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Cleary, Paul

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Cleary

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Paul

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Cleary, Paul
Author's Publications: search.filters.isAuthorOfPublication.c5ae9c8e-1a8e-4631-9ffd-84b75a4756d7

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    Physicians and Electronic Health Records: A Statewide Survey
    (American Medical Association (AMA), 2007-03-12) Simon, Steven R.; Kaushal, Rainu; Cleary, Paul; Jenter, Chelsea A.; Volk, Lynn A.; Orav, Endel; Burdick, Elisabeth; Poon, Eric G.; Bates, David
    Background: Electronic health records (EHRs) allow for a variety of functions, ranging from visit documen- tation to laboratory test ordering, but little is known about physicians’ actual use of these functions. Methods: We surveyed a random sample of 1884 phy- sicians in Massachusetts by mail and assessed availabil- ity and use of EHR functions, predictors of use, and the relationships between EHR use and physicians’ percep- tions of medical practice. Results: A total of 1345 physicians responded to the sur- vey (71.4% response rate), and 387 (28.8%) reported that their practice had adopted EHRs. More than 80% of phy- sicians with EHRs reported having the ability to view labo- ratory reports (84.8%) and document visits electroni- cally (84.0%), but considerably fewer reported being able to order laboratory tests electronically (46.8%) or trans- mit prescriptions to a pharmacy electronically (44.7%). Fewer than half of the physicians who had systems with clinical decision support, transmittal of electronic pre- scriptions, and radiology order entry actually used these functions most or all of the time. Compared with phy- sicians who had not adopted EHRs, EHR users reported more positive views of the effects of computers on health care; there were no significant differences in these atti- tudes between high and low users of EHRs. Overall, about 1 in 4 physicians reported dissatisfaction with medical practice; there was no difference in this measure by EHR adoption or use. Conclusions: There is considerable variability in the func- tions available in EHRs and in the extent to which phy- sicians use them. Future work should emphasize fac- tors that affect the use of available functions.
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    Older People's Experiences of Patient-Centered Treatment for Chronic Pain: A Qualitative Study
    (Oxford University Press (OUP), 2009) Teh, Carrie F.; Karp, Jordan F.; Kleinman, Arthur; Reynolds, Charles F.; Weiner, Debra; Cleary, Paul
    INTRODUCTION: Older adults with chronic pain who seek treatment often are in a health care environment that emphasizes patient-directed care, a change from the patriarchal model of care to which many older adults are accustomed. OBJECTIVE: To explore the experiences of older adults seeking treatment for chronic pain, with respect to patient-directed care and the patient-provider relationship. DESIGN: In-depth interviews with 15 Caucasian older adults with chronic pain who had been evaluated at a university-based pain clinic. All interviews were audiotaped and the transcripts were analyzed using a grounded theory based approach. RESULTS: Older adults with chronic pain vary in their willingness to be involved in their treatment decisions. Many frequently participate in decisions about their pain treatment by asking for or refusing specific treatments, demanding quality care, or operating outside of the patient-provider relationship to manage pain on their own. However, others prefer to let their provider make the decisions. In either case, having a mutually respectful patient-provider relationship is important to this population. Specifically, participants described the importance of "being heard" and "being understood" by providers. CONCLUSIONS: As some providers switch from a patriarchal model of care toward a model of care that emphasizes patient activation and patient-centeredness, the development and cultivation of valued patient-provider relationships may change. While it is important to encourage patient involvement in treatment decisions, high-quality, patient-centered care for older adults with chronic pain should include efforts to strengthen the patient-provider relationship by attending to differences in patients' willingness to engage in patient-directed care and emphasizing shared decision-making.