Center, Community Fairbanks Behavioral Health, Aspire Indiana Health, and Adult and Child Health. These four organizations are Division of Mental Health and Addiction (DMHA) designated Community Mental Health Centers (CMHCs) as well as grantees of the Substance Abuse and Mental Health Services Administration’s Certified Community Behavioral Health Center (CCBHC) award. This report contains all findings from the assessment, including: a. Identification of the level of need, including cultural, linguistic, treatment and staffing needs b. Identification of the level of services available, including resources to address transportation, income, culture, and other barriers c. Identification of the gaps between needs and services d. Recommendations derived from the interviews and other data.Item Evaluation of electronic recruitment efforts of primary care providers as research subjects during the COVID-19 pandemic(BMC, 2022-04-28) Mazurenko, Olena; Sanner, Lindsey; Apathy, Nate C.; Mamlin, Burke W.; Menachemi, Nir; Adams, Meredith C.B.; Hurley, Robert W.; Fortin Erazo, Saura; Harle, Christopher A.; Medicine, School of MedicineBackground: Recruiting healthcare providers as research subjects often rely on in-person recruitment strategies. Little is known about recruiting provider participants via electronic recruitment methods. In this study, conducted during the COVID-19 pandemic, we describe and evaluate a primarily electronic approach to recruiting primary care providers (PCPs) as subjects in a pragmatic randomized controlled trial (RCT) of a decision support intervention. Methods: We adapted an existing framework for healthcare provider research recruitment, employing an electronic consent form and a mix of brief synchronous video presentations, email, and phone calls to recruit PCPs into the RCT. To evaluate the success of each electronic strategy, we estimated the number of consented PCPs associated with each strategy, the number of days to recruit each PCP and recruitment costs. Results: We recruited 45 of 63 eligible PCPs practicing at ten primary care clinic locations over 55 days. On average, it took 17 business days to recruit a PCP (range 0-48) and required three attempts (range 1-7). Email communication from the clinic leaders led to the most successful recruitments, followed by brief synchronous video presentations at regularly scheduled clinic meetings. We spent approximately $89 per recruited PCP. We faced challenges of low email responsiveness and limited opportunities to forge relationships. Conclusion: PCPs can be efficiently recruited at low costs as research subjects using primarily electronic communications, even during a time of high workload and stress. Electronic peer leader outreach and synchronous video presentations may be particularly useful recruitment strategies.Item Examining primary care provider experiences with using a clinical decision support tool for pain management(Oxford University Press, 2023-08-09) Mazurenko, Olena; McCord, Emma; McDonnell, Cara; Apathy, Nate C.; Sanner, Lindsey; Adams, Meredith C. B.; Mamlin, Burke W.; Vest, Joshua R.; Hurley, Robert W.; Harle, Christopher A.; Health Policy and Management, School of Public HealthObjective: To evaluate primary care provider (PCP) experiences using a clinical decision support (CDS) tool over 16 months following a user-centered design process and implementation. Materials and methods: We conducted a qualitative evaluation of the Chronic Pain OneSheet (OneSheet), a chronic pain CDS tool. OneSheet provides pain- and opioid-related risks, benefits, and treatment information for patients with chronic pain to PCPs. Using the 5 Rights of CDS framework, we conducted and analyzed semi-structured interviews with 19 PCPs across 2 academic health systems. Results: PCPs stated that OneSheet mostly contained the right information required to treat patients with chronic pain and was correctly located in the electronic health record. PCPs used OneSheet for distinct subgroups of patients with chronic pain, including patients prescribed opioids, with poorly controlled pain, or new to a provider or clinic. PCPs reported variable workflow integration and selective use of certain OneSheet features driven by their preferences and patient population. PCPs recommended broadening OneSheet access to clinical staff and patients for data entry to address clinician time constraints. Discussion: Differences in patient subpopulations and workflow preferences had an outsized effect on CDS tool use even when the CDS contained the right information identified in a user-centered design process. Conclusions: To increase adoption and use, CDS design and implementation processes may benefit from increased tailoring that accommodates variation and dynamics among patients, visits, and providers.Item Factors that differentiate COVID-19 vaccine intentions among Indiana parents: Implications for targeted vaccine promotion(Elsevier, 2022) Head, Katharine J.; Zimet, Gregory D.; Yiannoutsos, Constantin T.; Silverman, Ross D.; Sanner, Lindsey; Menachemi, Nir; Communication Studies, School of Liberal ArtsGiven low rates of uptake of the COVID-19 vaccine for children 12-17 and 5-11 years old, research is needed to understand parental behaviors and behavioral intentions related to COVID-19 vaccination for their children. In the state of Indiana, we conducted a non-random, online survey of parents or caregivers (N = 10,266) about their COVID-19 vaccine intentions or behaviors, demographic characteristics, and potential motivating reasons for getting the vaccine. In terms of behaviors/intentions, 44.8% of participants indicated they were vaccine acceptors (i.e., had already had their children vaccinated or would as soon as it was possible), 13.0% indicated they were vaccine hesitators (i.e., wanted to wait and see), and 42.2% indicated they were vaccine rejecters (i.e., would not vaccinate or only would if mandated). Compared to vaccine rejecters, vaccine hesitators were more likely to be motivated by perceptions of vaccine safety and efficacy, normative influences such as close friends/family who had been vaccinated and a recommendation from a provider, as well as if they were vaccinated themselves. These findings have implications for the development of targeted vaccine promotion strategies, such as social norms messaging and a focus on vaccine safety, in order to increase COVID-19 vaccination for eligible children.Item Social Determinants of Health and Their Impact on Mental Health and Substance Misuse(Richard M. Fairbanks School of Public Health, 2020-01) Sanner, Lindsey; Greene, MarionHealth and wellbeing are shaped by many factors beyond healthcare and behavioral choices, including conditions that make up our social, economic, and physical environments. These factors are often referred to as social determinants of health (SDoHs). SDoHs not only affect our physical health, but they also can have an impact on a person’s mental wellbeing and substance use. These social determinants of health can be grouped into five major categories: 1) Neighborhood and built environment, 2) Health and healthcare, 3) Social and community context, 4) Education, 5) Economic stability. To address SDoHs effectively, a “health in all policies” approach that integrates health considerations into policymaking across sectors is essential.