Yes, we CAM: Increasing physician communication about complementary and alternative medicine through electronic medical record prompts in a pediatric hospital

Thanh M Huynh; Kira Molas-Torreblanca; Sanjay Chand; Namrata Ahuja; Sheree M Schrager; Ronen Zipkin; Jeffrey I Gold; Jennifer Maniscalco

doi:10.1016/j.ctcp.2021.101449

Yes, we CAM: Increasing physician communication about complementary and alternative medicine through electronic medical record prompts in a pediatric hospital

Complement Ther Clin Pract. 2021 Nov:45:101449. doi: 10.1016/j.ctcp.2021.101449. Epub 2021 Jul 21.

Authors

Thanh M Huynh¹, Kira Molas-Torreblanca², Sanjay Chand³, Namrata Ahuja², Sheree M Schrager⁴, Ronen Zipkin², Jeffrey I Gold⁵, Jennifer Maniscalco⁶

Affiliations

¹ Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA; Department of Pediatrics, Keck School of Medicine of USC, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA. Electronic address: thuynh@chla.usc.edu.
² Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA; Department of Pediatrics, Keck School of Medicine of USC, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA.
³ Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA.
⁴ Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA; Office of Research and Sponsored Programs, California State University Northridge University Hall 275, 18111 Nordhoff Street, Northridge, CA, 91330, USA.
⁵ Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA; Departments of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, 2250 Alcazar Street, #2200, Los Angeles, CA, 90033, USA.
⁶ Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA; Department of Pediatrics, Keck School of Medicine of USC, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA; Department of Pediatrics, Johns Hopkins University, Johns Hopkins All Children's Hospital, Office of Medical Education, 601 5th Avenue S, St. Petersburg, FL, 33701, USA.

PMID: 34311214
DOI: 10.1016/j.ctcp.2021.101449

Abstract

Background and purpose: Over half of patients utilize complementary and alternative medicine (CAM), yet fewer than 10 % of physicians inquire about use. This prospective cohort study sought to increase patient-provider communication about CAM through electronic medical record (EMR) prompts and education, as well as study concordance rates of physician and nursing CAM-related documentation.

Materials and methods: Recordings in history and physical (H&P) documents authored by first-year pediatric residents were used as a proxy for communication. Rates of documentation were assessed at baseline, after the introduction of an EMR prompt, and after an educational intervention. Nursing documentation was compared with resident documents to assess rates of concordance regarding CAM-related documentation.

Results: Baseline CAM-related documentation rate was 24 % and increased to 50 % after introducing an EMR CAM prompt (p < 0.001). No significant change occurred after education: 38 % had CAM-related documentation (p = 0.09). Physician and nursing documentation concordance rates were 58 % at baseline, 48 % after introduction of prompts, and 35 % after introducing education.

Conclusion: Visual cues alone may be effective in increasing patient-provider communication about CAM, though low concordance between physician and nursing documentation may suggest variability in how CAM is defined and inquired about.

Keywords: Complementary and alternative medicine; Documentation concordance; Electronic medical record; Integrative medicine; Medical education; Patient-provider communication.

MeSH terms

Child
Communication
Complementary Therapies*
Electronic Health Records
Hospitals, Pediatric
Humans
Physicians*
Prospective Studies