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Abel G, Atherton H, Sussex J, Akter N, Aminu AQ, Bak W, Bryce C, Clark CE, Cockcroft E, Evans H, Gkousis E, Jenkins G, Jenkinson C, Khan N, Lambert J, Leach B, Marriott C, Newbould J, Parkinson S, Parsons J, Pitchforth E, Sheard L, Stockwell S, Thomas C, Treadgold B, Winder R, Campbell JL. Current experience and future potential of facilitating access to digital NHS primary care services in England: the Di-Facto mixed-methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-197. [PMID: 39324475 DOI: 10.3310/jkyt5803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Background Current National Health Service policy in England encourages enhanced digital access in primary care service provision. In this study, we investigate 'digital facilitation' - that range of processes, procedures and personnel which seeks to support National Health Service primary care patients in their uptake and use of online services. Objectives Identify, characterise and explore the potential benefits and challenges associated with different models of digital facilitation currently in use in general practice which are aimed at improving patient access to online services in general practice in England. Use the resulting intelligence to design a framework for future evaluations of the effectiveness and cost effectiveness of such interventions. Explore how patients with mental health conditions experience digital facilitation and gauge their need for this support. Design Observational mixed-methods study (literature review, surveys, ethnographic observation and interviews); formal synthesis of findings. Setting General practice in four regions of England. Participants Practice survey: 156 staff. Patient survey: 3051 patients. Mental health survey: 756 patients. General practitioner patient survey: 3 million responders. Ethnographic case-studies: 8 practices; interviews with 36 staff, 33 patients and 10 patients with a mental health condition. Stakeholder interviews: 19 participants. Intervention Digital facilitation as undertaken in general practice. Main outcome measures Patient and practice staff reported use of, and views of, digital facilitation. Data sources Surveys, qualitative research; national General Practitioner Patient Survey (2019-22). Review methods Scoping-review methodology applied to academic and grey literature published 2015-20. Results While we did find examples of digital facilitation in routine practice, these often involved using passive or reactive modes of support. The context of COVID, and the necessary acceleration (at that time) of the move to a digital-first model of primary care, shaped the way digital facilitation was delivered. There was lack of clarity over where the responsibility for facilitation efforts lay; it was viewed as the responsibility of 'others'. Patients living with mental health conditions had similar needs and experiences regarding digital facilitation to other patients. Limitations The context of the COVID pandemic placed limitations on the project. Fewer practices responded to the practice survey than anticipated; reconfiguration of general practices to support COVID measures was a key consideration during non-participant observation with social distancing and other measures still in place during fieldwork. Conclusions Digital facilitation, while not a widely recognised concept, is important in supporting the move to a National Health Service with enhanced digital opportunities and enhanced digital access. General practice staff are allocating resources to provide such efforts in general practices in England. The establishment of clear lines of responsibility, the development of digital tools and platforms that work for patients and practice staff, and investment in staff time and training are needed if digital facilitation is to support the intended digital revolution. Future work We did not find one single dominant or preferred model of digital facilitation which might reasonably be considered to form the basis of an intervention to be tested. Rather, there is a need to co-develop such an intervention with patients, general practice staff and relevant policy experts. We outline a framework for a future evaluation of such an intervention. Study registration This study is registered as ResearchRegistry6523 (www.researchregistry.com/browse-the-registry#home/?view_2_search=Di-Facto&view_2_page=1) and PROSPERO CRD42020189019 (www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128268) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 32. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Gary Abel
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Helen Atherton
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Gibbet Hill, UK
| | - Jon Sussex
- RAND Europe, Westbrook Centre, Cambridge, UK
| | - Nurunnahar Akter
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Abodunrin Q Aminu
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Wiktoria Bak
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Carol Bryce
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Gibbet Hill, UK
| | - Christopher E Clark
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Emma Cockcroft
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | | | | | - Georgia Jenkins
- PenARC Patient and Public Involvement Team, University of Exeter, Exeter, UK
| | - Caroline Jenkinson
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Nada Khan
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | | | | | - Christine Marriott
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | | | | | - Jo Parsons
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Gibbet Hill, UK
| | - Emma Pitchforth
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Laura Sheard
- Department of Health Sciences, University of York, York, UK
| | | | - Chloe Thomas
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Bethan Treadgold
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - Rachel Winder
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
| | - John L Campbell
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter, UK
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Scheckel B, Schmidt K, Stock S, Redaèlli M. Patient Portals as Facilitators of Engagement in Patients With Diabetes and Chronic Heart Disease: Scoping Review of Usage and Usability. J Med Internet Res 2023; 25:e38447. [PMID: 37624629 PMCID: PMC10492174 DOI: 10.2196/38447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 02/08/2023] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patient portals have the potential to improve care for chronically ill patients by engaging them in their treatment. These platforms can work, for example, as a standalone self-management intervention or a tethered link to treatment providers in routine care. Many different types of portals are available for different patient groups, providing various features. OBJECTIVE This scoping review aims to summarize the current literature on patient portals for patients with diabetes mellitus and chronic heart disease regarding usage behavior and usability. METHODS We conducted this review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for scoping reviews. We performed database searches using PubMed, PsycInfo, and CINAHL, as well as additional searches in reviews and reference lists. We restricted our search to 2010. Qualitative and quantitative studies, and studies using both approaches that analyzed usage behavior or usability of patient portals were eligible. We mapped portal features according to broad thematic categories and summarized the results of the included studies separately according to outcome and research design. RESULTS After screening, we finally included 85 studies. Most studies were about patients with diabetes, included patients younger than 65 years, and were conducted in the United States. Portal features were categorized into educational/general information, reminder, monitoring, interactivity, personal health information, electronic/personal health record, and communication. Portals mostly provided educational, monitoring, and communication-related features. Studies reported on usage behavior including associated variables, usability dimensions, and suggestions for improvement. Various ways of reporting usage frequency were identified. A noticeable decline in portal usage over time was reported frequently. Age was most frequently studied in association with portal use, followed by gender, education, and eHealth literacy. Younger age and higher education were often associated with higher portal use. In two-thirds of studies reporting on portal usability, the portals were rated as user friendly and comprehensible, although measurement and reporting were heterogeneous. Portals were considered helpful for self-management through positive influences on motivation, health awareness, and behavioral changes. Helpful features for self-management were educational/general information and monitoring. Barriers to portal use were general (eg, aspects of design or general usability), related to specific situations during portal use (eg, login procedure), or not portal specific (eg, user skills and preferences). Frequent themes were aspects of design, usability, and technology. Suggestions for improvement were mainly related to technical issues and need for support. CONCLUSIONS The current state of research emphasizes the importance of involving patients in the development and evaluation of patient portals. The consideration of various research designs in a scoping review is helpful for a deeper understanding of usage behavior and usability. Future research should focus on the role of disease burden, and usage behavior and usability among older patients.
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Affiliation(s)
- Benjamin Scheckel
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katharina Schmidt
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Nelson LA, Reale C, Anders S, Beebe R, Rosenbloom ST, Hackstadt A, Harper KJ, Mayberry LS, Cobb JG, Peterson N, Elasy T, Yu Z, Martinez W. Empowering patients to address diabetes care gaps: formative usability testing of a novel patient portal intervention. JAMIA Open 2023; 6:ooad030. [PMID: 37124675 PMCID: PMC10139764 DOI: 10.1093/jamiaopen/ooad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/22/2023] [Accepted: 04/13/2023] [Indexed: 05/02/2023] Open
Abstract
Objective The aim of this study was to design and assess the formative usability of a novel patient portal intervention designed to empower patients with diabetes to initiate orders for diabetes-related monitoring and preventive services. Materials and Methods We used a user-centered Design Sprint methodology to create our intervention prototype and assess its usability with 3 rounds of iterative testing. Participants (5/round) were presented with the prototype and asked to perform common, standardized tasks using think-aloud procedures. A facilitator rated task performance using a scale: (1) completed with ease, (2) completed with difficulty, and (3) failed. Participants completed the System Usability Scale (SUS) scored 0-worst to 100-best. All testing occurred remotely via Zoom. Results We identified 3 main categories of usability issues: distrust about the automated system, content concerns, and layout difficulties. Changes included improving clarity about the ordering process and simplifying language; however, design constraints inherent to the electronic health record system limited our ability to respond to all usability issues (eg, could not modify fixed elements in layout). Percent of tasks completed with ease across each round were 67%, 60%, and 80%, respectively. Average SUS scores were 87, 74, and 93, respectively. Across rounds, participants found the intervention valuable and appreciated the concept of patient-initiated ordering. Conclusions Through iterative user-centered design and testing, we improved the usability of the patient portal intervention. A tool that empowers patients to initiate orders for disease-specific services as part of their existing patient portal account has potential to enhance the completion of recommended health services and improve clinical outcomes.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carrie Reale
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shilo Anders
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Russ Beebe
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - S Trent Rosenbloom
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amber Hackstadt
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kryseana J Harper
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jared G Cobb
- HealthIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Neeraja Peterson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tom Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zhihong Yu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William Martinez
- Corresponding Author: William Martinez, MD, MSc, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave., Suite 450, Nashville, TN 37203, USA;
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Sung M, He J, Zhou Q, Chen Y, Ji JS, Chen H, Li Z. Using an Integrated Framework to Investigate the Facilitators and Barriers of Health Information Technology Implementation in Noncommunicable Disease Management: Systematic Review. J Med Internet Res 2022; 24:e37338. [PMID: 35857364 PMCID: PMC9350822 DOI: 10.2196/37338] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Noncommunicable disease (NCD) management is critical for reducing attributable health burdens. Although health information technology (HIT) is a crucial strategy to improve chronic disease management, many health care systems have failed in implementing HIT. There has been a lack of research on the implementation process of HIT for chronic disease management. OBJECTIVE We aimed to identify the barriers and facilitators of HIT implementation, analyze how these factors influence the implementation process, and identify key areas for future action. We will develop a framework for understanding implementation determinants to synthesize available evidence. METHODS We conducted a systematic review to understand the barriers and facilitators of the implementation process. We searched MEDLINE, Cochrane, Embase, Scopus, and CINAHL for studies published between database inception and May 5, 2022. Original studies involving HIT-related interventions for NCD management published in peer-reviewed journals were included. Studies that did not discuss relevant outcome measures or did not have direct contact with or observation of stakeholders were excluded. The analysis was conducted in 2 parts. In part 1, we analyzed how the intrinsic attributes of HIT interventions affect the successfulness of implementation by using the intervention domain of the Consolidated Framework for Implementation Research (CFIR). In part 2, we focused on the extrinsic factors of HIT using an integrated framework, which was developed based on the CFIR and the levels of change framework by Ferlie and Shortell. RESULTS We identified 51 papers with qualitative, mixed-method, and cross-sectional methodologies. Included studies were heterogeneous regarding disease populations and HIT interventions. In part 1, having a relative advantage over existing health care systems was the most prominent intrinsic facilitator (eg, convenience, improvement in quality of care, and increase in access). Poor usability was the most noted intrinsic barrier of HIT. In part 2, we mapped the various factors of implementation to the integrated framework (the coordinates are shown as level of change-CFIR). The key barriers to the extrinsic factors of HIT included health literacy and lack of digital skills (individual-characteristics of individuals). The key facilitators included physicians' suggestions, cooperation (interpersonal-process), integration into a workflow, and adequate management of data (organizational-inner setting). The importance of health data security was identified. Self-efficacy issues of patients and organizational readiness for implementation were highlighted. CONCLUSIONS Internal factors of HIT and external human factors of implementation interplay in HIT implementation for chronic disease management. Strategies for improvement include ensuring HIT has a relative advantage over existing health care; tackling usability issues; and addressing underlying socioeconomic, interpersonal, and organizational conditions. Further research should focus on studying various stakeholders, such as service providers and administrative workforces; various disease populations, such as those with obesity and mental diseases; and various countries, including low- and middle-income countries.
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Affiliation(s)
- Meekang Sung
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - Jinyu He
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Qi Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Haotian Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China.,Institute for Healthy China, Tsinghua Universtiy, Beijing, China
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Korngiebel DM, West KM. Patient Recommendations for the Content and Design of Electronic Returns of Genetic Test Results: Interview Study Among Patients Who Accessed Their Genetic Test Results via the Internet. JMIRX MED 2022; 3:e29706. [PMID: 37725563 PMCID: PMC10414314 DOI: 10.2196/29706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/26/2021] [Accepted: 01/29/2022] [Indexed: 09/21/2023]
Abstract
BACKGROUND Genetic test results will be increasingly made available electronically as more patient-facing tools are developed; however, little research has been done that collects data on patient preferences for content and design before creating results templates. OBJECTIVE This study identifies patient preferences for the electronic return of genetic test results, including what considerations should be prioritized for content and design. METHODS Following user-centered design methods, 59 interviews were conducted by using semistructured protocols. The interviews explored the content and design issues of patient portals that facilitated the return of test results to patients. We interviewed patients who received electronic results for specific types of genetics tests (pharmacogenetic tests, hereditary blood disorder tests, and tests for the risk of heritable cancers) or electronically received any type of genetic or nongenetic test results. RESULTS In general, many of participants felt that there always needed to be some clinician involvement in electronic result returns and that electronic coversheets with simple summaries would be helpful for facilitating this. Coversheet summaries could accompany, but not replace, the more detailed report. Participants had specific suggestions for such results summaries, such as only reporting the information that was the most important for patients to understand, including next steps, and doing so by using clear language that is free of medical jargon. Electronic result returns should also include explicit encouragement for patients to contact health care providers about questions. Finally, many participants preferred to manage their care by using their smartphones, particularly in instances when they needed to access health information on the go. CONCLUSIONS Participants recommended that a patient-friendly front section should accompany the more detailed report and made suggestions for organization, content, and wording. Many used their smartphones regularly to access test results; therefore, health systems and patient portal software vendors should accommodate smartphone app design and web portal design concomitantly when developing platforms for returning results.
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Morgan E, Schnell P, Singh P, Fareed N. Outpatient portal use among pregnant individuals: Cross-sectional, temporal, and cluster analysis of use. Digit Health 2022; 8:20552076221109553. [PMID: 35837662 PMCID: PMC9274807 DOI: 10.1177/20552076221109553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Outpatient portal technology can improve patient engagement. For pregnant individuals, the level of engagement could have important implications for maternal and infant outcomes. Objective This study: (1) cross-sectionally and temporally characterized the outpatient portal use among pregnant individuals seen at our academic medical center; and (2) identified clusters of the outpatient portal user groups based on the cross-sectional and temporal patterns of use. Methods We used outpatient portal server-side log files to execute a hierarchical clustering algorithm to group 7663 pregnant individuals based on proportions of outpatient portal function use. Post-hoc analyses were performed to further assess outpatient portal use on key encounter characteristics. Results The most frequently used functions were MyRecord (access personal health information), Visits (manage appointments), Messaging (send/receive messages), and Billing (view bills, insurance information). Median outpatient portal function use plateaued by the third trimester. Four distinct clusters were identified among all pregnant individuals: “Schedulers,” “Resulters,” “Intense Digital Engagers,” and “Average Users.” Post-hoc analyses revealed that the use of the Visits function increased and the use of the MyRecord function decreased over time among clusters. Conclusions Our identification of distinct cluster groups of outpatient portal users among pregnant individuals underscores the importance of avoiding the use of generalizations when describing how such patients might engage with patient-facing technologies such as an outpatient portal. These results can be used to improve user experience and training with outpatient portal functions and may educate maternal health providers on patient engagement with the outpatient portal.
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Affiliation(s)
- Evan Morgan
- Department of Biomedical Informatics, The Ohio State University, USA
| | | | - Priti Singh
- Department of Biomedical Informatics, The Ohio State University, USA
| | - Naleef Fareed
- Department of Biomedical Informatics, The Ohio State University, USA
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Nimmons D, Armstrong M, Pigott J, Walters K, Schrag A, Ogunleye D, Dowridge W, Read J, Davies N. Exploring the experiences of people and family carers from under-represented groups in self-managing Parkinson's disease and their use of digital health to do this. Digit Health 2022; 8:20552076221102261. [PMID: 35651731 PMCID: PMC9149607 DOI: 10.1177/20552076221102261] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/05/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Digital health is thought to enable people to better manage chronic
conditions, such as Parkinson's. However, little is known about how people
from under-represented groups with chronic conditions use digital health to
self-manage. Objective The objective of our study was to explore the experiences of people and
family carers from under-represented groups in self-managing Parkinson's,
including their use of digital health to do this. Methods Semi-structured interviews (n = 18, including four dyadic) were conducted
remotely, with 16 people with Parkinson's and six family carers in
2020–2021. Participants were purposively sampled from under-represented
groups: belong to an ethnic minority, or having significant physical or
sensory impairment. Interviews were audio-recorded, transcribed and analysed
using thematic analysis. Results Three main themes of importance were developed: ‘self-management support’,
‘digital health use to support self-management’ and ‘identity, attitudes and
characteristics’. Participants received medical, psychological, social and
practical self-management support. Some participants used digital health
resources, e.g., Parkinson's UK website. Digital literacy was the biggest
barrier to using digital health, regardless of background, often dependant
on previous occupation and confidence. Few ethnic minority participants
thought race or culture alters self-management ability and most believed
there was no need for digital health interventions to be tailored to an
individual's race or culture. Some felt inclusivity was important in terms
of diverse images of people. A range of considerations were identified to
optimise digital health, such as assistive equipment for people with sensory
impairment. Conclusions Barriers to using digital health for self-management were primarily dependent
on personal factors including digital literacy and attitudes but rarely race
or culture. We recommend the optimisation of digital health interventions by
providing assistive technology at low cost, and visual inclusiveness should
be promoted by including images of people from diverse backgrounds.
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Affiliation(s)
- Danielle Nimmons
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
| | - Megan Armstrong
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
| | | | - Kate Walters
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
| | - Anette Schrag
- Department of Neurology, Institute of Neurology, UCL, UK
| | - Della Ogunleye
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
| | - Wesley Dowridge
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
| | - Joy Read
- Department of Neurology, Institute of Neurology, UCL, UK
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, UCL, UK
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Carini E, Villani L, Pezzullo AM, Gentili A, Barbara A, Ricciardi W, Boccia S. The Impact of Digital Patient Portals on Health Outcomes, System Efficiency, and Patient Attitudes: Updated Systematic Literature Review. J Med Internet Res 2021; 23:e26189. [PMID: 34494966 PMCID: PMC8459217 DOI: 10.2196/26189] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/24/2021] [Accepted: 05/24/2021] [Indexed: 01/02/2023] Open
Abstract
Background Patient portals are becoming increasingly popular worldwide even though their impact on individual health and health system efficiency is still unclear. Objective The aim of this systematic review was to summarize evidence on the impact of patient portals on health outcomes and health care efficiency, and to examine user characteristics, attitudes, and satisfaction. Methods We searched the PubMed and Web of Science databases for articles published from January 1, 2013, to October 31, 2019. Eligible studies were primary studies reporting on the impact of patient portal adoption in relation to health outcomes, health care efficiency, and patient attitudes and satisfaction. We excluded studies where portals were not accessible for patients and pilot studies, with the exception of articles evaluating patient attitudes. Results Overall, 3456 records were screened, and 47 articles were included. Among them, 11 studies addressed health outcomes reporting positive results, such as better monitoring of health status, improved patient-doctor interaction, and improved quality of care. Fifteen studies evaluated the impact of digital patient portals on the utilization of health services with mixed results. Patient characteristics were described in 32 studies, and it was reported that the utilization rate usually increases with age and female gender. Finally, 30 studies described attitudes and defined the main barriers (concerns about privacy and data security, and lack of time) and facilitators (access to clinical data and laboratory results) to the use of a portal. Conclusions Evidence regarding health outcomes is generally favorable, and patient portals have the potential to enhance the doctor-patient relationship, improve health status awareness, and increase adherence to therapy. It is still unclear whether the use of patient portals improves health service utilization and efficiency.
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Affiliation(s)
- Elettra Carini
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Leonardo Villani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Maria Pezzullo
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Gentili
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Barbara
- Hygiene and Public Health Service, ASL Roma 1, Rome, Italy.,Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Women, Children and Public Health Sciences - Public Health Area, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
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9
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Nguyen OT, Watson AK, Motwani K, Warpinski C, McDilda K, Leon C, Khanna N, Nall RW, Turner K. Patient-Level Factors Associated with Utilization of Telemedicine Services from a Free Clinic During COVID-19. Telemed J E Health 2021; 28:526-534. [PMID: 34255572 DOI: 10.1089/tmj.2021.0102] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Disparities in telemedicine use by race, age, and income have been consistently documented. To date, research has focused on telemedicine use among patients with adequate insurance coverage. To address this gap, this study identifies patient-level factors associated with telemedicine use during the coronavirus (COVID-19) pandemic among one free clinic network's patients who are underinsured or uninsured. Materials and Methods: Electronic health record data were reviewed for patient-level data on patients seen from March 2020 to September 2020. Patients were grouped by telemedicine use history. We controlled for sociodemographic factors (e.g., age, race/ethnicity) and comorbidities. Logistic regression analyses were conducted. Results: Across 198 adult patients, 56.6% received telemedicine care. Of these, 99.1% elected for audio-only telemedicine instead of video telemedicine. Telemedicine use was more likely among those living within 15 miles of their clinic (adjusted odds ratio [aOR] = 4.43, 95% confidence interval [CI] 1.70-11.53). It was less likely to be used by older patients (aOR = 0.97, 95% CI 0.94-1.00), patients of male sex (aOR = 0.85, 95% CI 0.18-0.92), and those establishing care as a new patient (aOR = 0.01, 95% CI 0.00-0.07). Conclusion: The moderate usage of telemedicine suggests that its implementation in free clinics may be feasible. Solutions specific to patients with smartphone-only internet access are needed to improve the use of video telemedicine as smartphone-specific factors (e.g., data use limits) may influence the ability for underserved patients to receive video telemedicine.
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Affiliation(s)
- Oliver T Nguyen
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Amelia K Watson
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kartik Motwani
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Chloe Warpinski
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA
| | - Katelin McDilda
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Carlos Leon
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Neel Khanna
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Ryan W Nall
- Department of Community Health and Family Medicine and University of Florida, Gainesville, Florida, USA.,Division of General Internal Medicine, University of Florida, Gainesville, Florida, United States
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
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10
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Nguyen OT, Alishahi Tabriz A, Huo J, Hanna K, Shea CM, Turner K. Impact of Asynchronous Electronic Communication-Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review. J Med Internet Res 2021; 23:e27531. [PMID: 33843592 PMCID: PMC8135030 DOI: 10.2196/27531] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/02/2021] [Accepted: 04/11/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Electronic visits (e-visits) involve asynchronous communication between clinicians and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of evidence regarding e-visits, such as the impact on clinical outcomes and health care delivery, is unclear. OBJECTIVE To address this gap, we examine how e-visits have impacted clinical outcomes and health care quality, access, utilization, and costs. METHODS We conducted a systematic review; MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits' impacts on clinical and health care delivery outcomes. RESULTS Out of 1859 papers, 19 met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (eg, diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions, but variable quality was observed in infection management (eg, appropriate antibiotic prescribing). Similarly, the impact on health care utilization varied across conditions (eg, lower utilization for dermatology but mixed impact in primary care). Health care costs were lower for e-visits than those for in-person visits for a wide range of conditions (eg, dermatology and acute visits). No studies examined the impact of e-visits on health care access. It is difficult to draw firm conclusions about effectiveness or impact on care delivery from the studies that were included because many used observational designs. CONCLUSIONS Overall, the evidence suggests e-visits may provide clinical outcomes that are comparable to those provided by in-person care and reduce health care costs for certain health care conditions. At the same time, there is mixed evidence on health care quality, especially regarding infection management (eg, sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (eg, clinical decision support for antibiotic prescribing) and to assess which conditions can be managed via e-visits.
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Affiliation(s)
- Oliver T Nguyen
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
| | - Jinhai Huo
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Karim Hanna
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Christopher M Shea
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States
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11
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Sabo R, Robins J, Lutz S, Kashiri P, Day T, Webel B, Krist A. Diabetes Engagement and Activation Platform for Implementation and Effectiveness of Automated Virtual Type 2 Diabetes Self-Management Education: Randomized Controlled Trial. JMIR Diabetes 2021; 6:e26621. [PMID: 33779567 PMCID: PMC8088852 DOI: 10.2196/26621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/10/2021] [Accepted: 02/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with type 2 diabetes require recommendations for self-management education and support. OBJECTIVE In this study, we aim to design the Diabetes Engagement and Activation Platform (DEAP)-an automated patient education tool integrated into primary care workflow-and examine its implementation and effectiveness. METHODS We invited patients aged 18-85 years with a hemoglobin A1c (HbA1c) level ≥8 to participate in a randomized controlled trial comparing DEAP with usual care. DEAP modules addressing type 2 diabetes self-management education and support domains were programmed into patient portals, each with self-guided educational readings, videos, and questions. Care teams received patient summaries and were alerted to patients with low confidence or requesting additional help. HbA1c, BMI, and systolic and diastolic blood pressure (DBP) were measured. RESULTS Out of the 680 patients invited to participate, 337 (49.5%) agreed and were randomized. All of the 189 intervention patients accessed the first module, and 140 patients (74.1%) accessed all 9 modules. Postmodule knowledge and confidence scores were high. Only 18 patients requested additional help from the care team. BMI was lower for intervention patients than controls at 3 months (31.7 kg/m2 vs 32.1 kg/m2; P=.04) and 6 months (32.5 kg/m2 vs 33.0 kg/m2; P=.003); improvements were even greater for intervention patients completing at least one module. There were no differences in 3- or 6-month HbA1c or blood pressure levels in the intent-to-treat analysis. However, intervention patients completing at least one module compared with controls had a better HbA1c level (7.6% vs 8.2%; P=.03) and DBP (72.3 mm Hg vs 75.9 mm Hg; P=.01) at 3 months. CONCLUSIONS The findings of this study concluded that a significant proportion of patients will participate in an automated virtual diabetes self-management program embedded into patient portals and health systems show promise in helping patients manage their diabetes, weight, and blood pressure. TRIAL REGISTRATION ClinicalTrials.gov NCT02957721; https://clinicaltrials.gov/ct2/show/NCT02957721.
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Affiliation(s)
- Roy Sabo
- Virginia Commonwealth University, Richmond, VA, United States
| | - Jo Robins
- Virginia Commonwealth University, Richmond, VA, United States
| | - Stacy Lutz
- Privia Health, LLC, Arlington, VA, United States
| | | | - Teresa Day
- Virginia Commonwealth University, Richmond, VA, United States
| | - Benjamin Webel
- Virginia Commonwealth University, Richmond, VA, United States
| | - Alex Krist
- Virginia Commonwealth University, Richmond, VA, United States
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12
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Casillas A, Perez-Aguilar G, Abhat A, Gutierrez G, Olmos-Ochoa TT, Mendez C, Mahajan A, Brown A, Moreno G. Su salud a la mano (your health at hand): patient perceptions about a bilingual patient portal in the Los Angeles safety net. J Am Med Inform Assoc 2021; 26:1525-1535. [PMID: 31373362 DOI: 10.1093/jamia/ocz115] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/18/2019] [Accepted: 06/13/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Driven by beneficial patient-centered outcomes associated with patient portal use and the Affordable Care Act, portal implementation has expanded into safety nets-health systems that offer access to care to a large share of uninsured, Medicaid, and other vulnerable populations. However, little attention has been paid to the factors that affect portal accessibility by the vulnerable patients served by these health systems-including those who are limited English proficient (LEP). MATERIALS AND METHODS The Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net system in the nation, launched its first patient portal, and one of the few bilingual English-Spanish interfaces in existence, in March of 2015. To explore portal awareness and perceptions, we conducted focus groups with LAC DHS patients, in English and Spanish (LEP). The Technology Acceptance Model was used to guide thematic analysis of focus group data. RESULTS Of the 46 participants, 37 were patients and 9 were caretakers; 23 were English-speaking and 23 Spanish-speaking LEP. All patients had diabetes or hypertension. Over half had an annual household income <$10 000, yet 78% of English-speaking and 65% of Spanish-speaking LEP participants reported at-home Internet access. Participants' discussion centered around 3 major thematic narratives: (1) participants' awareness or attitudes about the LAC DHS portal; (2) role of culture, language, or community with regard to portal accessibility and utility; and (3) perceived needs for successful portal implementation. CONCLUSIONS Safety net participants identified concrete benefits to the portal and emphasized the need for portal engagement that offered accessible education, support, and resources in clinical and community settings. The portal offers an additional opportunity to engage the patient and family with trusted and validated health information, and should be further developed in this capacity. This study provides a better understanding of preferred improvements of patient portal engagement that guide broader health technology efforts to address electronic health disparities.
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Affiliation(s)
- Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Giselle Perez-Aguilar
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Anshu Abhat
- Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Griselda Gutierrez
- Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA
| | | | - Carmen Mendez
- Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Anish Mahajan
- Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Arleen Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Gerardo Moreno
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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13
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Understanding cancer patients' use and perceptions of inpatient portal: A case study at a tertiary hospital in Saudi Arabia. Int J Med Inform 2021; 148:104398. [PMID: 33571744 DOI: 10.1016/j.ijmedinf.2021.104398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/19/2020] [Accepted: 01/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Inpatient portals have been introduced into tertiary hospitals to meet patients' information and communication needs, to increase their awareness of health care, and to facilitate their transition after discharge. However, there is inadequate knowledge about hospitalised oncology patients' use and perceptions of these technologies. OBJECTIVE To explore cancer patients' use and perceptions of an inpatient portal in a tertiary hospital and to identify the main benefits and barriers for patients in using the portal. METHOD A qualitative case study was conducted in a tertiary hospital in Riyadh, Saudi Arabia. Only cancer patients were invited to participate. Twenty-two semi-structured interviews were conducted in the patient's room in a cancer care centre in January 2020. Interviews were audio-recorded, fully transcribed, and analysed using a thematic analysis method. RESULTS Most patients used the portal for the first time. The most used features were entertainment, watching fall prevention videos and viewing medication lists. Although the majority of patients were positive towards the portal, and considered it to be useful and easy to use, only a small number of them used the key clinical feature of the system such as pain assessment, health education, and discharge preparation. The patients would like to see further improvement in usability of the portal, appropriate user training, adding further information, and incorporating more services and features in the portal. CONCLUSION The introduction of the inpatient portal is successful in improving cancer patients' hospitalisation experience. It helped cancer patients to acquire knowledge about their own health, to actively engage in their care processes, and to request and acquire electronic services, in addition to providing entertainment. Future research on which factors inspire patients' use of the portal and how the influence is achieved is needed for the successful integration of the portal into the patients' hospital care process.
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14
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Chakranon P, Lai YK, Tang YW, Choudhary P, Khunti K, Lee SWH. Distal technology interventions in people with diabetes: an umbrella review of multiple health outcomes. Diabet Med 2020; 37:1966-1976. [PMID: 31631398 DOI: 10.1111/dme.14156] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 12/15/2022]
Abstract
AIM To summarize and evaluate the existing evidence on the effectiveness of distal technology with regard to multiple health outcomes in people with diabetes. METHODS We searched PubMed, EMBASE and the Cochrane Database of Systematic Reviews from database inception to 31 August 2018 for systematic reviews and/or meta-analyses of studies that examined the impact of distal technology and reported any clinical or patient-related outcomes among people with type 1 or type 2 diabetes. RESULTS The umbrella review identified 95 reviews, including 162 meta-analyses with 46 unique outcomes. Evidence from meta-analyses of randomized controlled studies supports the use of distal technology, especially telehealth and mHealth (healthcare delivered by mobile technology), in people with diabetes for improving HbA1c values by 2-4 mmol/mol (0.2-0.4%). For other health outcomes, such as changes in fasting plasma glucose levels, risk of diabetic ketoacidosis or frequency of severe hypoglycaemia, the evidence was weaker. No evidence was reported for most patient-reported outcomes including quality of life, self-efficacy and medication-taking. The evidence base was poor, with most studies rated as low to very low quality. CONCLUSION Distal technologies were associated with a modest improvement in glycaemic control, but it was unclear if they improved major clinical outcomes or were cost-effective in people with diabetes. More robust research to improve wider outcomes in people with diabetes is needed before such technologies can be recommended as part of routine care for any patient group.
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Affiliation(s)
- P Chakranon
- Faculty of Pharmacy, Silapakorn University, Pathom, Thailand
| | - Y K Lai
- Department of Pharmacy, Hospital Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Y W Tang
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - P Choudhary
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - S W H Lee
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Selangor, Malaysia
- School of Pharmacy, Taylor's University Lakeside Campus, Jalan Taylors, Selangor, Malaysia
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15
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Antonio MG, Petrovskaya O, Lau F. The State of Evidence in Patient Portals: Umbrella Review. J Med Internet Res 2020; 22:e23851. [PMID: 33174851 PMCID: PMC7688386 DOI: 10.2196/23851] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 01/12/2023] Open
Abstract
Background Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals has grown rapidly. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical or health behavior and outcomes, and portal adoption over time. Objective This paper aims to comprehensively consolidate the current state of evidence on patient portals using the umbrella review methodology, introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews, and present a knowledge translation tool that can be used to inform all stages of patient portal adoption. Methods For this study, a modified version of the Joanna Briggs Institute umbrella review method was used. Multiple databases were searched for systematic reviews focused on patient portals, and the final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative, and mixed methods primary studies reported in systematic reviews. We organized the umbrella review findings according to the Clinical Adoption Meta-Model (CAMM). Vote-counting, GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), and CERQual (Confidence in the Evidence from Review of Qualitative Research) were used to assess the umbrella review evidence. Results Our knowledge translation tool summarizes the findings in the form of an evidence map. Organized by the CAMM categories, the map describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behavioral effects, clinical outcomes, and patient-reported outcomes. The map lists the theories and mechanisms recognized in the included portal research while identifying the need for business models and organizational theories that can inform all stages of portal adoption. Our GRADE and CERQual umbrella review evaluation resulted in the majority of evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, or mixed results in specific focus areas. The 2 findings with a high rating of evidence were patients' interest in using portals for communication and the importance of a simple display of information in the portals. Over 40 portal features were identified in the umbrella review, with communication through secure messaging and appointment booking mentioned in all systematic reviews. Conclusions Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects and overlooks the specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal use and effects.
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Affiliation(s)
| | | | - Francis Lau
- University of Victoria, Victoria, BC, Canada
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16
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Yousef CC, Thomas A, Alenazi AO, Elgadi S, Abu Esba LC, AlAzmi A, Alhameed AF, Hattan A, Almekhloof S, AlShammary MA, Alanezi NA, Alhamdan HS, Eldegeir M, Abulezz R, Khoshhal S, Masala CG, Ahmed O. Adoption of a Personal Health Record in the Digital Age: Cross-Sectional Study. J Med Internet Res 2020; 22:e22913. [PMID: 32998854 PMCID: PMC7657719 DOI: 10.2196/22913] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND As health care organizations strive to improve health care access, quality, and costs, they have implemented patient-facing eHealth technologies such as personal health records to better engage patients in the management of their health. In the Kingdom of Saudi Arabia, eHealth is also growing in accordance with Vision 2030 and its National Transformation Program framework, creating a roadmap for increased quality and efficiency of the health care system and supporting the goal of patient-centered care. OBJECTIVE The aim of this study was to investigate the adoption of the personal health record of the Ministry of National Guard Health Affairs (MNGHA Care). METHODS A cross-sectional survey was conducted in adults visiting outpatient clinics in hospitals at the Ministry of National Guard Health Affairs hospitals in Riyadh, Jeddah, Dammam, Madinah, and Al Ahsa, and primary health care clinics in Riyadh and Qassim. The main outcome measure was self-reported use of MNGHA Care. RESULTS In the sample of 546 adult patients, 383 (70.1%) reported being users of MNGHA Care. MNGHA Care users were more likely to be younger (P<.001), high school or university educated (P<.001), employed (P<.001), have a chronic condition (P=.046), use the internet to search for health-related information (P<.001), and use health apps on their mobile phones (P<.001). CONCLUSIONS The results of this study show that there is substantial interest for the use of MNGHA Care personal health record with 70% of participants self-reporting use. To confirm these findings, objective data from the portal usage logs are needed. Maximizing the potential of MNGHA Care supports patient engagement and is aligned with the national eHealth initiative to encourage the use of technology for high-quality, accessible patient-centered care. Future research should include health care provider perspectives, incorporate objective data, employ a mixed-methods approach, and use a theoretical framework.
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Affiliation(s)
- Consuela Cheriece Yousef
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abin Thomas
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed O Alenazi
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sumaya Elgadi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pharmacy Practice, College of Pharmacy, Princess Noura Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Laila Carolina Abu Esba
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Aeshah AlAzmi
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Abrar Fahad Alhameed
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
| | - Ahmed Hattan
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Saleh Almekhloof
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Al Ahsa, Saudi Arabia
| | - Mohammed A AlShammary
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Primary Health Care, Prince Bader Housing Clinic, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Nazzal Abdullah Alanezi
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Qassim Primary Health Care Center, Ministry of National Guard-Health Affairs, Qassim, Saudi Arabia
| | - Hani Solaiman Alhamdan
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Manal Eldegeir
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatrics, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
| | - Rayf Abulezz
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
| | - Sahal Khoshhal
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
| | - Clara Glynis Masala
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Nursing, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
| | - Omaima Ahmed
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Hematology/Oncology/BMT, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
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17
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Wijesundara JG, Ito Fukunaga M, Ogarek J, Barton B, Fisher L, Preusse P, Sundaresan D, Garber L, Mazor KM, Cutrona SL. Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial. J Med Internet Res 2020; 22:e16373. [PMID: 32975529 PMCID: PMC7547389 DOI: 10.2196/16373] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 06/24/2020] [Accepted: 08/03/2020] [Indexed: 01/30/2023] Open
Abstract
Background Patient reminders for influenza vaccination, delivered via an electronic health record patient portal and interactive voice response calls, offer an innovative approach to engaging patients and improving patient care. Objective The goal of this study was to test the effectiveness of portal and interactive voice response outreach in improving rates of influenza vaccination by targeting patients in early September, shortly after vaccinations became available. Methods Using electronic health record portal messages and interactive voice response calls promoting influenza vaccination, outreach was conducted in September 2015. Participants included adult patients within a large multispecialty group practice in central Massachusetts. Our main outcome was electronic health record–documented early influenza vaccination during the 2015-2016 influenza season, measured in November 2015. We randomly assigned all active portal users to 1 of 2 groups: (1) receiving a portal message promoting influenza vaccinations, listing upcoming clinics, and offering online scheduling of vaccination appointments (n=19,506) or (2) receiving usual care (n=19,505). We randomly assigned all portal nonusers to 1 of 2 groups: (1) receiving interactive voice response call (n=15,000) or (2) receiving usual care (n=43,596). The intervention also solicited patient self-reports on influenza vaccinations completed outside the clinic. Self-reported influenza vaccination data were uploaded into the electronic health records to increase the accuracy of existing provider-directed electronic health record clinical decision support (vaccination alerts) but were excluded from main analyses. Results Among portal users, 28.4% (5549/19,506) of those randomized to receive messages and 27.1% (5294/19,505) of the usual care group had influenza vaccinations documented by November 2015 (P=.004). In multivariate analysis of portal users, message recipients were slightly more likely to have documented vaccinations when compared to the usual care group (OR 1.07, 95% CI 1.02-1.12). Among portal nonusers, 8.4% (1262/15,000) of those randomized to receive calls and 8.2% (3586/43,596) of usual care had documented vaccinations (P=.47), and multivariate analysis showed nonsignificant differences. Over half of portal messages sent were opened (10,112/19,479; 51.9%), and over half of interactive voice response calls placed (7599/14,984; 50.7%) reached their intended target, thus we attained similar levels of exposure to the messaging for both interventions. Among portal message recipients, 25.4% of message openers (2570/10,112) responded to a subsequent question on receipt of influenza vaccination; among interactive voice response recipients, 72.5% of those reached (5513/7599) responded to a similar question. Conclusions Portal message outreach to a general primary care population achieved a small but statistically significant improvement in rates of influenza vaccination (OR 1.07, 95% CI 1.02-1.12). Interactive voice response calls did not significantly improve vaccination rates among portal nonusers (OR 1.03, 95% CI 0.96-1.10). Rates of patient engagement with both modalities were favorable. Trial Registration ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277
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Affiliation(s)
- Jessica G Wijesundara
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Mayuko Ito Fukunaga
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Meyers Primary Care Institute, Worcester, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jessica Ogarek
- Center for Gerontology and Healthcare Research, Brown University, Providence, MA, United States
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Lloyd Fisher
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States.,Reliant Medical Group, Worcester, MA, United States
| | | | | | - Lawrence Garber
- Meyers Primary Care Institute, Worcester, MA, United States.,Reliant Medical Group, Worcester, MA, United States
| | - Kathleen M Mazor
- Meyers Primary Care Institute, Worcester, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Health Services Research & Development, Center of Innovation, Edith Nourse Rogers Memorial Hospital, Veterans Health Administration, Bedford, MA, United States
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18
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Alturkistani A, Qavi A, Anyanwu PE, Greenfield G, Greaves F, Costelloe C. Patient Portal Functionalities and Patient Outcomes Among Patients With Diabetes: Systematic Review. J Med Internet Res 2020; 22:e18976. [PMID: 32960182 PMCID: PMC7539164 DOI: 10.2196/18976] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/16/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patient portal use could help improve the care and health outcomes of patients with diabetes owing to functionalities, such as appointment booking, electronic messaging (e-messaging), and repeat prescription ordering, which enable patient-centered care and improve patient self-management of the disease. OBJECTIVE This review aimed to summarize the evidence regarding patient portal use (portals that are connected to electronic health care records) or patient portal functionality use (eg, appointment booking and e-messaging) and their reported associations with health and health care quality outcomes among adult patients with diabetes. METHODS We searched the MEDLINE, Embase, and Scopus databases and reported the review methodology using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three independent reviewers screened titles and abstracts, and two reviewers assessed the full texts of relevant studies and performed data extraction and quality assessments of the included studies. We used the Cochrane Collaboration Risk of Bias Tool and the National Heart, Lung and Blood Institute (NHLBI) Study Quality Assessment Tool to assess the risk of bias of the included studies. Data were summarized through narrative synthesis. RESULTS Twelve studies were included in this review. Five studies reported overall patient portal use and its association with diabetes health and health care quality outcomes. Six studies reported e-messaging or email use-associated outcomes, and two studies reported prescription refill-associated outcomes. The reported health outcomes included the associations of patient portal use with blood pressure, low-density lipoprotein cholesterol, and BMI. Few studies reported health care utilization outcomes such as office visits, emergency department visits, and hospitalizations. A limited number of studies reported overall quality of care for patients with diabetes who used patient portals. CONCLUSIONS The included studies mostly reported improved glycemic control outcomes for patients with diabetes who used patient portals. However, limitations of studying the effects of patient portals exist, which do not guarantee whether the outcomes reported are completely the result of patient portal use or if confounding factors exist. Randomized controlled trials and mixed-methods studies could help understand the mechanisms involved in health outcome improvements and patient portal use among patients with diabetes. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42019141131; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019141131. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/14975.
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Affiliation(s)
- Abrar Alturkistani
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Ambar Qavi
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Philip Emeka Anyanwu
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Geva Greenfield
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Felix Greaves
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Ceire Costelloe
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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19
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Spence T, Kander I, Walsh J, Griffiths F, Ross J. Perceptions and Experiences of Internet-Based Testing for Sexually Transmitted Infections: Systematic Review and Synthesis of Qualitative Research. J Med Internet Res 2020; 22:e17667. [PMID: 32663151 PMCID: PMC7481875 DOI: 10.2196/17667] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/08/2020] [Accepted: 06/14/2020] [Indexed: 01/19/2023] Open
Abstract
Background Internet-based testing for sexually transmitted infections (STIs) allows asymptomatic individuals to order a self-sampling kit online and receive their results electronically, reducing the need to attend a clinic unless for treatment. This approach has become increasingly common; however, there is evidence that barriers exist to accessing it, particularly among some high-risk populations. We review the qualitative evidence on this topic, as qualitative research is well-placed to identify the complex influences that relate to accessing testing. Objective This paper aims to explore perceptions and experiences of internet-based testing for STIs among users and potential users. Methods Searches were run through 5 electronic databases (CINAHL, EMBASE, MEDLINE, PsycINFO, and Web of Science) to identify peer-reviewed studies published between 2005 and 2018. Search terms were drawn from 4 categories: STIs, testing or screening, digital health, and qualitative methods. Included studies were conducted in high-income countries and explored patient perceptions or experiences of internet-based testing, and data underwent thematic synthesis. Results A total of 11 studies from the 1735 studies identified in the initial search were included in the review. The synthesis identified that internet-based testing is viewed widely as being acceptable and is preferred over clinic testing by many individuals due to perceived convenience and anonymity. However, a number of studies identified concerns relating to test accuracy and lack of communication with practitioners, particularly when receiving results. There was a lack of consensus on preferred media for results delivery, although convenience and confidentiality were again strong influencing factors. The majority of included studies were limited by the fact that they researched hypothetical services. Conclusions Internet-based testing providers may benefit from emphasizing this testing’s comparative convenience and privacy compared with face-to-face testing in order to improve uptake, as well as alleviating concerns about the self-sampling process. There is a clear need for further research exploring in depth the perceptions and experiences of people who have accessed internet-based testing and for research on internet-based testing that explicitly gathers the views of populations that are at high risk of STIs. Trial Registration PROSPERO CRD42019146938; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=146938
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Affiliation(s)
- Tommer Spence
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Inès Kander
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Julia Walsh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jonathan Ross
- Whittall Street Clinic, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
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20
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Al-Ramahi M, Noteboom C. Mining User-generated Content of Mobile Patient Portal. ACTA ACUST UNITED AC 2020. [DOI: 10.1145/3394831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Patient portals are positioned as a central component of patient engagement through the potential to change the physician-patient relationship and enable chronic disease self-management. The incorporation of patient portals provides the promise to deliver excellent quality, at optimized costs, while improving the health of the population. This study extends the existing literature by extracting dimensions related to the Mobile Patient Portal Use. We use a topic modeling approach to systematically analyze users’ feedback from the actual use of a common mobile patient portal, Epic's MyChart. Comparing results of Latent Dirichlet Allocation analysis with those of human analysis validated the extracted topics. Practically, the results provide insights into adopting mobile patient portals, revealing opportunities for improvement and to enhance the design of current basic portals. Theoretically, the findings inform the social-technical systems and Task-Technology Fit theories in the healthcare field and emphasize important healthcare structural and social aspects. Further, findings inform the humanization of healthcare framework, support the results of existing studies, and introduce new important design dimensions (i.e., aspects) that influence patient satisfaction and adherence to patient portal.
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Affiliation(s)
| | - Cherie Noteboom
- College of Business & Information Systems, Dakota State University, Madison, SD, USA
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21
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Waterman AD, Wood EH, Ranasinghe ON, Faye Lipsey A, Anderson C, Balliet W, Holland-Carter L, Maurer S, Aurora Posadas Salas M. A Digital Library for Increasing Awareness About Living Donor Kidney Transplants: Formative Study. JMIR Form Res 2020; 4:e17441. [PMID: 32480362 PMCID: PMC7404010 DOI: 10.2196/17441] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background It is not common for people to come across a living kidney donor, let alone consider whether they would ever donate a kidney themselves while they are alive. Narrative storytelling, the sharing of first-person narratives based on lived experience, may be an important way to improve education about living donor kidney transplants (LDKTs). Developing ways to easily standardize and disseminate diverse living donor stories using digital technology could inspire more people to consider becoming living donors and reduce the kidney shortage nationally. Objective This paper aimed to describe the development of the Living Donation Storytelling Project, a web-based digital library of living donation narratives from multiple audiences using video capture technology. Specifically, we aimed to describe the theoretical foundation and development of the library, a protocol to capture diverse storytellers, the characteristics and experiences of participating storytellers, and the frequency with which any ethical concerns about the content being shared emerged. Methods This study invited kidney transplant recipients who had received LDKTs, living donors, family members, and patients seeking LDKTs to record personal stories using video capture technology by answering a series of guided prompts on their computer or smartphone and answering questions about their filming experience. The digital software automatically spliced responses to open-ended prompts, creating a seamless story available for uploading to a web-based library and posting to social media. Each story was reviewed by a transplant professional for the disclosure of protected health information (PHI), pressuring others to donate, and medical inaccuracies. Disclosures were edited. Results This study recruited diverse storytellers through social media, support groups, churches, and transplant programs. Of the 137 storytellers who completed the postsurvey, 105/137 (76.6%) were white and 99/137 (72.2%) were female. They spent 62.5 min, on average, recording their story, with a final median story length of 10 min (00:46 seconds to 32:16 min). A total of 94.8% (130/137) of storytellers were motivated by a desire to educate the public; 78.1% (107/137) were motivated to help more people become living donors; and 75.9% (104/137) were motivated to dispel myths. The ease of using the technology and telling their story varied, with the fear of being on film, emotional difficulty talking about their experiences, and some technological barriers being reported. PHI, most commonly surnames and transplant center names, was present in 62.9% (85/135) of stories and was edited out. Conclusions With appropriate sensitivity to ensure diverse recruitment, ethical review of content, and support for storytellers, web-based storytelling platforms may be a cost-effective and convenient way to further engage patients and increase the curiosity of the public in learning more about the possibility of becoming living donors.
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Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Terasaki Research Institute, Los Angeles, CA, United States
| | - Emily H Wood
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Omesh N Ranasinghe
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Crystal Anderson
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Wendy Balliet
- Medical University of South Carolina, Charleston, SC, United States
| | | | - Stacey Maurer
- Medical University of South Carolina, Charleston, SC, United States
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22
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Wildenbos GA, Jaspers M, Peute L. The equity paradox: older patients' participation in patient portal development. Int J Qual Health Care 2020; 31:793-797. [PMID: 30576454 DOI: 10.1093/intqhc/mzy245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/10/2018] [Accepted: 12/04/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE This paper reflects on ethical concerns to patient portals design and evaluation approaches and provides a comprehensive overview of methodological considerations to advance patient participation of older patients to patient portal research and development. REFLECTION Barriers to the use of current patient portals experienced by older patients are concentrated on access issues and difficulties with interpretation of medical content. As patient portals' functionalities are being expanded by means of co-creation and user-testing such barriers often remain unrecognized. A main challenge of these patient participation efforts is namely to include a variety of older patients; foremost autonomous patients seem to participate. By selecting autonomous participants in co-creation or user-testing, design solutions are proposed that specifically benefit the autonomy of that patient, whereas it does not do justice to values and interests of patients who are less independent and are confronted with a wider variety of use barriers. Consequently, there is a risk of widening the gap between those who can use and benefit from patient portals and those who cannot. To prevent this from happening, we propose three main methodological aspects to consider in co-creation and user-testing activities that aim to optimize patient portal functionalities. IMPLICATIONS We encourage policy makers and patient portal developers to use present-day's momentum to include older patients' abilities, needs and context in the decision-making and investments in further advancing patient portals. We further stimulate future research that aims to improve methods to overcome challenges of older patients' participation regarding design and evaluation of eHealth systems.
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Affiliation(s)
- Gaby Anne Wildenbos
- Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology (HIT-Lab), University of Amsterdam, Amsterdam UMC, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Postbus 22660, 1100 DD, Amsterdam, the Netherlands.,Amsterdam UMC, Department of Medical Informatics, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, Amsterdam UMC, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - Monique Jaspers
- Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology (HIT-Lab), University of Amsterdam, Amsterdam UMC, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Postbus 22660, 1100 DD, Amsterdam, the Netherlands.,Amsterdam UMC, Department of Medical Informatics, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, Amsterdam UMC, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - Linda Peute
- Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology (HIT-Lab), University of Amsterdam, Amsterdam UMC, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Postbus 22660, 1100 DD, Amsterdam, the Netherlands.,Amsterdam UMC, Department of Medical Informatics, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, Amsterdam UMC, Academisch Medisch Centrum, Meibergdreef 9, 1105 AZ, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
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23
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Fischer KI, De Faoite D, Rose M. Patient-reported outcomes feedback report for knee arthroplasty patients should present selective information in a simple design - findings of a qualitative study. J Patient Rep Outcomes 2020; 4:6. [PMID: 31965364 PMCID: PMC6973599 DOI: 10.1186/s41687-020-0173-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/10/2020] [Indexed: 02/06/2023] Open
Abstract
Background Technical innovation to assess patient-reported outcomes (PROs) facilitates their implementation in clinical practice. In particular, mobile applications (apps) allow PROs to be assessed outside of the clinical setting. A patient’s health status can be remotely monitored and evaluated after discharge, and their recovery process tracked. This is of particular interest for patients after knee arthroplasty, as the recovery phase after surgery usually takes place in an outpatient setting and requires a high level of patient engagement. Providing results of PRO assessments to patients in the form of a feedback report could increase patient engagement and may improve communication between health care professionals and patients. The aim of the study is to develop a PRO feedback report for mobile devices that is comprehensible and provides valuable information for patients after knee arthroplasty. Results In an iterative development process, our expert group developed two preliminary feedback reports (a text-based version and a graphical display) based on previous research results and practical experience. In a second step, we discussed these reports with orthopedic patients (n = 8) in terms of comprehensibility and value using semi-structured interviews and cognitive debriefing methods. Participants assessed the reports as informative, but had some difficulties in fully comprehending all of the information provided. Based on the feedback from patients, we modified both versions and reduced complexity to increase comprehensibility. Conclusions A PRO feedback report for patients for mobile app use has to take account of the heterogeneous user group, particularly demographics such as age and experience with mobile devices. Information should be presented in a simple way to be comprehensible and of value to patients. Technological advancements allow a simple default report to be set, something which enables patients interested in additional information to make customizations.
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Affiliation(s)
- Kathrin I Fischer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center of Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Berlin, Germany.
| | - Diarmuid De Faoite
- Smith & Nephew, Clinical Scientific and Medical Affairs, Global Clinical Strategy, Baar, Switzerland
| | - Matthias Rose
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center of Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Berlin, Germany.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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24
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Older adults' use of patient portals: Experiences, challenges, and suggestions shared through discussion board forums. Geriatr Nurs 2020; 41:387-393. [PMID: 31899003 DOI: 10.1016/j.gerinurse.2019.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 12/29/2022]
Abstract
Patient portals (PPs) are robust health IT programs that engage and empower patients in their care. Although PPs can benefit older adults who manage chronic conditions, their use of PPs have been largely overlooked and little training has been provided to them. Previously, our research team developed an older-adult-friendly Theory-based PP eLearning Program (T-PeP) and tested its impact on older adults with chronic conditions. As part of T-PeP, participants used discussion forums. The aim of this study was to explore older adults' experiences with using PPs, perceived impact of PP on their health, and suggestions for improvement through analysis of discussion posts. A total of 205 posts were subjected to content analysis. Findings from 10 major themes explained older adults' experiences with PPs and offered suggestions for vendors and healthcare organizations. As U.S. population is aging, older adults must be considered during the development and implementation of health IT programs.
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25
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Hockey K, Blackhall CA, Simmons DJ, MacMillan F, Simmons D. Wollondilly diabetes programme: Consumer evaluation of a pilot patient passport template. Aust J Rural Health 2019; 28:89-91. [PMID: 31782206 DOI: 10.1111/ajr.12580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 01/30/2023] Open
Affiliation(s)
- Kaitlyn Hockey
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | | | | | - Freya MacMillan
- School of Science and Health, Western Sydney University, Campbelltown, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia.,Diabetes Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia.,Diabetes Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, Australia
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26
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Sieverink F, Kelders S, Braakman-Jansen A, van Gemert-Pijnen J. Evaluating the implementation of a personal health record for chronic primary and secondary care: a mixed methods approach. BMC Med Inform Decis Mak 2019; 19:241. [PMID: 31775734 PMCID: PMC6882368 DOI: 10.1186/s12911-019-0969-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/06/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Personal health records (PHRs) provide the opportunity for self-management support, enhancing communication between patients and caregivers, and maintaining and/or improving the quality of chronic disease management. Their implementation is a multi-level and complex process, requiring a holistic approach that takes into account the technology, its users and the context of implementation. The aim of this research is to evaluate the fidelity of a PHR in chronic care (the degree to which it was implemented as intended) in order to explain the found effects. METHODS A convergent parallel mixed methods design was used, where qualitative and quantitative data were collected in parallel, analyzed separately, and finally merged. Log data of 536 users were used to gain insight into the actual long-term use of the PHR (the dose). Focus group meetings among caregivers (n = 13) were conducted to assess program differentiation (or intended use). Interviews with caregivers (n = 28) and usability tests with potential end-users (n = 13) of the PHR were used to understand the responsiveness and the differences and similarities between the intended and actual use of the PHR. RESULTS The results of the focus groups showed that services for coaching are strongly associated with monitoring health values and education. However, the PHR was not used that way during the study period. In the interviews, caregivers indicated that they were ignorant on how to deploy the PHR in current working routines. Therefore, they find it difficult to motivate their patients in using the PHR. Participants in the usability study indicate that they would value a PHR in the future, given that the usability will be improved and that the caregivers will use it in daily practice as well. CONCLUSIONS In this study, actual use of the PHRs by patients was influenced by the responsiveness of caregivers. This responsiveness is likely to be strongly influenced by the perceived support when defining the differentiation and delivery of the PHR. A mixed-methods approach to understand intervention fidelity was of added value in providing explanations for the found effects that could not be revealed by solely focusing on the effectiveness of the technology in an experimental trial.
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Affiliation(s)
- Floor Sieverink
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands.
| | - Saskia Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Annemarie Braakman-Jansen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
| | - Julia van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
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27
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Borg K, Boulet M, Smith L, Bragge P. Digital Inclusion & Health Communication: A Rapid Review of Literature. HEALTH COMMUNICATION 2019; 34:1320-1328. [PMID: 29889560 DOI: 10.1080/10410236.2018.1485077] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Information and communication technologies can be a valuable tool for enhancing health communication. However, not everyone is utilising the wide suite of digital opportunities. This disparity has the potential to exacerbate existing social and health inequalities, particularly among vulnerable groups such as those who are in poor health and the elderly. This review aimed to systematically identify the common barriers to, and facilitators of, digital inclusion. A comprehensive database search yielded 969 citations. Following screening, seven systematic reviews and three non-systematic reviews were identified. Collectively, the reviews found that physical access continues to be a barrier to digital inclusion. However, provision of access alone is insufficient, as digital ability and attitude were also potential barriers. Social support, direct user experience and collaborative learning/design were identified as key strategies to improve inclusion. These review findings provide guidance for health communication practitioners in designing and implementing effective programmes in the digital environment.
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Affiliation(s)
- Kim Borg
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University
| | - Mark Boulet
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University
| | - Liam Smith
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University
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McCleary NJ, Greenberg TL, Barysauskas CM, Guerette EJ, Hassan M, Jacobson JO, Schrag D. Oncology Patient Portal Enrollment at a Comprehensive Cancer Center: A Quality Improvement Initiative. J Oncol Pract 2019; 14:e451-e461. [PMID: 30096276 DOI: 10.1200/jop.17.00008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Patient portals (PPs) provide patients access to their electronic health record and may facilitate active engagement in their care. Because PP use has not been well studied among patients with cancer, we sought to: understand the willingness of patients with cancer to use the PP, identify barriers to PP use, and improve PP accessibility. MATERIALS AND METHODS As part of an institutional quality improvement initiative, we used a stakeholder-driven approach to examine PP use at the Dana-Farber Cancer Institute (Boston, MA). We conducted a survey across all ambulatory oncology practices as well as staff and patient focus groups in one ambulatory practice. We deployed three interventions to address barriers: staff education, staff-assisted enrollment support, and independent enrollment support. RESULTS In October 2015, 1,019 (87%) of 1,178 eligible patients completed the survey (PP enrolled, 57%; non-PP enrolled, 43%). PP-enrolled patients reported reviewing test results and appointment schedules. Non-PP-enrolled patients cited difficult PP enrollment, lack of computer access, and concern about sharing data electronically as barriers to PP enrollment. Focus groups (staff, n = 20; patient representatives, n = 5) also identified lack of awareness of PP benefits as a barrier. The interventions, deployed from November to December 2015, increased PP enrollment from 47% to 53% by January 2016. CONCLUSION Patients with cancer want to communicate with their team through the PP, but barriers to enrollment impede use. Straightforward system-level interventions may increase enrollment. Further work is necessary to ascertain the degree to which increased PP enrollment leads to greater engagement and better outcomes.
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Affiliation(s)
- Nadine J McCleary
- Dana-Farber/Partners Cancer Care; and Dana-Farber Cancer Institute, Boston, MA
| | - Teresa L Greenberg
- Dana-Farber/Partners Cancer Care; and Dana-Farber Cancer Institute, Boston, MA
| | | | - Elissa J Guerette
- Dana-Farber/Partners Cancer Care; and Dana-Farber Cancer Institute, Boston, MA
| | - Malyun Hassan
- Dana-Farber/Partners Cancer Care; and Dana-Farber Cancer Institute, Boston, MA
| | - Joseph O Jacobson
- Dana-Farber/Partners Cancer Care; and Dana-Farber Cancer Institute, Boston, MA
| | - Deborah Schrag
- Dana-Farber/Partners Cancer Care; and Dana-Farber Cancer Institute, Boston, MA
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Vreugdenhil MMT, Ranke S, de Man Y, Haan MM, Kool RB. Patient and Health Care Provider Experiences With a Recently Introduced Patient Portal in an Academic Hospital in the Netherlands: Mixed Methods Study. J Med Internet Res 2019; 21:13743. [PMID: 31432782 PMCID: PMC6788335 DOI: 10.2196/13743] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/14/2019] [Accepted: 06/29/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the Netherlands, the health care system and related information technology landscape are fragmented. Recently, hospitals have started to launch patient portals. It is not clear how these portals are used by patients and their health care providers (HCPs). OBJECTIVE The objective of this study was to explore the adoption, use, usability, and usefulness of a recently introduced patient portal in an academic hospital to learn lessons for the implementation of patient portals in a fragmented health care system. METHODS A mixed methods study design was used. In the quantitative study arm, characteristics of patients who used the portal were analyzed, in addition to the utilization of the different functionalities of the portal. In the qualitative study arms, think-aloud observations were made to explore usability. Focus group discussions were conducted among patients and HCPs of the dermatology and ophthalmology outpatient departments. Thematic content analysis of qualitative data was carried out and overarching themes were identified using a framework analysis. RESULTS One year after the introduction of the portal, 24,514 patients, 13.49% of all patients who visited the hospital, had logged in to the portal. Adoption of the portal was associated with the age group 45 to 75 years, a higher socioeconomic status, and having at least one medical diagnosis. Overarching themes from the qualitative analyses were (1) usability and user-friendliness of the portal, (2) HCP-patient communication through the portal, (3) usefulness of the information that can be accessed through the portal, (4) integration of the portal in care and work processes, and (5) HCP and patient roles and relationships. CONCLUSIONS One year after the introduction of the patient portal, patients and HCPs who used the portal recognized the potential of the portal to engage patients in their care processes, facilitate patient-HCP communication, and increase patient convenience. Uncertainties among patients and HCPs about how to use the messaging functionality and limited integration of the portal in care and work processes are likely to have limited portal use and usefulness.
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Affiliation(s)
| | - Sander Ranke
- IQ healthcare, Radboudumc, Nijmegen, Netherlands
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Antonio MG, Petrovskaya O, Lau F. Is research on patient portals attuned to health equity? A scoping review. J Am Med Inform Assoc 2019; 26:871-883. [PMID: 31066893 PMCID: PMC7647227 DOI: 10.1093/jamia/ocz054] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Our scoping review examined how research on patient portals addresses health equity. Questions guiding our review were: 1) What health equity concepts are addressed in patient portal research-both explicitly and implicitly? 2) What are the gaps? 3) Is the potential for ehealth-related health inequities explicitly acknowledged in studies on patient portals? 4) What novel approaches and interventions to reduce health inequities are tested in patient portal research? MATERIALS AND METHODS We searched 4 databases. Search terms included "patient portal" in combination with a comprehensive list of health equity terms relevant in ehealth context. Authors independently reviewed the papers during initial screening and full-text review. We applied the eHealth Equity Framework to develop search terms and analyze the included studies. RESULTS Based on eHealth Equity Framework categories, the main findings generated from 65 reviewed papers were governance structures, ehealth policies, and cultural and societal values may further inequities; social position of providers and patients introduces differential preferences in portal use; equitable portal implementation can be supported through diverse user-centered design; and intermediary strategies are typically recommended to encourage portal use across populations. DISCUSSION The predominant focus on barriers in portal use may be inadvertently placing individual responsibility in addressing these barriers on patients already experiencing the greatest health disparities. This approach may mask the impact of the socio-technical-economic-political context on outcomes for different populations. CONCLUSION To support equitable health outcomes related to patient portals we need to look beyond intermediary initiatives and develop equitable strategies across policy, practice, research, and implementation.
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Affiliation(s)
- Marcy G Antonio
- Schools of Health Information Science and Nursing, Victoria, British Columbia, Canada
| | - Olga Petrovskaya
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Francis Lau
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
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Zhou L, DeAlmeida D, Parmanto B. Applying a User-Centered Approach to Building a Mobile Personal Health Record App: Development and Usability Study. JMIR Mhealth Uhealth 2019; 7:e13194. [PMID: 31278732 PMCID: PMC6640070 DOI: 10.2196/13194] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/20/2019] [Accepted: 05/30/2019] [Indexed: 12/29/2022] Open
Abstract
Background A personal health record (PHR) system encourages patients to engage with their own health care by giving them the ability to manage and keep track of their own health data. Of the numerous PHR systems available in the market, many are Web-based patient portals and a few are mobile apps. They have mainly been created by hospitals and electronic health record (EHR) vendors. One major limitation of these hospital-created PHR systems is that patients can only view specific health data extracted from their EHR. Patients do not have the freedom to add important personal health data they collect in their daily lives into their PHR. Therefore, there is an information gap between clinical visits. Objective The aim of this study was to develop and evaluate a new mobile PHR app that can be easily used to manage various types of personal health data to fill the information gap. Methods A user-centered approach was used to guide the development and evaluation of the new mobile PHR app. There were three steps in this study: needs assessment, app design and development, and conducting a usability study. First, a large-scale questionnaire study was conducted with the general population to gain an understanding of their needs and expectations with regard to a mobile PHR app. A mobile PHR app for personal medical data tracking and management was then created based on the results of the questionnaire study. End users were actively involved in all stages of the app development. Finally, a usability study was performed with participants to evaluate the usability of the mobile PHR app, which involved asking participants to finish a set of tasks and to respond to a usability questionnaire. Results In the questionnaire study for needs assessment, there were 609 participants in total. The answers from these participants revealed that they wanted to manage various types of personal health data in a mobile PHR app. Participants also reported some features they desired to have in the app. On the basis of the needs assessment findings, a new mobile PHR app (PittPHR) was created with 6 major modules: health records, history, trackers, contacts, appointments, and resources. This app allows users to customize the trackers according to their needs. In the usability study, there were 15 participants. The usability study participants expressed satisfaction with the app and provided comments and suggestions for further development. Conclusions This new mobile PHR app provides options for users to manage a wide range of personal health data conveniently in one place. The app fills the information gap between clinical visits. The study results indicated that this new mobile PHR app meets the need of users and that users welcome this app.
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Affiliation(s)
- Leming Zhou
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dilhari DeAlmeida
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bambang Parmanto
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
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Hackett C, Brennan K, Smith Fowler H, Leaver C. Valuing Citizen Access to Digital Health Services: Applied Value-Based Outcomes in the Canadian Context and Tools for Modernizing Health Systems. J Med Internet Res 2019; 21:e12277. [PMID: 31172965 PMCID: PMC6592482 DOI: 10.2196/12277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/12/2019] [Accepted: 04/02/2019] [Indexed: 12/27/2022] Open
Abstract
Background In publicly funded health systems, digital health technologies are strategies that aim to improve the quality and safety of health care service delivery and enhance patient experiences and outcomes. In Canada, governments and health organizations have invested in digital health technologies such as personal health records (PHRs) and other electronic service functionalities and innovation across provincial and territorial health systems. Objective Patients’ access to their own information via secure, Web-based PHRs and integrated virtual care services are promising mechanisms for supporting patient engagement in health care. We draw on current evidence to develop an economic model that estimates the demonstrated and potential value of these digital health initiatives. Methods We first synthesized results from a variety of Canadian and international studies on the outcomes for patients and service providers associated with PHRs across a continuum of services, ranging from viewing information (eg, laboratory results) on the Web to electronic prescription renewal to email or video conferencing with care teams and providers. We then developed a quantitative model of estimated value, grounded in these demonstrated benefits and citizen use (2016-2017). In addition to estimating the costs saved from patient and system perspectives, we used a novel application of a compensating differential approach to assess the value (independent of costs) to society of improved health and well-being resulting from PHR use. Results Patients’ access to a range of digital PHR functions generated value for Canadians and health systems by increasing health system productivity, and improving access to and quality of health care provided. As opportunities increased to interact and engage with health care providers via PHR functions, the marginal value generated by utilization of PHR functionalities also increased. Web-based prescription renewal generated the largest share of the total current value from the patient perspective. From the health systems perspective, Canadians’ ability to view their information on the Web was the largest value share. If PHRs were to be implemented with more integrated virtual care services, the value generated from populations with chronic illnesses such as severe and persistent mental illness and diabetes could amount to between Can $800 million and Can $1 billion per year across Canadian health systems. Conclusions PHRs with higher interactivity could yield substantial potential value from wider implementation in Canada and increased adoption rates in certain target groups—namely, high-frequency health system users and their caregivers. Further research is needed to tie PHR use to health outcomes across PHR functions, care settings, and patient populations.
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Affiliation(s)
| | - Kelsey Brennan
- Social Research and Demonstration Corporation, Ottawa, ON, Canada
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Abd-alrazaq AA, Bewick BM, Farragher T, Gardner P. Factors that affect the use of electronic personal health records among patients: A systematic review. Int J Med Inform 2019; 126:164-175. [DOI: 10.1016/j.ijmedinf.2019.03.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/14/2018] [Accepted: 03/21/2019] [Indexed: 12/14/2022]
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Malik FS, Panlasigui N, Gritton J, Gill H, Yi-Frazier JP, Moreno MA. Adolescent Perspectives on the Use of Social Media to Support Type 1 Diabetes Management: Focus Group Study. J Med Internet Res 2019; 21:e12149. [PMID: 31199310 PMCID: PMC6592493 DOI: 10.2196/12149] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/23/2018] [Accepted: 03/29/2019] [Indexed: 01/08/2023] Open
Abstract
Background A majority of adolescents report the use of some form of social media, and many prefer to communicate via social networking sites. Social media may offer new opportunities in diabetes management, particularly in terms of how health care teams provide tailored support and treatment to adolescents with diabetes. Objective The aim of this study was to explore the experiences and perspectives of adolescents with type 1 diabetes on the feasibility of social media use as a tool to collaboratively manage their diabetes with their diabetes care team. Methods Focus groups of adolescents with type 1 diabetes were conducted in the Seattle metropolitan area in Washington State. Semistructured questions were used to elicit views around the preferred means of communication with the adolescents’ diabetes care team, how to best support diabetes self-management, and how social media could be used outside of the clinic setting by the diabetes care team to engage with adolescents with type 1 diabetes. Focus groups were audio recorded and transcribed verbatim. Qualitative content analysis was carried out, and emergent themes were subsequently mapped onto 4 domains of feasibility, which included acceptability, demand, implementation, and practicality. Results Participants included 45 adolescents with type 1 diabetes (mean age 15.9, SD 1.7 years; 58% male; diabetes duration mean 6.2, SD 3.6 years; 76% on insulin pumps; 49% wore continuous glucose monitors; 93% reported use of social media; 84% used smartphones as the primary means for social media access). A total of 7 major topics were identified and mapped onto areas consistent with our focus on feasibility. For acceptability and demand, participants expressed how communication over social media could help facilitate (1) improved communication outside of clinic visits to optimize diabetes management, (2) independence in diabetes self-management, (3) connection to other youth with diabetes for additional diabetes support, and (4) delivery of more timely and personalized care. Addressing implementation and practicality, participants shared the need to (1) ensure patient privacy, (2) maintain professional nature of provider-patient relationship, and (3) recognize that social media is not currently used for medical care by youth with diabetes. Conclusions Adolescents with type 1 diabetes expressed interest in the use of social media as a tool to support diabetes management and increase engagement with their diabetes care team. Specific implementation measures around privacy and professionalism should be considered when developing a social media intervention to facilitate communication between adolescents and care teams.
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Affiliation(s)
- Faisal S Malik
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Washington, Seattle, WA, United States.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Neil Panlasigui
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Jesse Gritton
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Harsimrat Gill
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Megan A Moreno
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
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Defining High Value Elements for Reducing Cost and Utilization in Patient-Centered Medical Homes for the TOPMED Trial. EGEMS 2019; 7:20. [PMID: 31106226 PMCID: PMC6498873 DOI: 10.5334/egems.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Like most patient-centered medical home (PCMH) models, Oregon’s program, the Patient-Centered Primary Care Home (PCPCH), aims to improve care while reducing costs; however, previous work shows that PCMH models do not uniformly achieve desired outcomes. Our objective was to describe a process for refining PCMH models to identify high value elements (HVEs) that reduce cost and utilization. Methods: We performed a targeted literature review of each PCPCH core attribute. Value-related concepts and their metrics were abstracted, and studies were assessed for relevance and strength of evidence. Focus groups were held with stakeholders and patients, and themes related to each attribute were identified; calculation of HVE attainment versus PCPCH criteria were completed on eight primary care clinics. Analyses consisted of descriptive statistics and criterion validity with stakeholder input. Results: 2,126 abstracts were reviewed; 22 met inclusion criteria. From these articles and focus groups of stakeholders/experts (n = 49; 4 groups) and patients (n = 7; 1 group), 12 HVEs were identified that may reduce cost and utilization. At baseline, clinics achieved, on average, 31.3 percent HVE levels compared to an average of 87.9 percent of the 35 PCMH measures. Discussion: A subset of measures from the PCPCH model were identified as “high value” in reducing cost and utilization. HVE performance was significantly lower than standard measures, and may better calibrate clinic ability to reduce costs. Conclusion: Through literature review and stakeholder engagement, we created a novel set of high value elements for advanced primary care likely to be more related to cost and utilization than other models.
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Abstract
INTRODUCTION Over the last two decades, patient portals have emerged as a noticeable eHealth strategy. To date, research on patient portals has been rapidly increasing. Our umbrella review aims to provide a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews (SRs). METHODS We will employ a modified version of the Joanna Briggs Institute umbrella review method. The search strategy encompasses multiple databases. The inclusion criterion is specific to SRs focused on patient portal. Patients or public were not involved in this work. ANALYSIS Two researchers will independently screen titles/abstracts and then full-text articles against the inclusion/exclusion criteria. Methodological quality of included reviews will be assessed and data will be extracted from the final selection of reviews. These reviews will be categorised into quantitative, qualitative and/or mixed-synthesis groups based on information about the design of primary studies provided in the reviews. Correspondingly, we will create quantitative, qualitative and/or mixed-synthesis Excel data-extraction tables. Within each table, data will be extracted with the reference to primary studies as reported in the reviews, and will be synthesised into themes and then a smaller number of findings/outcomes. Modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Confidence in the Evidence from Reviews of Qualitative research (CERQual) tools will be applied to assess the strength of evidence at the level of each finding/outcome. The output of our umbrella review will consist of summary of findings tables and evidence profile tables. A narrative meta-level synthesis will be provided. We will use the clinical adoption meta-model as an organising framework. ETHICS AND DISSEMINATION As an outcome of this review, we will create a guidance and roadmap to be used in a future Delphi study to gather feedback from Canadian eHealth stakeholders. We will also present at conferences and publish the final report. The umbrella review does not require ethical approval. PROSPERO REGISTRATION NUMBER CRD42018096657.
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Affiliation(s)
- Olga Petrovskaya
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Francis Lau
- School of Health Information Science, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
| | - Marcy Antonio
- School of Health Information Science, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
- School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
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Poduval S, Ahmed S, Marston L, Hamilton F, Murray E. Crossing the Digital Divide in Online Self-Management Support: Analysis of Usage Data From HeLP-Diabetes. JMIR Diabetes 2018; 3:e10925. [PMID: 30522988 PMCID: PMC6303008 DOI: 10.2196/10925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/02/2018] [Accepted: 08/14/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Digital health is increasingly recognized as a cost-effective means to support patient self-care. However, there are concerns about whether the "digital divide," defined as the gap between those who do and do not make regular use of digital technologies, will lead to increased health inequalities. Access to the internet, computer literacy, motivation to use digital health interventions, and fears about internet security are barriers to use of digital health interventions. Some of these barriers disproportionately affect people of older age, black or minority ethnic background, and low socioeconomic status. HeLP-Diabetes (Healthy Living for People with type 2 Diabetes), a theoretically informed online self-management program for adults with type 2 diabetes, was developed to meet the needs of people from a broad demographic background. OBJECTIVE This study aimed to determine whether there was evidence of a digital divide when HeLP-Diabetes was integrated into routine care. This was achieved by (1) comparing the characteristics of people who registered for the program against the target population (people with type 2 diabetes in inner London), (2) comparing the characteristics of people who registered for the program and used it with those who did not use it, and (3) comparing sections of the website visited by different demographic groups. METHODS A retrospective analysis of data on the use of HeLP-Diabetes in routine clinical practice in 4 inner London clinical commissioning groups was undertaken. Data were collected from patients who registered for the program as part of routine health services.. Data on gender, age, ethnicity, and educational attainment were collected at registration, and data on webpage visits (user identification number, date, time, and page visited) were collected automatically by software on the server side of the website. RESULTS The characteristics of people who registered for the program were found to reflect those of the target population. The mean age was 58.4 years (SD=28.0), over 50.0% were from black and minority ethnic backgrounds, and nearly a third (29.8%) had no qualifications beyond school leaving age. There was no association between demographic characteristics and use of the program, apart from weak evidence of less use by the mixed ethnicity group. There was no evidence of the differential use of the program by any demographic group, apart from weak evidence for people with degrees and school leavers being more likely to use the "Living and working with diabetes" (P=.03) and "Treating diabetes" (P=.04) sections of the website. CONCLUSIONS This study is one of the first to provide evidence that a digital health intervention can be integrated into routine health services without widening health inequalities. The relative success of the intervention may be attributed to integration into routine health care, and careful design with extensive user input and consideration of literacy levels. Developers of digital health interventions need to acknowledge barriers to access and use, and collect data on the demographic profile of users, to address inequalities.
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Affiliation(s)
- Shoba Poduval
- eHealth Unit, Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Saddif Ahmed
- eHealth Unit, Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Louise Marston
- eHealth Unit, Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Fiona Hamilton
- eHealth Unit, Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Elizabeth Murray
- eHealth Unit, Department of Primary Care & Population Health, University College London, London, United Kingdom
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Nahm ES, Zhu S, Bellantoni M, Keldsen L, Russomanno V, Rietschel M, Majid T, Son H, Smith L. The Effects of a Theory-Based Patient Portal e-Learning Program for Older Adults with Chronic Illnesses. Telemed J E Health 2018; 25:940-951. [PMID: 30431393 DOI: 10.1089/tmj.2018.0184] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Introduction: The high prevalence of chronic illnesses is a serious public health problem in the United States, and more than 70 million older adults have at least one chronic illness. Patient portals (PPs) have an excellent potential to assist older adults in managing chronic illnesses; however, older adults' PP adoption rates have been low. Lack of support for older adults using PPs remains a critical gap in most implementation processes. The main aim of this study was to assess the impact of an older adult friendly Theory-based Patient portal e-Learning Program (T-PeP) on PP knowledge, selected health outcomes (health decision-making self-efficacy [SE] and health communication), PP SE and use, and e-health literacy in older adults. Materials and Methods: A two-arm randomized controlled trial was conducted with older adults (N = 272) who had chronic conditions. Participants were recruited online, and data were collected at baseline, 3 weeks, and 4 months. The main intervention effects were tested using linear mixed models. Results: The average age of participants was 70.0 ± 8.5 years, and 78.3% (n = 213) were white. At 3 weeks, the intervention group showed significantly greater improvement than the control group in all outcomes except PP use. At 4 months, the intervention effects decreased, but PP SE remained significant (p = 0.015), and the intervention group showed higher frequency of PP use than the control group (p = 0.029). Conclusion: The study findings showed that the T-PeP was effective in improving selected health and PP usage outcomes. Further studies are needed to test the long-term effects of T-PeP using more diverse samples.
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Affiliation(s)
- Eun-Shim Nahm
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Shijun Zhu
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Michele Bellantoni
- Division of Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Linda Keldsen
- Veterans Health Education, Nursing Affiliations & My HealtheVet, VA Maryland Health Care System, Baltimore, Maryland
| | - Vince Russomanno
- eHealth Initiatives, University of Maryland Medical System, Baltimore, Maryland
| | - Matt Rietschel
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | | | - HyoJin Son
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
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Underserved Pregnant and Postpartum Women's Access and Use of Their Health Records. MCN Am J Matern Child Nurs 2018; 43:164-170. [PMID: 29702506 DOI: 10.1097/nmc.0000000000000432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this study was to examine knowledge of and experiences with use of their electronic health record (EHR) among mostly Hispanic women during pregnancy and postpartum. METHODS Women who were in the MOMS Orange County prenatal or postpartum home visitation program completed surveys and participated in focus groups. Descriptive and content analyses were used. RESULTS Twenty-six women participated. Nearly all women (24, 92.3%) knew what health records were and most (80.8%) felt that keeping their records would increase or greatly increase their confidence in caring for themselves and their families. Approximately one third reported already keeping a copy of their health records. Common barriers to accessing and understanding health records included healthcare providers' noncompliance with the Health Information Technology for Economic and Clinical Health Act, limited EHR adoption, unfriendly patient portals, complicated medical terminology, rushed appointments with healthcare providers, lack of Spanish interpreters, and lack of Spanish-speaking healthcare providers. CLINICAL IMPLICATIONS Programs are needed to educate and support women and providers in using health records to promote health literacy, pregnancy management, and patient-provider relationships in underserved populations.
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Martinez W, Threatt AL, Rosenbloom ST, Wallston KA, Hickson GB, Elasy TA. A Patient-Facing Diabetes Dashboard Embedded in a Patient Web Portal: Design Sprint and Usability Testing. JMIR Hum Factors 2018; 5:e26. [PMID: 30249579 PMCID: PMC6231745 DOI: 10.2196/humanfactors.9569] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 12/13/2022] Open
Abstract
Background Health apps and Web-based interventions designed for patients with diabetes offer novel and scalable approaches to engage patients and improve outcomes. However, careful attention to the design and usability of these apps and Web-based interventions is essential to reduce the barriers to engagement and maximize use. Objective The aim of this study was to apply design sprint methodology paired with mixed-methods, task-based usability testing to design and evaluate an innovative, patient-facing diabetes dashboard embedded in an existing patient portal and integrated into an electronic health record. Methods We applied a 5-day design sprint methodology developed by Google Ventures (Alphabet Inc, Mountain View, CA) to create our initial dashboard prototype. We identified recommended strategies from the literature for using patient-facing technologies to enhance patient activation and designed a dashboard functionality to match each strategy. We then conducted a mixed-methods, task-based usability assessment of dashboard prototypes with individual patients. Measures included validated metrics of task performance on 5 common and standardized tasks, semistructured interviews, and a validated usability satisfaction questionnaire. After each round of usability testing, we revised the dashboard prototype in response to usability findings before the next round of testing until the majority of participants successfully completed tasks, expressed high satisfaction, and identified no new usability concerns (ie, stop criterion was met). Results The sample (N=14) comprised 5 patients in round 1, 3 patients in round 2, and 6 patients in round 3, at which point we reached our stop criterion. The participants’ mean age was 63 years (range 45-78 years), 57% (8/14) were female, and 50% (7/14) were white. Our design sprint yielded an initial patient-facing diabetes dashboard prototype that displayed and summarized 5 measures of patients’ diabetes health status (eg, hemoglobin A1c). The dashboard used graphics to visualize and summarize health data and reinforce understanding, incorporated motivational strategies (eg, social comparisons and gamification), and provided educational resources and secure-messaging capability. More than 80% of participants were able to successfully complete all 5 tasks using the final prototype. Interviews revealed usability concerns with design, the efficiency of use, and content and terminology, which led to improvements. Overall satisfaction (0=worst and 7=best) improved from the initial to the final prototype (mean 5.8, SD 0.4 vs mean 6.7, SD 0.5). Conclusions Our results demonstrate the utility of the design sprint methodology paired with mixed-methods, task-based usability testing to efficiently and effectively design a patient-facing, Web-based diabetes dashboard that is satisfying for patients to use.
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Affiliation(s)
- William Martinez
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anthony L Threatt
- Health Information Technology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - S Trent Rosenbloom
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Gerald B Hickson
- Quality, Safety & Risk Prevention, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tom A Elasy
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
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Manias E, Gray K, Wickramasinghe N, Manojlovich M. Using electronic medical records to create big data and to communicate with patients—Is there room for both? Collegian 2018. [DOI: 10.1016/j.colegn.2018.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Lockwood MB, Dunn-Lopez K, Pauls H, Burke L, Shah SD, Saunders MA. If you build it, they may not come: modifiable barriers to patient portal use among pre- and post-kidney transplant patients. JAMIA Open 2018; 1:255-264. [PMID: 31984337 PMCID: PMC6951926 DOI: 10.1093/jamiaopen/ooy024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/11/2018] [Accepted: 06/05/2018] [Indexed: 12/19/2022] Open
Abstract
Background Patient access to health information using electronic patient portals is increasingly common. Portal use has the potential to improve patients’ engagement with their health and is particularly important for patients with chronic illness; however, patients’ abilities, attitudes, and use of portals are poorly understood. Methods A single-center, cross-sectional survey was conducted of 240 consecutive pre- and post-kidney transplant patients of all levels of technological proficiency who presented to an urban transplant center in the United States. The investigator-developed Patient Information and Technology Assessment-Patient Portal was used to assess patients’ attitudes towards the use of patient portals. Results Most patients surveyed did not use the patient portal (n = 176, 73%). Patients were more likely to use the patient portal if they were White, highly educated, in the post-transplant period, more comfortable with technology, and reported being a frequent internet user (P < .05). The most common reasons for not using the patient portal included: (1) preference for traditional communication, (2) not being aware of the portal, (3) low technological proficiency, and (4) poor interoperability between the portal at the transplant center and the patient’s primary care center. Conclusions We identified several modifiable barriers to patient portal use. Some barriers can be addressed by patient education and training on portal use, and federal initiatives are underway to improve interoperability; however, a preference for traditional communications represents the most prominent barrier. Additional strategies are needed to improve portal adoption by encouraging acceptance of technologies as a way of clinical communication.
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Affiliation(s)
- Mark B Lockwood
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA
| | - Karen Dunn-Lopez
- Department of Health Systems Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA
| | - Heather Pauls
- Office of Research Facilitation, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA
| | - Larisa Burke
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois, USA
| | - Sachin D Shah
- Departments of Medicine and Pediatrics, University of Chicago Medicine, Chicago, Illinois, USA
| | - Milda A Saunders
- General Internal Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
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43
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Zanaboni P, Ngangue P, Mbemba GIC, Schopf TR, Bergmo TS, Gagnon MP. Methods to Evaluate the Effects of Internet-Based Digital Health Interventions for Citizens: Systematic Review of Reviews. J Med Internet Res 2018; 20:e10202. [PMID: 29880470 PMCID: PMC6013714 DOI: 10.2196/10202] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/27/2018] [Accepted: 05/15/2018] [Indexed: 01/08/2023] Open
Abstract
Background Digital health can empower citizens to manage their health and address health care system problems including poor access, uncoordinated care and increasing costs. Digital health interventions are typically complex interventions. Therefore, evaluations present methodological challenges. Objective The objective of this study was to provide a systematic overview of the methods used to evaluate the effects of internet-based digital health interventions for citizens. Three research questions were addressed to explore methods regarding approaches (study design), effects and indicators. Methods We conducted a systematic review of reviews of the methods used to measure the effects of internet-based digital health interventions for citizens. The protocol was developed a priori according to Preferred Reporting Items for Systematic review and Meta-Analysis Protocols and the Cochrane Collaboration methodology for overviews of reviews. Qualitative, mixed-method, and quantitative reviews published in English or French from January 2010 to October 2016 were included. We searched for published reviews in PubMed, EMBASE, The Cochrane Database of Systematic Reviews, CINHAL and Epistemonikos. We categorized the findings based on a thematic analysis of the reviews structured around study designs, indicators, types of interventions, effects and perspectives. Results A total of 20 unique reviews were included. The most common digital health interventions for citizens were patient portals and patients' access to electronic health records, covered by 10/20 (50%) and 6/20 (30%) reviews, respectively. Quantitative approaches to study design included observational study (15/20 reviews, 75%), randomized controlled trial (13/20 reviews, 65%), quasi-experimental design (9/20 reviews, 45%), and pre-post studies (6/20 reviews, 30%). Qualitative studies or mixed methods were reported in 13/20 (65%) reviews. Five main categories of effects were identified: (1) health and clinical outcomes, (2) psychological and behavioral outcomes, (3) health care utilization, (4) system adoption and use, and (5) system attributes. Health and clinical outcomes were measured with both general indicators and disease-specific indicators and reported in 11/20 (55%) reviews. Patient-provider communication and patient satisfaction were the most investigated psychological and behavioral outcomes, reported in 13/20 (65%) and 12/20 (60%) reviews, respectively. Evaluation of health care utilization was included in 8/20 (40%) reviews, most of which focused on the economic effects on the health care system. Conclusions Although observational studies and surveys have provided evidence of benefits and satisfaction for patients, there is still little reliable evidence from randomized controlled trials of improved health outcomes. Future evaluations of digital health interventions for citizens should focus on specific populations or chronic conditions which are more likely to achieve clinically meaningful benefits and use high-quality approaches such as randomized controlled trials. Implementation research methods should also be considered. We identified a wide range of effects and indicators, most of which focused on patients as main end users. Implications for providers and the health system should also be included in evaluations or monitoring of digital health interventions.
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Patrice Ngangue
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, QC, Canada
| | | | - Thomas Roger Schopf
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Trine Strand Bergmo
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Marie-Pierre Gagnon
- Research Center of the CHU de Québec-Université Laval, Québec, QC, Canada.,Faculty of Nursing Sciences, Université Laval, Québec, QC, Canada
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44
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Nahm ES, Zhu S, Bellantoni M, Keldsen L, Charters K, Russomanno V, Rietschel M, Son H, Smith L. Patient Portal Use Among Older Adults: What Is Really Happening Nationwide? J Appl Gerontol 2018; 39:442-450. [PMID: 29779422 DOI: 10.1177/0733464818776125] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patient portals (PPs), secure websites that allow patients to access their electronic health records and other health tools, can benefit older adults managing chronic conditions. However, studies have shown a lack of PP use in older adults. Little is known about the way they use PPs in community settings and specific challenges they encounter. The aim of this study was to examine the current state of PP use in older adults, employing baseline data (quantitative and qualitative) from an ongoing nationwide online trial. The dataset includes 272 older adults (mean age, 70.0 years [50-92]) with chronic conditions. Findings showed that the majority of participants (71.3%) were using one or more PPs, but in limited ways. Their comments revealed practical difficulties with managing PPs, perceived benefits, and suggestions for improvement. Further studies with different older adult groups (e.g., clinic patients) will help develop and disseminate more usable PPs for these individuals.
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Affiliation(s)
- Eun-Shim Nahm
- University of Maryland School of Nursing, Baltimore, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, USA
| | | | | | | | | | - Matt Rietschel
- University of Maryland School of Nursing, Baltimore, USA
| | - HyoJin Son
- University of Maryland School of Nursing, Baltimore, USA
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Kooij L, Groen WG, van Harten WH. Barriers and Facilitators Affecting Patient Portal Implementation from an Organizational Perspective: Qualitative Study. J Med Internet Res 2018; 20:e183. [PMID: 29752253 PMCID: PMC5970285 DOI: 10.2196/jmir.8989] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/28/2018] [Accepted: 03/19/2018] [Indexed: 12/30/2022] Open
Abstract
Background The number of patient portals is rising, and although portals can have positive effects, their implementation has major impacts on the providing health care institutions. However, little is known about the organizational factors affecting successful implementation. Knowledge of the specific barriers to and facilitators of various stakeholders is likely to be useful for future implementations. Objective The objective of this study was to identify the barriers to and facilitators of patient portal implementation facing various stakeholders within hospital organizations in the Netherlands. Methods Purposive sampling was used to select hospitals of various types. A total of 2 university medical centers, 3 teaching hospitals, and 2 general hospitals were included. For each, 3 stakeholders were interviewed: (1) medical professionals, (2) managers, and (3) information technology employees. In total, 21 semistructured interviews were conducted using the Grol and Wensing model, which describes barriers to and facilitators of change in health care practice at 6 levels: (1) innovation; (2) individual professional; (3) patient; (4) social context; (5) organizational context; and (6) economic and political context. Two researchers independently selected and coded quotes by applying this model using a (deductive) directed content approach. Additional factors related to technical and portal characteristics were added using the model of McGinn et al, developed for implementation of electronic health records. Results In total, we identified 376 quotes, 26 barriers, and 28 facilitators. Thirteen barriers and 12 facilitators were common for all stakeholder groups. The facilitators’ perceived usefulness (especially less paperwork) was mentioned by all the stakeholders, followed by subjects’ positive attitude. The main barriers were lack of resources (namely, lack of staff and materials), financial difficulties (especially complying with high costs, lack of reimbursements), and guaranteeing privacy and security (eg, strict regulations). Both similarities and differences were found between stakeholder groups and hospital types. For example, managers and information technology employees mainly considered guaranteeing privacy and security as a predominant barrier. Financial difficulties were particularly mentioned by medical professionals and managers. Conclusions Patient portal implementation is a complex process and is not only a technical process but also affects the organization and its staff. Barriers and facilitators occurred at various levels and differed among hospital types (eg, lack of accessibility) and stakeholder groups (eg, sufficient resources) in terms of several factors. Our findings underscore the importance of involving multiple stakeholders in portal implementations. We identified a set of barriers and facilitators that are likely to be useful in making strategic and efficient implementation plans.
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Affiliation(s)
- Laura Kooij
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Wim G Groen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands.,Rijnstate Hospital, Arnhem, Netherlands
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Duke DC, Barry S, Wagner DV, Speight J, Choudhary P, Harris MA. Distal technologies and type 1 diabetes management. Lancet Diabetes Endocrinol 2018; 6:143-156. [PMID: 28867311 DOI: 10.1016/s2213-8587(17)30260-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 06/21/2017] [Accepted: 07/03/2017] [Indexed: 02/09/2023]
Abstract
Type 1 diabetes requires intensive self-management to avoid acute and long-term health complications. In the past two decades, substantial advances in technology have enabled more effective and convenient self-management of type 1 diabetes. Although proximal technologies (eg, insulin pumps, continuous glucose monitors, closed-loop and artificial pancreas systems) have been the subject of frequent systematic and narrative reviews, distal technologies have received scant attention. Distal technologies refer to electronic systems designed to provide a service remotely and include heterogeneous systems such as telehealth, mobile health applications, game-based support, social platforms, and patient portals. In this Review, we summarise the empirical literature to provide current information about the effectiveness of available distal technologies to improve type 1 diabetes management. We also discuss privacy, ethics, and regulatory considerations, issues of global adoption, knowledge gaps in distal technology, and recommendations for future directions.
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Affiliation(s)
- Danny C Duke
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA.
| | - Samantha Barry
- Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - David V Wagner
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Deakin University, and Diabetes Victoria, Melbourne, VIC, Australia
| | | | - Michael A Harris
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
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Bauer AM, Iles-Shih M, Ghomi RH, Rue T, Grover T, Kincler N, Miller M, Katon WJ. Acceptability of mHealth augmentation of Collaborative Care: A mixed methods pilot study. Gen Hosp Psychiatry 2018; 51:22-29. [PMID: 29272712 PMCID: PMC6512981 DOI: 10.1016/j.genhosppsych.2017.11.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/03/2017] [Accepted: 11/24/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the feasibility and acceptability of a mobile health platform supporting Collaborative Care. METHOD Collaborative Care patients (n=17) used a smartphone app to transmit PHQ-9 and GAD-7 scores and sensor data to a dashboard used by one care manager. Patients completed usability and satisfaction surveys and qualitative interviews at 4weeks and the care manager completed a qualitative interview. Mobile metadata on app usage was obtained. RESULTS All patients used the app for 4weeks, but only 35% (n=6) sustained use at 8weeks. Prior to discontinuing use, 88% (n=15) completed all PHQ-9 and GAD-7 measures, with lower response rates for daily measures. Four themes emerged from interviews: understanding the purpose; care manager's role in supporting use; benefits of daily monitoring; and privacy / security concerns. Two themes were user-specific: patients' desire for personalization; and care manager burden. CONCLUSIONS The feasibility and acceptability of the mobile platform is supported by the high early response rate, however attrition was steep. Our qualitative findings revealed nuanced participant experiences and uncovered some concerns about mobile health. To encourage retention, attention may need to be directed toward promoting patient understanding and provider engagement, and offering personalized patient experiences.
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Affiliation(s)
- Amy M. Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, United States,Corresponding author at: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States. (A.M. Bauer)
| | - Matthew Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, United States
| | - Reza Hosseini Ghomi
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, United States
| | - Tessa Rue
- Department of Biostatistics and Institute of Translational Health Sciences, University of Washington, Seattle, United States
| | - Tess Grover
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, United States
| | | | - Monica Miller
- University of Washington Neighborhood Clinics, United States
| | - Wayne J. Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, United States
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Clinician-Stakeholders' Perspectives on Using Patient Portals to Return Lynch Syndrome Screening Results. J Genet Couns 2017; 27:349-357. [PMID: 29159545 DOI: 10.1007/s10897-017-0179-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/14/2017] [Indexed: 12/12/2022]
Abstract
Test results for genetic conditions, such as Lynch Syndrome (LS), have traditionally been returned by genetic counselors or other providers who can explain results implications and provide psychosocial support. Returning genetic results through an Electronic Health Record's patient portal may increase the efficiency of returning results and could activate patient follow-up; however, stakeholder input is necessary to determine acceptability and appropriate implementation for LS. Twenty interviews were conducted with clinicians from six specialties involved in LS screening that represent a range of settings. Data were analyzed using directed content analysis and thematic analysis across content categories. Participants felt that patient portals could supplement personal calls, but the potential sensitive nature of LS screening results indicated the need for caution. Others felt that LS results could be returned through portals if there were clear explanations of the result, reputable additional information available within the portal, urging follow up confirmatory testing, and a referral to a genetics specialist. Patient portals were seen as helpful for prompting patient follow-up and providing resources to notify at-risk family members. There is potential for patient portals to return LS screening and other genetic results, however we raise several issues to resolve before implementation is warranted.
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49
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Plastiras P, O'Sullivan DM. Combining Ontologies and Open Standards to Derive a Middle Layer Information Model for Interoperability of Personal and Electronic Health Records. J Med Syst 2017; 41:195. [PMID: 29081012 DOI: 10.1007/s10916-017-0838-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/11/2017] [Indexed: 11/29/2022]
Abstract
The aim of our study was to enable better interoperability between Personal Health Record (PHR) and Electronic Health Record (EHR) systems and vice versa. A multi-layer architectural model that resides between a PHR and EHR system has been developed. The model consists of an ontology-driven information model and a set of transformation rules that work in conjunction to process data exported from a PHR or EHR system and prepare it accordingly for the receiving system. The model was evaluated by executing a set of case study scenarios containing data from both a PHR and an EHR system. This allowed various challenges to emerge and revealed gaps in current standards in use. The proposed information model offers a number of advantages. Altering only the information model can incorporate modifications to either a PHR or EHR system. The model uses classes and attributes to define how data is captured which allows greater flexibility in how data can be manipulated by receiving systems.
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Affiliation(s)
- Panagiotis Plastiras
- Health Informatics Research Group, Department of Computer Science, City University of London, EC1V 0HB, London, UK.
| | - Dympna M O'Sullivan
- Health Informatics Research Group, Department of Computer Science, City University of London, EC1V 0HB, London, UK
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50
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Murray E, Sweeting M, Dack C, Pal K, Modrow K, Hudda M, Li J, Ross J, Alkhaldi G, Barnard M, Farmer A, Michie S, Yardley L, May C, Parrott S, Stevenson F, Knox M, Patterson D. Web-based self-management support for people with type 2 diabetes (HeLP-Diabetes): randomised controlled trial in English primary care. BMJ Open 2017; 7:e016009. [PMID: 28954789 PMCID: PMC5623569 DOI: 10.1136/bmjopen-2017-016009] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of a web-based self-management programme for people with type 2 diabetes in improving glycaemic control and reducing diabetes-related distress. METHODS AND DESIGN Individually randomised two-arm controlled trial. SETTING 21 general practices in England. PARTICIPANTS Adults aged 18 or over with a diagnosis of type 2 diabetes registered with participating general practices. INTERVENTION AND COMPARATOR Usual care plus either Healthy Living for People with Diabetes (HeLP-Diabetes), an interactive, theoretically informed, web-based self-management programme or a simple, text-based website containing basic information only. OUTCOMES AND DATA COLLECTION Joint primary outcomes were glycated haemoglobin (HbA1c) and diabetes-related distress, measured by the Problem Areas in Diabetes (PAID) scale, collected at 3 and 12 months after randomisation, with 12 months the primary outcome point. Research nurses, blind to allocation collected clinical data; participants completed self-report questionnaires online. ANALYSIS The analysis compared groups as randomised (intention to treat) using a linear mixed effects model, adjusted for baseline data with multiple imputation of missing values. RESULTS Of the 374 participants randomised between September 2013 and December 2014, 185 were allocated to the intervention and 189 to the control. Final (12 month) follow-up data for HbA1c were available for 318 (85%) and for PAID 337 (90%) of participants. Of these, 291 (78%) and 321 (86%) responses were recorded within the predefined window of 10-14 months. Participants in the intervention group had lower HbA1c than those in the control (mean difference -0.24%; 95% CI -0.44 to -0.049; p=0.014). There was no significant overall difference between groups in the mean PAID score (p=0.21), but prespecified subgroup analysis of participants who had been more recently diagnosed with diabetes showed a beneficial impact of the intervention in this group (p = 0.004). There were no reported harms. CONCLUSIONS Access to HeLP-Diabetes improved glycaemic control over 12 months. TRIAL REGISTRATION NUMBER ISRCTN02123133.
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Affiliation(s)
- Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Michael Sweeting
- Department of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Kingshuk Pal
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kerstin Modrow
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Mohammed Hudda
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | - Jamie Ross
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Ghadah Alkhaldi
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, UK
| | - Lucy Yardley
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Psychology, University of Southampton, Southampton, UK
| | - Carl May
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Malcolm Knox
- Research Department of Primary Care and Population Health, University College London, London, UK
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