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Yu Y, Wu Y, Huang Z, Sun X. Associations between media use, self-efficacy, and health literacy among Chinese rural and urban elderly: A moderated mediation model. Front Public Health 2023; 11:1104904. [PMID: 36969672 PMCID: PMC10034173 DOI: 10.3389/fpubh.2023.1104904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectivesThe influence of media use on health literacy among urban and rural elderly has been unknown in China. This study aims to examine the association between media use and health literacy and to explore the mediating role of self-efficacy and the moderating role of urban-rural residency.MethodsBased on the cross-sectional study of the Psychology and Behavior Investigation of Chinese Residents (PBICR) in 2022, a total of 4,070 Chinese old people aged 60 years and above were included. We adopted the simplified New General Self-Efficacy Scale (NGSES) and the simplified Health Literacy Scale-Short Form (HLS-SF) to measure self-efficacy and health literacy. Media use was measured using a self-administrated questionnaire.ResultsResults showed that Chinese urban elderly had a higher frequency of media use than rural ones in the aspects of social activities, self-presentation, social action, leisure and entertainment, information acquisition, and business transactions through media (P < 0.001). Among all participants, self-presentation (B = 0.217, 95% CI: 0.040, 0.394), leisure and entertainment (B = 0.345, 95% CI: 0.189, 0.502), and information acquisition (B = 0.918, 95% CI: 0.761, 1.076) were significantly associated with health literacy. Self-efficacy partially mediated the effect of media use on health literacy (Bindirect = 0.045, 95% CI: 0.032, 0.058), accounting for 18.37% of the total effect. Urban-rural residency (B = 0.049, 95% CI: 0.024, 0.075) moderated the relationship between media use and self-efficacy significantly.ConclusionThe urban-rural gap in health literacy requires more attention. The promotion of media use and self-efficacy may play a role in eliminating health disparities.LimitationsAs a cross-sectional study, it could not establish cause-effect relationships.
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Affiliation(s)
- Yebo Yu
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Yibo Wu
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
- Health Culture Research Center of Shaanxi, Key Research Base of Philosophy and Social Sciences in Shaanxi Province, Xi'an, Shaanxi, China
| | - Zhen Huang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Xinying Sun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
- *Correspondence: Xinying Sun
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Cheng C, Gearon E, Hawkins M, McPhee C, Hanna L, Batterham R, Osborne RH. Digital Health Literacy as a Predictor of Awareness, Engagement, and Use of a National Web-Based Personal Health Record: Population-Based Survey Study. J Med Internet Res 2022; 24:e35772. [PMID: 36112404 PMCID: PMC9526109 DOI: 10.2196/35772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/16/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Web-based personal health records (PHRs) have the potential to improve the quality, accuracy, and timeliness of health care. However, the international uptake of web-based PHRs has been slow. Populations experiencing disadvantages are less likely to use web-based PHRs, potentially widening health inequities within and among countries.
Objective
With limited understanding of the predictors of community uptake and use of web-based PHR, the aim of this study was to identify the predictors of awareness, engagement, and use of the Australian national web-based PHR, My Health Record (MyHR).
Methods
A population-based survey of adult participants residing in regional Victoria, Australia, was conducted in 2018 using telephone interviews. Logistic regression, adjusted for age, was used to assess the relationship among digital health literacy, health literacy, and demographic characteristics, and the 3 dependent variables of MyHR: awareness, engagement, and use. Digital health literacy and health literacy were measured using multidimensional tools, using all 7 scales of the eHealth Literacy Questionnaire and 4 out of the 9 scales of the Health Literacy Questionnaire.
Results
A total of 998 responses were analyzed. Many elements of digital health literacy were strongly associated with MyHR awareness, engagement, and use. A 1-unit increase in each of the 7 eHealth Literacy Questionnaire scales was associated with a 2- to 4-fold increase in the odds of using MyHR: using technology to process health information (odds ratio [OR] 4.14, 95% CI 2.34-7.31), understanding of health concepts and language (OR 2.25, 95% CI 1.08-4.69), ability to actively engage with digital services (OR 4.44, 95% CI 2.55-7.75), feel safe and in control (OR 2.36, 95% CI 1.43-3.88), motivated to engage with digital services (OR 4.24, 95% CI 2.36-7.61), access to digital services that work (OR 2.49, 95% CI 1.32-4.69), and digital services that suit individual needs (OR 3.48, 95% CI 1.97-6.15). The Health Literacy Questionnaire scales of health care support, actively managing health, and social support were also associated with a 1- to 2-fold increase in the odds of using MyHR. Using the internet to search for health information was another strong predictor; however, older people and those with less education were less likely to use MyHR.
Conclusions
This study revealed strong and consistent patterns of association between digital health literacy and the use of a web-based PHR. The results indicate potential actions for promoting PHR uptake, including improving digital technology and skill experiences that may improve digital health literacy and willingness to engage in web-based PHR. Uptake may also be improved through more responsive digital services, strengthened health care, and better social support. A holistic approach, including targeted solutions, is needed to ensure that web-based PHR can realize its full potential to help reduce health inequities.
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Affiliation(s)
- Christina Cheng
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Emma Gearon
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | | | - Lisa Hanna
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Roy Batterham
- Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
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Marziliano A, Diefenbach MA, Hudson SV, Tagai EK, Handorf EA, Bator A, Miller SM. Demographic and Psychosocial Characteristics Associated With Use of a Prostate Cancer Survivorship Website: Implications From a Multisite Randomized Controlled Trial. J Med Internet Res 2022; 24:e27890. [PMID: 35311678 PMCID: PMC8981019 DOI: 10.2196/27890] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/13/2021] [Accepted: 10/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Many prostate cancer (PC) survivors experience disease and treatment-related symptomatology in both the physical and psychosocial domains. Although the benefits and barriers to using web-based resources for cancer patients are well-documented, less research has focused on the personal characteristics important for efficient tailoring and targeting of information that are associated with usage. Objective We used the Cognitive-Social Health Information Processing (C-SHIP) framework to guide our exploration of personal characteristics associated with use of PROGRESS, an informational PC survivorship website that addresses physical, emotional, interpersonal, and practical concerns relevant for PC survivors. Methods PC survivors (N=217) were randomized to the intervention arm (PROGRESS) of a randomized controlled trial. Of those randomized to the intervention arm, 84 used PROGRESS, and 133 did not use PROGRESS. Multivariable analyses evaluated demographic and psychosocial characteristics (eg, style of coping, health literacy, self-efficacy, affective states of depression, anxiety, and fatigue) associated with website use. Results A larger proportion of non-Hispanic White (68/160, 42.5%), compared with non-Hispanic Black (9/40, 23%), participants used PROGRESS (P<.001). Further, PROGRESS users were older in age (P<.001), had a monitoring style of coping (P=.01), and were less depressed (P=.004), anxious (P=.02), and fatigued (P<.001) than nonusers. Education, income, health literacy, blunting style of coping, self-efficacy, and treatment type (radiation therapy or surgery) were not significantly related to use. On multivariable analyses, race (OR 0.28, P<.001), age (OR 1.05, P<.001), monitoring style of coping (OR 1.27, P=.02), and overall mood (OR 0.98, P<.001) remained significant. Conclusions A combination of monitoring and low levels of negative affect were associated with website use. Additionally, users were older, non-Hispanic White survivors. To ensure that important survivorship-relevant information reaches users, future efforts need to focus on enhancing patient engagement. Trial Registration ClinicalTrials.gov NCT02224482; https://clinicaltrials.gov/ct2/show/NCT02224482
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Affiliation(s)
- Allison Marziliano
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Michael A Diefenbach
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Shawna V Hudson
- Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Erin K Tagai
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, United States
| | - Elizabeth A Handorf
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, United States
| | - Alicja Bator
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, United States
| | - Suzanne M Miller
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, United States
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Schwarz J, Bärkås A, Blease C, Collins L, Hägglund M, Markham S, Hochwarter S. Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review. JMIR Ment Health 2021; 8:e34170. [PMID: 34904956 PMCID: PMC8715358 DOI: 10.2196/34170] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/25/2021] [Accepted: 10/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) are increasingly implemented internationally, whereas digital sharing of EHRs with service users (SUs) is a relatively new practice. Studies of patient-accessible EHRs (PAEHRs)-often referred to as open notes-have revealed promising results within general medicine settings. However, studies carried out in mental health care (MHC) settings highlight several ethical and practical challenges that require further exploration. OBJECTIVE This scoping review aims to map available evidence on PAEHRs in MHC. We seek to relate findings with research from other health contexts, to compare different stakeholders' perspectives, expectations, actual experiences with PAEHRs, and identify potential research gaps. METHODS A systematic scoping review was performed using 6 electronic databases. Studies that focused on the digital sharing of clinical notes or EHRs with people affected by mental health conditions up to September 2021 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews guided narrative synthesis and reporting of findings. RESULTS Of the 1034 papers screened, 31 were included in this review. The studies used mostly qualitative methods or surveys and were predominantly published after 2018 in the United States. PAEHRs were examined in outpatient (n=29) and inpatient settings (n=11), and a third of all research was conducted in Veterans Affairs Mental Health. Narrative synthesis allowed the integration of findings according to the different stakeholders. First, SUs reported mainly positive experiences with PAEHRs, such as increased trust in their clinician, health literacy, and empowerment. Negative experiences were related to inaccurate notes, disrespectful language use, or uncovering of undiscussed diagnoses. Second, for health care professionals, concerns outweigh the benefits of sharing EHRs, including an increased clinical burden owing to more documentation efforts and possible harm triggered by reading the notes. Third, care partners gained a better understanding of their family members' mental problems and were able to better support them when they had access to their EHR. Finally, policy stakeholders and experts addressed ethical challenges and recommended the development of guidelines and trainings to better prepare both clinicians and SUs on how to write and read notes. CONCLUSIONS PAEHRs in MHC may strengthen user involvement, patients' autonomy, and shift medical treatment to a coproduced process. Acceptance issues among health care professionals align with the findings from general health settings. However, the corpus of evidence on digital sharing of EHRs with people affected by mental health conditions is limited. Above all, further research is needed to examine the clinical effectiveness, efficiency, and implementation of this sociotechnical intervention.
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Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany.,Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Annika Bärkås
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Lorna Collins
- Social Science Research Unit, University College London, London, United Kingdom
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sarah Markham
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Stefan Hochwarter
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany.,Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
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Grossman LV, Masterson Creber RM, Benda NC, Wright D, Vawdrey DK, Ancker JS. Interventions to increase patient portal use in vulnerable populations: a systematic review. J Am Med Inform Assoc 2021; 26:855-870. [PMID: 30958532 DOI: 10.1093/jamia/ocz023] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/05/2019] [Accepted: 02/12/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND More than 100 studies document disparities in patient portal use among vulnerable populations. Developing and testing strategies to reduce disparities in use is essential to ensure portals benefit all populations. OBJECTIVE To systematically review the impact of interventions designed to: (1) increase portal use or predictors of use in vulnerable patient populations, or (2) reduce disparities in use. MATERIALS AND METHODS A librarian searched Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Reviews for studies published before September 1, 2018. Two reviewers independently selected English-language research articles that evaluated any interventions designed to impact an eligible outcome. One reviewer extracted data and categorized interventions, then another assessed accuracy. Two reviewers independently assessed risk of bias. RESULTS Out of 18 included studies, 15 (83%) assessed an intervention's impact on portal use, 7 (39%) on predictors of use, and 1 (6%) on disparities in use. Most interventions studied focused on the individual (13 out of 26, 50%), as opposed to facilitating conditions, such as the tool, task, environment, or organization (SEIPS model). Twelve studies (67%) reported a statistically significant increase in portal use or predictors of use, or reduced disparities. Five studies (28%) had high or unclear risk of bias. CONCLUSION Individually focused interventions have the most evidence for increasing portal use in vulnerable populations. Interventions affecting other system elements (tool, task, environment, organization) have not been sufficiently studied to draw conclusions. Given the well-established evidence for disparities in use and the limited research on effective interventions, research should move beyond identifying disparities to systematically addressing them at multiple levels.
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Affiliation(s)
- Lisa V Grossman
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | | - Natalie C Benda
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
| | - Drew Wright
- Samuel J Wood Library, Information Technologies and Services, Weill Cornell Medicine, New York, New York, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Value Institute, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jessica S Ancker
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
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Patient portal use among veterans with depression: Associations with symptom severity and demographic characteristics. J Affect Disord 2020; 275:255-259. [PMID: 32734917 PMCID: PMC9373006 DOI: 10.1016/j.jad.2020.06.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patient portals can support self-management behaviors and increase continuity of care. It is therefore important to understand how individuals with depression are interacting with patient portals, to ensure that they have access to tools that can improve outcomes. The purpose of the current retrospective analysis was to examine associations between symptom severity, demographic characteristics and patient portal adoption and use among Veterans with depression diagnoses. METHODS Data were collected within a larger retrospective analysis of use of the Veterans Health Administration patient portal, My HealtheVet (MHV). The final sample included 3053 Veterans with diagnoses of depression and at least two measures of depressive symptoms. Regressions tested whether depressive symptoms and demographic variables were associated with MHV registration and feature use. RESULTS Veterans with more severe depression were more likely to have registered for MHV and downloaded medical record content compared to those with milder symptoms. Maleand older Veterans had lower rates of portal registration, and African American Veterans had lower rates of portal feature use. LIMITATIONS Limitations include restriction to a Veteran population who first used MHV in FY2013 as opposed to prior or subsequent years. CONCLUSIONS Patients with more severe depression may have increased interest in and use of patient portals. Demographic differences in portal use continue to be observed; barriers to uptake must be identified so disparities can be addressed.
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7
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Antonio MG, Petrovskaya O, Lau F. Is research on patient portals attuned to health equity? A scoping review. J Am Med Inform Assoc 2019; 26:871-883. [PMID: 31066893 PMCID: PMC7647227 DOI: 10.1093/jamia/ocz054] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Our scoping review examined how research on patient portals addresses health equity. Questions guiding our review were: 1) What health equity concepts are addressed in patient portal research-both explicitly and implicitly? 2) What are the gaps? 3) Is the potential for ehealth-related health inequities explicitly acknowledged in studies on patient portals? 4) What novel approaches and interventions to reduce health inequities are tested in patient portal research? MATERIALS AND METHODS We searched 4 databases. Search terms included "patient portal" in combination with a comprehensive list of health equity terms relevant in ehealth context. Authors independently reviewed the papers during initial screening and full-text review. We applied the eHealth Equity Framework to develop search terms and analyze the included studies. RESULTS Based on eHealth Equity Framework categories, the main findings generated from 65 reviewed papers were governance structures, ehealth policies, and cultural and societal values may further inequities; social position of providers and patients introduces differential preferences in portal use; equitable portal implementation can be supported through diverse user-centered design; and intermediary strategies are typically recommended to encourage portal use across populations. DISCUSSION The predominant focus on barriers in portal use may be inadvertently placing individual responsibility in addressing these barriers on patients already experiencing the greatest health disparities. This approach may mask the impact of the socio-technical-economic-political context on outcomes for different populations. CONCLUSION To support equitable health outcomes related to patient portals we need to look beyond intermediary initiatives and develop equitable strategies across policy, practice, research, and implementation.
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Affiliation(s)
- Marcy G Antonio
- Schools of Health Information Science and Nursing, Victoria, British Columbia, Canada
| | - Olga Petrovskaya
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Francis Lau
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
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Grossman LV, Masterson Creber RM, Ancker JS, Ryan B, Polubriaginof F, Qian M, Alarcon I, Restaino S, Bakken S, Hripcsak G, Vawdrey DK. Technology Access, Technical Assistance, and Disparities in Inpatient Portal Use. Appl Clin Inform 2019; 10:40-50. [PMID: 30650448 PMCID: PMC6335107 DOI: 10.1055/s-0038-1676971] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/22/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Disadvantaged populations, including minorities and the elderly, use patient portals less often than relatively more advantaged populations. Limited access to and experience with technology contribute to these disparities. Free access to devices, the Internet, and technical assistance may eliminate disparities in portal use. OBJECTIVE To examine predictors of frequent versus infrequent portal use among hospitalized patients who received free access to an iPad, the Internet, and technical assistance. MATERIALS AND METHODS This subgroup analysis includes 146 intervention-arm participants from a pragmatic randomized controlled trial of an inpatient portal. The participants received free access to an iPad and inpatient portal while hospitalized on medical and surgical cardiac units, together with hands-on help using them. We used logistic regression to identify characteristics predictive of frequent use. RESULTS More technology experience (adjusted odds ratio [OR] = 5.39, p = 0.049), less severe illness (adjusted OR = 2.07, p = 0.077), and private insurance (adjusted OR = 2.25, p = 0.043) predicted frequent use, with a predictive performance (area under the curve) of 65.6%. No significant differences in age, gender, race, ethnicity, level of education, employment status, or patient activation existed between the frequent and infrequent users in bivariate analyses. Significantly more frequent users noticed medical errors during their hospital stay. DISCUSSION AND CONCLUSION Portal use was not associated with several sociodemographic characteristics previously found to limit use in the inpatient setting. However, limited technology experience and high illness severity were still barriers to frequent use. Future work should explore additional strategies, such as enrolling health care proxies and improving usability, to reduce potential disparities in portal use.
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Affiliation(s)
- Lisa V. Grossman
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Ruth M. Masterson Creber
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Jessica S. Ancker
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Beatriz Ryan
- Value Institute, New York-Presbyterian Hospital, New York, New York, United States
| | | | - Min Qian
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States
| | - Irma Alarcon
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Susan Restaino
- Department of Medicine, New York-Presbyterian Hospital, New York, New York, United States
| | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - David K. Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
- Value Institute, New York-Presbyterian Hospital, New York, New York, United States
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Zhao JY, Song B, Anand E, Schwartz D, Panesar M, Jackson GP, Elkin PL. Barriers, Facilitators, and Solutions to Optimal Patient Portal and Personal Health Record Use: A Systematic Review of the Literature. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2017:1913-1922. [PMID: 29854263 PMCID: PMC5977619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Patient portal and personal health record adoption and usage rates have been suboptimal. A systematic review of the literature was performed to capture all published studies that specifically addressed barriers, facilitators, and solutions to optimal patient portal and personal health record enrollment and use. Consistent themes emerged from the review. Patient attitudes were critical as either barrier or facilitator. Institutional buy-in, information technology support, and aggressive tailored marketing were important facilitators. Interface redesign was a popular solution. Quantitative studies identified many barriers to optimal patient portal and personal health record enrollment and use, and qualitative and mixed methods research revealed thoughtful explanations for why they existed. Our study demonstrated the value of qualitative and mixed research methodologies in understanding the adoption of consumer health technologies. Results from the systematic review should be used to guide the design and implementation of future patient portals and personal health records, and ultimately, close the digital divide.
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Affiliation(s)
- Jane Y Zhao
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Buer Song
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Edwin Anand
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Diane Schwartz
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Mandip Panesar
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Gretchen P Jackson
- Departments of Surgery, Pediatrics, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter L Elkin
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
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10
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Wieland D, Gibeau A, Dewey C, Roshto M, Frankel H. Patient portal readiness among postpartum patients in a safety net setting. Appl Clin Inform 2017; 8:698-709. [PMID: 28678891 PMCID: PMC6220684 DOI: 10.4338/aci-2016-12-ra-0204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 04/21/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Maternity patients interact with the healthcare system over an approximately ten-month interval, requiring multiple visits, acquiring pregnancy-specific education, and sharing health information among providers. Many features of a web-based patient portal could help pregnant women manage their interactions with the healthcare system; however, it is unclear whether pregnant women in safety-net settings have the resources, skills or interest required for portal adoption. OBJECTIVES In this study of postpartum patients in a safety net hospital, we aimed to: (1) determine if patients have the technical resources and skills to access a portal, (2) gain insight into their interest in health information, and (3) identify the perceived utility of portal features and potential barriers to adoption. METHODS We developed a structured questionnaire to collect demographics from postpartum patients and measure use of technology and the internet, self-reported literacy, interest in health information, awareness of portal functions, and perceived barriers to use. The questionnaire was administered in person to women in an inpatient setting. RESULTS Of the 100 participants surveyed, 95% reported routine internet use and 56% used it to search for health information. Most participants had never heard of a patient portal, yet 92% believed that the portal functions were important. The two most appealing functions were to check results and manage appointments. CONCLUSIONS Most participants in this study have the required resources such as a device and familiarity with the internet to access a patient portal including an interest in interacting with a healthcare institution via electronic means. Pregnancy is a critical episode of care where active engagement with the healthcare system can influence outcomes. Healthcare systems and portal developers should consider ways to tailor a portal to address the specific health needs of a maternity population including those in a safety net setting.
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Affiliation(s)
- Daryl Wieland
- Daryl Wieland, MD, MS, Department of Obstetrics and Gynecology, Jacobi Medical Center, 1400 Pelham Parkway S, Bldg 1, 3West, Rm 6b, Bronx, NY 10461, Phone: 1 718 918 6337, Fax: 1 718 918 6787,
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Ose D, Baudendistel I, Pohlmann S, Winkler EC, Kunz A, Szecsenyi J. Persönliche Patientenakten im Internet. Ein narrativer Review zu Einstellungen, Erwartungen, Nutzung und Effekten. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 122:9-21. [DOI: 10.1016/j.zefq.2017.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/23/2017] [Accepted: 04/07/2017] [Indexed: 12/20/2022]
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Showell C. Barriers to the use of personal health records by patients: a structured review. PeerJ 2017; 5:e3268. [PMID: 28462058 PMCID: PMC5410160 DOI: 10.7717/peerj.3268] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 04/03/2017] [Indexed: 12/20/2022] Open
Abstract
Introduction An increasing focus on personal electronic health records (PHRs) offers healthcare benefits for patients, particularly those in undeserved and marginalised populations, who are at risk of receiving less effective healthcare, and may have worse health outcomes. However, PHRs are likely to favour text, technical and health literate users, and be less suitable for disadvantaged patients. These concerns have prompted this review of the literature, which seeks evidence about barriers to the adoption and continued use of PHRs, the nature of the evidence for those barriers, and the stage of PHR implementation where particular barriers apply. Methods Searches in PubMed, Embase, CINAHL and ProQuest databases were used to retrieve articles published in English after 2003 in a refereed journal, or presented in a refereed conference or scientific meeting. After screening to remove items which were out of scope, the phase of the PHR implementation, the type of investigation, and PHR barriers were categorised using thematic coding. Results The search retrieved 395 items; screening identified 34 in-scope publications, which provided evidence of 21 identified barriers to patient adoption and continued use of PHRs, categorised here as Individual, Demographic, Capability, Health-related, PHR or Attitudinal factors. Barriers were identified in most phases of PHR implementation, and in most types of study. A secondary outcome identified that eleven of the publications may have introduced a bias by excluding participants who were less affluent, less capable, or marginalised. Conclusions PHR barriers can interfere with the decision to start using a PHR, with the adoption process, and with continued use, and the impact of particular barriers may vary at different phases of PHR adoption. The complex interrelationships which exist between many of the barriers is suggested in some publications, and emerges more clearly from this review. Many PHR barriers appear to be related to low socioeconomic status. A better understanding is needed of how the effect of barriers is manifested, how that effect can be countered, and how planning and implementation of PHR initiatives can make allowance for patient level barriers to PHR adoption and use, with appropriate actions to mitigate the effect of those barriers for more disadvantaged patients.
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Affiliation(s)
- Chris Showell
- eHealth Services Research Group, University of Tasmania, Australia
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Lester M, Boateng S, Studeny J, Coustasse A. Personal Health Records: Beneficial or Burdensome for Patients and Healthcare Providers? PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2016; 13:1h. [PMID: 27134613 PMCID: PMC4832132] [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
Personal health records (PHRs) have been mandated to be made available to patients to provide increased access to medical care information, encourage participation in healthcare decision making, and enable correction of errors within medical records. The purpose of this study was to analyze the usefulness of PHRs from the perspectives of patients and providers. The methodology of this qualitative study was a literature review using 34 articles. PHRs are powerful tools for patients and healthcare providers. Better healthcare results and correction of medical records have been shown to be positive outcomes of the use of PHRs. PHRs have also been shown to be difficult for patients to use and understand, and providers had concerns about correct information transferring to the portals and patients eliminating information from the record. Concerns regarding patient understanding of medical records, legal liability, and the response time required of providers were also identified. For the PHR to succeed in the US healthcare system, assurance that the information will be protected, useful, and easily accessed is necessary.
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Affiliation(s)
- Melissa Lester
- Marshall University Health Care Administration program Lewis College of Business in South Charleston, WV
| | - Samuel Boateng
- Marshall University Health Care Administration program, Lewis College of Business in South Charleston, WV
| | - Jana Studeny
- Marshall University Health Informatics program. Health Professions School, in Huntington, WV
| | - Alberto Coustasse
- Marshall University Health Care Administration program, Lewis College of Business in South Charleston, WV
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Dawson Rose C, Cuca YP, Kamitani E, Eng S, Zepf R, Draughon J, Lum P. Using Interactive Web-Based Screening, Brief Intervention and Referral to Treatment in an Urban, Safety-Net HIV Clinic. AIDS Behav 2015; 19 Suppl 2:186-93. [PMID: 25963770 DOI: 10.1007/s10461-015-1078-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Substance use among people living with HIV is high, and screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach to addressing the issue. We examined whether patients would participate in a technology-based SBIRT program in an urban HIV clinic. An SBIRT intervention was programmed into the clinic's web-based patient portal linked to their personal health record. We examined: demographic, health, HIV, and substance use characteristics of participants who completed the web-based intervention compared to those who did not. Fewer than half of the 96 participants assigned to the web-based SBIRT completed it (n = 39; 41 %). Participants who completed the web-based intervention had significantly higher amphetamine SSIS scores than those who did not complete the intervention. Participants whose substance use is more harmful may be more motivated to seek help from a variety of sources. In addition, it is important that technology-based approaches to behavioral interventions in clinics take into consideration feasibility, client knowledge, and comfort using technology.
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15
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Czaja SJ, Zarcadoolas C, Vaughon WL, Lee CC, Rockoff ML, Levy J. The usability of electronic personal health record systems for an underserved adult population. HUMAN FACTORS 2015; 57:491-506. [PMID: 25875437 PMCID: PMC4710573 DOI: 10.1177/0018720814549238] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 07/25/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The goals of this study were to identify the demands associated with using electronic personal health records (PHRs) and to evaluate the ability of adults of lower socioeconomic status and low health literacy to use PHRs to perform health management activities. BACKGROUND PHRs are proliferating in clinical practices and health care organizations. These systems offer the potential of increasing the active involvement of patients in health self-management. However, little is known about the actual usability of these tools for health consumers. METHOD We used task analysis and health literacy load analysis to identify the cognitive and literacy demands inherent in the use of PHRs and evaluated the usability of three currently available PHR systems with a sample of 54 adults. Participants used the systems to perform tasks related to medication management, interpretation of lab/test results, and health maintenance. Data were also gathered on the participants' perception of the potential value of using a PHR. RESULTS The results indicated that a majority of the participants had difficulty completing the tasks and needed assistance. There was some variability according to task and PHR system. However, most participants perceived the use of PHRs as valuable. CONCLUSIONS Although considered a valuable tool by consumers, the use of PHR systems may be challenging for many people. Strategies are needed to enhance the usability of these systems, especially for people with low literacy, low health literacy, or limited technology skills. APPLICATION The data from this study have implications for the design of PHRs.
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Affiliation(s)
| | | | | | | | | | - Joslyn Levy
- Joslyn Levy and Associates, New York, New York
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Crouch PCB, Rose CD, Johnson M, Janson SL. A pilot study to evaluate the magnitude of association of the use of electronic personal health records with patient activation and empowerment in HIV-infected veterans. PeerJ 2015; 3:e852. [PMID: 25802815 PMCID: PMC4369326 DOI: 10.7717/peerj.852] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/04/2015] [Indexed: 11/20/2022] Open
Abstract
The HITECH Act signed into law in 2009 requires hospitals to provide patients with electronic access to their health information through an electronic personal health record (ePHR) in order to receive Medicare/Medicaid incentive payments. Little is known about who uses these systems or the impact these systems will have on patient outcomes in HIV care. The health care empowerment model provides rationale for the hypothesis that knowledge from an electronic personal health record can lead to greater patient empowerment resulting in improved outcomes. The objective was to determine the patient characteristics and patient activation, empowerment, satisfaction, knowledge of their CD4, Viral Loads, and antiretroviral medication, and medication adherence outcomes associated with electronic personal health record use in Veterans living with HIV at the San Francisco VA Medical Center. The participants included HIV-Infected Veterans receiving care in a low volume HIV-clinic at the San Francisco VA Medical Center, divided into two groups of users and non-users of electronic personal health records. The research was conducted using in-person surveys either online or on paper and data abstraction from medical records for current anti-retroviral therapy (ART), CD4 count, and plasma HIV-1 viral load. The measures included the Patient Activation Measure, Health Care Empowerment Inventory, ART adherence, provider satisfaction, current CD4 count, current plasma viral load, knowledge of current ART, knowledge of CD4 counts, and knowledge of viral load. In all, 40 participants were recruited. The use of electronic personal health records was associated with significantly higher levels of patient activation and levels of patient satisfaction for getting timely appointments, care, and information. ePHR was also associated with greater proportions of undetectable plasma HIV-1 viral loads, of knowledge of current CD4 count, and of knowledge of current viral load. The two groups differed by race and computer access. There was no difference in the current CD4, provider satisfaction, Health Care Empowerment Inventory score, satisfaction with provider-patient communication, satisfaction with courteous and helpful staff, knowledge of ART, or ART adherence. The use of electronic personal health records is associated with positive clinical and behavioral characteristics. The use of these systems may play a role in improving the health of people with HIV. Larger studies are needed to further evaluate these associations.
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Affiliation(s)
- Pierre-Cédric B Crouch
- Department of Community Health Systems, University of California , San Francisco, CA , USA
| | - Carol Dawson Rose
- Department of Community Health Systems, University of California , San Francisco, CA , USA
| | - Mallory Johnson
- Center for AIDS Prevention Studies, University of California , San Francisco, CA , USA
| | - Susan L Janson
- Department of Community Health Systems, University of California , San Francisco, CA , USA
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Pritzlaff M, Yorczyk A, Robinson LS, Pirzadeh-Miller S, Lin T, Euhus D, Ross TS. An internal performance assessment of CancerGene Connect: an electronic tool to streamline, measure and improve the genetic counseling process. J Genet Couns 2014; 23:1034-44. [PMID: 24916850 DOI: 10.1007/s10897-014-9732-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/14/2014] [Indexed: 11/24/2022]
Abstract
CancerGene Connect (CGC) is a web-based program that combines the collection of family and medical history, cancer risk assessment, psychosocial assessment, report templates, a result tracking system, and a patient follow up system. The performance of CGC was assessed in several ways: pre-appointment completion data analyzed for demographic and health variables; a time study to assess overall time per case and to compare the data entry by the genetic counselor compared to the patient, and a measured quality assessment of the program via observation and interview of patients. Prior to their appointment, 52.3% of 2,414 patients completed the online patient questionnaire section of CGC. There were significant differences in completion rates among racial and ethnic groups. County hospital patients were less likely to complete the questionnaire than insured patients (p < 0.0001); and likewise uninsured patients and patients with Medicare/Medicaid were less likely to complete the questionnaire than private patients (p < 0.0001). The average genetic counseling time per case was 82 min, with no significant differences whether the counselor or the patient completed CGC. CGC reduces genetic counselor time by approximately 14-46% compared to average time per case using traditional risk assessment and documentation methods previously reported. All surveyed users felt the questionnaire was easy to understand. CGC is an effective tool that streamlines workflow, and provides a standardized data collection tool that can be used to evaluate and improve the genetic counseling process.
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Affiliation(s)
- Mary Pritzlaff
- Department of Cancer Genetics, University of Texas Southwestern Medical Center's Simmons Comprehensive Cancer Center, Dallas and Moncrief Cancer Institute, Dallas, TX, USA
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Zarcadoolas C, Vaughon WL, Czaja SJ, Levy J, Rockoff ML. Consumers' perceptions of patient-accessible electronic medical records. J Med Internet Res 2013; 15:e168. [PMID: 23978618 PMCID: PMC3758049 DOI: 10.2196/jmir.2507] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/18/2013] [Accepted: 06/13/2013] [Indexed: 11/23/2022] Open
Abstract
Background Electronic health information (eHealth) tools for patients, including patient-accessible electronic medical records (patient portals), are proliferating in health care delivery systems nationally. However, there has been very limited study of the perceived utility and functionality of portals, as well as limited assessment of these systems by vulnerable (low education level, racial/ethnic minority) consumers. Objective The objective of the study was to identify vulnerable consumers’ response to patient portals, their perceived utility and value, as well as their reactions to specific portal functions. Methods This qualitative study used 4 focus groups with 28 low education level, English-speaking consumers in June and July 2010, in New York City. Results Participants included 10 males and 18 females, ranging in age from 21-63 years; 19 non-Hispanic black, 7 Hispanic, 1 non-Hispanic White and 1 Other. None of the participants had higher than a high school level education, and 13 had less than a high school education. All participants had experience with computers and 26 used the Internet. Major themes were enhanced consumer engagement/patient empowerment, extending the doctor’s visit/enhancing communication with health care providers, literacy and health literacy factors, improved prevention and health maintenance, and privacy and security concerns. Consumers were also asked to comment on a number of key portal features. Consumers were most positive about features that increased convenience, such as making appointments and refilling prescriptions. Consumers raised concerns about a number of potential barriers to usage, such as complex language, complex visual layouts, and poor usability features. Conclusions Most consumers were enthusiastic about patient portals and perceived that they had great utility and value. Study findings suggest that for patient portals to be effective for all consumers, portals must be designed to be easy to read, visually engaging, and have user-friendly navigation.
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Druss BG, Dimitropoulos L. Advancing the adoption, integration and testing of technological advancements within existing care systems. Gen Hosp Psychiatry 2013; 35:345-8. [PMID: 23643032 DOI: 10.1016/j.genhosppsych.2013.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/20/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This manuscript reviews the work on uptake and dissemination of health information technologies in mental health populations and settings, with the goal of informing the future research agenda. METHODS We reviewed both the formal and "grey" literature describing the rates and correlates of uptake for electronic health records (EHRs) and personal health records (PHRs) for general and specialty mental health settings. RESULTS Rates of uptake and use of EHRs and PHRs are low in general medical settings, and the limited evidence suggests even lower rates for specialty mental health settings. Many of the patient, provider and system-level characteristics associated with lower rates of use in general populations would be expected to be exacerbated in mental health settings. CONCLUSIONS The findings suggest a need to better understand both the causes and strategies for overcoming barriers to uptake of health information technology (HIT) in mental health settings. Observational studies could help to better elucidate the barriers to adoption of HIT that are unique or disproportionate in mental health populations. Implementation science studies are needed to better identify strategies for addressing these barriers and optimizing uptake of mental health HIT interventions.
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Ralston JD, Silverberg MJ, Grothaus L, Leyden WA, Ross T, Stewart C, Carzasty S, Horberg M, Catz SL. Use of web-based shared medical records among patients with HIV. THE AMERICAN JOURNAL OF MANAGED CARE 2013; 19:e114-e124. [PMID: 23725449 PMCID: PMC3951974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To compare use of 7 shared electronic medical record (SMR) features by adult HIV patients. STUDY DESIGN Observational cohort study of adult HIV-positive patients in the first 36 months following implementation of the SMR at Group Health and Kaiser Permanente Northern California. METHODS Automated data from the 36 months following SMR implementation were assessed in 2 integrated delivery systems. Cox proportional hazards analysis identified factors associated with any SMR use. RESULTS Most (3888/7398) patients used the SMR at least once. Users were most likely to view medical test results (49%), use secure messaging (43%), or request appointments (31%) or medication refills (30%). Initial use was associated with new prescription for antiretroviral therapy (rate ratio [RR] 1.65, P <.001), recent change to a CD4+ count of fewer than 200 cells per microliter (RR = 1.34, P <.02), new HIV RNA of 75 or more copies per milliliter (RR = 1.63, P <.001), or recent increase in non-HIV comorbidity score (RR = 1.49, P = .0001). Users were less likely to be women (RR = 0.49, P = .0001), injection drug users (RR = 0.59, P = .0001), or from lower-socioeconomic status neighborhoods (RR = 0.68, P = .0001), and were less likely to be black (RR = 0.38, P = .0001), Hispanic (RR = 0.52, P = .0001) or Asian/Pacific Islander (RR = 0.59, P = .001). CONCLUSIONS SMR use was higher among HIV patients who had indicators of recent increases in healthcare needs and lower among several vulnerable populations.
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Affiliation(s)
- James D. Ralston
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | | | - Louis Grothaus
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | | | - Tyler Ross
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Christine Stewart
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Steven Carzasty
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Michael Horberg
- Department of Research, Mid-Atlantic Permanente Medical Group, Rockville, MD
| | - Sheryl L. Catz
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
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Luque AE, van Keken A, Winters P, Keefer MC, Sanders M, Fiscella K. Barriers and Facilitators of Online Patient Portals to Personal Health Records Among Persons Living With HIV: Formative Research. JMIR Res Protoc 2013; 2:e8. [PMID: 23612564 PMCID: PMC3628162 DOI: 10.2196/resprot.2302] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 11/30/2012] [Accepted: 12/12/2012] [Indexed: 11/13/2022] Open
Abstract
Background Federal meaningful use standards are promoting adoption of online portals to personal health records (PHRs). However, relatively little is known regarding barriers and facilitators for vulnerable groups such as persons living with human immunodeficiency virus (PLWH). Objective The objective of this study was to assess barriers and facilitators to use of online PHRs among PLWH. Methods We conducted formative research using a written waiting room survey among 120 PLWH regarding barriers and facilitators of portal PHR use. We supplemented findings with data collected from a PLWH focus group, where some members had personal experience with use of a portal. Results The survey had 90 respondents. Eight PLWH participated in the focus group. Most patients (77/90, 86%) reported having at least some experience using the Internet and most expressed interest in features offered by the portal. Notably, 70% (63/90) expressed some interest in being taught how to use it to communicate with their provider. Focus group themes reinforced these findings, but also voiced concern regarding access to private computers. Conclusions Many PLWH in our sample have experience using computers and most are interested in PHR features. However, computer or broadband access and privacy are important barriers.
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Affiliation(s)
- Amneris E Luque
- Department of Medicine, Infectious Disease Division, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
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