Evaluation of the impact of enhanced virtual forms and gamification on intervention identification in a pharmacist-led ambulatory care clinic

Courtney E Gamston; Joshua C Hollingsworth; Brent I Fox; Sylvia Rogers; Mary Elizabeth O'Barr; Kimberly Braxton Lloyd

doi:10.1016/j.rcsop.2021.100068

Evaluation of the impact of enhanced virtual forms and gamification on intervention identification in a pharmacist-led ambulatory care clinic

Explor Res Clin Soc Pharm. 2021 Sep 4:4:100068. doi: 10.1016/j.rcsop.2021.100068. eCollection 2021 Dec.

Authors

Courtney E Gamston¹, Joshua C Hollingsworth², Brent I Fox¹, Sylvia Rogers¹, Mary Elizabeth O'Barr¹, Kimberly Braxton Lloyd¹

Affiliations

¹ Auburn University Harrison School of Pharmacy, 2316 Walker Building, Auburn, Al 36849, USA.
² Edward Via College of Osteopathic Medicine - Auburn Campus, 910 S. Donahue Dr., Auburn, Al 36832, USA.

Abstract

Background: Adoption of healthcare technology in the ambulatory care setting is nearly universal. Clinical decision support system (CDSS) technologies improve patient care through the identification of additional care opportunities. With the movement from paper-based to electronic clinical intake forms, the opportunity to improve identification of gaps in care utilizing CDSS in the ambulatory care setting exists.

Objective: To evaluate the impact of CDSS-enhanced digital intake forms, with- and without aspects of gamification, on the identification of intervention opportunities in an ambulatory care pharmacy setting.

Methods: Patients were invited to complete visit intake paperwork via virtual forms as part of a CDSS-enhanced mobile application designed to identify potential interventions based on patient age, sex, disease state(s), and user-provided information. Patients were randomized to receive optional patient-specific health questions 1) with or 2) without elements of gamification. Gamification elements included trivia questions, fun facts, and the chance to win a prize. A retrospective review was used to assess interventions identified for a random sample of patients seen within the same time frame who did not utilize the mobile application. Interventions were compared across groups utilizing ANOVA. t-tests were used for a subgroup analysis.

Results: From January to May 2019, 353 potential interventions were identified for 220 study participants. 0.44 (±0.82), 1.8 (±2.0) and 2.1 (±1.8) interventions per participant were identified for the control, virtual forms, and virtual forms + gamification groups, respectively. Significant differences in intervention identification across groups were found using a one-way ANOVA (F = 17.46, p < .001). Post hoc analysis demonstrated a significant difference in interventions identified for those completing 50-100% (n = 32) and those completing less than 50% (n = 18; p < .001) of the optional health questions in the virtual forms + gamification group.

Conclusions: Utilization of CDSS-enhanced clinical intake forms increased identification of potential interventions, though gamification did not significantly impact this identification.

Keywords: Ambulatory care; Clinical; Decision support systems; Electronic health records; Mobile health; Pharmacy.