Faculty Bibliography

OBJECTIVE: The aim of this study was to measure the effect of an electronic heparin-induced thrombocytopenia (HIT) alert on provider ordering behaviors and on patient outcomes. MATERIALS AND METHODS: A pop-up alert was created for providers when an individual's platelet values had decreased by 50% or to <100,000/mm(3) in the setting of recent heparin exposure. The authors retrospectively compared inpatients admitted between January 24, 2008 and August 24, 2008 to a control group admitted 1 year prior to the HIT alert. The primary outcome was a change in HIT antibody testing. Secondary outcomes included an assessment of incidence of HIT antibody positivity, percentage of patients started on a direct thrombin inhibitor (DTI), length of stay and overall mortality. RESULTS: There were 1006 and 1081 patients in the control and intervention groups, respectively. There was a 33% relative increase in HIT antibody test orders (p=0.01), and 33% more of these tests were ordered the first day after the criteria were met when a pop-up alert was given (p=0.03). Heparin was discontinued in 25% more patients in the alerted group (p=0.01), and more direct thrombin inhibitors were ordered for them (p=0.03). The number who tested HIT antibody-positive did not differ, however, between the two groups (p=0.99). The length of stay and mortality were similar in both groups. CONCLUSIONS: The HIT alert significantly impacted provider behaviors. However, the alert did not result in more cases of HIT being detected or an improvement in overall mortality. Our findings do not support implementation of a computerized HIT alert.

OBJECTIVES: To examine older persons' willingness to participate in exercise and relaxation programs for managing chronic pain, to identify characteristics associated with willingness to participate, and to ascertain their barriers to participation. DESIGN: Cross-sectional survey. SETTING: A geriatric ambulatory care practice located in New York, New York, and the General Clinical Research Center of Weill Cornell Medical College. PARTICIPANTS: Sixty-eight English-speaking patients aged 70 and older with chronic pain. MEASUREMENTS: Participants' level of willingness to participate in the programs was assessed using 5-point Likert scales, and information regarding their demographic, clinical, psychological, and pain status was obtained. Qualitative methods were used to ascertain participants' perceived barriers to participation. RESULTS: Participants had a mean age+/-standard deviation of 81.9+/-7.0 and were mostly white (85%) and female (68%). Although only 16% of participants reported current use of exercise as a pain-management strategy, 73% reported a willingness to try the exercise program. Four percent reported current use of relaxation methods; 70% reported an interest in learning these techniques. Moderate correlations were found between increasing days of restricted activity due to pain and greater willingness to participate. Seventeen unique barriers were identified; the mean number of barriers reported per person was 2.9+/-1.8 for exercise and 2.2+/-1.4 for relaxation. Commonly reported barriers to participating in either program included time conflicts, transportation, treatment efficacy concerns, and fear of pain or injury. CONCLUSION: Older primary care patients with chronic pain are willing to try exercise and relaxation therapies to help manage pain but report a substantial number of barriers to participating in these programs. Addressing patient-level barriers could improve engagement in and adherence to exercise and relaxation therapies for managing pain in older persons.