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Alsaqqa HH, Alwawi A. Digital intervention for public health: searching for implementing characteristics, concepts and recommendations: scoping review. Front Public Health 2023; 11:1142443. [PMID: 37790710 PMCID: PMC10544338 DOI: 10.3389/fpubh.2023.1142443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Studying the impact of digital interventions on public health can help ensure that the offered services produce the desired results. In order to address these factors, the subsequent study uses a scope review to evaluate the state of the field while concentrating on ideas and suggestions that represent factors that have been crucial in the management of digital intervention for public health. To shed light on the traits, ideas and suggestions related to public health digital intervention, a scoping review was carried out. Five electronic databases were used to locate pertinent research that were published before February 2022. All texts were examined, and study abstracts were scrutinized to determine their eligibility. The last analysis of this study included fifteen publications; five reviews, four qualitative studies, two quantitative studies, one viewpoint study, one mixed-method study, one perspective study, and one interventional study. The key ideas for digital interventions in population management and health studies are presented in this overview. Many concepts, implementation characteristics and recommendations have been raised which highlight the future role of these interventions to enhance public engagement and health equity.
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Affiliation(s)
- Hatem H. Alsaqqa
- Deanship of Scientific Research, Al-Quds University, Jerusalem, Palestine
- Ministry of Health, Gaza Strip, Palestine
| | - Abdallah Alwawi
- Anesthesia and Resuscitation Technology, Health Professions Faculty, Al Quds University, Jerusalem, Palestine
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Zanaboni P, Kristiansen E, Lintvedt O, Wynn R, Johansen MA, Sørensen T, Fagerlund AJ. Impact on patient-provider relationship and documentation practices when mental health patients access their electronic health records online: a qualitative study among health professionals in an outpatient setting. BMC Psychiatry 2022; 22:508. [PMID: 35902841 PMCID: PMC9331580 DOI: 10.1186/s12888-022-04123-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient accessible electronic health records (PAEHR) hold the potential to increase patient empowerment, especially for patients with complex, long-term or chronic conditions. However, evidence of its benefits for patients who undergo mental health treatment is unclear and inconsistent, and several concerns towards use of PAEHR emerged among health professionals. This study aimed at exploring the impact of PAEHR among mental health professionals in terms of patient-provider relationship, changes in the way of writing in the electronic health records and reasons for denying access to information. METHODS In-depth qualitative interviews with health professionals working in two mental health outpatient clinics at Helgelandssykehuset in Northern Norway, one of the first hospitals in Norway to implement the PAEHR in 2015. The interviews were conducted by phone or videoconferencing, audio recorded and transcribed verbatim. Data were analyzed by a multidisciplinary research team using the Framework Method. RESULTS A total of 16 in-depth qualitative interviews were conducted in April and May 2020. The PAEHR implemented in Norway was seen as a tool to increase transparency and improve the patient-provider relationship. The PAEHR was seen to have negative consequences only in limited situations, such as for patients with severe mental conditions, for child protective services when parents access their children's journal, or for patients with abusive partners. The functionality to deny access to the journal was used rarely. A more common practice for making information not immediately available was to delay the final approval of the notes. The documentation practices changed over the years, but it was not clear to what extent the changes were attributable to the introduction of the PAEHR. Health professionals write their notes keeping in mind that patients might read them, and they try to avoid unclear language, information about third parties, and hypotheses that might create confusion. CONCLUSIONS The concerns voiced by mental health professionals regarding the impact of the PAEHR on the patient-provider relationship and practices to deny access to information were not supported by the results of this study. Future research should explore changes in documentation practices by analysing the content of the electronic health records.
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway. .,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Eli Kristiansen
- grid.412244.50000 0004 4689 5540Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Ove Lintvedt
- grid.412244.50000 0004 4689 5540Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Rolf Wynn
- grid.10919.300000000122595234Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Monika A. Johansen
- grid.412244.50000 0004 4689 5540Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | | | - Asbjørn J. Fagerlund
- grid.412244.50000 0004 4689 5540Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
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Ancker JS, Benda NC, Reddy M, Unertl KM, Veinot T. Guidance for publishing qualitative research in informatics. J Am Med Inform Assoc 2021; 28:2743-2748. [PMID: 34537840 PMCID: PMC8633663 DOI: 10.1093/jamia/ocab195] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022] Open
Abstract
Qualitative research, the analysis of nonquantitative and nonquantifiable data through methods such as interviews and observation, is integral to the field of biomedical and health informatics. To demonstrate the integrity and quality of their qualitative research, authors should report important elements of their work. This perspective article offers guidance about reporting components of the research, including theory, the research question, sampling, data collection methods, data analysis, results, and discussion. Addressing these points in the paper assists peer reviewers and readers in assessing the rigor of the work and its contribution to the literature. Clearer and more detailed reporting will ensure that qualitative research will continue to be published in informatics, helping researchers disseminate their understanding of people, organizations, context, and sociotechnical relationships as they relate to biomedical and health data.
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Affiliation(s)
- Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natalie C Benda
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Madhu Reddy
- Department of Informatics, University of California, Irvine, Irvine, California, USA
| | - Kim M Unertl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tiffany Veinot
- School of Information, University of Michigan, Ann Arbor, Michigan, USA
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Ruhi U, Majedi A, Chugh R. Socio-technical drivers and barriers in the consumer adoption of personal health records: An empirical investigation. JMIR Med Inform 2021; 9:e30322. [PMID: 34343106 PMCID: PMC8501412 DOI: 10.2196/30322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/07/2021] [Accepted: 08/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increasingly popular in the healthcare domain, electronic personal health records (PHRs) have the potential to foster engagement towards improving health outcomes, achieve efficiencies in care, and reducing costs. Despite touted benefits, the uptake of PHRs is lackluster, with low adoption rates. OBJECTIVE This paper reports findings from an empirical investigation on socio-technical factors affecting the adoption of PHRs. METHODS A research model comprising personal and technological determinants of PHR adoption is developed and validated in this study. Demographic, technographic and psychographic data pertaining to the use of PHRs was collected through an online questionnaire for past, current, and potential users. Partial least squares (PLS) based structural equation modeling (SEM) was used to estimate a structural model of cognitive and affective factors impacting intentions to use PHRs. RESULTS Analysis reveal that in addition to the expected positive impact of a PHR system's usefulness and usability, system integration also positively effects consumer intention to adopt. Results also suggest that higher levels of perceived usability and integration do not translate into higher levels of perceived usefulness. The study also highlights the importance of subjective norm, technology awareness, and technology anxiety as direct antecedents of intention to adopt PHRs. Differential effects of adoption factors are also discussed. CONCLUSIONS Our study hopes to contribute to an understanding of consumer adoption of PHRs, and to help improve the design and delivery of consumer-centric healthcare technologies. After implications for research, we provide suggestions and guidelines for PHR technology developers and constituents in the healthcare delivery chain. CLINICALTRIAL
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Affiliation(s)
- Umar Ruhi
- Business Analytics & Information Systems, Telfer School of Management, University of Ottawa, 55 Laurier East, Ottawa, CA
| | | | - Ritesh Chugh
- College of Information & Communication Technology, School of Engineering & Technology, Central Queensland University, Melbourne, AU
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Hussain MI, Figueiredo MC, Tran BD, Su Z, Molldrem S, Eikey EV, Chen Y. A scoping review of qualitative research in JAMIA: past contributions and opportunities for future work. J Am Med Inform Assoc 2021; 28:402-413. [PMID: 33225361 DOI: 10.1093/jamia/ocaa179] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/07/2020] [Accepted: 07/17/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Qualitative methods are particularly well-suited to studying the complexities and contingencies that emerge in the development, preparation, and implementation of technological interventions in real-world clinical practice, and much remains to be done to use these methods to their full advantage. We aimed to analyze how qualitative methods have been used in health informatics research, focusing on objectives, populations studied, data collection, analysis methods, and fields of analytical origin. METHODS We conducted a scoping review of original, qualitative empirical research in JAMIA from its inception in 1994 to 2019. We queried PubMed to identify relevant articles, ultimately including and extracting data from 158 articles. RESULTS The proportion of qualitative studies increased over time, constituting 4.2% of articles published in JAMIA overall. Studies overwhelmingly used interviews, observations, grounded theory, and thematic analysis. These articles used qualitative methods to analyze health informatics systems before, after, and separate from deployment. Providers have typically been the main focus of studies, but there has been an upward trend of articles focusing on healthcare consumers. DISCUSSION While there has been a rich tradition of qualitative inquiry in JAMIA, its scope has been limited when compared with the range of qualitative methods used in other technology-oriented fields, such as human-computer interaction, computer-supported cooperative work, and science and technology studies. CONCLUSION We recommend increased public funding for and adoption of a broader variety of qualitative methods by scholars, practitioners, and policy makers and an expansion of the variety of participants studied. This should lead to systems that are more responsive to practical needs, improving usability, safety, and outcomes.
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Affiliation(s)
- Mustafa I Hussain
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California Irvine, Irvine, California, USA
| | - Mayara Costa Figueiredo
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California Irvine, Irvine, California, USA
| | - Brian D Tran
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California Irvine, Irvine, California, USA.,Medical Scientist Training Program, School of Medicine, University of California Irvine, Irvine, California, USA
| | - Zhaoyuan Su
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California Irvine, Irvine, California, USA
| | - Stephen Molldrem
- Department of Anthropology, University of California Irvine, Irvine, California, USA
| | - Elizabeth V Eikey
- Department of Family Medicine and Public Health & Design Lab, University of California San Diego, San Diego, California, USA
| | - Yunan Chen
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California Irvine, Irvine, California, USA
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Ruhi U, Chugh R. Utility, Value, and Benefits of Contemporary Personal Health Records: Integrative Review and Conceptual Synthesis. J Med Internet Res 2021; 23:e26877. [PMID: 33866308 PMCID: PMC8120425 DOI: 10.2196/26877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/30/2021] [Accepted: 04/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background Contemporary personal health record (PHR) technologies offer a useful platform for individuals to maintain a lifelong record of personally reported and clinically sourced data from various points of medical care. Objective This paper presents an integrative review and synthesis of the extant literature on PHRs. This review draws upon multiple lenses of analysis and deliberates value perspectives of PHRs at the product, consumer, and industry levels. Methods Academic databases were searched using multiple keywords related to PHRs for the years 2001-2020. Three research questions were formulated and used as selection criteria in our review of the extant literature relevant to our study. Results We offer a high-level functional utility model of PHR features and functions. We also conceptualize a consumer value framework of PHRs, highlighting the applications of these technologies across various health care delivery activities. Finally, we provide a summary of the benefits of PHRs for various health care constituents, including consumers, providers, payors, and public health agencies. Conclusions PHR products offer a myriad of content-, connectivity-, and collaboration-based features and functions for their users. Although consumers benefit from the tools provided by PHR technologies, their overall value extends across the constituents of the health care delivery chain. Despite advances in technology, our literature review identifies a shortfall in the research addressing consumer value enabled by PHR tools. In addition to scholars and researchers, our literature review and proposed framework may be especially helpful for value analysis committees in the health care sector that are commissioned for the appraisal of innovative health information technologies such as PHRs.
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Affiliation(s)
- Umar Ruhi
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Ritesh Chugh
- School of Engineering & Technology, Central Queensland University, Melbourne, Australia
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Tapuria A, Porat T, Kalra D, Dsouza G, Xiaohui S, Curcin V. Impact of patient access to their electronic health record: systematic review. Inform Health Soc Care 2021; 46:192-204. [PMID: 33840342 DOI: 10.1080/17538157.2021.1879810] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Patient access to their own electronic health records (EHRs) is likely to become an integral part of healthcare systems worldwide. It has the potential to decrease the healthcare provision costs, improve access to healthcare data, self-care, quality of care, and health and patient-centered outcomes. This systematic literature review is aimed at identifying the impact in terms of benefits and issues that have so far been demonstrated by providing patients access to their own EHRs, via providers' secure patient portals from primary healthcare centers and hospitals. Searches were conducted in PubMed, MEDLINE, CINHAL, and Google scholar. Over 2000 papers were screened and were filtered based on duplicates, then by reading the titles and finally based on their abstracts or full text. In total, 74 papers were retained, analyzed, and summarized. Papers were included if providing patient access to their own EHRs was the primary intervention used in the study and its impact or outcome was evaluated. The search technique used to identify relevant literature for this paper involved input from five experts. While findings from 54 of the 74 papers showed positive outcome or benefits of patient access to their EHRs via patient portals, 10 papers have highlighted concerns, 8 papers have highlighted both and 2 have highlighted absence of negative outcomes. The benefits range from re-assurance, reduced anxiety, positive impact on consultations, better doctor-patient relationship, increased awareness and adherence to medication, and improved patient outcomes (e.g., improving blood pressure and glycemic control in a range of study populations). In addition, patient access to their health information was found to improve self-reported levels of engagement or activation related to self-management, enhanced knowledge, and improve recovery scores, and organizational efficiencies in a tertiary level mental health care facility. However, three studies did not find any statistically significant effect of patient portals on health outcomes. The main concerns have been around security, privacy and confidentiality of the health records, and the anxiety it may cause amongst patients. This literature review identified some benefits, concerns, and attitudes demonstrated by providing patients' access to their own EHRs. This access is often part of government strategies when developing patient-centric self-management elements of a sustainable healthcare system. The findings of this review will give healthcare providers a framework to analyze the benefits offered by promoting patient access to EHRs and decide on the best approach for their own specialties and clinical setup. A robust cost-benefit evaluation of such initiatives along with its impact on major stakeholders within the healthcare system would be essential in understanding the overall impact of such initiatives. Implementation of patient access to their EHRs could help governments to appropriately prioritize the development or adoption of national standards, whilst taking care of local variations and fulfilling the healthcare needs of the population, e.g., UK Government is aiming to make full primary care records available online to every patient. Ultimately, increasing transparency and promoting personal responsibility are key elements of a sustainable healthcare system for future generations.
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Affiliation(s)
- Archana Tapuria
- King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Talya Porat
- Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Dipak Kalra
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Glen Dsouza
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Sun Xiaohui
- King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Vasa Curcin
- King's College London, London, United Kingdom of Great Britain and Northern Ireland
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McMillan B, Davidge G, Brown L, Lyons M, Atherton H, Goulding R, Mold F, Morris RL, Sanders C. A qualitative exploration of patients' experiences, needs and expectations regarding online access to their primary care record. BMJ Open 2021; 11:e044221. [PMID: 33707271 PMCID: PMC7957122 DOI: 10.1136/bmjopen-2020-044221] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Primary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients' needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need. DESIGN Focus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach. SETTING Focus groups and interviews were conducted in community settings in the UK. PARTICIPANTS Fifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else. RESULTS Participants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated. CONCLUSIONS Discussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.
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Affiliation(s)
- Brian McMillan
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Gail Davidge
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Lindsey Brown
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Moira Lyons
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Helen Atherton
- Warwick Medical School, Social Science and Systems in Health, University of Warwick, Coventry, UK
| | - Rebecca Goulding
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Freda Mold
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Rebecca L Morris
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Caroline Sanders
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
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Bui TM, Hoang MT, Ngo TV, Do CD, Nghiem SH, Byrnes J, Phung DT, Nguyen THT, Vu GT, Do HT, Latkin CA, Ho RC, Ho CS. Smartphone Use and Willingness to Pay for HIV Treatment-Assisted Smartphone Applications among HIV-Positive Patients in Urban Clinics of Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041467. [PMID: 33557412 PMCID: PMC7915809 DOI: 10.3390/ijerph18041467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
This study aimed to examine the effectiveness of Human Immunodeficiency Virus (HIV)-assisted smartphone applications in the treatment of HIV/AIDS patients in Vietnam. A cross-sectional study was performed in two urban outpatient clinics in Hanoi from May to December 2019. A simple random sampling method and a structured questionnaire were used to recruit 495 eligible participants and to collect data. Multivariable modified Poisson regression and multivariable linear regression models were employed to investigate the factors associated with the willingness to pay (WTP) and amount of money patients were willing to pay. Approximately 82.8% of respondents were willing to pay for the hypothetical applications, with the mean amount the participants were willing to pay of Vietnam Dong (VND) 72,100/month. Marital status (separate/divorced/widow: Odds ratio (OR) = 1.28, 95% confidence interval (CI) = (1.09; 1.50) and having spouse/partner: OR = 1.18, 95% CI = (1.03; 1.36)) and using health services (OR = 1.03, 95% CI = (1.01; 1.04)) were positively associated with nominating they would be WTP for the app, whereas the duration of antiretroviral treatment (ART) (OR = 0.98, 95% CI = (0.96; 0.99)) had a negative association. The frequency of using health services (β = 0.04, 95% CI = (−0.07; −0.01)) was negatively associated with the amount of WTP. High levels of WTP revealed the feasibility of implementing smartphone-based apps for HIV treatment. This study implied the necessity to consider a co-payment system to reach populations who were in need but where such applications may be unaffordable in lieu of other treatment-associated expenses. Developers also need to pay attention to privacy features to attract single people living with HIV/AIDS and additional measures to initiate people with a long duration on ART into using the applications.
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Affiliation(s)
- Thu Minh Bui
- Bach Mai Medical College, Bach Mai Hospital, Hanoi 100000, Vietnam;
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
| | - Men Thi Hoang
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam;
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
- Correspondence: ; Tel.: +84-902-850-236
| | - Toan Van Ngo
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
| | - Cuong Duy Do
- National Hospital of Tropical Diseases, Bach Mai Hospital, Hanoi 100000, Vietnam;
| | - Son Hong Nghiem
- Centre for Applied Health Economics (CAHE), Griffith University, Brisbane, QLD 4222, Australia; (S.H.N.); (J.B.)
| | - Joshua Byrnes
- Centre for Applied Health Economics (CAHE), Griffith University, Brisbane, QLD 4222, Australia; (S.H.N.); (J.B.)
| | - Dung Tri Phung
- School of Medicine, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia;
| | - Trang Huyen Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam;
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam;
| | - Hoa Thi Do
- Institute of Health Economics and Technology, Hanoi 100000, Vietnam;
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Roger C.M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore; (R.C.M.H.); (C.S.H.H.)
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119074, Singapore
| | - Cyrus S.H. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore; (R.C.M.H.); (C.S.H.H.)
- Department of Psychological Medicine, National University Health System, Singapore 119228, Singapore
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A Comparative Analysis of Online Medical Record Utilization and Perception by Cancer Survivorship. Med Care 2020; 58:1075-1081. [PMID: 32925466 DOI: 10.1097/mlr.0000000000001413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cancer survivors face many challenges including coordinating care across multiple providers and maintaining medical records from multiple institutions. Access and utilization of online medical records could help cancer survivors manage this complexity. Here, we examined how cancer survivors differ from those without a history of cancer with regards to utilization and perception of medical records. METHODS We conducted a cross-sectional study of 3491 respondents, from the Health Information National Trends survey 5, cycle 2. The association of medical record utilization and perceptions with cancer survivorship was assessed using survey-weighted logistic regression. RESULTS Cancer survivors (n=593) were more likely to report that a provider maintains a computerized medical record [adjusted odds ratio (AOR)=2.05; 95% confidence (CI), 1.24-3.41] and were more likely to report confidence in medical record safeguards (AOR=1.44; 95% CI, 1.03-2.03). However, cancer survivors were no more likely to access online medical records than those without a history of cancer (AOR=1.13; 95% CI, 0.69-1.86). Cancer survivors were no more likely to report privacy concerns as a reason for not accessing online medical records, however, survivors were more likely to report a preference for speaking directly with a provider as a reason for not accessing online medical records (AOR=2.24; 95% CI, 0.99-5.05). CONCLUSIONS Although cancer survivors are more likely to trust medical record safe guards and do not express increased concerns about online medical record privacy, a preference to speak directly with provider is a barrier of use.
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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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13
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Zanaboni P, Kummervold PE, Sørensen T, Johansen MA. Patient Use and Experience With Online Access to Electronic Health Records in Norway: Results From an Online Survey. J Med Internet Res 2020; 22:e16144. [PMID: 32031538 PMCID: PMC7055829 DOI: 10.2196/16144] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/04/2019] [Accepted: 12/16/2019] [Indexed: 01/16/2023] Open
Abstract
Background The electronic health record (EHR) has been fully established in all Norwegian hospitals. Patient-accessible electronic health records (PAEHRs) are available to citizens aged 16 years and older through the national health portal Helsenorge. Objective This study aimed at understanding how patients use PAEHRs. Three research questions were addressed in order to explore (1) characteristics of users, (2) patients’ use of the service, and (3) patient experience with the service. Methods We conducted an online survey of users who had accessed their EHR online at least once through the national health portal. Patients from two of the four health regions in Norway were invited to participate. Quantitative data were supplemented by qualitative information. Results A total of 1037 respondents participated in the survey, most of whom used the PAEHR regularly (305/1037, 29.4%) or when necessary (303/1037, 29.2%). Service utilization was associated with self-reported health, age, gender, education, and health care professional background. Patients found the service useful to look up health information (687/778, 88.3%), keep track of their treatment (684/778, 87.9%), prepare for a hospital appointment (498/778, 64.0%), and share documents with their general practitioner (292/778, 37.5%) or family (194/778, 24.9%). Most users found it easy to access their EHR online (965/1037, 93.1%) and did not encounter technical challenges. The vast majority of respondents (643/755, 85.2%) understood the content, despite over half of them acknowledging some difficulties with medical terms or phrases. The overall satisfaction with the service was very high (700/755, 92.7%). Clinical advantages to the patients included enhanced knowledge of their health condition (565/691, 81.8%), easier control over their health status (685/740, 92.6%), better self-care (571/653, 87.4%), greater empowerment (493/674, 73.1%), easier communication with health care providers (493/618, 79.8%), and increased security (655/730, 89.7%). Patients with complex, long-term or chronic conditions seemed to benefit the most. PAEHRs were described as useful, informative, effective, helpful, easy, practical, and safe. Conclusions PAEHRs in Norway are becoming a mature service and are perceived as useful by patients. Future studies should include experimental designs focused on specific populations or chronic conditions that are more likely to achieve clinically meaningful benefits. Continuous evaluation programs should be conducted to assess implementation and changes of wide-scale routine services over time.
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | | | | | - Monika Alise Johansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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14
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Denneson LM, Pisciotta M, Hooker ER, Trevino A, Dobscha SK. Impacts of a web-based educational program for veterans who read their mental health notes online. J Am Med Inform Assoc 2019; 26:3-8. [PMID: 30445648 DOI: 10.1093/jamia/ocy134] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/20/2018] [Indexed: 11/14/2022] Open
Abstract
Objective This study evaluates whether a web-based educational program for patients who read their mental health notes online improves patient-clinician communication and increases patient activation. Methods The web-based educational program, developed with end-user input, was designed to educate patients on the content of mental health notes, provide guidance on communicating with clinicians about notes, and facilitate patients' safe and purposeful use of their health information. Eligible patients were engaged in mental health treatment (≥1 visit in the prior 6 months) and had logged into the Veterans Health Administration (VHA) patient portal at least twice. Participants completed measures of patient activation, perceived efficacy in healthcare interactions, patient trust in their clinicians, and patient assessment of the therapeutic relationship before and after participating in the program. A total of 247 participants had complete data and engaged with the program for 5 minutes or more, comprising the analytic sample. Multivariate analysis using mixed effects models were used to examine pre-post changes in outcomes. Results In bivariate analyses, patient activation, perceived efficacy in healthcare interactions, and trust in clinicians increased significantly between pre- and post-training assessments. In fully adjusted models, changes in patient activation [b = 2.71 (1.41, 4.00), P < 0.01] and perceived efficacy in healthcare interactions [b = 1.27 (0.54, 2.01), P < 0.01)] remained significant. Conclusions Findings suggest that this educational program may help empower mental health patients who read their notes online to be active participants in their care, while also providing information and tools that may facilitate better relationships with their clinicians.
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Affiliation(s)
- Lauren M Denneson
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Maura Pisciotta
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | - Elizabeth R Hooker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | - Amira Trevino
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
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15
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Van Dort BA, Zheng WY, Baysari MT. Prescriber perceptions of medication-related computerized decision support systems in hospitals: A synthesis of qualitative research. Int J Med Inform 2019; 129:285-295. [DOI: 10.1016/j.ijmedinf.2019.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/24/2019] [Accepted: 06/24/2019] [Indexed: 01/01/2023]
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16
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Bruni A, Miele F, Piras EM. 'Homemade': Building, mending, and coordinating a care network. Soc Sci Med 2019; 237:112449. [PMID: 31394398 DOI: 10.1016/j.socscimed.2019.112449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/30/2022]
Abstract
In recent decades, longer life expectancy, the consequent greater number of patients with often concurrent diseases, and the need of healthcare institutions to reduce the costs of services, have engendered changes in all European healthcare systems. On one side, healthcare systems increasingly rely on the self-management skills of patients, who undertake a growing amount of 'sickness work' from which they are relieved only in the case of severe illness. On the other, the inability of public healthcare systems to satisfy the increased demand for care has led to the growth of private healthcare organizations as well as cooperatives of health professionals who offer their services privately. The care of citizens, therefore, is increasingly distributed across networks of actors with very different objectives, logics of action and professional backgrounds (public and private healthcare organizations, community medical services, voluntary organizations). Despite the attention devoted by social studies of medicine to the work done by citizens in supporting the work of clinicians and nurses, the work performed in connection to the management of care networks have been only marginally investigated. Drawing on a qualitative research carried out in the Province of Trento (Italy) and focused on the different ways in which elderly people with chronic conditions manage their conditions outside the healthcare and welfare institutions, in this paper we are interested in deepening the understanding of the invisible work citizens perform in connection to the management of care services and professionals. That is, the work needed in order to activate, mend and coordinate complex networks of care.
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17
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Ali R, Zhang Z, Bux Soomro M. Smoking-cessation acceptance via mobile health. HUMAN SYSTEMS MANAGEMENT 2019. [DOI: 10.3233/hsm-180380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Rahib Ali
- School of Management Science and Economy, Harbin Institute of Technology, Heilongjiang, China
| | - Ziqiong Zhang
- School of Management Science and Economy, Harbin Institute of Technology, Heilongjiang, China
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18
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McAlearney AS, Sieck CJ, Gaughan A, Fareed N, Volney J, Huerta TR. Patients' Perceptions of Portal Use Across Care Settings: Qualitative Study. J Med Internet Res 2019; 21:e13126. [PMID: 31172960 PMCID: PMC6592494 DOI: 10.2196/13126] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/01/2019] [Accepted: 03/24/2019] [Indexed: 01/22/2023] Open
Abstract
Background Patient portals are a promising instrument to improve patient-centered care, as they provide patients information and tools that can help them better manage their health. The implementation of portals in both the inpatient and outpatient setting gives health care providers an opportunity to support patients both during hospitalization and after discharge. Thus, there is a need to better understand how inpatient and outpatient portals are used across care contexts. Objective This study aimed to examine patients’ perceptions of using inpatient and outpatient portals across the care settings, including how they used the portals and the benefits and concerns associated with portal use. Methods This study was conducted in a large Midwestern academic medical center consisting of seven hospitals. We interviewed 120 patients who had used an inpatient portal during their hospitalization, at 15 days and 6 months postdischarge, to determine their perspectives of portal use in both hospital and outpatient settings. Interview transcripts were analyzed inductively and deductively by using team coding processes consistent with a grounded theory approach. Results Interviews focused on three main areas of portal use: experience with the portal features, perceived benefits, and concerns. Responses at 15 days (n=60) and 6 months (n=60) postdischarge were consistent with respect to perceptions about portal use. Patients identified viewing their health information, managing their schedule, and communicating with providers as notable activities. Convenience, access to information, and better engagement in care were indicated as benefits. Concerns were related to technology issues and privacy/security risks. Conclusions Implementation of inpatient portals as a complement to outpatient portals is increasing and can enable patients to better manage aspects of their care. Although care processes vary substantively across settings, the benefits of convenience, improved access to information, and better engagement in care provide opportunities for portal use across care settings to support patient-centered care.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Cynthia J Sieck
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Alice Gaughan
- CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Naleef Fareed
- CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Jaclyn Volney
- CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,CATALYST (Center for the Advancement of Team Science, Analytics, and Systems Thinking), College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
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Fortuna G, Schiavo JH, Aria M, Mignogna MD, Klasser GD. The usefulness of YouTube™ videos as a source of information on burning mouth syndrome. J Oral Rehabil 2019; 46:657-665. [PMID: 30919986 DOI: 10.1111/joor.12796] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/05/2019] [Accepted: 03/23/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Giulio Fortuna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University of Naples Naples Italy
- D.eb.RA. Mexico Foundation Monterrey Mexico
- Federico Navarro Institute—School of Orgonomy “Piero Borrelli” Naples Italy
| | - Julie H. Schiavo
- Department of Libraries, New Orleans School of Dentistry Louisiana State University Health Sciences Center New Orleans Louisiana
| | - Massimo Aria
- Department of Economics and Statistics Federico II University of Naples Naples Italy
| | - Michele D. Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University of Naples Naples Italy
| | - Gary D. Klasser
- Department of Diagnostic Science, New Orleans School of Dentistry Louisiana State University Health Sciences Center New Orleans Louisiana
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20
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Pisciotta M, Denneson LM, Williams HB, Woods S, Tuepker A, Dobscha SK. Providing mental health care in the context of online mental health notes: advice from patients and mental health clinicians. J Ment Health 2018; 28:64-70. [PMID: 30468100 DOI: 10.1080/09638237.2018.1521924] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The OpenNotes initiative provides patients online access to their clinical notes. Mental health clinicians in the Veterans Health Administration report a need for guidance on how to provide care, write notes, and discuss them in the context of OpenNotes. AIM To provide mental health clinicians recommendations identified by patients and clinicians that help them effectively practice in the context of OpenNotes. METHOD Twenty-eight mental health clinicians and 28 patients in mental health care participated in semi-structured interviews about their experiences and perceptions with OpenNotes. A rapid review approach was used to analyze transcripts. RESULTS Analysis of interviews identified three domains of advice for mental health clinicians: writing notes that maintain the therapeutic relationship, communicating with patients about their notes and utilizing clinical notes as a patient resource to enhance care. Specific recommendations are provided. CONCLUSION Findings provide mental health clinicians with guidance from service users and clinicians on how to leverage clinical notes to maintain - and potentially enhance -therapeutic relationships in a healthcare system in which patients are able to read their mental health notes online.
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Affiliation(s)
- Maura Pisciotta
- a Center to Improve Veteran Involvement in Care (CIVIC) , VA Portland Health Care System , Portland , OR , USA
| | - Lauren M Denneson
- a Center to Improve Veteran Involvement in Care (CIVIC) , VA Portland Health Care System , Portland , OR , USA.,b Department of Psychiatry , Oregon Health & Science University , Portland , OR , USA
| | - Holly B Williams
- a Center to Improve Veteran Involvement in Care (CIVIC) , VA Portland Health Care System , Portland , OR , USA
| | - Susan Woods
- c Center for Outcomes Research & Evaluation , Maine Medical Center , Portland , ME , USA
| | - Anais Tuepker
- a Center to Improve Veteran Involvement in Care (CIVIC) , VA Portland Health Care System , Portland , OR , USA
| | - Steven K Dobscha
- a Center to Improve Veteran Involvement in Care (CIVIC) , VA Portland Health Care System , Portland , OR , USA.,b Department of Psychiatry , Oregon Health & Science University , Portland , OR , USA
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21
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Veinot TC, Mitchell H, Ancker JS. Good intentions are not enough: how informatics interventions can worsen inequality. J Am Med Inform Assoc 2018; 25:1080-1088. [PMID: 29788380 PMCID: PMC7646885 DOI: 10.1093/jamia/ocy052] [Citation(s) in RCA: 279] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 04/12/2018] [Accepted: 05/03/2018] [Indexed: 01/09/2023] Open
Abstract
Health informatics interventions are designed to help people avoid, recover from, or cope with disease and disability, or to improve the quality and safety of healthcare. Unfortunately, they pose a risk of producing intervention-generated inequalities (IGI) by disproportionately benefiting more advantaged people. In this perspective paper, we discuss characteristics of health-related interventions known to produce IGI, explain why health informatics interventions are particularly vulnerable to this phenomenon, and describe safeguards that can be implemented to improve health equity. We provide examples in which health informatics interventions produced inequality because they were more accessible to, heavily used by, adhered to, or effective for those from socioeconomically advantaged groups. We provide a brief outline of precautions that intervention developers and implementers can take to guard against creating or worsening inequality through health informatics. We conclude by discussing evaluation approaches that will ensure that IGIs are recognized and studied.
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Affiliation(s)
- Tiffany C Veinot
- School of Information and Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Hannah Mitchell
- Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medical College, New York, New York, USA
| | - Jessica S Ancker
- Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medical College, New York, New York, USA
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22
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Chan CWT, Gogovor A, Valois MF, Ahmed S. Age, gender, and current living status were associated with perceived access to treatment among Canadians using a cross sectional survey. BMC Health Serv Res 2018; 18:471. [PMID: 29921265 PMCID: PMC6006735 DOI: 10.1186/s12913-018-3215-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 05/18/2018] [Indexed: 11/12/2022] Open
Abstract
Background Access, particularly timely access, to care is the Canadian public’s most important healthcare concern. The drivers of perceived appropriateness of access to care among patients with at least one chronic health condition (CHC) are not, however, well defined. This study evaluated whether personal characteristics, self-reported health status and care received were associated with patients’ perception of effective access in managing a chronic illness. Methods The study population (n = 619) was drawn from a representative sample of the adult Canadian population who reported having ≥1 CHC in the 2013–2014 Health Care in Canada survey. Ordinal regression, with the continuation ratio model, was used to evaluate association of perceived level of access to treatment with socio-demographic factors, perceived health status and care utilization experience. Results Factors most closely associated with patients’ satisfaction with care access were: age, sex, current cohabitation, care affordability, and availability of support and information to help manage their CHCs. Individuals, particularly females, < 35 years, currently living alone, with poor access to professional support or information and who feel affordability of care has worsened over the past five years were more likely to report a poorer level of treatment access. Conclusions Individuals living alone, who are younger, and women may be especially susceptible to lower perceived access to care of CHCs and a sense of pessimism about things not getting better. Further evaluation of the reasons behind these findings may help develop effective strategies to assist these populations to access the care they need. Electronic supplementary material The online version of this article (10.1186/s12913-018-3215-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine W T Chan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| | - Amédé Gogovor
- Department of Medicine, McGill University, 687 Pine Avenue West, Ross Building, Montreal, QC, H3A 1A1, Canada.,Centre for Outcomes Research and Evaluation, McGill University Health Centre, 5252 Boul. De Maisonneuve, Montreal, QC, H4A 3S5, Canada.,School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.,Centre de recherche interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center du CIUSSS de Centre-Ouest-de-l'Île-de-Montréal, 7005 de Maisonneuve Boulevard West, Montreal, QC, H4B 1T3, Canada
| | - Marie-France Valois
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada.,Department of Medicine, McGill University, 687 Pine Avenue West, Ross Building, Montreal, QC, H3A 1A1, Canada
| | - Sara Ahmed
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada. .,Centre for Outcomes Research and Evaluation, McGill University Health Centre, 5252 Boul. De Maisonneuve, Montreal, QC, H4A 3S5, Canada. .,School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada. .,Centre de recherche interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center du CIUSSS de Centre-Ouest-de-l'Île-de-Montréal, 7005 de Maisonneuve Boulevard West, Montreal, QC, H4B 1T3, Canada.
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Razmak J, Bélanger C. Using the technology acceptance model to predict patient attitude toward personal health records in regional communities. INFORMATION TECHNOLOGY & PEOPLE 2018. [DOI: 10.1108/itp-07-2016-0160] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to statistically measure (quantify) how a sample of Canadians perceives the usability of electronic personal health records (PHRs) and, in the process, to increase Canadian patients’ awareness of PHRs and improve physicians’ confidence in their patients’ ability to manage their own health information through PHRs.
Design/methodology/approach
The authors surveyed 325 Canadian patients living in Northern Ontario to assess a research model consisting of seven perceptions of PHR systems used to manage personal health information electronically, and to assess their perceived ability to use PHR systems. The survey questions were adapted from the 2014 National Physician Survey in Canada. The authors compared the patients’ results with physicians’ own perceptions of their patients’ ability to use PHR systems.
Findings
First, there was a positive relationship between surveyed patients’ prior experiences, needs, values, and their attitude toward adopting the PHR system. Second, how patients saw a PHR system’s user-friendliness was the strongest predictor of how useful they considered it would be. Finally, of the 243 physician respondents, 90.3 percent believed their patients would not be able to manage their own e-health information via a PHR system, but 54.8 percent of the 325 patient respondents indicated they would be able to do so.
Originality/value
This study is unique in that the authors know of no other Canadian study that purports to predict, using the technology acceptance model factors, people’s attitudes toward adopting a PHR system. As well, this is the first Canadian study to compare the perspectives of healthcare providers and their patients on e-health applications.
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McBain H, Newman S, Shipley M, Olaleye A, Moore S. Experiences of a patient-initiated self-monitoring service in inflammatory arthritis: A qualitative exploration. Musculoskeletal Care 2018; 16:278-286. [PMID: 29380961 DOI: 10.1002/msc.1232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aim of the present study was to explore patients' experience of a patient-initiated self-monitoring service for people with rheumatoid or psoriatic arthritis who are on methotrexate. METHODS The study took the form of qualitative semi-structured interviews, embedded within a randomized controlled trial. Twelve participants who were randomly assigned to the intervention arm were interviewed. Interviews digitally, transcribed verbatim and analysed using inductive thematic analysis. The study received full National Health Service ethics approval from Camden and Islington Community Local Research Ethics Committee (Ref. 09/H0722/91). RESULTS Analysis revealed five key themes. Participants described usual care as burdensome and an inefficient use of time, particularly those in employment. Being able to self-monitor and initiate their own care increased patients' knowledge about their illness and its treatment, and enabled them to gain a sense of control and ownership over their arthritis. They appreciated the personalized nature of the new service, which allowed them to be seen at a time and by a method more appropriate to their needs. There were, however, some concerns about fidelity to the service protocol, confusion about the lack of consistency between symptoms and laboratory results, and anxiety about self-monitoring. CONCLUSIONS Overall, participants were positive about the new service, in comparison with usual care, valuing its tailored approach and empowering effects. Further work is needed to ensure adherence to the service protocol and address anxieties around self-monitoring prior to any widespread implementation of the service.
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Affiliation(s)
- Hayley McBain
- School of Health Sciences, City, University of London, London, UK
| | - Stanton Newman
- School of Health Sciences, City, University of London, London, UK
| | - Michael Shipley
- Centre for Rheumatology, University College London Hospital, London, UK
| | - Abigail Olaleye
- Centre for Rheumatology, University College London Hospital, London, UK
| | - Samantha Moore
- Centre for Rheumatology, University College London Hospital, London, UK
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Dou K, Yu P, Deng N, Liu F, Guan Y, Li Z, Ji Y, Du N, Lu X, Duan H. Patients' Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test. JMIR Mhealth Uhealth 2017; 5:e177. [PMID: 29212629 PMCID: PMC5738544 DOI: 10.2196/mhealth.7886] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/20/2017] [Accepted: 10/11/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. OBJECTIVE The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients' acceptance of smartphone health technology for chronic disease management. METHODS Multiple theories and factors that may influence patients' acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients' acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients' actual use of a smartphone health app. The partial least square method was used to test the theoretical model. RESULTS The model accounted for .412 of the variance in patients' intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients' smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients' intentions to use the technology. Age and gender had no significant influence on patients' acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use and actual use of smartphone health apps for chronic disease management. CONCLUSIONS This study developed a theoretical model to predict patients' acceptance of smartphone health technology for chronic disease management. Although resistance to change is a significant barrier to technology acceptance, careful management of doctor-patient relationship, and raising patients' awareness of the negative effect of chronic disease can negate the effect of resistance and encourage acceptance and use of smartphone health technology to support chronic disease management for patients in the community.
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Affiliation(s)
- Kaili Dou
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Ping Yu
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Ning Deng
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Fang Liu
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - YingPing Guan
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zhenye Li
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yumeng Ji
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Ningkai Du
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Xudong Lu
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Huilong Duan
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
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Maxwell J, Williams L, Adamson K, Karmali A, Quinlan B. Supporting Client and Family Engagement in Care Through the Planning and Implementation of an Online Consumer Health Portal. J Patient Exp 2017; 3:48-51. [PMID: 28725836 PMCID: PMC5513619 DOI: 10.1177/2374373516652256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Web-based portals and electronic health records are making it easier for clients and families to access health information. This improved transparency and access to information has the potential to promote activation and improve outcomes, but to realize these benefits, the information needs to be valuable, meaningful, and understandable. Engagement of the end users in the planning and implementation will ensure that the product meets the needs of the consumers. The purpose of this case study is to describe the client and family engagement strategies that were employed to support the process of planning and implementing an online consumer health portal at a pediatric rehabilitation hospital to support the successful launch of this new information-sharing technology platform.
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Affiliation(s)
- Joanne Maxwell
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,University of Toronto's School of Occupational Therapy and Occupational Science, Toronto, Canada
| | - Laura Williams
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Faculty of Social Work, University of Toronto's Factor-Inwentash, Toronto, Canada
| | - Keith Adamson
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Faculty of Social Work, University of Toronto's Factor-Inwentash, Toronto, Canada
| | - Amir Karmali
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Becky Quinlan
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
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Denneson LM, Cromer R, Williams HB, Pisciotta M, Dobscha SK. A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship. J Med Internet Res 2017; 19:e208. [PMID: 28615152 PMCID: PMC5489707 DOI: 10.2196/jmir.6915] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND As part of the national OpenNotes initiative, the Veterans Health Administration (VHA) provides veterans online access to their clinical progress notes, raising concern in mental health settings. OBJECTIVE The aim of this study was to examine the perspectives and experiences of mental health clinicians with OpenNotes to better understand how OpenNotes may be affecting mental health care. METHODS We conducted individual semi-structured interviews with 28 VHA mental health clinicians and nurses. Transcripts were analyzed using a thematic analysis approach, which allows for both inductive and deductive themes to be explored using an iterative, constant comparative coding process. RESULTS OpenNotes is changing VHA mental health care in ways that mental health clinicians perceive as both challenging and beneficial. At the heart of these changes is a shifting power distribution within the patient-clinician relationship. Some clinicians view OpenNotes as an opportunity to better partner with patients, whereas others feel that it has the potential to undo the therapeutic relationship. Many clinicians are uncomfortable with OpenNotes, but acknowledge that this discomfort could both improve and diminish care and documentation practices. Specifically, we found that (1) OpenNotes is empowering patients, (2) OpenNotes is affecting how clinicians build and maintain the therapeutic relationship, and (3) mental health clinicians are adjusting their practices to protect patients and themselves from adverse consequences of OpenNotes. CONCLUSIONS Our findings suggest that future research should monitor whether OpenNotes notes facilitates stronger patient-clinician relationships, enhancing patient-centered mental health care, or diminishes the quality of mental health care through disruptions in the therapeutic relationship and reduced documentation.
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Affiliation(s)
- Lauren M Denneson
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, United States.,Oregon Health & Science University, Department of Psychiatry, Portland, OR, United States
| | - Risa Cromer
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, United States
| | - Holly B Williams
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, United States
| | - Maura Pisciotta
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, United States
| | - Steven K Dobscha
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, United States.,Oregon Health & Science University, Department of Psychiatry, Portland, OR, United States
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Shi L, Sun J, Yang Y, Ling T, Wang M, Gu Y, Yang Z, Hua Y, Zhang J. Three-Dimensional Visual Patient Based on Electronic Medical Diagnostic Records. IEEE J Biomed Health Inform 2017; 22:161-172. [PMID: 28500014 DOI: 10.1109/jbhi.2017.2702201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE an innovative concept and method is introduced to use a 3-D anatomical graphic pattern called visual patient (VP) visually to index, represent, and render the medical diagnostic records (MDRs) of a patient, so that a doctor can quickly learn the current and historical medical status of the patient by manipulating VP. The MDRs can be imaging diagnostic reports and DICOM images, laboratory reports and clinical summaries which can have clinical information relating to medical status of human organs or body parts. METHODS the concept and method included three steps. First, a VP data model called visual index object (VIO) and a VP graphic model called visual anatomic object (VAO) were introduced. Second, a series of processing methods of parsing and extracting key information from MDRs were used to fill the attributes of the VIO model of a patient. Third, a VP system (VPS) was designed to map VIO to VAO, to create a VP instance for each patient. RESULTS a prototype VPS has been implemented in a simulated hospital PACS/RIS integrated environment. Two evaluation results showed that more than 70% participating radiologists would like to use the VPS in their radiological imaging tasks, and the efficiency of using VPS to review the tested patients' MDRs was 2.24 times higher than that of using PACS/RIS, while the average accuracy <Pac> by using PACS/RIS was better than that by using VPS; however, this difference was only about 4%. CONCLUSION the developed VPS can show the medical status of patient organs/sub-organs with 3-D anatomical graphic pattern and will be welcomed by radiologists with better efficiency in reviewing the patients' MDRs and with acceptable accuracy. SIGNIFICANCE the VP introduces a new way for medical professionals to access and interact with a huge amount of patient records with better efficiency in the big data era.
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Rief JJ, Hamm ME, Zickmund SL, Nikolajski C, Lesky D, Hess R, Fischer GS, Weimer M, Clark S, Zieth C, Roberts MS. Using Health Information Technology to Foster Engagement: Patients' Experiences with an Active Patient Health Record. HEALTH COMMUNICATION 2017; 32:310-319. [PMID: 27223684 DOI: 10.1080/10410236.2016.1138378] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Personal health records (PHRs) typically employ "passive" communication strategies, such as non-personalized medical text, rather than direct patient engagement in care. Currently there is a call for more active PHRs that directly engage patients in an effort to improve their health by offering elements such as personalized medical information, health coaches, and secure messaging with primary care providers. As part of a randomized clinical trial comparing "passive" with "active" PHRs, we explore patients' experiences with using an "active" PHR known as HealthTrak. The "passive" elements of this PHR included problem lists, medication lists, information about patient allergies and immunizations, medical and surgical histories, lab test results, health reminders, and secure messaging. The active arm included all of these elements and added personalized alerts delivered through the secure messaging platform to patients for services coming due based on various demographic features (including age and sex) and chronic medical conditions. Our participants were part of the larger clinical trial and were eligible if they had been randomized to the active PHR arm, one that included regular personalized alerts. We conducted focus group discussions on the benefits of this active PHR for patients who are at risk for cardiovascular disease. Forty-one patients agreed to participate and were organized into five separate focus group sessions. Three main themes emerged from the qualitatively analyzed focus groups: participants reported that the active PHR promoted better communication with providers; enabled them to more effectively partner with their providers; and helped them become more proactive about tracking their health information. In conclusion, patients reported improved communication, partnership with their providers, and a sense of self-management, thus adding insights for PHR designers hoping to address low adoption rates and other patient barriers to the development and use of the technology.
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Affiliation(s)
- John J Rief
- a Department of Communication and Rhetorical Studies , Duquesne University
| | - Megan E Hamm
- b Qualitative, Evaluation and Stakeholder Engagement Services, Center for Research on Health Care , University of Pittsburgh
| | - Susan L Zickmund
- c Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Division of General Internal Medicine, Department of Medicine , University of Pittsburgh School of Medicine, University of Pittsburgh
| | - Cara Nikolajski
- d Center for Research on Health Care , University of Pittsburgh
| | - Dan Lesky
- e University of Pittsburgh School of Medicine , University of Pittsburgh
| | - Rachel Hess
- f Departments of Population Health Sciences and Internal Medicine , University of Utah
| | - Gary S Fischer
- g Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine , University of Pittsburgh
| | - Melissa Weimer
- d Center for Research on Health Care , University of Pittsburgh
| | - Sunday Clark
- h Department of Emergency Medicine , Weill Cornell Medical College
| | - Caroline Zieth
- d Center for Research on Health Care , University of Pittsburgh
| | - Mark S Roberts
- g Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine , University of Pittsburgh
- i Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health , University of Pittsburgh
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Lyles CR, Allen JY, Poole D, Tieu L, Kanter MH, Garrido T. "I Want to Keep the Personal Relationship With My Doctor": Understanding Barriers to Portal Use among African Americans and Latinos. J Med Internet Res 2016; 18:e263. [PMID: 27697748 PMCID: PMC5067358 DOI: 10.2196/jmir.5910] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/19/2016] [Accepted: 09/07/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the widespread implementation of electronic health records (EHRs), there is growing evidence that racial/ethnic minority patients do not use portals as frequently as non-Hispanic whites to access their EHR information online. This differential portal use could be problematic for health care disparities since early evidence links portal use to better outcomes. OBJECTIVE We sought to understand specific barriers to portal use among African American and Latino patients at Kaiser Permanente, which has had a portal in place for over a decade, and broad uptake among the patient population at large. METHODS We conducted 10 focus groups with 87 participants in 2012 and 2013 among African American and Latino Kaiser Permanente members in the mid-Atlantic, Georgia, and Southern California regions. Members were eligible to participate if they were not registered for portal access. Focus groups were conducted within each racial/ethnic group, and each included individuals who were older, had a chronic disease, or were parents (as these are the three biggest users of the portal at Kaiser Permanente overall). We videotaped each focus group and transcribed the discussion for analysis. We used general inductive coding to develop themes for major barriers to portal use, overall and separately by racial/ethnic group. RESULTS We found that lack of support was a key barrier to initiating portal use in our sample-both in terms of technical assistance as well as the fear of the portal eroding existing personal relationships with health care providers. This held true across a range of focus groups representing a mix of age, income, health conditions, and geographic regions. CONCLUSIONS Our study was among the first qualitative explorations of barriers to portal use among racial/ethnic subgroups. Our findings suggest that uniform adoption of portal use across diverse patient groups requires more usable and personalized websites, which may be particularly important for reducing health care disparities. This work is particularly important as all health care systems continue to offer and promote more health care features online via portals.
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O’Connor S, Hanlon P, O’Donnell CA, Garcia S, Glanville J, Mair FS. Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies. BMC Med Inform Decis Mak 2016; 16:120. [PMID: 27630020 PMCID: PMC5024516 DOI: 10.1186/s12911-016-0359-3] [Citation(s) in RCA: 316] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 09/03/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the qualitative literature on barriers and facilitators to engagement and recruitment to DHIs to inform future implementation efforts. METHODS PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library were searched for English language qualitative studies from 2000 - 2015 that discussed factors affecting engagement and enrolment in a range of DHIs (e.g. 'telemedicine', 'mobile applications', 'personal health record', 'social networking'). Text mining and additional search strategies were used to identify 1,448 records. Two reviewers independently carried out paper screening, quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory, and Burden of Treatment Theory helped conceptualise the interpretation of results. RESULTS Nineteen publications were included in the review. Four overarching themes that affect patient and public engagement and enrolment in DHIs emerged; 1) personal agency and motivation; 2) personal life and values; 3) the engagement and recruitment approach; and 4) the quality of the DHI. The review also summarises engagement and recruitment strategies used. A preliminary DIgital Health EnGagement MOdel (DIEGO) was developed to highlight the key processes involved. Existing knowledge gaps are identified and a number of recommendations made for future research. Study limitations include English language publications and exclusion of grey literature. CONCLUSION This review summarises and highlights the complexity of digital health engagement and recruitment processes and outlines issues that need to be addressed before patients and the public commit to digital health and it can be implemented effectively. More work is needed to create successful engagement strategies and better quality digital solutions that are personalised where possible and to gain clinical accreditation and endorsement when appropriate. More investment is also needed to improve computer literacy and ensure technologies are accessible and affordable for those who wish to sign up to them. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews CRD42015029846.
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Affiliation(s)
- Siobhan O’Connor
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, G12 9LX UK
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Peter Hanlon
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, G12 9LX UK
| | - Catherine A. O’Donnell
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, G12 9LX UK
| | | | | | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, G12 9LX UK
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Shearer JE, Jenkins CH, Magwood GS, Pope CA. Contested Ownership of Disease and Ambulatory-Sensitive Emergency Department Visits for Type 2 Diabetes. Am J Med Sci 2016; 351:400-6. [PMID: 27079346 DOI: 10.1016/j.amjms.2016.01.007] [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] [Indexed: 11/27/2022]
Abstract
BACKGROUND Approximately 21 million persons have diabetes and account for 11.9% of all emergency department (ED) visits for a total cost of $14.1 billion. Nonemergent visits for ambulatory-sensitive conditions that could be managed by the primary care provider make up almost one-third of the ED visits. African Americans comprise approximately 30% of South Carolina's population but make up approximately 50% of the ED visits for diabetes. The purpose of the research was to explore the experiences of 20 African-American adults with diabetes with ambulatory-sensitive ED use. RESEARCH DESIGN AND METHODS The research design for this study is grounded theory with dimensional analysis methods. Following ethics approval and informed consent, interviews were conducted, recorded and transcribed verbatim, and themes were analyzed to form the explanatory framework or matrix for ED use. The framework of context, conditions, processes and consequences provides a key for understanding the themes of the story embedded in the descriptive narratives. RESULTS The contested ownership of diabetes was the overarching perspective--"doing what I got to do," "it's always on mind… wishing not to be a diabetic" and "it's a constant burden." And handling diabetes involved taking decisions "into your hands." The context of perceived urgency of symptoms included all the reasons that precipitated ED visit--personal experience, primary care access and services and social network support for decisions--influenced ownership of these decisions.
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Affiliation(s)
- Jennifer E Shearer
- College of Nursing, Charleston Southern University, Charleston, South Carolina
| | - Carolyn H Jenkins
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina.
| | - Gayenell S Magwood
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Charlene A Pope
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Farmahini Farahani M, Purfarzad Z, Ghorbani M, Ghamari Zare Z, Ghorbani F. The impact of Multimedia Software Support on the Knowledge and Self-Care Behaviors of Patients with Type 2 Diabetes: a Randomized Clinical Trial. J Caring Sci 2016; 5:111-20. [PMID: 27354975 PMCID: PMC4923835 DOI: 10.15171/jcs.2016.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 10/30/2015] [Indexed: 12/25/2022] Open
Abstract
Introduction: Education is the most effective and economical
part of diabetes treatment. The purpose of this study was to investigate the effect of a
training program with multimedia software on the knowledge and self-care behaviors of
patients with type 2 diabetes. Methods: This study was a randomized controlled clinical
trial in which 60 patients referred to diabetes clinic at Arak city were divided randomly
into experimental (n=30) and control (n=30) groups. The instruments for collecting data
were "Summary of Diabetes self-care activities questionnaire" and "knowledge of self-care
in patients with diabetes". Data were collected before and 2 months after the intervention
in the both groups. Educational program with equal content was applied for both
experimental group (self-care program with multimedia software support) & control
group (lecture and presentation with PowerPoint). Data analysis was done using SPSS
Ver.13. Results: Implementation of the self-care program with
multimedia software support resulted in improvements in patients’ self-care behaviors in
the experimental group, whereas these behaviors had not significant changes in the control
group after eight weeks. There was a significant difference in the mean score of knowledge
in both the experiment and control groups before and after the intervention. Conclusion: Considering beneficial effects of training
program with multimedia software support on the knowledge and self-care behaviors and the
importance of this issue, suggested that the patients preferably provide terms of use of
educational software for themselves.
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Affiliation(s)
- Moloud Farmahini Farahani
- Department of Nursing, Nursing and Midwifery Faculty, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Purfarzad
- Department of Nursing, Nursing and Midwifery Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Ghorbani
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Fateme Ghorbani
- Department of Exercise Physiology, Faculty of Physical Education & Sport Sciences, Isfahan University, Isfahan, Iran
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Schneider H, Hill S, Blandford A. Patients Know Best: Qualitative Study on How Families Use Patient-Controlled Personal Health Records. J Med Internet Res 2016; 18:e43. [PMID: 26912201 PMCID: PMC4785240 DOI: 10.2196/jmir.4652] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/29/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022] Open
Abstract
Background Self-management technologies, such as patient-controlled electronic health records (PCEHRs), have the potential to help people manage and cope with disease. Objective This study set out to investigate patient families’ lived experiences of working with a PCEHR. Methods We conducted a semistructured qualitative field study with patient families and clinicians at a children’s hospital in the UK that uses a PCEHR (Patients Know Best). All families were managing the health of a child with a serious chronic condition, who was typically under the care of multiple clinicians. As data gathering and analysis progressed, it became clear that while much of the literature assumes that patients are willing and waiting to take more responsibility for and control over their health management (eg, with PCEHRs), only a minority of participants in our study responded in this way. Their experiences with the PCEHR were diverse and strongly shaped by their coping styles. Theory on coping identifies a continuum of coping styles, from approach to avoidance oriented, and proposes that patients’ information needs depend on their style. Results We identified 3 groups of patient families and an outlier, distinguished by their coping style and their PCEHR use. We refer to the outlier as controlling (approach oriented, highly motivated to use PCEHR), and the 3 groups as collaborating (approach oriented, motivated to use PCEHR), cooperating (avoidance oriented, less motivated to use PCEHR), and avoiding (very avoidance oriented, not motivated to use PCEHR). Conclusions The PCEHR met the needs of controller and collaborators better than the needs of cooperators and avoiders. We draw on the Self-Determination Theory to propose ways in which a PCEHR design might better meet the needs of avoidance-oriented users. Further, we highlight the need for families to also relinquish control at times, and propose ways in which PCEHR design might support a better distribution of control, based on effective training, ease of use, comprehensibility of data security mechanisms, timely information provision (recognizing people’s different needs), personalization of use, and easy engagement with clinicians through the PCEHR.
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Dobscha SK, Denneson LM, Jacobson LE, Williams HB, Cromer R, Woods S. VA mental health clinician experiences and attitudes toward OpenNotes. Gen Hosp Psychiatry 2016; 38:89-93. [PMID: 26380876 DOI: 10.1016/j.genhosppsych.2015.08.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe Department of Veterans Affairs (VA) mental health clinician attitudes toward and experiences with OpenNotes (also known as Blue Button), which provides patients direct access to clinical notes online. METHOD A 35-item online survey was administered to 263 mental health clinicians and nurses from one VA Medical Center. RESULTS Seventy-nine percent of eligible subjects participated. Most respondents agreed or somewhat agreed that OpenNotes is a good idea in general, but only half agreed that making mental health notes available online is a good idea. Most believed that patients will better remember plans of care and be better prepared for visits. Most also felt that patients will worry more and request changes in notes. Many clinicians reported being less detailed and changing the tone of their notes. CONCLUSION As a group, mental health clinicians are positive about OpenNotes in general but ambivalent about the use of OpenNotes in mental health care. The results call for research on outcomes of OpenNotes use in mental health and to develop education and support to help clinicians adapt to OpenNotes.
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Affiliation(s)
- Steven K Dobscha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System; PO Box 1034 (R&D66), Portland, OR 97207, USA; Mental Health and Clinical Neurosciences Division, VA Portland Health Care System; PO Box 1034 (R&D66), Portland, OR 97207, USA; Department of Psychiatry, Oregon Health & Science University; 3181 Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Lauren M Denneson
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System; PO Box 1034 (R&D66), Portland, OR 97207, USA; Mental Health and Clinical Neurosciences Division, VA Portland Health Care System; PO Box 1034 (R&D66), Portland, OR 97207, USA; Department of Psychiatry, Oregon Health & Science University; 3181 Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Laura E Jacobson
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System; PO Box 1034 (R&D66), Portland, OR 97207, USA.
| | - Holly B Williams
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System; PO Box 1034 (R&D66), Portland, OR 97207, USA.
| | - Risa Cromer
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System; PO Box 1034 (R&D66), Portland, OR 97207, USA.
| | - Susan Woods
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System; PO Box 1034 (R&D66), Portland, OR 97207, USA.
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Tieu L, Sarkar U, Schillinger D, Ralston JD, Ratanawongsa N, Pasick R, Lyles CR. Barriers and Facilitators to Online Portal Use Among Patients and Caregivers in a Safety Net Health Care System: A Qualitative Study. J Med Internet Res 2015; 17:e275. [PMID: 26681155 PMCID: PMC4704882 DOI: 10.2196/jmir.4847] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/14/2015] [Accepted: 10/09/2015] [Indexed: 01/17/2023] Open
Abstract
Background Patient portals have the potential to support self-management for chronic diseases and improve health outcomes. With the rapid rise in adoption of patient portals spurred by meaningful use incentives among safety net health systems (a health system or hospital providing a
significant level of care to low-income, uninsured, and vulnerable populations), it is important to understand the readiness and willingness of patients and caregivers in safety net settings to access their personal health records online. Objective To explore patient and caregiver perspectives on online patient portal use before its implementation at San Francisco General Hospital, a safety net hospital. Methods We conducted 16 in-depth interviews with chronic disease patients and caregivers who expressed interest in using the Internet to manage their health. Discussions focused on health care experiences, technology use, and interest in using an online portal to manage health tasks. We used open coding to categorize all the barriers and facilitators to portal use, followed by a second round of coding that compared the categories to previously published findings. In secondary analyses, we also examined specific barriers among 2 subgroups: those with limited health literacy and caregivers. Results We interviewed 11 patients and 5 caregivers. Patients were predominantly male (82%, 9/11) and African American (45%, 5/11). All patients had been diagnosed with diabetes and the majority had limited health literacy (73%, 8/11). The majority of caregivers were female (80%, 4/5), African American (60%, 3/5), caregivers of individuals with diabetes (60%, 3/5), and had adequate health literacy (60%, 3/5). A total of 88% (14/16) of participants reported interest in using the portal after viewing a prototype. Major perceived barriers included security concerns, lack of technical skills/interest, and preference for in-person communication. Facilitators to portal use included convenience, health monitoring, and improvements in patient-provider communication. Participants with limited health literacy discussed more fundamental barriers to portal use, including challenges with reading and typing, personal experience with online security breaches/viruses, and distrust of potential security measures. Caregivers expressed high interest in portal use to support their roles in interpreting health information, advocating for quality care, and managing health behaviors and medical care. Conclusions Despite concerns about security, difficulty understanding medical information, and satisfaction with current communication processes, respondents generally expressed enthusiasm about portal use. Our findings suggest a strong need for training and support to assist vulnerable patients with portal registration and use, particularly those with limited health literacy. Efforts to encourage portal use among vulnerable patients should directly address health literacy and security/privacy issues and support access for caregivers.
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Affiliation(s)
- Lina Tieu
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, United States.
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Cochran GL, Lander L, Morien M, Lomelin DE, Brittin J, Reker C, Klepser DG. Consumer Opinions of Health Information Exchange, e-Prescribing, and Personal Health Records. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2015; 12:1e. [PMID: 26604874 PMCID: PMC4632874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Consumer satisfaction is a crucial component of health information technology (HIT) utilization, as high satisfaction is expected to increase HIT utilization among providers and to allow consumers to become full participants in their own healthcare management. OBJECTIVE The primary objective of this pilot study was to identify consumer perspectives on health information technologies including health information exchange (HIE), e-prescribing (e-Rx), and personal health records (PHRs). METHODS Eight focus groups were conducted in seven towns and cities across Nebraska in 2013. Each group consisted of 10-12 participants. Discussions were organized topically in the following categories: HIE, e-Rx, and PHR. The qualitative analysis consisted of immersion and crystallization to develop a coding scheme that included both preconceived and emergent themes. Common themes across focus groups were identified and compiled for each discussion category. RESULTS The study had 67 participants, of which 18 (27 percent) were male. Focus group findings revealed both perceived barriers and benefits to the adoption of HIT. Common HIT concerns expressed across focus groups included privacy and security of medical information, decreases in quality of care, inconsistent provider participation, and the potential cost of implementation. Positive expectations regarding HIT included better accuracy and completeness of information, and improved communication and coordination between healthcare providers. Improvements in patient care were expected as a result of easy physician access to consolidated information across providers as well as the speed of sharing and availability of information in an emergency. In addition, participants were optimistic about patient empowerment and convenient access to and control of personal health data. CONCLUSION Consumer concerns focused on privacy and security of the health information, as well as the cost of implementing the technologies and the possibility of an unintended negative impact on the quality of care. While negative perceptions present barriers for potential patient acceptance, benefits such as speed and convenience, patient oversight of health data, and safety improvements may counterbalance these concerns.
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Affiliation(s)
- Gary L Cochran
- Gary L. Cochran, PharmD, SM, is an assistant professor in the Department of Pharmacy Practice at the University of Nebraska Medical Center in Omaha, NE
| | - Lina Lander
- Lina Lander, ScD, is an associate professor in the Department of Epidemiology at the University of Nebraska Medical Center in Omaha, NE
| | - Marsha Morien
- Marsha Morien, MSBA, FHFMA, FACHE, is an instructor in the Department of Health Services Research and Administration at the University of Nebraska Medical Center in Omaha, NE
| | - Daniel E Lomelin
- Daniel E. Lomelin is a graduate research assistant in the College of Public Health at the University of Nebraska Medical Center in Omaha, NE
| | - Jeri Brittin
- Jeri Brittin, MM, is a graduate research assistant in the College of Public Health at the University of Nebraska Medical Center in Omaha, NE
| | - Celeste Reker
- Celeste Reker is a research assistant in the College of Public Health at the University of Nebraska Medical Center in Omaha, NE
| | - Donald G Klepser
- Donald G. Klepser, PhD, MBA, is an associate professor in the Department of Pharmacy Practice at the University of Nebraska Medical Center in Omaha, NE
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Claudio D, Velázquez MA, Bravo-Llerena W, Okudan GE, Freivalds A. Perceived Usefulness and Ease of Use of Wearable Sensor-Based Systems in Emergency Departments. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/21577323.2015.1040559] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mwachofi AK, Khaliq AA, Carrillo ER, Winfree W. Technology versus humanism: how patients perceive the use of electronic health records in physicians' offices--a qualitative study. HEALTH COMMUNICATION 2015; 31:257-264. [PMID: 26305852 DOI: 10.1080/10410236.2014.947467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Electronic Health Records (EHRs) have the potential to improve the quality of care. In view of the accelerated adoption of EHRs, there is a need to understand conditions necessary for their effective use. Patients are the focus of healthcare and their perceptions and expectations need to be included in developing and implementing EHRs. The purpose of this study was to gather exploratory qualitative information from patients about their experiences and perceptions regarding the effects of EHRs on healthcare quality in physicians' offices. We conducted five focus groups with patients representing a random mix of diverse socio-demographic backgrounds in Oklahoma. Related to EHRs, patients reported improvements on the technical side of care but no change on the human side. They expressed concerns about the potential for breach of confidentiality and security of medical records. They were also concerned about the possibility of governmental agencies or insurance companies having unauthorized access to patient records. Patients differentiated between the human and technical sides of care and reported no change or improvement in the doctor-patient interaction. Patients have an important perspective on the use of EHRs and their perceptions and experiences should be considered in the development, adoption and implementation of EHRs. Otherwise, the use of EHRs may not be fully effective. There is also a need to educate patients about the potential benefits and risks of EHRs and the steps being taken to mitigate such risks.
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Affiliation(s)
- Ari K Mwachofi
- a Department of Public Health, Brody School of Medicine , East Carolina University
| | - Amir A Khaliq
- b Department of Health Administration and Policy, College of Public Health , University of Oklahoma Health Sciences Center
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mHealth Technology as a Persuasive Tool for Treatment, Care and Management of Persons Living with HIV. AIDS Behav 2015; 19 Suppl 2:81-9. [PMID: 25572830 DOI: 10.1007/s10461-014-0984-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Mobile health (mHealth) technology can be a valuable tool in the management of chronic illnesses, including HIV. Qualitative research methods were used to identify the desired content and features of a mobile app for meeting and improving the healthcare needs of persons living with HIV (PLWH). We conducted six focus group sessions with 50 English-or Spanish-speaking PLWH in New York City. To inform data analysis and to illustrate how mHealth technology can be used as a persuasive strategy for improving the health of PLWH, we integrated Fogg's functional role triad for computing technology model with the self-determination theory to illustrate how mHealth technology can be used as a persuasive strategy for improving the health of PLWH. Participants suggested several tools for meeting their healthcare needs, including: reminders/alerts, lab results tracking, and notes on health status. mHealth technology can function as a social actor by providing chat boxes/forums, testimonials of lived experiences, and personal outreach. Examples of media that can be used as a persuasive technology include games/virtual rewards, coding of health tasks, and simulations on how to connect with PLWH. Findings from these focus groups can be used to design a mobile app for PLWH that is targeted to meet their healthcare needs.
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Vydra TP, Cuaresma E, Kretovics M, Bose-Brill S. Diffusion and Use of Tethered Personal Health Records in Primary Care. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2015; 12:1c. [PMID: 26755897 PMCID: PMC4696089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Personal health records (PHRs) enable patients to access their healthcare information in a secure environment, increasing patient engagement in medical care. PHRs can be tethered to a patient's electronic health record (EHR). Tethered PHRs, also known as patient portals, allow patients to access relevant medical information from their provider. Despite recent policy efforts to promote the use of health information technology and increased availability of PHRs in the clinical setting, PHR adoption rates remain relatively low overall. This article examines physician characteristics of high vs. low PHR adopters. OBJECTIVE The objectives of this study were to (1) examine PHR use patterns in the primary care setting, (2) identify physician characteristics affecting PHR adoption, and (3) explore physician perspectives encouraging and deterring use. METHODS Information technology records provided data on primary care patient portal use at a large Midwestern academic medical center. Electronic surveys were administered to affiliated primary care physicians to measure their perceived use of patient portals. A focus group consisting of physician providers who completed the survey was used to further elucidate the trends and perceived utilization of the patient portal in the clinical setting. RESULTS While they expended significant time communicating with patients using the portal, physicians generally overestimated the time spent per week on the system. Physicians who had been in practice longer estimated a higher average time spent on the system when compared to newer physicians. Patient portal activation rates and use decreased with increased years in practice. During the focus groups, physicians voiced motivation to use patient portals because they perceived improved patient communication and satisfaction with use. However, continued lack of reimbursement for time spent in portal communication was reported as a major barrier to providers' engagement with this technology. DISCUSSION Physician endorsement and engagement is critical to achieve widespread adoption of PHRs. Such endorsement can be obtained through (1) providing rewards from health system employers for high use of PHRs, (2) providing financial reimbursement for time spent electronically communicating with patients via the PHR from federal initiatives incentivizing meaningful use of health information technology, (3) building robust support staff assistance for PHR communication into primary care workflows, and (4) integrating more PHR-specific education into providers' EHR training.
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Affiliation(s)
| | | | - Matthew Kretovics
- Division of General Internal Medicine at the Ohio State University Wexner Medical Center in Columbus, OH
| | - Seuli Bose-Brill
- Division of General Internal Medicine at the Ohio State University Wexner Medical Center in Columbus, OH
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Vassilakaki E, Johnson F. The use of grounded theory in identifying the user experience during search. LIBRARY & INFORMATION SCIENCE RESEARCH 2015. [DOI: 10.1016/j.lisr.2014.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Collaborative interaction points in post-discharge stroke care. Int J Integr Care 2014; 14:e032. [PMID: 25414623 PMCID: PMC4238053 DOI: 10.5334/ijic.1549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 10/10/2014] [Accepted: 10/20/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction Lack of appropriate electronic tools for supporting patient involvement and
collaboration with care professionals is a problem in health care. Methods Care and rehabilitation processes of post-discharge stroke patients were analysed
using the concept of interaction points where patients, next-of-kin and care
professionals interact and exchange information. Thirteen interviews with care
professionals and five non-participatory observations were performed. Data were
analysed using content analysis and modelling of interaction points in the patient
journey. Results Patient participation and interaction patterns vary; patients requiring home care
have a passive role and next-of-kin or nurses become advocates by coordinating
care on behalf of the patient, whereas patients who are able to visit primary care
coordinate their own care by initiating interactions. Important categories of
participation include the following: participation in care planning, in monitoring
risk factors and in rehabilitation planning. Conclusions Designing a supportive electronic tool requires understanding the interactions and
patients’ activity levels at each interaction point. A tool for patients
with higher activity level should support them to coordinate their own care,
whereas for a less-active patient group, the tool could focus on supporting
next-of-kin and care professionals in motivating, guiding and including passive
patients in their care and rehabilitation processes.
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Phelps RG, Taylor J, Simpson K, Samuel J, Turner AN. Patients' continuing use of an online health record: a quantitative evaluation of 14,000 patient years of access data. J Med Internet Res 2014; 16:e241. [PMID: 25344621 PMCID: PMC4259918 DOI: 10.2196/jmir.3371] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 08/28/2014] [Accepted: 09/22/2014] [Indexed: 11/13/2022] Open
Abstract
Background Online access to all or part of their health records is widely demanded by patients and, where provided in form of patient portals, has been substantially used by at least subgroups of patients, particularly those with chronic disease. However, little is reported regarding the longer-term patient use of patient-accessible electronic health record services, which is important in allocating resources. Renal PatientView (RPV) is an established system that gives patients with chronic kidney disease access to live test results and information about their condition and treatment. It is available in most UK renal units with up to 75% of particular patient groups registered in some centers. We have analyzed patient use out to 4 years and investigated factors associated with more persistent use. Objective Our aim was to investigate RPV use by patients over time from initial registration in order to understand which patients choose to access RPV and the endurance of its appeal for different patient groups. Methods We analyzed an anonymized extract of the database underlying RPV containing information on patient registration and events including patient access and the arrival of new blood test results or letters that patients might wish to view. Results At the time of the extract, there were 11,352 patients registered on RPV for 0-42 months (median 17). More than half of registrants became persistent users, logging in a median of 2.0 times each month over post-registration intervals of up to 42 months (median 18.9). Provision of assistance with first logon was strongly associated with becoming a persistent user, even at 3 years. Logons by persistent users occurred around the time of consultations/tests, strongly suggestive of patient engagement. While indices indicative of greater deprivation were the strongest determinants of non-participation, they had negligible influence on drop-out rates among established users. Conclusions In this mature patient portal system, a large proportion of patients made regular use of their online health records over protracted periods. The patterns and timing of use indicate strong patient interest in detailed information such as recent test results and clinic letters. Supporting patients through the first steps of establishing access to their online records is associated with much higher rates of long-term use of RPV and likely would increase use of other electronic health records provided for patients with chronic disease.
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Affiliation(s)
- Richard G Phelps
- University of Edinburgh, Renal Autoimmunity Group, Centre for Inflammation Research, Edinburgh, United Kingdom.
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Andrews L, Gajanayake R, Sahama T. The Australian general public's perceptions of having a personally controlled electronic health record (PCEHR). Int J Med Inform 2014; 83:889-900. [PMID: 25200198 DOI: 10.1016/j.ijmedinf.2014.08.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 08/06/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The move internationally by Governments and other health providers to encourage patients to have their own electronic personal health record (e-PHRs) is growing exponentially. In Australia the initiative for a personally controlled electronic health record (known as PCEHR) is directed towards the public at large. The first objective of this study then, is to examine how individuals in the general population perceive the promoted idea of having a PCEHR. The second objective is to extend research on applying a theoretically derived consumer technology acceptance model to guide the research. METHOD An online survey was conducted to capture the perceptions and beliefs about having a PCEHR identified from technology acceptance models and extant literature. The survey was completed by 750 Queensland respondents, 97% of whom did not have a PCEHR at that time. The model was examined using exploratory factor analysis, regressions and mediation tests. RESULTS Findings support eight of the 11 hypothesised relationships in the model. Perceived value and perceived risk were the two most important variables explaining attitude, with perceived usefulness and compatibility being weak but significant. The perception of risk was reduced through partial mediation from trust and privacy concerns. Additionally, web-self efficacy and ease of use partially mediate the relationship between attitude and intentions. CONCLUSIONS The findings represent a snapshot of the early stages of implementing this Australian initiative and capture the perceptions of Queenslanders who at present do not have a PCEHR. Findings show that while individuals appreciate the value of having this record, they do not appear to regard it as particularly useful at present, nor is it particularly compatible with their current engagement with e-services. Moreover, they will need to have any concerns about the risks alleviated, particularly through an increased sense of trust and reduction of privacy concerns. It is noted that although the respondents are non-adopters, they do not feel that they lack the necessary web skills to set up and use a PCEHR. To the best of our knowledge this is one of a very limited number of studies that examines a national level implementation of an e-PHR system, where take-up of the PCEHR is optional rather than a centralised, mandated requirement.
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Affiliation(s)
- Lynda Andrews
- School of Advertising, Marketing and Public Relations, Faculty of Business, Queensland University of Technology, P.O. Box 2434, Brisbane, Queensland, Australia.
| | - Randike Gajanayake
- School of Electrical Engineering and Computer Science, Faculty of Science and Engineering, Queensland University of Technology, P.O. Box 2434, Brisbane, Queensland, Australia.
| | - Tony Sahama
- School of Electrical Engineering and Computer Science, Faculty of Science and Engineering, Queensland University of Technology, P.O. Box 2434, Brisbane, Queensland, Australia.
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O’Sullivan D, Doyle J, Michalowski W, Wilk S, Thomas R, Farion K. Expanding usability analysis with intrinsic motivation concepts to learn about CDSS adoption: a case study. HEALTH POLICY AND TECHNOLOGY 2014. [DOI: 10.1016/j.hlpt.2014.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kelstrup AM, Juillerat P, Korzenik J. The accuracy of self-reported medical history: a preliminary analysis of the promise of internet-based research in Inflammatory Bowel Diseases. J Crohns Colitis 2014; 8:349-56. [PMID: 24183653 DOI: 10.1016/j.crohns.2013.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 08/13/2013] [Accepted: 09/12/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Internet-based surveys provide a potentially important tool for Inflammatory Bowel Disease (IBD) research. The advantages include low cost, large numbers of participants, rapid study completion and less extensive infrastructure than traditional methods. The aim was to determine the accuracy of patient self-reporting in internet-based IBD research and identify predictors of greater reliability. METHODS 197 patients from a tertiary care center answered an online survey concerning personal medical history and an evaluation of disease specific knowledge. Self-reported medical details were compared with data abstracted from medical records. Agreement was assessed by kappa (κ) statistics. RESULTS Participants responded correctly with excellent agreement (κ=0.96-0.97) on subtype of IBD and history of surgery. The agreement was also excellent for colectomy (κ=0.88) and small bowel resection (κ=0.91), moderate for abscesses and fistulas (κ=0.60 and 0.63), but poor regarding partial colectomy (κ=0.39). Time since last colonoscopy was self-reported with better agreement (κ=0.84) than disease activity. For disease location/extent, moderate agreements at κ=69% and 64% were observed for patients with Crohn's disease and ulcerative colitis, respectively. Subjects who scored higher than the average in the IBD knowledge assessment were significantly more accurate about disease location than their complementary group (74% vs. 59%, p=0.02). CONCLUSION This study demonstrates that IBD patients accurately report their medical history regarding type of disease and surgical procedures. More detailed medical information is less reliably reported. Disease knowledge assessment may help in identifying the most accurate individuals and could therefore serve as validity criteria. Internet-based surveys are feasible with high reliability about basic disease features only. However, the participants in this study were engaged at a tertiary center, which potentially leads to a bias and compromises generalization to an unfiltered patient group.
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Affiliation(s)
- Anne Mette Kelstrup
- Crohn's and Colitis Center, Massachusetts General Hospital, Boston, United States; Department of Medicine, Køge Hospital, Denmark.
| | - Pascal Juillerat
- Crohn's and Colitis Center, Massachusetts General Hospital, Boston, United States; Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Joshua Korzenik
- Crohn's and Colitis Center, Massachusetts General Hospital, Boston, United States
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Wells S, Rozenblum R, Park A, Dunn M, Bates DW. Personal health records for patients with chronic disease: a major opportunity. Appl Clin Inform 2014; 5:416-29. [PMID: 25024758 DOI: 10.4338/aci-2014-01-ra-0002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/05/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Personal health records (PHRs) connected to a physician's electronic health record system hold substantial promise for supporting and engaging patients with chronic disease. OBJECTIVES To explore how U.S. health care organizations are currently utilizing PHRs for chronic disease populations. METHODS A mixed methods study including semi-structured interviews and a questionnaire was conducted. A purposive sample was developed of health care organizations which were recognized as exemplars for PHRs and were high performers in national patient satisfaction surveys (H-CAHPS or CAHPS). Within each organization, participants were health IT leaders or those managing high-risk or chronic disease populations. RESULTS Interviews were conducted with 30 informants and completed questionnaires were received from 16 organizations (84% response rate). Most PHRs allowed patients to access health records and educational material, message their provider, renew prescriptions and request appointments. Patient generated data was increasingly being sought and combined with messaging, resulted in greater understanding of patient health and functioning outside of the clinic visit. However for chronic disease populations, there was little targeted involvement in PHR design and few tools to help interpret and manage their conditions beyond those offered for all. The PHR was largely uncoupled from high risk population management interventions and no clear framework for future PHR development emerged. CONCLUSION This technology is currently underutilized and represents a major opportunity given the potential benefits of patient engagement and shared decision making. A coherent patient-centric PHR design and evaluation strategy is required to realize its potential and maximize this natural hub for multidisciplinary care co-ordination.
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Affiliation(s)
- S Wells
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland , Auckland, New Zealand ; Department of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - R Rozenblum
- Department of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - A Park
- Department of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - M Dunn
- Department of Health Care Policy and Management, Harvard School of Public Health , Boston, Massachusetts
| | - D W Bates
- Department of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts ; Department of Health Care Policy and Management, Harvard School of Public Health , Boston, Massachusetts
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