Implementation outcomes of Humanwide: integrated precision health in team-based family practice primary care.
Background: Humanwide was precision health embedded in primary care aiming to leverage high-tech and high-touch medicine to promote wellness, predict and prevent illness, and tailor treatment to individual medical and psychosocial needs. Methods: We conducted a study assessing implementation outcome...
| Publicado en: | BMC Family Practice Vol. 22; no. 1; pp. 1 - 9 |
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| Autores principales: | , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
BioMed Central
2/2/2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=148447275&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 148447275 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14712296 1CHN jtl: BMC Family Practice issn: 14712296 maglogo: N pubinfo: dt: 2/2/2021 vid: 22 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 148447275 148447275 148447275 10.1186/s12875-021-01373-4 148447275 ppf: 1 ppct: 8 formats: tig: atl: Implementation outcomes of Humanwide: integrated precision health in team-based family practice primary care. aug: au: Brown-Johnson, Cati G. Safaeinili, Nadia Baratta, Juliana Palaniappan, Latha Mahoney, Megan Rosas, Lisa G. Winget, Marcy affil: Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford MSOB, 1265 Welch Rd x216, 94305, Palo Alto, CA, USA sug: subj: Primary Health Care Health Care Delivery, Integrated Individualized Medicine Family Practice Multidisciplinary Care Team Implementation Science Outcome Assessment Human Multimethod Studies Semi-Structured Interview Attitude of Health Personnel Record Review Health Education Digital Technology Pharmacogenetics Genetic Screening Health Screening Patient Attitudes Professional-Patient Relations Self-Efficacy Descriptive Statistics ab: Background: Humanwide was precision health embedded in primary care aiming to leverage high-tech and high-touch medicine to promote wellness, predict and prevent illness, and tailor treatment to individual medical and psychosocial needs. Methods: We conducted a study assessing implementation outcomes to inform spread and scale, using mixed methods of semi-structured interviews with diverse stakeholders and chart reviews. Humanwide included: 1) health coaching; 2) four digital health tools for blood-pressure, weight, glucose, and activity; 3) pharmacogenomic testing; and 4) genetic screening/testing. We examined implementation science constructs: reach/penetration, acceptability, feasibility, and sustainability. Chart reviews captured preliminary clinical outcomes. Results: Fifty of 69 patients (72%) invited by primary care providers participated in the Humanwide pilot. We performed chart reviews for the 50 participating patients. Participants were diverse overall (50% non-white, 66% female). Over half of the participants were obese and 58% had one or more major cardiovascular risk factor: dyslipidemia, hypertension, diabetes. Reach/penetration of Humanwide components varied: pharmacogenomics testing 94%, health coaching 80%, genetic testing 72%, and digital health 64%. Interview participants (n=27) included patients (n=16), providers (n=9), and the 2 staff who were allocated dedicated time for Humanwide patient intake and orientation. Patients and providers reported Humanwide was acceptable; it engaged patients holistically, supported faster medication titration, and strengthened patient-provider relationships. All patients benefited clinically from at least one Humanwide component. Feasibility challenges included: low provider self-efficacy for interpreting genetics and pharmacogenomics; difficulties with data integration; patient technology challenges; and additional staffing needs. Patient financial burden concerns surfaced with respect to sustainability. Conclusion: This is the first report of implementation of a multi-component precision health model embedded in team-based primary care. We found acceptance from both patients and providers; however, feasibility barriers must be overcome to enable broad spread and sustainability. We found that barriers to implementation of precision health in a team-based primary care clinic are mundane and straightforward, though not necessarily easy to overcome. Future implementation endeavors should invest in basics: education, workflow, and reflection/evaluation. Strengthening fundamentals will enable healthcare systems to more nimbly accept the responsibility of meeting patients at the crossroads of innovative science and routinized clinical systems. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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