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Indrio F, Pettoello-Mantovani M, Giardino I, Masciari E. The Role of Artificial Intelligence in Pediatrics from Treating Illnesses to Managing Children's Overall Well-Being. J Pediatr 2024:114291. [PMID: 39242077 DOI: 10.1016/j.jpeds.2024.114291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 09/02/2024] [Indexed: 09/09/2024]
Affiliation(s)
- Flavia Indrio
- Department of Experimental Medicine, Pediatric Unit, University of Salento, Lecce, Italy; European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany
| | - Massimo Pettoello-Mantovani
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany; Department of Medical and Surgical Sciences, Pediatric Unit, University of Foggia, Foggia, Italy.
| | - Ida Giardino
- Department of Clinical and Experimental Medicine, Center of Laboratory Medicine, University of Foggia, Foggia, Italy
| | - Elio Masciari
- Department of Electrical Engineering and Information Technologies, University of Naples Federico II, Naples, Italy
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2
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Brands MR, Haverman L, Muis JJ, Driessens MHE, Meijer S, van der Meer FJM, de Jong M, van der Bom JG, Cnossen MH, Fijnvandraat K, Gouw SC. Toward Personalized Care and Patient Empowerment and Perspectives on a Personal Health Record in Hemophilia Care: Qualitative Interview Study. JMIR Hum Factors 2024; 11:e48359. [PMID: 39226550 DOI: 10.2196/48359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/07/2023] [Accepted: 06/28/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND To enable personalized treatment and shared decision-making in chronic care, relevant health information is collected. However, health information is often fragmented across hospital information systems, digital health apps, and questionnaire portals. This also pertains to hemophilia care, in which scattered information hampers integrated care. We intend to co-design a nationwide digital personal health record (PHR) for patients to help manage their health information. For this, user perspectives are crucial. OBJECTIVE This study aims to assess patients' and health care providers' perspectives regarding the use of a PHR in hemophilia care in the Netherlands, required functionalities, and expectations and concerns. METHODS In this semistructured interview study, 19 pediatric and adult persons with hemophilia, parents, and women with other inherited bleeding disorders, as well as 18 health care providers working within and outside of hemophilia treatment centers, participated. Perspectives of patients and providers were explored separately. To explore requirements, participants were asked to prioritize functionalities. RESULTS Participants expected a PHR would increase the transparency of health information, improve patients' understanding of their illness, and help the coordination of care between health care providers and institutions. Prioritized functionalities included the integration of relevant health information and patient-entered data. Formulated expectations and concerns focused on 4 themes: usability, safety, inclusiveness, and implementation. While patients expressed worries over medicalization (ie, more confrontational reminders of their illness), providers were concerned about an increased workload. CONCLUSIONS People with hemophilia, their parents, and health care providers welcomed the development of a PHR, as they expected it would result in better coordinated care. Formulated expectations and concerns will contribute to the successful development of a PHR for persons with hemophilia, and ultimately, for all persons with a chronic condition.
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Affiliation(s)
- Martijn R Brands
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Lotte Haverman
- Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Child and Adolescent Psychiatry & Psychological Care, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Jelmer J Muis
- Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Child and Adolescent Psychiatry & Psychological Care, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | | | - Stephan Meijer
- Netherlands Hemophilia Patient Society, Nijkerk, Netherlands
| | - Felix J M van der Meer
- HemoNED Foundation, Leiden, Netherlands
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden University, Leiden, Netherlands
| | | | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden University, Leiden, Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - Samantha C Gouw
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden University, Leiden, Netherlands
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van der Mee FAM, Schaper F, Jansen J, Bons JAP, Meex SJR, Cals JWL. Enhancing Patient Understanding of Laboratory Test Results: Systematic Review of Presentation Formats and Their Impact on Perception, Decision, Action, and Memory. J Med Internet Res 2024; 26:e53993. [PMID: 39133906 PMCID: PMC11347896 DOI: 10.2196/53993] [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: 10/26/2023] [Revised: 04/07/2024] [Accepted: 05/27/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Direct access of patients to their web-based patient portal, including laboratory test results, has become increasingly common. Numeric laboratory results can be challenging to interpret for patients, which may lead to anxiety, confusion, and unnecessary doctor consultations. Laboratory results can be presented in different formats, but there is limited evidence regarding how these presentation formats impact patients' processing of the information. OBJECTIVE This study aims to synthesize the evidence on effective formats for presenting numeric laboratory test results with a focus on outcomes related to patients' information processing, including affective perception, perceived magnitude, cognitive perception, perception of communication, decision, action, and memory. METHODS The search was conducted in 3 databases (PubMed, Web of Science, and Embase) from inception until May 31, 2023. We included quantitative, qualitative, and mixed methods articles describing or comparing formats for presenting diagnostic laboratory test results to patients. Two reviewers independently extracted and synthesized the characteristics of the articles and presentation formats used. The quality of the included articles was assessed by 2 independent reviewers using the Mixed Methods Appraisal Tool. RESULTS A total of 18 studies were included, which were heterogeneous in terms of study design and primary outcomes used. The quality of the articles ranged from poor to excellent. Most studies (n=16, 89%) used mock test results. The most frequently used presentation formats were numerical values with reference ranges (n=12), horizontal line bars with colored blocks (n=12), or a combination of horizontal line bars with numerical values (n=8). All studies examined perception as an outcome, while action and memory were studied in 1 and 3 articles, respectively. In general, participants' satisfaction and usability were the highest when test results were presented using horizontal line bars with colored blocks. Adding reference ranges or personalized information (eg, goal ranges) further increased participants' perception. Additionally, horizontal line bars significantly decreased participants' tendency to search for information or to contact their physician, compared with numerical values with reference ranges. CONCLUSIONS In this review, we synthesized available evidence on effective presentation formats for laboratory test results. The use of horizontal line bars with reference ranges or personalized goal ranges increased participants' cognitive perception and perception of communication while decreasing participants' tendency to contact their physicians. Action and memory were less frequently studied, so no conclusion could be drawn about a single preferred format regarding these outcomes. Therefore, the use of horizontal line bars with reference ranges or personalized goal ranges is recommended to enhance patients' information processing of laboratory test results. Further research should focus on real-life settings and diverse presentation formats in combination with outcomes related to patients' information processing.
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Affiliation(s)
- Frederieke A M van der Mee
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Fleur Schaper
- Department of Clinical Chemistry, Reinier Medical Diagnostic Center, Delft, Netherlands
- Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jesse Jansen
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Judith A P Bons
- Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Steven J R Meex
- Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jochen W L Cals
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Hackstadt AJ, Elasy TA, Gangaputra S, Harper KJ, Mayberry LS, Nelson LA, Peterson NB, Rosenbloom ST, Yu Z, Martinez W. Effects of a Patient Portal Intervention to Address Diabetes Care Gaps: Protocol for a Pragmatic Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e56123. [PMID: 38941148 PMCID: PMC11245660 DOI: 10.2196/56123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Despite the potential to significantly reduce complications, many patients do not consistently receive diabetes preventive care. Our research team recently applied user-centered design sprint methodology to develop a patient portal intervention empowering patients to address selected diabetes care gaps (eg, no diabetes eye examination in last 12 months). OBJECTIVE This study aims to evaluate the effect of our novel diabetes care gap intervention on completion of selected evidence-based diabetes preventive care services and secondary outcomes. METHODS We are conducting a pragmatic randomized controlled trial of the effect of the intervention on diabetes care gaps. Adult patients with diabetes mellitus (DM) are recruited from primary care clinics affiliated with Vanderbilt University Medical Center. Participants are eligible if they have type 1 or 2 DM, can read in English, are aged 18-75 years, have a current patient portal account, and have reliable access to a mobile device with internet access. We exclude patients with medical conditions that prevent them from using a mobile device, severe difficulty seeing, pregnant women or women who plan to become pregnant during the study period, and patients on dialysis. Participants will be randomly assigned to the intervention or usual care. The primary outcome measure will be the number of diabetes care gaps among 4 DM preventive care services (diabetes eye examination, pneumococcal vaccination, hemoglobin A1c, and urine microalbumin) at 12 months after randomization. Secondary outcomes will include diabetes self-efficacy, confidence managing diabetes in general, understanding of diabetes preventive care, diabetes distress, patient portal satisfaction, and patient-initiated orders at baseline, 3 months, 6 months, and 12 months after randomization. An ordinal logistic regression model will be used to quantify the effect of the intervention on the number of diabetes care gaps at the 12-month follow-up. For dichotomous secondary outcomes, a logistic regression model will be used with random effects for the clinic and provider variables as needed. For continuous secondary outcomes, a regression model will be used. RESULTS This study is ongoing. Recruitment was closed in February 2022; a total of 433 patients were randomized. Of those randomized, most (n=288, 66.5%) were non-Hispanic White, 33.5% (n=145) were racial or ethnic minorities, 33.9% (n=147) were aged 65 years or older, and 30.7% (n=133) indicated limited health literacy. CONCLUSIONS The study directly tests the hypothesis that a patient portal intervention-alerting patients about selected diabetes care gaps, fostering understanding of their significance, and allowing patients to initiate care-will reduce diabetes care gaps compared with usual care. The insights gained from this study may have broad implications for developing future interventions to address various care gaps, such as gaps in cancer screening, and contribute to the development of effective, scalable, and sustainable approaches to engage patients in chronic disease management and prevention. TRIAL REGISTRATION ClinicalTrials.gov NCT04894903; https://classic.clinicaltrials.gov/ct2/show/NCT04894903. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56123.
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Affiliation(s)
- Amber J Hackstadt
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tom A Elasy
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sapna Gangaputra
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kryseana J Harper
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lindsay S Mayberry
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lyndsay A Nelson
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Neeraja B Peterson
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Zhihong Yu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - William Martinez
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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Kuppanda PM, Jenkins J. Evaluation of Experiences and Attitudes of Patients Towards Patient Portal-Enabled Access to Their Health Information or Medical Records: A Qualitative Grounded Theory Study. QUALITATIVE HEALTH RESEARCH 2023; 33:1080-1090. [PMID: 37575030 PMCID: PMC10552347 DOI: 10.1177/10497323231192379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
The demand for patient-centred care and patient engagement in their healthcare has driven patient portal introduction. The widespread adoption and use of patient portals, however, has been a rather slow process in the United Kingdom. Hence, a limited number of studies have explored patient perceptions and experiences of general portal use, which forms a foundation for successful implementation of a portal. This study, therefore, focuses on the experiences and attitudes of patients regarding use of patient portals and access to their health information. It further explores various factors perceived by patients that may influence portal use and uptake. The overall findings from this study highlight positive patient perceptions of portal use. Nevertheless, it demonstrates various areas of improvement essential to ensure future success of portal implementation and acceptance.
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Affiliation(s)
| | - Judy Jenkins
- Swansea University Medical School, Sketty, Swansea, Wales, UK
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Stocks JB, Calvetti S, Rosso MT, Slay L, Kipke M, Puentes M, Hightow-Weidman LB. Evaluating the Feasibility and Acceptability of a Digital Pre-Exposure Prophylaxis Navigation and Activation Intervention for Racially and Ethnically Diverse Sexual and Gender Minority Youth (PrEPresent): Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e50866. [PMID: 37773616 PMCID: PMC10576232 DOI: 10.2196/50866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND To end the HIV epidemic by 2030, we must double down on efforts to tailor prevention interventions to both young men who have sex with men and transgender and nonbinary youth. There is an urgent need for interventions that specifically focus on pre-exposure prophylaxis (PrEP) uptake in sexual and gender minority youth (SGMY) populations. There are several factors that impact the ability of SGMY to successfully engage in the HIV prevention continuum, including uptake of PrEP. Patient activation, having the knowledge, skills, and self-efficacy to manage one's health, is an important indicator of willingness and ability to manage one's own health and care autonomously. Patient navigation also plays an important role in helping SGMY access PrEP and PrEP care, as navigators help guide patients through the health care system, set up medical appointments, and get financial, legal, and social support. OBJECTIVE This study aims to evaluate the feasibility and acceptability of a digital PrEP navigation and activation intervention among a racially and ethnically diverse sample of SGMY living in the Los Angeles area. METHODS In phase 1, we will conduct formative research to inform the development of PrEPresent using qualitative data from key informant interviews involving PrEP care providers and navigators and working groups with SGMY. In phase 2, we will complete 2 rounds of usability testing of PrEPresent with 8-10 SGMY assessing both the intervention content and mobile health delivery platform to ensure features are usable and content is understood. In phase 3, we will conduct a pilot randomized controlled trial to evaluate the feasibility and acceptability of PrEPresent. We will randomize, 1:1, a racially and ethnically diverse sample of 150 SGMY aged 16-26 years living in the Los Angeles area and follow participants for 6 months. RESULTS Phase 1 (formative work) was completed in April 2021. Usability testing was completed in December 2021. As of June 2023, 148 participants have been enrolled into the PrEPresent pilot randomized controlled trial (phase 3). Enrollment is expected to be completed in July 2023, with final results anticipated in December 2023. CONCLUSIONS The PrEPresent intervention aims to bridge the gaps in PrEP eligibility and PrEP uptake among racially and ethnically diverse SGMY. By facilitating the delivery of PrEP navigation and focusing on improving patient activation, the PrEPresent intervention has the potential to positively impact the PrEP uptake cascade in the HIV care continuum as well as serve as a model for the tailoring of PrEP interventions based on behavior-based qualifications for PrEP instead of generalized gender-based eligibility. TRIAL REGISTRATION ClinicalTrials.gov NCT05281393; https://clinicaltrials.gov/ct2/show/NCT05281393. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50866.
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Affiliation(s)
- Jacob B Stocks
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Sam Calvetti
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Matthew T Rosso
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Lindsay Slay
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Michele Kipke
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Manuel Puentes
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Lisa B Hightow-Weidman
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, United States
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Lau-Min KS, Bleznuck J, Wollack C, McKenna DB, Long JM, Hubert AP, Johnson M, Rochester SE, Constantino G, Dudzik C, Doucette A, Wangensteen K, Domchek SM, Landgraf J, Chen J, Nathanson KL, Katona BW. Development of an Electronic Health Record-Based Clinical Decision Support Tool for Patients With Lynch Syndrome. JCO Clin Cancer Inform 2023; 7:e2300024. [PMID: 37639653 PMCID: PMC10857752 DOI: 10.1200/cci.23.00024] [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: 02/15/2023] [Revised: 04/22/2023] [Accepted: 07/12/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE To develop an electronic health record (EHR)-based clinical decision support (CDS) tool to promote guideline-recommended cancer risk management among patients with Lynch syndrome (LS), an inherited cancer syndrome that confers an increased risk of colorectal and other cancer types. MATERIALS AND METHODS We conducted a cross-sectional study to determine the baseline prevalence and predictors of guideline-recommended colonic surveillance and annual genetics program visits among patients with LS. Multivariable log-binomial regressions estimated prevalence ratios (PRs) of cancer risk management adherence by baseline sociodemographic and clinical characteristics. These analyses provided rationale for the development of an EHR-based CDS tool to support patients and clinicians with LS-related endoscopic surveillance and annual genetics program visits. The CDS leverages an EHR platform linking discrete genetic data to LS Genomic Indicators, in turn driving downstream clinician- and patient-facing CDS. RESULTS Among 323 patients with LS, cross-sectional adherence to colonic surveillance and annual genetics program visits was 69.3% and 55.4%, respectively. Patients with recent electronic patient portal use were more likely to be adherent to colonic surveillance (PR, 1.67; 95% CI, 1.11 to 2.52). Patients more recently diagnosed with LS were more likely to be adherent to annual genetics program visits (PR, 0.58; 95% CI, 0.44 to 0.76 for 2-4 years; PR, 0.62; 95% CI, 0.51 to 0.75 for ≥4 compared with <2 years). Our EHR-based CDS tool is now active for 421 patients with LS throughout our health system. CONCLUSION We have successfully developed an EHR-based CDS tool to promote guideline-recommended cancer risk management among patients with LS.
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Affiliation(s)
- Kelsey S. Lau-Min
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Joseph Bleznuck
- Information Services Applications, Penn Medicine, University of Pennsylvania, Philadelphia, PA
| | - Colin Wollack
- Information Services Applications, Penn Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danielle B. McKenna
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica M. Long
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Anna P. Hubert
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mariah Johnson
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shavon E. Rochester
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gillain Constantino
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christina Dudzik
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Abigail Doucette
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kirk Wangensteen
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Susan M. Domchek
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jeffrey Landgraf
- Information Services Applications, Penn Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica Chen
- Information Services Applications, Penn Medicine, University of Pennsylvania, Philadelphia, PA
| | - Katherine L. Nathanson
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bryson W. Katona
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Griesser A, Bidmon S. A Process Related View on the Usage of Electronic Health Records from the Patients' Perspective: A Systematic Review. J Med Syst 2022; 47:2. [PMID: 36580132 PMCID: PMC9800349 DOI: 10.1007/s10916-022-01886-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/02/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND In recent years, there has been an increasing interest in electronic health record (EHR) systems and various approaches of encouraging acceptance. Multiple methods of EHR acceptance have been proposed. However, a systematic review of patient's perspectives of their role and challenges in processing EHR remains lacking. Moreover, so far, there has been little discussion about barriers and facilitators of EHR system acceptance and usage from the patients' perspective. METHODS The study was reported according to the PRISMA statement. Six databases were systematically searched using keywords for articles from 2002-2020. We reviewed these data and used an inductive approach to analyse findings. RESULTS A total of 36 studies met the inclusion criteria. Our systematic literature review results reveal a wide range of barriers and facilitators assigned to four distinct stages of EHR system usage: awareness, adoption, behaviour and perception, and consequences. Results were described in a narrative synthesis of the included empirical studies. DISCUSSION Results underline the necessity to put a particular emphasis - but not exclusively - on the initial stage of awareness in the future. Further research in the field is therefore strongly recommended in order to develop tailored mediated communication to foster EHR system usage in the long run.
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Affiliation(s)
- Anna Griesser
- Department of Marketing and International Management, Alpen-Adria-Universität Klagenfurt, Universitätsstraße 65-67, 9020, Klagenfurt am Wörthersee, Austria
| | - Sonja Bidmon
- Department of Marketing and International Management, Alpen-Adria-Universität Klagenfurt, Universitätsstraße 65-67, 9020, Klagenfurt am Wörthersee, Austria.
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Vachon E, Robb BW, Haggstrom DA. Impact of a Personal Health Record Intervention Upon Surveillance Among Colorectal Cancer Survivors: Feasibility Study. JMIR Cancer 2022; 8:e34851. [PMID: 35969424 PMCID: PMC9412760 DOI: 10.2196/34851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/07/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are currently an estimated 1.5 million individuals living in the United States with colorectal cancer (CRC), and although the 5-year survival rate has increased, survivors are at risk for recurrence, particularly within the first 2-3 years after treatment. National guidelines recommend continued surveillance after resection to identify recurrence early on. Adherence among survivors ranges from 23% to 94%. Novel interventions are needed to increase CRC survivors' knowledge and confidence in managing their cancer and thus to increase adherence to follow-up surveillance. OBJECTIVE The objective of this study is to develop and test the feasibility and efficacy of a stand-alone, web-based personal health record (PHR) to increase surveillance adherence among CRC survivors, with patient beliefs about surveillance as secondary outcomes. METHODS A pre- and postintervention feasibility trial was conducted testing the efficacy of the colorectal cancer survivor (CRCS)-PHR, which had been previously developed using an iterative, user-centered design approach. RESULTS The average age of the sample was 58 (SD 9.9) years, with 57% (16/28) male and the majority married (20/28, 71%) and employed full-time (15/28, 54%). We observed a significant increase in adherence to colonoscopy (before: 11/21, 52% vs after: 18/21, 86%; P=.005) and CEA (14/21, 67% vs 20/21, 95%; P=.01), as well as a slight increase in CT scans (14/21, 67% vs 18/21, 86%; P=.10). The only significant impact on secondary outcome (patient beliefs) was benefits of CEA test (P=.04), as most of the beliefs were high at baseline. CONCLUSIONS This feasibility study lays the groundwork for continued development of the CRCS-PHR to increase CRC surveillance. Patient-centered technologies, such as the CRCS-PHR, represent an important potential approach to improving the receipt of guideline-concordant care and follow-up surveillance, and not just for CRC survivors. Researchers should continue to develop patient-centered health technologies with clinician implementation in mind to increase patient self-efficacy and surveillance adherence.
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Affiliation(s)
- Eric Vachon
- School of Nursing, Indiana University, Indianapolis, IN, United States
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
| | - Bruce W Robb
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - David A Haggstrom
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
- Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
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Neves AL, Smalley KR, Freise L, Harrison P, Darzi A, Mayer EK. Determinants of Use of the Care Information Exchange Portal: Cross-sectional Study. J Med Internet Res 2021; 23:e23481. [PMID: 34762063 PMCID: PMC8663598 DOI: 10.2196/23481] [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: 08/14/2020] [Revised: 03/11/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023] Open
Abstract
Background Sharing electronic health records with patients has been shown to improve patient safety and quality of care. Patient portals represent a convenient tool to enhance patient access to their own health care data. However, the success of portals will only be possible through sustained adoption by its end users: the patients. A better understanding of the characteristics of users and nonusers is critical for understanding which groups remain excluded from using such tools. Objective This study aims to identify the determinants of the use of the Care Information Exchange, a shared patient portal program in the United Kingdom. Methods A cross-sectional study was conducted using a web-based questionnaire. Information collected included age, gender, ethnicity, educational level, health status, postcode, and digital literacy. Registered individuals were defined as having had an account created in the portal, independent of their actual use of the platform; users were defined as having ever used the portal. Multivariate logistic regression was used to model the probability of being a user. Statistical analysis was performed in R and Tableau was used to create maps of the proportion of Care Information Exchange users by postcode area. Results A total of 1083 participants replied to the survey (186% of the estimated minimum target sample). The proportion of users was 61.58% (667/1083). Among these, most (385/667, 57.7%) used the portal at least once a month. To characterize the system’s users and nonusers, we performed a subanalysis of the sample, including only participants who had provided at least information regarding gender and age. The subanalysis included 650 individuals (389/650, 59.8% women; 551/650, 84.8% >40 years). Most participants were White (498/650, 76.6%) and resided in London (420/650, 64.6%). Individuals with a higher educational degree (undergraduate and professional, or postgraduate and higher) had higher odds of being a portal user (adjusted odds ratio [OR] 1.58, 95% CI 1.04-2.39 and OR 2.38, 95% CI 1.42-4.02, respectively) compared with those with a secondary degree or below. Higher digital literacy scores (≥30) were associated with higher odds of being a user (adjusted OR 2.96, 95% CI 2.02-4.35). Those with a good overall health status had lower odds of being a user (adjusted OR 0.58, 95% CI 0.37-0.91). Conclusions This work adds to the growing body of evidence highlighting the importance of educational aspects (educational level and digital literacy) in the adoption of patient portals. Further research should not only describe but also systematically address these inequalities through patient-centered interventions aimed at reducing the digital divide. Health care providers and policy makers must partner in investing and delivering strategic programs that improve access to technology and digital literacy in an effort to improve digital inclusion and reduce inequities in the delivery of care.
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Affiliation(s)
- Ana Luisa Neves
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College, London, United Kingdom.,Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Health Information and Decision, University of Porto, Porto, Portugal
| | - Katelyn R Smalley
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College, London, United Kingdom
| | - Lisa Freise
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College, London, United Kingdom
| | - Paul Harrison
- Imperial National Health Service Healthcare Trust, London, United Kingdom
| | - Ara Darzi
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College, London, United Kingdom
| | - Erik K Mayer
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College, London, United Kingdom
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11
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Osorio SN, Gage S, Mallory L, Soung P, Satty A, Abramson EL, Provost L, Cooperberg D. Factorial Analysis Quantifies the Effects of Pediatric Discharge Bundle on Hospital Readmission. Pediatrics 2021; 148:peds.2021-049926. [PMID: 34593650 DOI: 10.1542/peds.2021-049926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Factorial design of a natural experiment was used to quantify the benefit of individual and combined bundle elements from a 4-element discharge transition bundle (checklist, teach-back, handoff to outpatient providers, and postdischarge phone call) on 30-day readmission rates (RRs). METHODS A 24 factorial design matrix of 4 bundle element combinations was developed by using patient data (N = 7725) collected from January 2014 to December 2017 from 4 hospitals. Patients were classified into 3 clinical risk groups (CRGs): no chronic disease (CRG1), single chronic condition (CRG2), and complex chronic condition (CRG3). Estimated main effects of each bundle element and their interactions were evaluated by using Study-It software. Because of variation in subgroup size, important effects from the factorial analysis were determined by using weighted effect estimates. RESULTS RR in CRG1 was 3.5% (n = 4003), 4.1% in CRG2 (n = 1936), and 17.6% in CRG3 (n = 1786). Across the 3 CRGs, the number of subjects in the factorial groupings ranged from 16 to 674. The single most effective element in reducing RR was the checklist in CRG1 and CRG2 (reducing RR by 1.3% and 3.0%) and teach-back in CRG3 (by 4.7%) The combination of teach-back plus a checklist had the greatest effect on reducing RR in CRG3 by 5.3%. CONCLUSIONS The effect of bundle elements varied across risk groups, indicating that transition needs may vary on the basis of population. The combined use of teach-back plus a checklist had the greatest impact on reducing RR for medically complex patients.
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Affiliation(s)
- Snezana Nena Osorio
- Department of Pediatrics, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Sandra Gage
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin.,Department of Child Health, College of Medicine-Phoenix, University of Arizona and Phoenix Children's Hospital, Phoenix, Arizona
| | - Leah Mallory
- Department of Pediatrics, School of Medicine, Tufts University and The Barbara Bush Children's Hospital, Portland, Maine
| | - Paula Soung
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Alexandra Satty
- Department of Pediatrics, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Erika L Abramson
- Department of Pediatrics, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
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12
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Fitzsimons M, Power K, McCrea Z, Kiersey R, White M, Dunleavy B, O'Donoghue S, Lambert V, Delanty N, Doherty CP. Democratizing epilepsy care: Utility and usability of an electronic patient portal. Epilepsy Behav 2021; 122:108197. [PMID: 34273742 DOI: 10.1016/j.yebeh.2021.108197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Electronic patient portals (ePortals) can facilitate greater healthcare democratization by providing patients and/or their authorized care partners with secure access to their medical records when and where needed. Such democratization can promote effective healthcare provider-patient partnerships, shared decision-making, and greater patient engagement in managing their health condition. This study examined the usefulness of providing individualized services and care in epilepsy (PiSCES), an epilepsy ePortal, as an enabler of more democratized epilepsy care. METHODS Seventy-two individuals with epilepsy and 18 care partners were invited to report on their experience of interacting via PiSCES with clinical documents (epilepsy care summary record; epilepsy clinic letters) authored about them by healthcare providers. The OpenNotes reporting tool was adapted to capture participant experience. RESULTS Twenty-five percent of invited patients and 44% of invited care partners reported on interacting with their epilepsy care summary; 14% of patients and 67% of care partners invited reported on their epilepsy clinic letters. Participant testimonials illustrate the value of PiSCES in: promoting autonomy, aiding memory, developing the knowledgeable patient, and enhancing healthcare partnerships. Ninety-six percent and 100% of respondents, respectively, reported understanding their epilepsy care summary and epilepsy clinic letter; 77% said the summary described their epilepsy history to date; 96% indicated that the letter provided an accurate description of their clinical encounter; 92% and 96%, respectively, valued access to their summary record and clinic letters; 77% of summary record and 73% clinic letter respondents reported learning something about their epilepsy or the healthcare service via PiSCES. Illustrating their potential patient and care partner safety role, 42% respondents identified inaccuracies in their clinical documents which were subsequently resolved by a clinician. SIGNIFICANCE In the post-digital world highly customized on-demand products and services have come to be expected. Similarly, in epilepsy care, technologies such as PiSCES can enable more personalized, transparent, and engaging services.
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Affiliation(s)
- Mary Fitzsimons
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Kevin Power
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zita McCrea
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rachel Kiersey
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maire White
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Brendan Dunleavy
- ERGO IT Solutions, 1st Floor, Block T, East Point Business Park, Dublin 3, Ireland
| | - Sean O'Donoghue
- ERGO IT Solutions, 1st Floor, Block T, East Point Business Park, Dublin 3, Ireland
| | - Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Norman Delanty
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Colin P Doherty
- FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Neurology, St. James's Hospital, Dublin, Ireland; Academic Unit of Neurology, Trinity College Dublin
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13
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Martinez W, Hackstadt AJ, Hickson GB, Rosenbloom ST, Elasy TA. Evaluation of the My Diabetes Care Patient Portal Intervention: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e25955. [PMID: 34032578 PMCID: PMC8188319 DOI: 10.2196/25955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/01/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background My Diabetes Care (MDC) is a multi-faceted intervention embedded within an established patient portal, My Health at Vanderbilt. MDC is designed to help patients better understand their diabetes health data and support self-care. MDC uses infographics to visualize and summarize patients’ diabetes health data, incorporates motivational strategies, provides literacy-level appropriate educational resources, and links to a diabetes online patient support community and diabetes news feeds. Objective This study aims to evaluate the effects of MDC on patient activation in adult patients with type 2 diabetes mellitus. Moreover, we plan to assess secondary outcomes, including system use and usability, and the effects of MDC on cognitive and behavioral outcomes (eg, self-care and self-efficacy). Methods We are conducting a 6-month, 2-arm, parallel-design, pragmatic pilot randomized controlled trial of the effect of MDC on patient activation. Adult patients with type 2 diabetes mellitus are recruited from primary care clinics affiliated with Vanderbilt University Medical Center. Participants are eligible for the study if they are currently being treated with at least one diabetes medication, are able to speak and read in English, are 21 years or older, and have an existing My Health at Vanderbilt account and reliable access to a desktop or laptop computer with internet access. We exclude patients living in long-term care facilities, patients with known cognitive deficits or severe visual impairment, and patients currently participating in any other diabetes-related research study. Participants are randomly assigned to MDC or usual care. We collect self-reported survey data, including the Patient Activation Measure (R) at baseline, 3 months, and 6 months. We will use mixed-effects regression models to estimate potentially time-varying intervention effects while adjusting for the baseline measure of the outcome. The mixed-effects model will use fixed effects for patient-level characteristics and random effects for health care provider variables (eg, primary care physicians). Results This study is ongoing. Recruitment was closed in May 2020; 270 patients were randomized. Of those randomized, most (214/267, 80.1%) were non-Hispanic White, and 13.1% (35/267) were non-Hispanic Black, 43.7% (118/270) reported being 65 years or older, and 33.6% (90/268) reported limited health literacy. We obtained at least 95.6% (258/270) completion among participants through the 3-month follow-up assessment. Conclusions This randomized controlled trial will be one of the first to evaluate a patient-facing diabetes digital health intervention delivered via a patient portal. By embedding MDC into Epic’s MyChart platform with more than 127 million patient records, our intervention is directly integrated into routine care, highly scalable, and sustainable. Our findings and evolving patient portal functionality will inform the continued development of MDC to best meet users’ needs and a larger trial focused on the impact of MDC on clinical end points. Trial Registration ClinicalTrials.gov NCT03947333; https://clinicaltrials.gov/ct2/show/NCT03947333 International Registered Report Identifier (IRRID) DERR1-10.2196/25955
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Affiliation(s)
- William Martinez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Amber J Hackstadt
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Gerald B Hickson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - S Trent Rosenbloom
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tom A Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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14
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Chu D, Schuster T, Lessard D, Mate K, Engler K, Ma Y, Abulkhir A, Arora A, Long S, de Pokomandy A, Lacombe K, Rougier H, Cox J, Kronfli N, Hijal T, Kildea J, Routy JP, Asselah J, Lebouché B. Acceptability of a Patient Portal (Opal) in HIV Clinical Care: A Feasibility Study. J Pers Med 2021; 11:jpm11020134. [PMID: 33669439 PMCID: PMC7920437 DOI: 10.3390/jpm11020134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/30/2021] [Accepted: 02/11/2021] [Indexed: 11/16/2022] Open
Abstract
Opal (opalmedapps.com), a patient portal in use at the Cedars Cancer Centre of the McGill University Health Centre (MUHC) (Montreal, Canada), gives cancer patients access to their medical records, collects information on patient-reported outcome measures (PROMs), and has demonstrated patient satisfaction with care. This feasibility study aims to evaluate Opal's potential acceptability in the context of HIV care. People living with HIV (PLWH) and their healthcare providers (HCPs) completed cross-sectional surveys from August 2019 to February 2020 at large HIV centers, including the Chronic Viral Illness Service of the MUHC, and other HIV clinical sites in Montreal and Paris, France. This study comprised 114 PLWH (mean age 48 years old, SD = 12.4), including 74% men, 24% women, and 2% transgender or other; and 31 HCPs (mean age 46.5 years old, SD = 11.4), including 32% men, 65% women, and 3% other. Ownership of smartphones and tablets was high (93% PLWH, 96% HCPs), and participants were willing to use Opal (74% PLWH, 68% HCPs). Participants were interested in most Opal functions and PROMs, particularly PROMs capturing quality of life (89% PLWH, 77% HCPs), experience of healthcare (86% PLWH, 97% HCPs), and HIV self-management (92% PLWH, 97% HCPs). This study suggests Opal has high acceptability and potential usefulness as perceived by PLWH and HCPs.
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Affiliation(s)
- Dominic Chu
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
| | - David Lessard
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Kedar Mate
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
| | - Kim Engler
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Yuanchao Ma
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Ayoub Abulkhir
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
| | - Anish Arora
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
| | - Stephanie Long
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Karine Lacombe
- AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, 75012 Paris, France; (K.L.); (H.R.)
| | - Hayette Rougier
- AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, 75012 Paris, France; (K.L.); (H.R.)
- IMEA, Institut de Médecine et d’Epidémiologie Appliquée, F75018 Paris, France
| | - Joseph Cox
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Nadine Kronfli
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Tarek Hijal
- Department of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (T.H.); (J.A.)
| | - John Kildea
- Medical Physics Unit, Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada;
| | - Jean-Pierre Routy
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Jamil Asselah
- Department of Radiation Oncology, Cedars Cancer Centre, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; (T.H.); (J.A.)
| | - Bertrand Lebouché
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (D.C.); (T.S.); (A.A.); (A.A.); (S.L.); (A.d.P.); (N.K.)
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials in HIV, Montreal, QC K1A 0W9, Canada; (D.L.); (K.M.); (K.E.); (Y.M.); (J.C.)
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3S9, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Correspondence: ; Tel.: +1-514-843-2090
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15
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Abd-Alrazaq A, Safi Z, Bewick BM, Househ M, Gardner PH. Patients' Perspectives About Factors Affecting Their Use of Electronic Personal Health Records in England: Qualitative Analysis. J Med Internet Res 2021; 23:e17500. [PMID: 33439126 PMCID: PMC7840286 DOI: 10.2196/17500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/22/2020] [Accepted: 05/14/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND General practices (GPs) in England have recently introduced a nationwide electronic personal health record (ePHR) system called Patient Online or GP online services, which allows patients to view parts of their medical records, book appointments, and request prescription refills. Although this system is free of charge, its adoption rates are low. To improve patients' adoption and implementation success of the system, it is important to understand the factors affecting their use of the system. OBJECTIVE The aim of this study is to explore patients' perspectives of factors affecting their use of ePHRs in England. METHODS A cross-sectional survey was carried out between August 21 and September 26, 2017. A questionnaire was used in this survey to collect mainly quantitative data through closed-ended questions in addition to qualitative data through an open-ended question. A convenience sample was recruited in 4 GPs in West Yorkshire, England. Given that the quantitative data were analyzed in a previous study, we analyzed the qualitative data using thematic analysis. RESULTS Of the 800 eligible patients invited to participate in the survey, 624 (78.0%) returned a fully completed questionnaire. Of those returned questionnaires, the open-ended question was answered by 136/624 (21.8%) participants. A total of 2 meta-themes emerged from participants' responses. The first meta-theme comprises 5 themes about why patients do not use Patient Online: concerns about using Patient Online, lack of awareness of Patient Online, challenges regarding internet and computers, perceived characteristics of nonusers, and preference for personal contact. The second meta-theme contains 1 theme about why patients use Patient Online: encouraging features of Patient Online. CONCLUSIONS The challenges and concerns that impede the use of Patient Online seem to be of greater importance than the facilitators that encourage its use. There are practical considerations that, if incorporated into the system, are likely to improve its adoption rate: Patient Online should be useful, easy to use, secure, and easy to access. Different channels should be used to increase the awareness of the system, and GPs should ease registration with the system and provide manuals, training sessions, and technical support. More research is needed to assess the effect of the new factors found in this study (eg, lack of trust, difficulty registering with Patient Online) and factors affecting the continuing use of the system.
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Affiliation(s)
- Alaa Abd-Alrazaq
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Zeineb Safi
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Bridgette M Bewick
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Peter H Gardner
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
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16
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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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17
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Lin SC, Lyles CR, Sarkar U, Adler-Milstein J. Are Patients Electronically Accessing Their Medical Records? Evidence From National Hospital Data. Health Aff (Millwood) 2020; 38:1850-1857. [PMID: 31682494 DOI: 10.1377/hlthaff.2018.05437] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Substantial policy effort has been directed at improving patients' ability to access and use electronic health records. Using nationwide data from 2,410 hospitals for the period 2014-16, we examined associations between patient- and hospital-level characteristics and access to and use of electronic health record data among discharged patients. On average, hospitals gave 95 percent of discharged patients access to view, download, and transmit their information, but only about 10 percent of those with access used it-levels that were stagnant during the study period. Access rates were highest among system-member, teaching, and for-profit hospitals. In contrast, access rates were lower for hospitals in the highest quartile for disproportionate share hospital status and for hospitals located in counties with high proportions of residents who were dually eligible for Medicare and Medicaid; use rates were lower for hospitals in counties with a high proportion of residents who were dually eligible, lacked computer or internet access, or were Hispanic. Overall, our findings suggest that policy efforts have failed to engage a large proportion of patients in the electronic use of their data or to bridge the "digital divide" that accompanies health care disparities. Additional-possibly targeted-policy incentives, as well as higher thresholds for meeting the requirements of the Promoting Interoperability Program, merit policy makers' consideration.
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Affiliation(s)
- Sunny C Lin
- Sunny C. Lin ( sunny. lin@pdx. edu ) is an assistant professor of public health at the Oregon Health and Science University-Portland State University School of Public Health, in Portland, Oregon
| | - Courtney R Lyles
- Courtney R. Lyles is an associate professor of medicine at the University of California San Francisco (UCSF)
| | - Urmimala Sarkar
- Urmimala Sarkar is an associate professor of medicine in the Division of General Internal Medicine, UCSF, and a primary care physician at Zuckerberg San Francisco General Hospital's Richard H. Fine People's Clinic
| | - Julia Adler-Milstein
- Julia Adler-Milstein is an associate professor of medicine and director of the Clinical Informatics and Improvement Research Center, School of Medicine, UCSF
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18
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Alturkistani A, Qavi A, Anyanwu PE, Greenfield G, Greaves F, Costelloe C. Patient Portal Functionalities and Patient Outcomes Among Patients With Diabetes: Systematic Review. J Med Internet Res 2020; 22:e18976. [PMID: 32960182 PMCID: PMC7539164 DOI: 10.2196/18976] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/16/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patient portal use could help improve the care and health outcomes of patients with diabetes owing to functionalities, such as appointment booking, electronic messaging (e-messaging), and repeat prescription ordering, which enable patient-centered care and improve patient self-management of the disease. OBJECTIVE This review aimed to summarize the evidence regarding patient portal use (portals that are connected to electronic health care records) or patient portal functionality use (eg, appointment booking and e-messaging) and their reported associations with health and health care quality outcomes among adult patients with diabetes. METHODS We searched the MEDLINE, Embase, and Scopus databases and reported the review methodology using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three independent reviewers screened titles and abstracts, and two reviewers assessed the full texts of relevant studies and performed data extraction and quality assessments of the included studies. We used the Cochrane Collaboration Risk of Bias Tool and the National Heart, Lung and Blood Institute (NHLBI) Study Quality Assessment Tool to assess the risk of bias of the included studies. Data were summarized through narrative synthesis. RESULTS Twelve studies were included in this review. Five studies reported overall patient portal use and its association with diabetes health and health care quality outcomes. Six studies reported e-messaging or email use-associated outcomes, and two studies reported prescription refill-associated outcomes. The reported health outcomes included the associations of patient portal use with blood pressure, low-density lipoprotein cholesterol, and BMI. Few studies reported health care utilization outcomes such as office visits, emergency department visits, and hospitalizations. A limited number of studies reported overall quality of care for patients with diabetes who used patient portals. CONCLUSIONS The included studies mostly reported improved glycemic control outcomes for patients with diabetes who used patient portals. However, limitations of studying the effects of patient portals exist, which do not guarantee whether the outcomes reported are completely the result of patient portal use or if confounding factors exist. Randomized controlled trials and mixed-methods studies could help understand the mechanisms involved in health outcome improvements and patient portal use among patients with diabetes. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42019141131; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019141131. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/14975.
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Affiliation(s)
- Abrar Alturkistani
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Ambar Qavi
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Philip Emeka Anyanwu
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Geva Greenfield
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Felix Greaves
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Ceire Costelloe
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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Portz JD, Brungardt A, Shanbhag P, Staton EW, Bose-Brill S, Lin CT, Kutner JS, Lum HD. Advance Care Planning Among Users of a Patient Portal During the COVID-19 Pandemic: Retrospective Observational Study. J Med Internet Res 2020; 22:e21385. [PMID: 32716900 PMCID: PMC7423389 DOI: 10.2196/21385] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/13/2020] [Accepted: 07/24/2020] [Indexed: 01/14/2023] Open
Abstract
Background Advance care planning is the process of discussing health care treatment preferences based on patients’ personal values, and it often involves the completion of advance directives. In the first months of 2020, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began circulating widely in the American state of Colorado, leading to widespread diagnosis of coronavirus disease (COVID-19), hospitalizations, and deaths. In this context, the importance of technology-based, non–face-to-face methods to conduct advance care planning via patient portals has increased. Objective The aim of this study was to determine the rates of use of a web-based advance care planning tool through a health system–based electronic patient portal both before and in the early months of the COVID-19 pandemic. Methods In 2017, we implemented web-based tools through the patient portal of UCHealth’s electronic health record (EHR) for patients to learn about advance care planning and complete an electronically signed medical durable power of attorney (MDPOA) to legally appoint a medical decision maker. Patients accessing the portal can complete and submit a legally valid MDPOA, which becomes part of their medical record. We collected data on the patients’ date of MDPOA completion, use of advance care planning messaging, age, sex, and geographic location during the early phase of the COVID-19 pandemic (December 29, 2019, to May 30, 2020). Results Over a 5-month period that includes the early phase of the COVID-19 pandemic in Colorado, total monthly use of the advance care planning portal tool increased from 418 users in January to 1037 users in April and then decreased slightly to 815 users in May. The number of MDPOA forms submitted per week increased 2.4-fold after the stay-at-home order was issued in Colorado on March 26, 2020 (P<.001). The mean age of the advance care planning portal users was 47.7 years (SD 16.1), and 2206/3292 (67.0%) were female. Women were more likely than men to complete an MDPOA, particularly in younger age groups (P<.001). The primary use of the advance care planning portal tools was the completion of an MDPOA (3138/3292, 95.3%), compared to sending an electronic message (148/3292, 4.5%). Over 50% of patients who completed an MDPOA did not have a prior agent in the EHR. Conclusions Use of a web-based patient portal to complete an MDPOA increased substantially during the first months of the COVID-19 pandemic in Colorado. There was an increase in advance care planning that corresponded with state government shelter-in-place orders as well as public health reports of increased numbers of COVID-19 cases and deaths. Patient portals are an important tool for providing advance care planning resources and documenting medical decision makers during the pandemic to ensure that medical treatment aligns with patient goals and values.
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Affiliation(s)
- Jennifer D Portz
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Adreanne Brungardt
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Prajakta Shanbhag
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Elizabeth W Staton
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Seuli Bose-Brill
- Department of Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Chen-Tan Lin
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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20
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Struikman B, Bol N, Goedhart A, van Weert JCM, Talboom-Kamp E, van Delft S, Brabers AEM, van Dijk L. Features of a Patient Portal for Blood Test Results and Patient Health Engagement: Web-Based Pre-Post Experiment. J Med Internet Res 2020; 22:e15798. [PMID: 32706704 PMCID: PMC7399951 DOI: 10.2196/15798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/15/2020] [Accepted: 03/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of patient portals for presenting health-related patient data, such as blood test results, is becoming increasingly important in health practices. Patient portals have the potential to enhance patient health engagement, but content might be misinterpreted. OBJECTIVE This study aimed to discover whether the way of presenting blood test outcomes in an electronic patient portal is associated with patient health engagement and whether this varies across different blood test outcomes. METHODS A 2x3 between-subjects experiment was conducted among members of the Nivel Dutch Health Care Consumer Panel. All participants read a scenario in which they were asked to imagine themselves receiving blood test results. These results differed in terms of the presented blood values (ie, normal vs partially abnormal vs all abnormal) as well as in terms of whether the results were accompanied with explanatory text and visualization. Patient health engagement was measured both before (T0) and after (T1) participants were exposed to their fictive blood test results. RESULTS A total 487 of 900 invited members responded (response rate 54%), of whom 50.3% (245/487) were female. The average age of the participants was 52.82 years (SD 15.41 years). Patient health engagement saw either a significant decrease or a nonsignificant difference in the experimental groups after viewing the blood test results. The mean difference was smaller in the groups that received blood test results with additional text and visualization (meanT0 5.33, SE 0.08; meanT1 5.14, SE 0.09; mean difference 0.19, SE 0.08, P=.02) compared with groups that received blood test results without explanatory text and visualization (meanT0 5.19, SE 0.08; meanT1 4.55, SE 0.09; mean difference 0.64, SE 0.08, P<.001). Adding text and visualization, in particular, reduced the decline in patient health engagement in participants who received normal results or mixed results (ie, combination of normal and abnormal results). CONCLUSIONS Adding text and visualization features can attenuate the decrease in patient health engagement in participants who receive outcomes of a blood test via a patient portal, particularly when blood test results are (partly) normal. This suggests that explanatory text and visualization can be reassuring. Future research is warranted to determine whether these results can be generalized to a patient population who receive their actual blood test results.
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Affiliation(s)
- Bas Struikman
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Nadine Bol
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands.,Department of Communication Science, Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | | | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | - Esther Talboom-Kamp
- Saltro, Diagnostics Center for Health Care, Utrecht, Netherlands.,Department National eHealth Living Lab, Leiden University, Leiden, Netherlands
| | - Sanne van Delft
- Saltro, Diagnostics Center for Health Care, Utrecht, Netherlands
| | - Anne E M Brabers
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Liset van Dijk
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands.,Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, Netherlands
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21
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Crameri KA, Maher L, Van Dam P, Prior S. Personal electronic healthcare records: What influences consumers to engage with their clinical data online? A literature review. HEALTH INF MANAG J 2020; 51:3-12. [PMID: 31918578 DOI: 10.1177/1833358319895369] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background:Online electronic records such as patient portals and personally controlled electronic health records (PEHRs) have been widely viewed as a key component to modernising the delivery of healthcare but the uptake of such systems has been slow.Objective:The purpose of this literature review was to determine what influences consumers to engage and interact with their clinical data online.Method:A scoping literature review following PRISMA guidelines was completed. Electronic patient record research published between January 2009 and December 2018 was included. Following screening and full-text reviews, a total of 64 records were included in this review.Results:Three key areas of influence on consumer engagement with their clinical data online emerged: demographic factors affecting consumer interaction with PEHRs; consumers’ perceived benefits and detriments of PEHR use; and the influence of PEHR use on consumer empowerment and responsibility.Discussion:Consumer motivation and readiness for engaging with their clinical data online and their long-term ongoing use of these systems requires further exploration.Conclusion:As worldwide rates of consumer interactions with individual online clinical data remain low, what influences consumer engagement with a PEHR remains unknown. Further research into the consumer perspective of, and interaction with, a PEHR, needs to be undertaken to determine if factors such as frequent usage of the system by consumers leads to improved clinical outcomes.
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22
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Hernández C, Valdera CJ, Cordero J, López E, Plaza J, Albi M. Impact of telemedicine on assisted reproduction treatment in the public health system. J Healthc Qual Res 2019; 35:27-34. [PMID: 31883955 DOI: 10.1016/j.jhqr.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/17/2019] [Accepted: 08/20/2019] [Indexed: 11/26/2022]
Abstract
AIM Telemedicine has helped to make health care more efficient. However, to date no studies have measured its impact on infertility and fertility healthcare. We assessed the potential care benefits and clinical advantages of an initiative implementing electronic patient portal (EPP) for patients scheduled to undergo assisted reproduction treatment, to reduce waiting times for medical consultation and treatment. METHODS This was designed as a retrospective cohort study. The experimental group comprised 1972 referral requests received by the assisted reproduction unit of our institution between 2015 and 2016, which were included in the group receiving telemedicine, while the control group was defined by 283 requests received in 2013, all of which were assigned face-to-face care. RESULTS We found a statistically significant reduction in the experimental group in terms of the days elapsed between the receipt of the assessment request and the first outpatient visit (68 days vs. 180 days, p<.001). Time to initiation of treatment was also significantly lower in this group (169 days vs. 229 days; p<.001). The experimental group contained around 7 times as many patients receiving treatment as the control group. No differences were observed in the pregnancy rate (29.9% vs. 31.1%; p=.77) or in the complication rate (3.2% vs. 0%; p=.16). CONCLUSIONS Use of telemedicine in electronic portal patient form reduces the total waiting time involved in patient requests for infertility treatment and indirectly increases the number of patients treated, causing no negative impact on treatment outcome.
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Affiliation(s)
- C Hernández
- Assisted Reproduction Unit, Fundación Jiménez Díaz, Madrid, Spain; Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain
| | - C J Valdera
- Assisted Reproduction Unit, Fundación Jiménez Díaz, Madrid, Spain; Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain.
| | - J Cordero
- Assisted Reproduction Unit, Fundación Jiménez Díaz, Madrid, Spain; Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain
| | - E López
- Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - J Plaza
- Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain
| | - M Albi
- Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain
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23
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Abd-alrazaq A, Safi Z, Bewick BM, Househ M, Gardner PH. Patients’ Perspectives About Factors Affecting Their Use of Electronic Personal Health Records in England: Qualitative Analysis (Preprint).. [DOI: 10.2196/preprints.17500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
General practices (GPs) in England have recently introduced a nationwide electronic personal health record (ePHR) system called Patient Online or GP online services, which allows patients to view parts of their medical records, book appointments, and request prescription refills. Although this system is free of charge, its adoption rates are low. To improve patients’ adoption and implementation success of the system, it is important to understand the factors affecting their use of the system.
OBJECTIVE
The aim of this study is to explore patients’ perspectives of factors affecting their use of ePHRs in England.
METHODS
A cross-sectional survey was carried out between August 21 and September 26, 2017. A questionnaire was used in this survey to collect mainly quantitative data through closed-ended questions in addition to qualitative data through an open-ended question. A convenience sample was recruited in 4 GPs in West Yorkshire, England. Given that the quantitative data were analyzed in a previous study, we analyzed the qualitative data using thematic analysis.
RESULTS
Of the 800 eligible patients invited to participate in the survey, 624 (78.0%) returned a fully completed questionnaire. Of those returned questionnaires, the open-ended question was answered by 136/624 (21.8%) participants. A total of 2 meta-themes emerged from participants’ responses. The first meta-theme comprises 5 themes about why patients do not use Patient Online: concerns about using Patient Online, lack of awareness of Patient Online, challenges regarding internet and computers, perceived characteristics of nonusers, and preference for personal contact. The second meta-theme contains 1 theme about why patients use Patient Online: encouraging features of Patient Online.
CONCLUSIONS
The challenges and concerns that impede the use of Patient Online seem to be of greater importance than the facilitators that encourage its use. There are practical considerations that, if incorporated into the system, are likely to improve its adoption rate: Patient Online should be useful, easy to use, secure, and easy to access. Different channels should be used to increase the awareness of the system, and GPs should ease registration with the system and provide manuals, training sessions, and technical support. More research is needed to assess the effect of the new factors found in this study (eg, lack of trust, difficulty registering with Patient Online) and factors affecting the continuing use of the system.
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25
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Bush RA, Vemulakonda VM, Richardson AC, Deakyne Davies SJ, Chiang GJ. Providing Access: Differences in Pediatric Portal Activation Begin at Patient Check-in. Appl Clin Inform 2019; 10:670-678. [PMID: 31509879 DOI: 10.1055/s-0039-1695792] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The patient portal interface with individual electronic health records (EHR) was introduced as a tool to enhance participatory medicine. Recent studies suggest adults from racial and ethnic minorities as well as non-English speakers face disproportionate barriers to adoption; however, little data are available for pediatric patients. OBJECTIVE The purpose of this study was to examine patient portal offers and activation patterns among pediatric urology patients at two geographically diverse tertiary pediatric hospitals. METHODS Retrospective analysis of 2011 to 2016 electronic portal audit records was conducted among patients aged 18 and younger with at least one outpatient urology clinic visit at two tertiary academic pediatric hospitals and their affiliated networks. Differences in utilization among parents/caregivers and adolescents were examined using multivariate analysis. RESULTS Of 44,608 individuals seen in a participating urology department during the study period, 21,815 (48.9%) were offered a code for patient portal activation; of these, 8,605 (19.3% of total eligible individuals) activated portal access. Logistic regression demonstrated associations between an offer and site (p < 0.001), being female (p < 0.001), being Asian or white (p < 0.05), being non-Hispanic (p < 0.001), and reporting English as preferred language (p < 0.001). Activating patient portal access was associated with site (p < 0.001), being Asian or white (p < 0.001), and reporting English as preferred language (p < 0.001). CONCLUSION This study found that demographic variations in portal began with demographic differences in which patients were offered an activation code. Fewer than half of those given an access code activated their account. Preferred language, race/ethnicity, and clinic location were associated with likelihood of portal activation. Although patients are increasingly expected to schedule appointments, manage correspondence, request prescription refills, obtain authorizations and referrals, and communicate with the medical team using the portal, this study suggests that in the pediatric specialty setting many patients and caregivers are not offered the opportunity to access these tools.
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Affiliation(s)
- Ruth A Bush
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California, United States.,Department of Urology, Rady Children's Hospital San Diego, San Diego, California, United States
| | - Vijaya M Vemulakonda
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, Colorado, United States.,Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, United States
| | - Andrew C Richardson
- Clinical Research Informatics, Rady Children's Hospital San Diego, San Diego, California, United States
| | - Sara J Deakyne Davies
- Research Informatics and Analytics, Analytics Resource Center, Children's Hospital Colorado, Aurora, Colorado, United States
| | - George J Chiang
- Department of Urology, University of California San Diego, San Diego, California, United States.,Rady Children's Institute of Genomic Medicine, Rady Children's Hospital San Diego, San Diego, California, United States
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26
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Abd-Alrazaq A, Bewick BM, Farragher T, Gardner P. Factors Affecting Patients' Use of Electronic Personal Health Records in England: Cross-Sectional Study. J Med Internet Res 2019; 21:e12373. [PMID: 31368442 PMCID: PMC6693305 DOI: 10.2196/12373] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/26/2019] [Accepted: 05/29/2019] [Indexed: 01/23/2023] Open
Abstract
Background Electronic personal health records (ePHRs) are secure Web-based tools that enable individuals to access, manage, and share their medical records. England recently introduced a nationwide ePHR called Patient Online. As with ePHRs in other countries, adoption rates of Patient Online remain low. Understanding factors affecting patients’ ePHR use is important to increase adoption rates and improve the implementation success of ePHRs. Objective This study aimed to examine factors associated with patients’ use of ePHRs in England. Methods The unified theory of acceptance and use of technology was adapted to the use of ePHRs. To empirically examine the adapted model, a cross-sectional survey of a convenience sample was carried out in 4 general practices in West Yorkshire, England. Factors associated with the use of ePHRs were explored using structural equation modeling. Results Of 800 eligible patients invited to take part in the survey, 624 (78.0%) returned a valid questionnaire. Behavioral intention (BI) was significantly influenced by performance expectancy (PE; beta=.57, P<.001), effort expectancy (EE; beta=.16, P<.001), and perceived privacy and security (PPS; beta=.24, P<.001). The path from social influence to BI was not significant (beta=.03, P=.18). Facilitating conditions (FC) and BI significantly influenced use behavior (UB; beta=.25, P<.001 and beta=.53, P<.001, respectively). PE significantly mediated the effect of EE and PPS on BI (beta=.19, P<.001 and beta=.28, P=.001, respectively). Age significantly moderated 3 paths: PE→BI, EE→BI, and FC→UB. Sex significantly moderated only the relationship between PE and BI. A total of 2 paths were significantly moderated by education and internet access: EE→BI and FC→UB. Income moderated the relationship between FC and UB. The adapted model accounted for 51% of the variance in PE, 76% of the variance in BI, and 48% of the variance in UB. Conclusions This study identified the main factors that affect patients’ use of ePHRs in England, which should be taken into account for the successful implementation of these systems. For example, developers of ePHRs should involve patients in the process of designing the system to consider functions and features that fit patients’ preferences and skills to ensure systems are useful and easy to use. The proposed model accounted for 48% of the variance in UB, indicating the existence of other, as yet unidentified, factors that influence the adoption of ePHRs. Future studies should confirm the effect of the factors included in this model and identify additional factors.
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Affiliation(s)
- Alaa Abd-Alrazaq
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, London, United Kingdom.,Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Bridgette M Bewick
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, London, United Kingdom
| | - Tracey Farragher
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, London, United Kingdom
| | - Peter Gardner
- School of Psychology, University of Leeds, Leeds, United Kingdom
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Abd-alrazaq AA, Bewick BM, Farragher T, Gardner P. Factors that affect the use of electronic personal health records among patients: A systematic review. Int J Med Inform 2019; 126:164-175. [DOI: 10.1016/j.ijmedinf.2019.03.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/14/2018] [Accepted: 03/21/2019] [Indexed: 12/14/2022]
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28
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Masterson Creber RM, Grossman LV, Ryan B, Qian M, Polubriaginof FCG, Restaino S, Bakken S, Hripcsak G, Vawdrey DK. Engaging hospitalized patients with personalized health information: a randomized trial of an inpatient portal. J Am Med Inform Assoc 2019; 26:115-123. [PMID: 30534990 PMCID: PMC6339515 DOI: 10.1093/jamia/ocy146] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/02/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022] Open
Abstract
Objective To determine the effects of an inpatient portal intervention on patient activation, patient satisfaction, patient engagement with health information, and 30-day hospital readmissions. Methods and Materials From March 2014 to May 2017, we enrolled 426 English- or Spanish-speaking patients from 2 cardiac medical-surgical units at an urban academic medical center. Patients were randomized to 1 of 3 groups: 1) usual care, 2) tablet with general Internet access (tablet-only), and 3) tablet with an inpatient portal. The primary study outcome was patient activation (Patient Activation Measure-13). Secondary outcomes included all-cause readmission within 30 days, patient satisfaction, and patient engagement with health information. Results There was no evidence of a difference in patient activation among patients assigned to the inpatient portal intervention compared to usual care or the tablet-only group. Patients in the inpatient portal group had lower 30-day hospital readmissions (5.5% vs. 12.9% tablet-only and 13.5% usual care; P = 0.044). There was evidence of a difference in patient engagement with health information between the inpatient portal and tablet-only group, including looking up health information online (89.6% vs. 51.8%; P < 0.001). Healthcare providers reported that patients found the portal useful and that the portal did not negatively impact healthcare delivery. Conclusions Access to an inpatient portal did not significantly improve patient activation, but it was associated with looking up health information online and with a lower 30-day hospital readmission rate. These results illustrate benefit of providing hospitalized patients with real-time access to their electronic health record data while in the hospital. Trial Registration ClinicalTrials.gov Identifier: NCT01970852.
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Affiliation(s)
- Ruth M Masterson Creber
- Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medicine, New York, New York, USA
| | - Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Beatriz Ryan
- The Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
| | - Min Qian
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Fernanda C G Polubriaginof
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- The Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
| | - Susan Restaino
- Columbia University Medical Center, New York, New York, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, School of Nursing, Data Science Institute, Columbia University, New York, New York, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- The Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
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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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Tavares J, Oliveira T. New Integrated Model Approach to Understand the Factors That Drive Electronic Health Record Portal Adoption: Cross-Sectional National Survey. J Med Internet Res 2018; 20:e11032. [PMID: 30455169 PMCID: PMC6318146 DOI: 10.2196/11032] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 12/13/2022] Open
Abstract
Background The future of health care delivery is becoming more patient-focused, and electronic health record (EHR) portals are gaining more attention from worldwide governments that consider this technology as a valuable asset for the future sustainability of the national health care systems. Overall, this makes the adoption of EHR portals an important field to study. Objective The aim of this study is to understand the factors that drive individuals to adopt EHR portals. Methods We applied a new adoption model that combines 3 different theories, namely, extended unified theory of acceptance and use of technology, health belief model, and the diffusion of innovation; all the 3 theories provided relevant contributions for the understanding of EHR portals. To test the research model, we used the partial least squares causal modeling approach. We executed a national survey based on randomly generated mobile phone numbers. We collected 139 questionnaires. Results Performance expectancy (beta=.203; t=2.699), compatibility (beta=.530; t=6.189), and habit (beta=.251; t=2.660) have a statistically significant impact on behavior intention (R2=76.0%). Habit (beta=.378; t=3.821), self-perception (beta=.233; t=2.971), and behavior intention (beta=.263; t=2.379) have a statistically significant impact on use behavior (R2=61.8%). In addition, behavior intention (beta=.747; t=10.737) has a statistically significant impact on intention to recommend (R2=69.0%), results demonstrability (beta=.403; t=2.888) and compatibility (beta=.337; t=2.243) have a statistically significant impact on effort expectancy (R2=48.3%), and compatibility (beta=.594; t=6.141) has a statistically significant impact on performance expectancy (R2=42.7%). Conclusions Our research model yields very good results, with relevant R2 in the most important dependent variables that help explain the adoption of EHR portals, behavior intention, and use behavior.
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Affiliation(s)
- Jorge Tavares
- NOVA Information Management School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Tiago Oliveira
- NOVA Information Management School, Universidade NOVA de Lisboa, Lisboa, Portugal
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Abd-alrazaq AA, Bewick B, Farragher T, Gardner P. (Preprint).. [DOI: 10.2196/preprints.12373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND
Electronic Personal Health Records (ePHRs) are secure web-based tools that enable individuals to access, manage, and share their medical records. England recently introduced a nationwide ePHR called Patient Online. As with ePHRs in other countries, adoption rates of Patient Online remain low. Understanding factors affecting patients’ use of ePHRs is important to increase adoption rates and improve the implementation success of ePHRs.
OBJECTIVE
This study aims to examine factors associated with patients’ use of ePHRs in England.
METHODS
The Unified Theory of Acceptance and Use of Technology (UTAUT) was adapted to the use of ePHRs. To empirically examine the adapted model, a cross-sectional survey of a convenience sample was carried out in four general practices in West Yorkshire, England. Factors associated with use of ePHRs were explored using Structural Equation Modelling (SEM).
RESULTS
Of 800 eligible patients invited to take part in the survey, 624 (78%) participants returned a valid questionnaire. Behavioural intention was significantly influenced by performance expectancy (β=0.57, P<0.001), effort expectancy (β=0.16, P<0.001), and perceived privacy and security (β=0.24, P<0.001). The path from social influence to behavioural intention was not significant (β=0.03, P=0.183). Facilitating conditions and behavioural intention significantly influenced use behaviour (β=0.25, P<0.001; β=0.53, P<0.001, respectively). Performance expectancy significantly mediated the effect of effort expectancy and perceived privacy and security on behavioural intention (β=0.19, P<0.001; β=0.28, P=0.001, respectively). Age significantly moderated three paths; PEBI, EEBI, and FCUB. Sex significantly moderated only the relationship between performance expectancy and behavioural intention. Two paths were significantly moderated by education and internet access: EEBI and FCUB. Income moderated the relationship between facilitating conditions and use behaviour. The adapted model accounted for 51% of the variance in performance expectancy, 76% of the variance in behavioural intention, and 48% of the variance in use behaviour.
CONCLUSIONS
This study identified the main factors that affect patients’ use of ePHRs in England, which should be taken into account for the successful implementation of these systems. For example, developers of ePHRs should involve patients in the process of designing the system to consider functions and features that fit patients’ preferences and skills, thereby, create a useful and easy to use system. The proposed model accounted for 48% of the variance in use behaviour, indicating the existence of other, as yet unidentified, factors that influence adoption of ePHRs. Future studies should confirm the effect of the factors included in the current model and to identify additional factors.
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Hoogenbosch B, Postma J, de Man-van Ginkel JM, Tiemessen NA, van Delden JJ, van Os-Medendorp H. Use and the Users of a Patient Portal: Cross-Sectional Study. J Med Internet Res 2018; 20:e262. [PMID: 30224334 PMCID: PMC6231740 DOI: 10.2196/jmir.9418] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/05/2018] [Accepted: 06/21/2018] [Indexed: 12/15/2022] Open
Abstract
Background Patient portals offer patients access to their medical information and tools to communicate with health care providers. It has been shown that patient portals have the potential to positively impact health outcomes and efficiency of health care. It is therefore important that health care organizations identify the patients who use or do not use the patient portal and explore the reasons in either case. The Unified Theory of Acceptance and Use of Technology (UTAUT) is a frequently used theory for explaining the use of information technology. It consists of the following constructs: performance expectancy, effort expectancy, social influence, facilitating conditions, and behavioral intention to use. Objective This study aimed to explore the prevalence of patient portal use and the characteristics of patients who use or do not use a patient portal. The main constructs of UTAUT, together with demographics and disease- and care-related characteristics, have been measured to explore the predictive factors of portal use. Methods A cross-sectional study was conducted in the outpatient departments for adult patients of a university hospital in the Netherlands. Following outcomes were included: self-reported portal use, characteristics of users such as demographics, disease- and care-related data, eHealth literacy (modified score), and scores of UTAUT constructs. Descriptive analyses and univariate and multivariate logistic regression were also conducted. Results In the analysis, 439 adult patients were included. Furthermore, 32.1% (141/439) identified as being a user of the patient portal; 31.2% (137/439) indicated as nonusers, but being aware of the existence of the portal; and 36.6% (161/439) as being nonusers not aware of the existence of the portal. In the entire study population, the factors of being chronically ill (odds ratio, OR 1.62, 95% CI 1.04-2.52) and eHealth literacy (modified score; OR 1.12, 95% CI 1.07-1.18) best predicted portal use. In users and nonusers who were aware of the portal, UTAUT constructs were added to the multivariate logistic regression, with chronically ill and modified eHealth literacy sum score. Effort expectancy (OR 13.02, 95% CI 5.68-29.87) and performance expectancy (OR 2.84, 95% CI 1.65-4.90) are shown to significantly influence portal use in this group. Conclusions Approximately one-third of the patients of a university hospital self-reported using the patient portal; most expressed satisfaction. At first sight, being chronically ill and higher scores on the modified eHealth literacy scale explained portal use. Adding UTAUT constructs to the model revealed that effort expectancy (ease of use and knowledge and skills related to portal use) and performance expectancy (perceived usefulness) influenced portal use. Interventions to improve awareness of the portal and eHealth literacy skills of patients and further integration of the patient portal in usual face-to-face care are needed to increase use and potential subsequent patient benefits.
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Affiliation(s)
- Bas Hoogenbosch
- Department of Information Technology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Jeroen Postma
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | | | - Nicole Am Tiemessen
- Department of Information Technology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Johannes Jm van Delden
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands
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Bell K, Warnick E, Nicholson K, Ulcoq S, Kim SJ, Schroeder GD, Vaccaro A. Patient Adoption and Utilization of a Web-Based and Mobile-Based Portal for Collecting Outcomes After Elective Orthopedic Surgery. Am J Med Qual 2018; 33:649-656. [PMID: 29562769 DOI: 10.1177/1062860618765083] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health care increasingly collects patient-reported outcomes (PROs) via web-based platforms. The purpose of this study was to evaluate how patient age influences portal engagement. Patients undergoing elective surgery at a single multispecialty orthopedic practice from September 2014 to February 2017 had access to an online portal to complete PROs, message the clinic, and view physical therapy instructions. A mobile app was optionally available. Age, sex, log-in frequency, PRO completion rates, and number of messages sent were reviewed retrospectively. Message frequency, log-in rates, and PRO compliance were highest for patients aged 41 to 50, 51 to 60, and 61 to 70, respectively. Mobile app use decreased with age ( P = .002); yet, at all ages, the mobile app group was more engaged. In particular, for patients aged 18 to 30 years, log-in frequency increased 2.5-fold and PRO compliance improved 44% ( P < .001) in the mobile app group. This study demonstrates that portal interaction varies by age and that data capture is highest in patients who choose the mobile app.
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Affiliation(s)
- Kerri Bell
- 1 The Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Eugene Warnick
- 1 The Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Kristen Nicholson
- 1 The Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - Alexander Vaccaro
- 1 The Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Fraccaro P, Vigo M, Balatsoukas P, Buchan IE, Peek N, van der Veer SN. The influence of patient portals on users' decision making is insufficiently investigated: A systematic methodological review. Int J Med Inform 2018; 111:100-111. [PMID: 29425621 DOI: 10.1016/j.ijmedinf.2017.12.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/25/2017] [Accepted: 12/30/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patient portals are considered valuable conduits for supporting patients' self-management. However, it is unknown why they often fail to impact on health care processes and outcomes. This may be due to a scarcity of robust studies focusing on the steps that are required to induce improvement: users need to effectively interact with the portal (step 1) in order to receive information (step 2), which might influence their decision-making (step 3). We aimed to explore this potential knowledge gap by investigating to what extent each step has been investigated for patient portals, and explore the methodological approaches used. METHODS We performed a systematic literature review using Coiera's information value chain as a guiding theoretical framework. We searched MEDLINE and Scopus by combining terms related to patient portals and evaluation methodologies. Two reviewers selected relevant papers through duplicate screening, and one extracted data from the included papers. RESULTS We included 115 articles. The large majority (n = 104) evaluated aspects related to interaction with patient portals (step 1). Usage was most often assessed (n = 61), mainly by analysing system interaction data (n = 50), with most authors considering participants as active users if they logged in at least once. Overall usability (n = 57) was commonly assessed through non-validated questionnaires (n = 44). Step 2 (information received) was investigated in 58 studies, primarily by analysing interaction data to evaluate usage of specific system functionalities (n = 34). Eleven studies explicitly assessed the influence of patient portals on patients' and clinicians' decisions (step 3). CONCLUSIONS Whereas interaction with patient portals has been extensively studied, their influence on users' decision-making remains under-investigated. Methodological approaches to evaluating usage and usability of portals showed room for improvement. To unlock the potential of patient portals, more (robust) research should focus on better understanding the complex process of how portals lead to improved health and care.
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Affiliation(s)
- Paolo Fraccaro
- Health eResearch Centre, Farr Institute of Health Informatics Research, UK; Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Markel Vigo
- School of Computer Science, University of Manchester, Manchester, UK
| | | | | | - Niels Peek
- Health eResearch Centre, Farr Institute of Health Informatics Research, UK; Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Sabine N van der Veer
- Health eResearch Centre, Farr Institute of Health Informatics Research, UK; Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Ramsey A, Lanzo E, Huston-Paterson H, Tomaszewski K, Trent M. Increasing Patient Portal Usage: Preliminary Outcomes From the MyChart Genius Project. J Adolesc Health 2018; 62:29-35. [PMID: 29169768 PMCID: PMC5963535 DOI: 10.1016/j.jadohealth.2017.08.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/13/2017] [Accepted: 08/14/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the feasibility, acceptability, and preliminary effectiveness of dedicating staff ("MyChart Geniuses") to assist adolescents with patient portal sign-up; to examine patient satisfaction with MyChart Genius services; and to determine patient preferences for future communications related to health issues. METHODS Adolescent patients (13-25 years old) in an urban, academic, primary care clinic were approached by MyChart Genius staff to assist with enrolling in MyChart and downloading the MyChart mobile App. Patients were also invited to partake in a brief, online survey assessing their technology use and access, as well as their preferences surrounding communication with their health-care providers. Survey responses were analyzed using SPSS Statistics (SPSS Inc., Chicago, IL). RESULTS Ninety-six patients were approached, 84 (87.5%) of whom enrolled in MyChart. Sixty-four adolescents agreed to answer survey questions. Respondents were primarily African-American patients (87%), with a mean age of 18.7 years. The majority (79%) of participants were either satisfied or very satisfied with the Genius program. The respondents reported high access to and use of basic technology, and a high perceived need for an electronic health record App. Preferences for future communications with health-care providers revealed population subsets, indicating an area to further individualize interventions. CONCLUSIONS This is one of the first studies to examine a strategy to increase patient portal uptake and usage among minority, urban adolescents (a group with demonstrated preferences on communications with health-care providers). The presence of specially trained MyChart Genius staff is a feasible, effective, and patient-satisfactory method of engaging with this group of adolescents.
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Affiliation(s)
- Alexandra Ramsey
- Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Erin Lanzo
- Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Hattie Huston-Paterson
- Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kathy Tomaszewski
- Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maria Trent
- Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
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Sadeghi M, Thomassie R, Sasangohar F. Objective Assessment of Functional Information Requirements for Patient Portals. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1541931213601928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There has been an increase in the usage of electronic health records by healthcare providers as a result of recent federal incentive programs. One benefit of electronic systems is providing patients remote access to their records and an online interface with their healthcare provider via a patient portal. Patients, however, have been slow to adopt these systems and many studies have been conducted in attempts to investigate such slow adoption. It is not clear if the users were involved in the design of such systems and if the functionality meets user expectation. This paper aims to address this issue by documenting a comprehensive and systematically-derived set of functional and information requirements for patient portals based on a review of literature and interviews with patients.
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Affiliation(s)
- Mahnoosh Sadeghi
- Industrial and Systems Engineering, Texas A&M University, College Station, TX
| | - Rachal Thomassie
- Industrial and Systems Engineering, Texas A&M University, College Station, TX
| | - Farzan Sasangohar
- Industrial and Systems Engineering, Texas A&M University, College Station, TX
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Woods SS, Forsberg CW, Schwartz EC, Nazi KM, Hibbard JH, Houston TK, Gerrity M. The Association of Patient Factors, Digital Access, and Online Behavior on Sustained Patient Portal Use: A Prospective Cohort of Enrolled Users. J Med Internet Res 2017; 19:e345. [PMID: 29042345 PMCID: PMC5663951 DOI: 10.2196/jmir.7895] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/13/2017] [Accepted: 07/31/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND As electronic health records and computerized workflows expand, there are unprecedented opportunities to digitally connect with patients using secure portals. To realize the value of patient portals, initial reach across populations will need to be demonstrated, as well as sustained usage over time. OBJECTIVE The study aim was to identify patient factors associated with short-term and long-term portal usage after patients registered to access all portal functions. METHODS We prospectively followed a cohort of patients at a large Department of Veterans Affairs (VA) health care facility who recently completed identity proofing to use the VA patient portal. Information collected at baseline encompassed patient factors potentially associated with portal usage, including: demographics, Internet access and use, health literacy, patient activation, and self-reported health conditions. The primary outcome was the frequency of portal log-ins during 6-month and 18-month time intervals after study enrollment. RESULTS A total of 270 study participants were followed prospectively. Almost all participants (260/268, 97.0%) reported going online, typically at home (248/268, 92.5%). At 6 months, 84.1% (227/270) of participants had visited the portal, with some variation in usage across demographic and health-related subgroups. There were no significant differences in portal log-ins by age, gender, education, marital status, race/ethnicity, distance to a VA facility, or patient activation measure. Significantly higher portal usage was seen among participants using high-speed broadband at home, greater self-reported ability using the Internet, and routinely going online. By 18 months, 91% participants had logged in to the portal, and no significant associations were found between usage and demographics, health status, or patient activation. When examining portal activity between 6 and 18 months, patients who were infrequent or high portal users remained in those categories, respectively. CONCLUSIONS Short-term and long-term portal usage was associated with having broadband at home, high self-rated ability when using the Internet, and overall online behavior. Digital inclusion, or ready access to the Internet and digital skills, appears to be a social determinant in patient exposure to portal services.
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Affiliation(s)
- Susan S Woods
- VA Maine Healthcare System, Augusta, ME, United States.,VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR, United States.,Connected Care Office, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, DC, United States
| | - Christopher W Forsberg
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR, United States
| | - Erin C Schwartz
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR, United States
| | - Kim M Nazi
- Connected Care Office, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, DC, United States
| | - Judith H Hibbard
- Health Policy Research Group, University of Oregon, Eugene, OR, United States
| | - Thomas K Houston
- Bedford VA Medical Center, Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
| | - Martha Gerrity
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR, United States
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Risling T, Martinez J, Young J, Thorp-Froslie N. Evaluating Patient Empowerment in Association With eHealth Technology: Scoping Review. J Med Internet Res 2017; 19:e329. [PMID: 28963090 PMCID: PMC5640823 DOI: 10.2196/jmir.7809] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/06/2017] [Accepted: 08/16/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The prioritization of sustainable patient-centered care in contemporary health care has resulted in an increased focus on patient empowerment, which in turn is considered to facilitate patient independence, self-management, and self-efficacy. However, a definitional consensus of empowerment remains elusive, impeding efforts to translate the conceptual ideals of empowerment into a measurable entity associated with changes in health care behavior or outcomes. The rapid integration of technology in health care serves to add another layer of complexity in the measurability and operationalization of empowerment and helps to create a specific context in which this conceptual entity should be further examined. OBJECTIVE The primary objective of this scoping review was to explore the concept of patient empowerment within the electronic health (eHealth) context. A further focus on the association or measurement of this concept in conjunction with tethered patient portal use was also employed. METHODS In this scoping review, a six-step framework was used to guide the search and paper selection process. The review was initiated with two broad research questions, which are as follows: (1) What is the relationship between empowerment and the use of eHealth technologies from a patient perspective? (2) How is patient empowerment (and/or engagement or activation) influenced by accessing personal health information through a tethered patient portal? Multiple databases were employed in a comprehensive search strategy, and papers were primarily evaluated and selected for inclusion by 2 review authors, and a third author was consulted to resolve any issues in reaching consensus. RESULTS From an initial count of 1387 publications, this review returned nine systematic or literature review papers and 19 empirical studies that pertained to patient empowerment (and/or engagement and activation) in relation to the use of tethered patient portals providing access to electronic health records (EHRs). Of the 19 empirical publications, only four were found to have used specific patient empowerment measures with significant variety in their identified conceptual elements. CONCLUSIONS There is a persistent lack of conceptual clarity in patient empowerment research, and this has extended to study within the eHealth context. The interchangeable use or conflation of terms such as patient empowerment, engagement, and activation, has further complicated the advancement of distinct conceptual measures. To more strongly align changes in patient empowerment with supportive eHealth solutions, the challenges of achieving a consensus on how best to operationalize and measure patient empowerment must be met.
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Affiliation(s)
- Tracie Risling
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Juan Martinez
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jeremy Young
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
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Chen YC, Roebuck AE, Sami A, Ersin ÖH, Mirro MJ. The Use of Electronic Personal Health Records to Improve Medication Adherence and Patient Engagement: A Randomized Study of Non-valvular Atrial Fibrillation Patients. J Innov Card Rhythm Manag 2017; 8:2804-2813. [PMID: 32494465 PMCID: PMC7252939 DOI: 10.19102/icrm.2017.080803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/29/2017] [Indexed: 12/22/2022] Open
Abstract
Embolic stroke is a major complication of atrial fibrillation (AF) that frequently results in disability or death. The administration of oral anticoagulation can reduce stroke risk in AF patients; however, medication non-adherence can eliminate this benefit. To date, reported patient adherence rates to oral anticoagulation regimens vary. The objective of the current study was to examine the impact of medication-specific education delivered via a personal health record (PHR) system on medication adherence. A randomized, prospective study was conducted from February 2014 to June 2014 at Parkview Health, a not-for-profit, community-based health care clinic that serves a northeastern Indiana population of more than 820,000. AF patients receiving dabigatran (Pradaxa®; Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany) to prevent stroke participated in this study. The study participants were predominantly Caucasian males over 65 years of age who were educated, insured, and living above the poverty level. Patients were allowed to view online, download, and transmit health information via a PHR. The intervention group received PHR training and dabigatran education via the PHR. The control group received standard care and PHR access without training. A longitudinal survey pertaining to medication knowledge, medication adherence, and patient engagement was administered at baseline and at the end of the study. Medication-dispensing data collected from pharmacy refill prescriptions were used for calculating the medication possession ratio (MPR). Ninety patients were included in this study, and were randomly assigned to either the intervention group (n = 46) or the control group (n = 44). All participants completed the baseline survey, and 95.6% of patients finished the follow-up survey. The mean score for knowledge increased significantly in the intervention group (from 3.77 to 4.23, p = 0.005), but not in the control group (from 3.70 to 3.95, p = 0.72). The MPR was significantly higher in the intervention group (97.47% vs. 87.67%, p = 0.001). Both groups had similar levels of improvement in Patient Activation Measure scores (from 63.0 to 65.8, p = 0.078 vs. from 63.1 to 63.6, p = 0.814). Patients who used the PHR achieved greater medication knowledge, resulting in improved medication adherence. To our knowledge, no published randomized trial has reported on the use of PHRs to improve medication adherence and knowledge. This study is the first to demonstrate a positive impact on anticoagulation adherence with PHR use.
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Affiliation(s)
- Yu-Chieh Chen
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - Amelia E Roebuck
- Parkview Research Center, Parkview Health System, Fort Wayne, IN
| | - Areej Sami
- Parkview Research Center, Parkview Health System, Fort Wayne, IN.,Indiana University School of Medicine, Indianapolis, IN
| | - Özlem H Ersin
- College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
| | - Michael J Mirro
- Parkview Research Center, Parkview Health System, Fort Wayne, IN.,Indiana University School of Medicine, Indianapolis, IN
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Greenberg AJ, Falisi AL, Finney Rutten LJ, Chou WYS, Patel V, Moser RP, Hesse BW. Access to Electronic Personal Health Records Among Patients With Multiple Chronic Conditions: A Secondary Data Analysis. J Med Internet Res 2017; 19:e188. [PMID: 28576755 PMCID: PMC5473948 DOI: 10.2196/jmir.7417] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/24/2017] [Accepted: 04/29/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the United States, national incentives for offering access to electronic personal health records (ePHRs) through electronic means are geared toward creating a culture of patient engagement. One group of patients who stand to benefit from online access to ePHRs is the growing population with multiple chronic conditions (MCC). However, little is known about the current availability and use of ePHRs and patient portals among those managing MCC. OBJECTIVE The aim was to determine the associations between number of chronic conditions and sociodemographic characteristics and usage of ePHRs, and to assess how the public's use of ePHRs varies across subpopulations, including those with MCC. METHODS This study used data collected from the 2014 Health Information National Trends Survey (HINTS), and assessed differences in use of ePHRs between those with and without MCC (N=3497) using multiple logistic regression techniques. Variables associated with health care systems (insurance status, having a regular provider) and patient-reported self-efficacy were included in the statistical models. RESULTS Those with MCC (n=1555) had significantly higher odds of accessing their records three or more times in the past year compared to those reporting no chronic conditions (n=1050; OR 2.46, 95% CI 1.37-4.45), but the overall percentage of those with MCC using ePHRs remained low (371 of 1529 item respondents, 25.63% weighted). No difference in odds of accessing their records was found between those reporting one chronic condition (n=892) and those reporting none (n=1050; OR 1.02, 95% CI 0.66-1.58). Significant differences in odds of accessing ePHRs were seen between income and age groups (P<.001 and P=.05, respectively), and by whether respondents had a regular provider (P=.03). CONCLUSIONS We conclude that ePHRs provide a unique opportunity to enhance MCC patient self-management, but additional effort is needed to ensure that these patients are able to access their ePHRs. An increase in availability of patient access to their ePHRs may provide an opportunity to increase patient engagement and support self-management for all patients and especially those with MCC.
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Affiliation(s)
| | - Angela L Falisi
- Behavioral Research Program, National Cancer Institute, Bethesda, MD, United States
| | | | - Wen-Ying Sylvia Chou
- Behavioral Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Vaishali Patel
- Office of the National Coordinator, US Department of Health and Human Services, Washington, DC, United States
| | - Richard P Moser
- Behavioral Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Bradford W Hesse
- Behavioral Research Program, National Cancer Institute, Bethesda, MD, United States
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Kipping S, Stuckey MI, Hernandez A, Nguyen T, Riahi S. A Web-Based Patient Portal for Mental Health Care: Benefits Evaluation. J Med Internet Res 2016; 18:e294. [PMID: 27852556 PMCID: PMC5131190 DOI: 10.2196/jmir.6483] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/06/2016] [Accepted: 10/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background Treatment for mental illness has shifted from focusing purely on treatment of symptoms to focusing on personal recovery. Patient activation is an important component of the recovery journey. Patient portals have shown promise to increase activation in primary and acute care settings, but the benefits to tertiary level mental health care remain unknown. Objective To conduct a benefits evaluation of a Web-based portal for patients undergoing treatment for serious or persistent mental illness in order to examine the effects on (1) patient activation, (2) recovery, (3) productivity, and (4) administrative efficiencies. Methods All registered inpatients and outpatients at a tertiary level mental health care facility were offered the opportunity to enroll and utilize the patient portal. Those who chose to use the portal and those who did not were designated as “users” and “nonusers,” respectively. All patients received usual treatment. Users had Web-based access to view parts of their electronic medical record, view upcoming appointments, and communicate with their health care provider. Users could attend portal training or support sessions led by either the engagement coordinator or peer support specialists. A subset of patients who created and utilized their portal account completed 2 Web-based surveys at baseline (just after enrollment; n=91) and at follow-up (6 and 10 months; n=65). The total score of the Mental Health Recovery Measure (MHRM) was a proxy for patient activation and the individual domains measured recovery. The System and Use Survey Tool (SUS) examined the use of functions and general feedback about the portal. Organizational efficiencies were evaluated by examining the odds of portal users and nonusers missing appointments (productivity) or requesting information from health information management (administrative efficiencies) in the year before (2014) and the year after (2015) portal implementation. Results A total of 461 patients (44.0% male, n=203) registered for the portal, which was used 4761 times over the 1-year follow-up period. The majority of uses (95.34%, 4539/4761) were for e-views. The overall MHRM score increased from 70.4 (SD 23.6) at baseline to 81.7 (SD 25.1) at combined follow-up (P=.01). Of the 8 recovery domains, 7 were increased at follow-up (all P<.05). The odds of a portal user attending an appointment were 67% (CI 56%-79%) greater than that of nonusers over the follow-up period. Compared with 2014, over 2015 there was an 86% and 57% decrease in requests for information in users and nonusers, respectively. The SUS revealed that users felt an increased sense of autonomy and found the portal to be user-friendly, helpful, and efficient but felt that more information should be accessible. Conclusions The benefits evaluation suggested that access to personal health records via patient portals may improve patient activation, recovery scores, and organizational efficiencies in a tertiary level mental health care facility.
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Affiliation(s)
- Sarah Kipping
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
| | - Melanie I Stuckey
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
| | | | - Tan Nguyen
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
| | - Sanaz Riahi
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Lämsä E, Timonen J, Mäntyselkä P, Ahonen R. Pharmacy customers' experiences with the national online service for viewing electronic prescriptions in Finland. Int J Med Inform 2016; 97:221-228. [PMID: 27919380 DOI: 10.1016/j.ijmedinf.2016.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 10/01/2016] [Accepted: 10/22/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To investigate (1) Finnish pharmacy customers' familiarity with My Kanta, the national online service for viewing electronic prescriptions (ePrescriptions), (2) how commonly My Kanta is used, (3) who the typical users are, and (4) users' experiences of the usability of My Kanta. METHOD A survey was conducted among pharmacy customers (aged ≥18) purchasing medicines for themselves. Questionnaires (N=2915) were distributed from 18 community pharmacies across Finland in autumn 2015. The data obtained was stored in SPSS for Windows and subjected to descriptive analysis, chi-square tests and logistic regression analysis. RESULTS In total, 1288 respondents were included (response rate 44%). Most (62%) of the customers were familiar with My Kanta. The majority of them (78%) were using it to view their ePrescriptions. My Kanta was perceived as clear, easy to use and to provide a good overall picture of the prescribed medications. Familiarity with My Kanta was associated with a higher education than basic school, regular use of prescription medicines, and sufficient information received about ePrescriptions. Men used My Kanta more often than women. Respondents aged 75 or older were less likely to be familiar with and to use the service compared to 18-34year olds. CONCLUSIONS Most of the Finnish pharmacy customers were familiar with the national online service, My Kanta, for viewing ePrescriptions. Service users perceived it as easy to use and beneficial in managing their overall medication. Customers under 75, those educated beyond basic school, those using prescription medicines regularly, and those who had obtained sufficient information about ePrescriptions were most likely to be familiar with My Kanta. Men and customers under 75 were the typical users of the service. Some customers, however, were unaware of the service, or unable or reluctant to use it.
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Affiliation(s)
- Elina Lämsä
- School of Pharmacy/Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O.B. 1627, FI-70211 Kuopio, Finland.
| | - Johanna Timonen
- School of Pharmacy/Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O.B. 1627, FI-70211 Kuopio, Finland.
| | - Pekka Mäntyselkä
- School of Public Health and Clinical Nutrition, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O.B. 1627, FI-70211 Kuopio, Finland; Primary Health Care Unit, Hospital District of Northern Savo, P.O.B. 100, 70029, Kuopio University Hospital, Kuopio, Finland.
| | - Riitta Ahonen
- School of Pharmacy/Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O.B. 1627, FI-70211 Kuopio, Finland.
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Toscos T, Daley C, Heral L, Doshi R, Chen YC, Eckert GJ, Plant RL, Mirro MJ. Impact of electronic personal health record use on engagement and intermediate health outcomes among cardiac patients: a quasi-experimental study. J Am Med Inform Assoc 2016; 23:119-28. [PMID: 26912538 DOI: 10.1093/jamia/ocv164] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine the impact of tethered personal health record (PHR) use on patient engagement and intermediate health outcomes among patients with coronary artery disease (CAD). METHODS Adult CAD patients (N = 200) were enrolled in this prospective, quasi-experimental observational study. Each patient received a PHR account and training on its use. PHRs were populated with information from patient electronic medical records, hosted by a Health Information Exchange. Intermediate health outcomes including blood pressure, body mass index, and hemoglobin A1c (HbA1c) were evaluated through electronic medical record review or laboratory tests. Trends in patient activation measure® (PAM) were determined through three surveys conducted at baseline, 6 and 12 months. Frequency of PHR use data was collected and used to classify participants into groups for analysis: Low, Active, and Super users. RESULTS There was no statistically significant improvement in patient engagement as measured by PAM scores during the study period. HbA1c levels improved significantly in the Active and Super user groups at 6 months; however, no other health outcome measures improved significantly. Higher PAM scores were associated with lower body mass index and lower HbA1c, but there was no association between changes in PAM scores and changes in health outcomes. Use of the PHR health diary increased significantly following PHR education offered at the 6-month study visit and an elective group refresher course. CONCLUSIONS The study findings show that PHR use had minimal impact on intermediate health outcomes and no significant impact on patient engagement among CAD patients.
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Affiliation(s)
- Tammy Toscos
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA Indiana University School of Informatics and Computing, Indianapolis, Indiana, USA
| | - Carly Daley
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA
| | - Lisa Heral
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA
| | - Riddhi Doshi
- Department of Community Medicine, University of Connecticut, Hartford, Connecticut, USA
| | - Yu-Chieh Chen
- College of Pharmacy, Manchester University, Fort Wayne, Indiana, USA
| | - George J Eckert
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert L Plant
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA Indiana University School of Medicine, Fort Wayne, Indiana, USA
| | - Michael J Mirro
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA Indiana University School of Medicine, Fort Wayne, Indiana, USA
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Grosberg D, Grinvald H, Reuveni H, Magnezi R. Frequent Surfing on Social Health Networks is Associated With Increased Knowledge and Patient Health Activation. J Med Internet Res 2016; 18:e212. [PMID: 27511272 PMCID: PMC4997002 DOI: 10.2196/jmir.5832] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/19/2016] [Accepted: 06/29/2016] [Indexed: 12/02/2022] Open
Abstract
Background The advent of the Internet has driven a technological revolution that has changed our lives. As part of this phenomenon, social networks have attained a prominent role in health care. A variety of medical services is provided over the Internet, including home monitoring, interactive communications between the patient and service providers, and social support, among others. This study emphasizes some of the practical implications of Web-based health social networks for patients and for health care systems. Objective The objective of this study was to assess how participation in a social network among individuals with a chronic condition contributed to patient activation, based on the Patient Activation Measure (PAM). Methods A prospective, cross-sectional survey with a retrospective component was conducted. Data were collected from Camoni, a Hebrew-language Web-based social health network, participants in the diabetes mellitus, pain, hypertension, and depression/anxiety forums, during November 2012 to 2013. Experienced users (enrolled at least 6 months) and newly enrolled received similar versions of the same questionnaire including sociodemographics and PAM. Results Among 686 participants, 154 of 337 experienced and 123 of 349 newly enrolled completed the questionnaire. Positive correlations (P<.05) were found between frequency and duration of site visits and patient activation, social relationships, and chronic disease knowledge. Men surfed longer than women (χ²3=10.104, P<.05). Experienced users with diabetes surfed more than those with other illnesses and had significantly higher PAM scores (mean, M=69.3, standard deviation, SD=19.1, PAM level 4; Z=−4.197, P<.001) than new users (M=62.8, SD=18.7, PAM level 3). Disease knowledge directly predicted PAM for all users (β=.26 and .21, respectively). Frequency and duration of social health network use were correlated with increased knowledge about a chronic disease. Experienced surfers had higher PAM than newly enrolled, suggesting that continued site use may contribute to increased activation. Conclusions Web-based social health networks offer an opportunity to expand patient knowledge and increase involvement in personal health, thereby increasing patient activation. Further studies are needed to examine these changes on other aspects of chronic illnesses such as quality of life and costs.
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Affiliation(s)
- Dafna Grosberg
- Bar Ilan University, Interdisciplinary Department for Social Sciences, Ramat Gan, Israel
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Weisner CM, Chi FW, Lu Y, Ross TB, Wood SB, Hinman A, Pating D, Satre D, Sterling SA. Examination of the Effects of an Intervention Aiming to Link Patients Receiving Addiction Treatment With Health Care: The LINKAGE Clinical Trial. JAMA Psychiatry 2016; 73:804-14. [PMID: 27332703 PMCID: PMC4972645 DOI: 10.1001/jamapsychiatry.2016.0970] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Research has shown that higher activation and engagement with health care is associated with better self-management. To our knowledge, the linkage intervention (LINKAGE) is the first to engage patients receiving addiction treatment with health care using the electronic health record and a patient activation approach. OBJECTIVE To examine the effects of an intervention aiming to link patients receiving addiction treatment with health care. DESIGN, SETTING, AND PARTICIPANTS A nonrandomized clinical trial evaluating the LINKAGE intervention vs usual care by applying an alternating 3-month off-and-on design over 30 months. Participants were recruited from an outpatient addiction treatment clinic in a large health system between April 7, 2011, and October 2, 2013. INTERVENTIONS Six group-based, manual-guided sessions on patient engagement in health care and the use of health information technology resources in the electronic health record, as well as facilitated communication with physicians, vs usual care. MAIN OUTCOMES AND MEASURES Primary outcomes, measured at 6 months after enrollment, were patient activation (by interview using the Patient Activation Measure), patient engagement in health care (by interview and electronic health record), and alcohol, drug, and depression outcomes (by interview using the Addiction Severity Index for alcohol and drug outcomes and Patient Health Questionnaire (PHQ) for depression). RESULTS A total of 503 patients were recruited and assigned to the LINKAGE (n = 252) or usual care (n = 251) conditions, with no differences in baseline characteristics between conditions. The mean (SD) age of the patients was 42.5 (11.8) years, 31.0% (n = 156) were female, and 455 (90.5%) completed the 6-month interview. Compared with usual care participants, LINKAGE participants showed an increase in the mean number of log-in days (incidence rate ratio, 1.53; 95% CI, 1.19-1.97; P = .001). Similar results were found across types of patient portal use (communicating by email, viewing laboratory test results and information, and obtaining medical advice). LINKAGE participants were more likely to talk with their physicians about addiction problems (odds ratio, 2.30; 95% CI, 1.52-3.49; P < .001). Although 6-month abstinence rates were high for both conditions (≥70.0% for both) and depression symptoms improved (the proportion with scores ≥15 on the 9-item PHQ dropped from 15.1% [38 of 252] to 8.0% [18 of 225] among LINKAGE participants), there were no differences between conditions. Those who received all intervention components had significantly better alcohol and other drug outcomes than those who received fewer intervention components. CONCLUSIONS AND RELEVANCE Findings support the feasibility and effectiveness of the LINKAGE intervention in helping patients receiving addiction treatment engage in health care and increase communication with their physicians. The intervention did not affect short-term abstinence or depression outcomes. Understanding if the LINKAGE intervention helps prevent relapse and manage long-term recovery will be important. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01621711.
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Affiliation(s)
- Constance M. Weisner
- Department of Psychiatry, University of California, San Francisco2Division of Research, Kaiser Permanente Northern California, Oakland
| | - Felicia W. Chi
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Yun Lu
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Thekla B. Ross
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Sabrina B. Wood
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Agatha Hinman
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - David Pating
- Chemical Dependency Recovery Program, Kaiser Permanente Medical Center, San Francisco, California4The Permanente Medical Group, Kaiser Permanente Northern California, Oakland
| | - Derek Satre
- Department of Psychiatry, University of California, San Francisco2Division of Research, Kaiser Permanente Northern California, Oakland
| | - Stacy A. Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland
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Abstract
OBJECTIVES This study investigated major factors affecting personal health records (PHRs) management skills associated with survey respondents' health information management related activities. METHODS A self-report survey was used to assess individuals' personal characteristics, health knowledge, PHR skills, and activities. Factors underlying respondents' current PHR-related activities were derived using principal component analysis (PCA). Scale scores were calculated based on the results of the PCA, and hierarchical linear regression analyses were used to identify respondent characteristics associated with the scale scores. Internal consistency of the derived scale scores was assessed with Cronbach's α. RESULTS Among personal health information activities surveyed (N = 578 respondents), the four extracted factors were subsequently grouped and labeled as: collecting skills (Cronbach's α = 0.906), searching skills (Cronbach's α = 0.837), sharing skills (Cronbach's α = 0.763), and implementing skills (Cronbach's α = 0.908). In the hierarchical regression analyses, education and computer knowledge significantly increased the explanatory power of the models. Health knowledge (β = 0.25, p < 0.001) emerged as a positive predictor of PHR collecting skills. CONCLUSIONS This study confirmed that PHR training and learning should consider a full spectrum of information management skills including collection, utilization and distribution to support patients' care and prevention continua.
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Affiliation(s)
- Sujin Kim
- a Division of Biomedical Informatics , College of Public Health & School of Library and Information Science, College of Communication and Information, University of Kentucky , Lexington , KY , USA
| | - Erin Abner
- b Department of Epidemiology , Sanders-Brown Center on Aging, University of Kentucky , Lexington , KY , USA
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Irizarry T, DeVito Dabbs A, Curran CR. Patient Portals and Patient Engagement: A State of the Science Review. J Med Internet Res 2015; 17:e148. [PMID: 26104044 PMCID: PMC4526960 DOI: 10.2196/jmir.4255] [Citation(s) in RCA: 448] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/10/2015] [Accepted: 04/03/2015] [Indexed: 12/30/2022] Open
Abstract
Background Patient portals (ie, electronic personal health records tethered to institutional electronic health records) are recognized as a promising mechanism to support greater patient engagement, yet questions remain about how health care leaders, policy makers, and designers can encourage adoption of patient portals and what factors might contribute to sustained utilization. Objective The purposes of this state of the science review are to (1) present the definition, background, and how current literature addresses the encouragement and support of patient engagement through the patient portal, and (2) provide a summary of future directions for patient portal research and development to meaningfully impact patient engagement. Methods We reviewed literature from 2006 through 2014 in PubMed, Ovid Medline, and PsycInfo using the search terms “patient portal” OR “personal health record” OR “electronic personal health record”. Final inclusion criterion dictated that studies report on the patient experience and/or ways that patients may be supported to make competent health care decisions and act on those decisions using patient portal functionality. Results We found 120 studies that met the inclusion criteria. Based on the research questions, explicit and implicit aims of the studies, and related measures addressed, the studies were grouped into five major topics (patient adoption, provider endorsement, health literacy, usability, and utility). We discuss the findings and conclusions of studies that address the five topical areas. Conclusions Current research has demonstrated that patients’ interest and ability to use patient portals is strongly influenced by personal factors such age, ethnicity, education level, health literacy, health status, and role as a caregiver. Health care delivery factors, mainly provider endorsement and patient portal usability also contribute to patient’s ability to engage through and with the patient portal. Future directions of research should focus on identifying specific populations and contextual considerations that would benefit most from a greater degree of patient engagement through a patient portal. Ultimately, adoption by patients and endorsement by providers will come when existing patient portal features align with patients’ and providers’ information needs and functionality.
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Affiliation(s)
- Taya Irizarry
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States.
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