Ranney Leah M, Kowitt Sarah D, Mottus Kathleen, McDowell Susan, Beane Amber N, Denslow Sheri, Sturm Kit, Rice Noah, Hernandez Michelle, Jaspers Ilona, Hickman Elise, Halladay Jacqueline R
Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
The North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC.
HCA Healthc J Med. 2022 Oct 31;3(5):283-297. doi: 10.36518/2689-0216.1443. eCollection 2022.
Vaping is an epidemic among young people, but there is little guidance on how medical providers should counsel young adults about vaping. To address this gap, we examined how electronic health record (EHR) systems prompt providers to collect vaping data and interviewed young adults about vaping communications with providers and preferred information sources.
In this mixed methods study, we used survey research methods to explore if prompts exist in EHR systems to guide discussions about vaping with youth seen in primary care. We collected primary care practice information about EHR prompts regarding e-cigarette use from 10 rural North Carolina practices from August 2020 through November 2020 and interviewed 17 young adults (age 18-21 years) who reviewed resources and provided their opinion on the resource's relevance for their age group. Interviews were stratified by vaping status, transcribed, coded, and thematically analyzed.
Only 5 of 10 EHR systems included prompts to capture information about vaping and data capture was optional in all 5 cases. Of the 17 interviewees, 10 were female, 14 were White, 3 were non-White and the mean age was 19.6 years. Two central themes emerged. Young adults: 1) were open to confidential, non-confrontational interactions with trusted providers and supported the use of a 2-page resource/discussion guide, questionnaires about vaping, and other waiting room resources, and 2) wanted prevention and cessation resources to be age-appropriate, including medical facts from a trusted source, and to be disseminated via social media platforms used by young adults.
We found a lack of EHR functionalities in screening for vaping status hindered patients from receiving counseling on use. Young adults report a willingness to communicate with and learn from trusted providers and to gain understanding from information accessed via social media.
电子烟在年轻人中盛行，但对于医疗服务提供者应如何向年轻成年人提供有关电子烟的咨询，几乎没有相关指导。为了填补这一空白，我们研究了电子健康记录（EHR）系统如何促使医疗服务提供者收集电子烟数据，并就与医疗服务提供者关于电子烟的沟通以及偏好的信息来源对年轻成年人进行了访谈。
在这项混合方法研究中，我们采用调查研究方法来探究EHR系统中是否存在提示，以指导在初级保健中与青少年进行关于电子烟的讨论。我们从2020年8月至2020年11月收集了北卡罗来纳州10个农村初级保健机构关于EHR中电子烟使用提示的信息，并采访了17名年轻成年人（年龄在18 - 21岁之间），他们查看了相关资源并就这些资源与他们年龄组的相关性发表了意见。访谈按电子烟使用状况进行分层，进行转录、编码和主题分析。
10个EHR系统中只有5个包含收集电子烟信息的提示，并且在所有5个案例中数据收集都是可选的。17名受访者中，10名是女性，14名是白人，3名是非白人，平均年龄为19.6岁。出现了两个核心主题。年轻成年人：1）愿意与值得信赖的医疗服务提供者进行保密、非对抗性的互动，并支持使用一份两页的资源/讨论指南、关于电子烟的问卷以及其他候诊室资源；2）希望预防和戒烟资源适合其年龄，包括来自可靠来源的医学事实，并通过年轻成年人使用的社交媒体平台进行传播。
我们发现EHR系统在筛查电子烟使用状况方面功能不足，阻碍了患者接受关于使用电子烟的咨询。年轻成年人表示愿意与值得信赖的医疗服务提供者沟通并向其学习，并从通过社交媒体获取的信息中获得理解。
