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Bridging the Digital Health Divide: Characterizing Patient Portal Users and Nonusers in the U.S.

Ahmed N, Brown J, Parau C, McCullers A, Sanghavi K, Littlejohn R, Wesley D. Bridging the Digital Health Divide: Characterizing Patient Portal Users and Nonusers in the U.S. Med Care. 2023;61(7):448-455. 

Increasing access to digital patient portals is critical for moving the healthcare field forward. Patient portals reduce overhead and streamline patient and provider access to records and test results while providing secure communications outside increasingly brief face-to-face meetings. Despite the benefits, uptake remains challenging. To understand the differences between users and non-users, 489 self-selecting participants completed an online survey collecting demographic information, participants’ knowledge, skills, and confidence for self-management of chronic conditions (Patient Activation Measure (PAM)), health literacy (BRIEF Health Literacy Screening Tool (BRIEF)), and measures of their media and technology literacy and use (Media and Technology Usage and Attitudes Scale (MTUAS)). Compared to the individuals who did not use patient portals, users were more likely to have formal education after high school (p < 0.001) and live in urban areas (p = 0.03).  Individuals with active health insurance (p < 0.001), a primary care physician (p < 0.001), or disability/chronic conditions (p < 0.001) were more likely to use the patient portal. Individuals who used patient portals showed higher confidence in managing a chronic condition (PAM, p < 0.001) and more positive technology attitudes (MTUAS, p = 0.002) compared to non-users. Contrary to expectations, non-users showed higher health literacy (BRIEF inadequate literacy 61.1%) than users (70.0%). Together this data provides interesting insight into a section of the population familiar with the internet (volunteered for an online survey) but evenly mixed on the use of patient portals (users n = 263, non-users n = 226). Further research is needed to explain why higher health literacy would discourage people from engaging with a patient portal. It is possible, as the authors suggested, that individuals who feel they can accurately read health materials to answer questions they may have about their care would render the portal and unnecessary step in care-management.


The adoption and sustainability of digital therapeutics in justice systems: A pilot feasibility study.

Wilde JA, Zawislak K, Sawyer-Morris G, Hulsey J, Molfenter T, Taxman FS. The adoption and sustainability of digital therapeutics in justice systems: A pilot feasibility study. Int J Drug Policy. 2023;116:104024. doi:10.1016/j.drugpo.2023.104024

This article reports the adoption and sustainability of the Connections App (CHESS Health, 2018) in self-referred and justice-referred participants. The Connections App is an evidence-based smartphone app that uses community engagement and cognitive behavioral therapy programming to support patients in recovery from substance use disorder (SUD). Participants were either given access to the Connections App through justice-related programs or by voluntary enrollment in the study. Participation was completely voluntary in both groups and included free access to the Connections app including in-app tools such as Computer-Based Treatment for Cognitive Behavioral Therapy (CBT4CBT) and access to external access to recovery support services. Of the 1973 participants offered use of the Connections app only 796 individuals (40.3%) downloaded the app (declined: justice-referred n = 994, self-referred n = 183). Of those that downloaded the app, less than half (n = 350) engaged with the app. Most of the self-referred participants (77.9%) engaged with the app, whereas less than half (36.2%) of the justice-referred participants used the app once downloaded. When comparing the groups across engagement type, the number of participants who used the app alone was the same between referral types. In contrast to this a greater proportion of the justice-referred subjects used the additional external recovery support services compared to self-referred participants (p < 0.001). Referral type did not impact the number of activities completed or days of maintained app usage. While brief addiction monitor (BAM) scores were reported, a third of participants (engaged users, n = 350) only completed the assessment one of the possible 43 times (n = 111). Approximately 35% completed the BAM more than once (n = 121), with only 3.4% completing it more than 20 times (n = 12). Both groups showed the benefits of continued use of the Connections app, as demonstrated by BAM score improvement over time using the app. Future research is needed to address the implementation issues revealed during site debriefing that hindered downloads in justice-referred populations.


William C. Torrey, MD, Named Chair of the Department of Psychiatry

Article Excerpt: William C. (Will) Torrey, MD, has been named chair of the Department of Psychiatry for Dartmouth Health and the Geisel School of Medicine at Dartmouth, a role he has held on an interim basis since 2020. This appointment comes in the midst of a national and regional mental health and addiction care crisis. Torrey’s wide-ranging experience in addressing psychiatric population health needs through advocacy, clinical programming, educational initiatives, and research combined with his drive for improvement will advance Dartmouth Health and the Geisel School of Medicine at Dartmouth’s positions as leaders in education, care delivery, and research in the field of psychiatry.

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Article Source: Dartmouth Geisel School of Medicine News


ChatGPT Gets Dartmouth Talking

Article Excerpt: ChatGPT, OpenAI’s trending chatbot that generates conversational responses to user prompts through advanced artificial intelligence, has been busy since its launch in late November… “ChatGPT and other generative AI technologies have huge potential for—and will have huge effects on—education,” says Provost David Kotz ’86, the Pat and John Rosenwald Professor in the Department of Computer Science. “My hope is to provide immediate support to faculty and instructors to become familiar with the technology and its impacts, and then look further down the road to consider how we can leverage it as a pedagogical tool, recognizing that it will be part of the future of teaching, learning, scholarship, and work.”

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Article Source: Dartmouth News


A Peer-Led Online Community to Increase HIV Self-Testing Among African American and Latinx MSM: A Randomized Controlled Trial

Young SD, Cumberland WG, Singh P, Coates T. A Peer-Led Online Community to Increase HIV Self-Testing Among African American and Latinx MSM: A Randomized Controlled Trial. J Acquir Immune Defic Syndr. 2022 May 1;90(1):20-26. doi: 10.1097/QAI.0000000000002919. PMID: 35044989; PMCID: PMC8986620.

Researchers conducted a randomized controlled trial to assess the effectiveness of a peer-led online community for increasing HIV self-testing among Latinx and African American men who have sex with men (MSM). Nine hundred MSM living in Los Angeles were recruited from online advertisements, community centers and referrals. Eligible participants were HIV negative and/or serostatus unknown. Seventy-nine peer leaders were also recruited from local community organizations and attended training sessions on HIV epidemiology, building an online community, and promoting discussion on health and stigmatizing topics. Participants randomly assigned to the intervention joined a 12-week private online community group with peer leaders on Facebook and the control group joined a private Facebook group without peer leaders. Each group had about 30 participants and 5 peer leaders. During the intervention period, peer leaders communicated with participants weekly via sending messages, chats, and posts in their Facebook group to build trust and deliver HIV information. Every four weeks, all participants were offered a free HIV self-testing kit. All participants were administered self-report assessments at baseline and at 12-weeks at post-intervention. Results indicated the intervention group was significantly more likely to accept the offer for self-testing compared to the control group (OR=1.43, 95% CI 1.04 to 1.95). Compared to the control, intervention participants were significantly more likely to take a HIV self-test within the past 3 months (OR=1.47, 95% CI 1.01 to 2.13) and consume less alcohol in an average week (p=0.01) at post-intervention follow-up relative to baseline. The study observed a high retention rate (93%). Findings suggest that online communities are effective platforms for increasing HIV testing and reducing alcohol consumption among MSM of color. Results have implications for public health policy and scalability of technology-based interventions.


Geisel Launches New Center for Implementation Science

Article Excerpt: Despite the many advances made in academic medicine in recent decades, successfully applying what is learned in research to patient care remains a major challenge. For example, it takes, on average, 17 years for research to reach clinical practice. And most evidence-based guidelines are adopted only about 25 percent of the time. With the establishment of the new Dartmouth Center for Implementation Science (DCIS) at the Geisel School of Medicine, community partners across the Dartmouth enterprise will work to help close those gaps. “Implementation science is an emerging area of multidisciplinary research that focuses on moving scientific evidence into routine practice,” explains Jeremiah Brown, PhD, a professor of epidemiology at Geisel and founding director of DCIS. In addition to Brown, the DCIS leadership team includes co-directors Sarah Lord, PhD, associate professor of psychiatry and biomedical data science, Kelly Aschbrenner, PhD, associate professor of psychiatry and principal scientist at Dartmouth Health, and program manager Sherry Owens, PhD. Genevieve Shaefer ’26, the first Women In Science Project (WISP) intern for DCIS, will be working with the team on campus engagement and training.

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Article Source: Dartmouth Geisel School of Medicine News


A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial

Brody C, Chhoun P, Tuot S, Fehrenbacher A, Moran A, Swendeman D, Yi S. A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial. J Med Internet Res 2022;24(1):e27696 DOI: 10.2196/27696

This study evaluated the efficacy of the Mobile Link intervention to improve female entertainment workers’ (FEW) health through engagement and connection to HIV, sexual and reproductive health, and gender-based violence services. In Cambodia, FEWs are employed at karaoke bars, restaurants, bars, and massage parlors and many exchange sex to supplement their income. Researchers conducted a randomized controlled trial in the capital city and 3 other regions in Cambodia with high numbers of FEWs and HIV prevalence. Eligible participants were aged 18-30 years, working as a FEW, sexually active, and owned a mobile phone. Participants were randomized to the Mobile Link intervention arm (n=218) or to the control arm (standard care; n=170). For 60 weeks, participants in the Mobile Link arm received automated twice-weekly text messages and voice messages with health information and direct links to community outreach workers. Outcomes included self-reported HIV and sexually transmitted infection (STI) testing, condom use, and contraceptive use at baseline and 6- and 12-month follow up. Results showed significant improvements in HIV and STI testing, condom use, and contraceptive use in both arms. The Mobile Link intervention was effective in connecting FEWs with outreach workers – contact increased by 61% in the intervention arm compared to a decrease of 30% in the control arm. Additionally, participants in the intervention arm reported significant reductions in forced drinking behavior at work from supervisors or peers compared to those in the control arm. Although there were no differences in the main outcomes, the Mobile Link intervention may be helpful in linking to outreach workers and could be potentially implemented among other populations in Cambodia, perhaps as an adjunct to standard care. Future research may consider using longer-term messaging to increase access to services and impact health outcomes.


Technology-Assisted Opioid Education for Out-of-Treatment Adults With Opioid Use Disorder

Toegel F, Novak MD, Rodewald AM, Leoutsakos JM, Silverman K & Holtyn AF. (2022). Technology-assisted opioid education for out-of-treatment adults with opioid use disorder. Psychology of Addictive Behaviors, 36(5), 555–564.

This pre-post study evaluated the feasibility and preliminary efficacy of a technology-assisted education program for adults at higher risk of opioid overdose. The education program was self-paced and included three courses: 1) introduction to opioids, 2) preventing, detecting, and responding to an opioid overdose, and 3) opioid use disorder medications. Each course presented information and then prompted the user to complete a multiple-choice quiz to assess mastery of course material; incorrect answers produced feedback and participants were required to answer the question again to be able to advance to the next course. Forty adult participants with opioid use disorder who were not currently in treatment and who were living in Baltimore, Maryland were referred from community agencies and enrolled in the study. The education program took on average 91 minutes to complete and most participants completed the program in a single day. The mean score for the baseline test was 85% accuracy, indicating that participants already had prior knowledge of opioids, opioid overdoses, and medications. After completion of the program, participants showed significant improvement in test scores across all three courses (increase of 9.1%, 5.8%, and 10.1% respectively; p<.001); this was independent of education, employment, and poverty status. Participants with less than 12 years of education had significantly lower scores than those with 12 or more years of education. The computerized opioid education program demonstrated preliminary feasibility and efficacy in an uncontrolled trial among at-risk adults. Mobile technology allows for the potential to disseminate widely.


Building Strong Futures: The Feasibility of Using a Targeted Digital Media Campaign to Improve Knowledge About Pregnancy and Low Birthweight Among Black Women

Bonnevie E, Rosenberg SD, Goldbarg J, Ashley-West A, & Smyser J. (2021). Building Strong Futures: The Feasibility of Using a Targeted Digital Media Campaign to Improve Knowledge About Pregnancy and Low Birthweight Among Black Women. Maternal and Child Health Journal, 25(1), 127–135.

This article reports the campaign methods for a digital intervention targeting Black women in one Florida county to promote positive pregnancy-related knowledge and attitudes related to low birthweight. The Strong Beautiful Future campaign was tailored toward Black women around a reproductive empowerment lens. Content focused on emphasizing healthy pregnancy-related behaviors (prenatal care, nutrition, weight gain, and birthweight) and creating positive representations of Black women throughout the pregnancy stages, using images and videos. Content was posted 5-7 times each week on Instagram, Facebook, and Twitter for 2 years and digital ads and local social media influencers were used to promote the campaign. Researchers measured campaign engagement through digital metrics. After two years of campaign implementation, social media accounts had 1784 total followers, with most on Facebook (n=920). In the two years, on a monthly average, Facebook had the highest number of times the content was displayed, but Instagram showed highest level of engagement (number of likes, comments, shares, views and clicks). Three cross-sectional surveys were conducted online over the study period to examine Black women’s pregnancy-related knowledge, attitudes, and behaviors. Findings showed a non-significant increase in knowledge about prenatal care, weight gain, exercise, and health impacts of low birthweight. Overall, this study highlights how a targeted digital campaign to providing health information is feasible in reaching Black women in targeted locations.