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Stagg BC, Schlechter CR, Del Fiol G. The Digital Divide in Eye Health Care Delivery. JAMA Ophthalmol 2024; 142:452-453. [PMID: 38573614 DOI: 10.1001/jamaophthalmol.2024.0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Affiliation(s)
- Brian C Stagg
- John Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City
- Department of Biomedical Informatics, University of Utah, Salt Lake City
| | | | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City
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Ploegmakers KJ, Linn AJ, Medlock S, Seppälä LJ, Bahat G, Caballero-Mora MA, Ilhan B, Landi F, Masud T, Morrissey Y, Ryg J, Topinkova E, van der Velde N, van Weert JCM. A European survey of older peoples' preferences, and perceived barriers and facilitators to inform development of a medication-related fall-prevention patient portal. Eur Geriatr Med 2024:10.1007/s41999-024-00951-w. [PMID: 38587614 DOI: 10.1007/s41999-024-00951-w] [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: 08/02/2023] [Accepted: 01/23/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Falls are a major and growing health care problem in older adults. A patient portal has the potential to provide older adults with fall-prevention advice to reduce fall-risk. However, to date, the needs and preferences regarding a patient portal in older people who have experienced falls have not been explored. This study assesses content preferences, potential barriers and facilitators with regard to using a patient portal, as perceived by older people who have experienced falls, and explores regional differences between European participants. METHODS We conducted a survey of older adults attending an outpatient clinic due to a fall or fall-related injury, to explore their content preferences, perceived barriers, and facilitators with respect to a fall-prevention patient portal. Older adults (N = 121, 69.4% female, mean age: 77.9) were recruited from seven European countries. RESULTS Almost two-thirds of respondents indicated they would use a fall-prevention patient portal. The portal would preferably include information on Fall-Risk-Increasing Drugs (FRIDs), and ways to manage other related/relevant medical conditions. Facilitators included a user-friendly portal, with easily accessible information and physician recommendations to use the portal. The most-commonly-selected barriers were privacy issues and usage fees. A family member's recommendation to use the portal was seemingly more important for Southern and Eastern European participants compared to the other regions. CONCLUSION The majority of older people with lived falls experience expressed an interest in a fall-prevention patient portal providing personalized treatment advice to prevent further falls. The results will be used to inform the development of a fall-prevention patient portal. The fall-prevention patient portal is intended to be used in addition to a consultation with a physician. Future research is needed to explore how to prevent falls in older patients who are not interested in a fall-prevention patient portal.
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Affiliation(s)
- Kim J Ploegmakers
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, Amsterdam UMC, University of Amsterdam, D3-227, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - A J Linn
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, Amsterdam UMC, University of Amsterdam, D3-227, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - S Medlock
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - L J Seppälä
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, Amsterdam UMC, University of Amsterdam, D3-227, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - G Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - M A Caballero-Mora
- Servicio de Geriatría, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - B Ilhan
- Division of Geriatrics, Department of Internal Medicine, Liv Hospital Vadistanbul, Istanbul, Turkey
| | - F Landi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - T Masud
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Y Morrissey
- Health Care of Older People, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - J Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - E Topinkova
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, South Bohemian University, České Budějovice, Czech Republic
| | - N van der Velde
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, Amsterdam UMC, University of Amsterdam, D3-227, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - J C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
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Wu QL, Brannon GE. What's after COVID-19?: Communication pathways influencing future use of telehealth. PATIENT EDUCATION AND COUNSELING 2024; 118:108025. [PMID: 37852153 DOI: 10.1016/j.pec.2023.108025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Telehealth usage for healthcare encounters has increased dramatically due to the coronavirus disease (COVID-19) precautions. As the pandemic health threat subsides, it is important to understand how telehealth encounters are perceived by users. In this study, we explore how patient-centered communication (PCC), and media and organizational factors, influence patients' intentions to use telehealth in the future. METHODS An online survey was conducted among 326 adult patients who reported visiting a healthcare provider using telehealth within the past 12 months. Structural equation modeling explored how contextual factors influenced patients' adoption of telehealth. RESULTS PCC and ease of use indirectly predicted telehealth adoption through enhanced patient satisfaction and sense of care continuity. Sense of security indirectly predicted telehealth adoption via its association with enhanced rating of care quality. CONCLUSION The functionality of telehealth technology does not solely determine patients' telehealth adoption. Instead, positive healthcare experiences, facilitated by organizational support, quality media designs, as well as patient-centered communication, are associated with telehealth adoption. PRACTICE IMPLICATIONS Healthcare providers should strategically improve telehealth-related communication processes that can lead to better patient health outcomes.
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Affiliation(s)
- Qiwei Luna Wu
- School of Communication, Cleveland State University, USA.
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Bratches RWR, Wall JA, Puga F, Pilonieta G, Jablonski R, Bakitas M, Geldmacher DS, Odom JN. Patient Portal Use Among Family Caregivers of Individuals With Dementia and Cancer: Regression Analysis From the National Study of Caregiving. JMIR Aging 2023; 6:e44166. [PMID: 38235767 PMCID: PMC10811454 DOI: 10.2196/44166] [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: 11/08/2022] [Revised: 08/10/2023] [Accepted: 08/25/2023] [Indexed: 01/19/2024] Open
Abstract
Background Family caregivers are often inexperienced and require information from clinic visits to effectively provide care for patients. Despite reported deficiencies, 68% of health systems facilitate sharing information with family caregivers through the patient portal. The patient portal is especially critical in the context of serious illnesses, like advanced cancer and dementia, where caregiving is intense and informational needs change over the trajectory of disease progression. Objective The objective of our study was to analyze a large, nationally representative sample of family caregivers from the National Study of Caregiving (NSOC) to determine individual characteristics and demographic factors associated with patient portal use among family caregivers of persons living with dementia and those living with cancer. Methods We conducted a secondary data analysis using data from the 2020 NSOC sample of family caregivers linked to National Health and Aging Trends Study. Weighted regression analysis by condition (ie, dementia or cancer) was used to examine associations between family caregiver use of the patient portal and demographic variables, including age, race or ethnicity, gender, employment status, caregiver health, education, and religiosity. Results A total of 462 participants (representing 4,589,844 weighted responses) were included in our analysis. In the fully adjusted regression model for caregivers of persons living with dementia, Hispanic ethnicity was associated with higher odds of patient portal use (OR: 2.81, 95% CI 1.05-7.57; P=.04), whereas qualification lower than a college degree was associated with lower odds of patient portal use by family caregiver (OR 0.36, 95% CI 0.18-0.71; P<.001. In the fully adjusted regression model for caregivers of persons living with cancer, no variables were found to be statistically significantly associated with patient portal use at the .05 level. Conclusions In our analysis of NSOC survey data, we found differences between how dementia and cancer caregivers access the patient portal. As the patient portal is a common method of connecting caregivers with information from clinic visits, future research should focus on understanding how the portal is used by the groups we have identified, and why.
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Affiliation(s)
- Reed W R Bratches
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - Jaclyn A Wall
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - Frank Puga
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - Giovanna Pilonieta
- Department of Neurology, University of Alabama at Birmingham, BirminghamAL, United States
| | - Rita Jablonski
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
| | - David S Geldmacher
- Department of Neurology, University of Alabama at Birmingham, BirminghamAL, United States
| | - J Nicholas Odom
- School of Nursing, University of Alabama at Birmingham, BirminghamAL, United States
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Gleason KT, Wu MMJ, Wec A, Powell DS, Zhang T, Gamper MJ, Green AR, Nothelle S, Amjad H, Wolff JL. Use of the patient portal among older adults with diagnosed dementia and their care partners. Alzheimers Dement 2023; 19:5663-5671. [PMID: 37354066 PMCID: PMC10808947 DOI: 10.1002/alz.13354] [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: 03/22/2023] [Revised: 04/28/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Care partners are at the forefront of dementia care, yet little is known about patient portal use in the context of dementia diagnosis. METHODS We conducted an observational cohort study of date/time-stamped patient portal use for a 5-year period (October 3, 2017-October 2, 2022) at an academic health system. The cohort consisted of 3170 patients ages 65+ with diagnosed dementia with 2+ visits within 24 months. Message authorship was determined by manual review of 970 threads involving 3065 messages for 279 patients. RESULTS Most (71.20%) older adults with diagnosed dementia were registered portal users but far fewer (10.41%) had a registered care partner with shared access. Care partners authored most (612/970, 63.09%) message threads, overwhelmingly using patient identity credentials (271/279, 97.13%). DISCUSSION The patient portal is used by persons with dementia and their care partners. Organizational efforts that facilitate shared access may benefit the support of persons with dementia and their care partners. Highlights Patient portal registration and use has been increasing among persons with diagnosed dementia. Two thirds of secure messages from portal accounts of patients with diagnosed dementia were identified as being authored by care partners, primarily using patient login credentials. Care partners who accessed the patient portal using their own identity credentials through shared access demonstrate similar levels of activity to patients without dementia. Organizational initiatives should recognize and support the needs of persons with dementia and their care partners by encouraging awareness, registration, and use of proper identity credentials, including shared, or proxy, portal access.
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Affiliation(s)
- Kelly T. Gleason
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Mingche M. J. Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aleksandra Wec
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Danielle S. Powell
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Talan Zhang
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary Jo Gamper
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Ariel R. Green
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephanie Nothelle
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Halima Amjad
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer L. Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Casafont C, González-García MJ, Casadamon-Munarriz I, Piazuelo M, Cobo-Sánchez JL, Bravo M, Frías CE, Zabalegui A. Impact of Hospitalization of People With Dementia or Cognitive Impairment on Family Caregivers. Res Gerontol Nurs 2023; 16:283-290. [PMID: 37616481 DOI: 10.3928/19404921-20230817-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
People with dementia (PWD) have a higher risk of hospitalization than people without dementia. Hospitalizations are stressful events for PWD and their caregivers, representing a considerable change to their routines. The current descriptive longitudinal study aimed to identify the positive and negative reactions, experiences related to health and social integrated care, resource use, and work status of family caregivers of PWD or cognitive impairment admitted to the hospital with a proximal femur fracture undergoing surgery. Findings indicated that family caregivers (N = 174) are fully committed to providing assistance in activities of daily living and supervision, showing positive attitudes on self-esteem and negative attitudes toward lack of family support and impact on finances, schedule, and health. Overall caregiver experiences with integrated health and social care improved after hospitalization but decreased after discharge. One month after hospitalization, family caregivers maintained the same work hours but used fewer health care resources. Hospitalization represents a good opportunity to approach family caregivers and determine their needs to provide them with interventions to minimize their burden and improve their well-being. [Research in Gerontological Nursing, 16(6), 283-290.].
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Velázquez López L, Achar de la Macorra R, Colin Ramirez E, Muñoz Torres AV, Pineda Del Aguila I, Medina Bravo PG, Klünder Klünder M, Medina Gómez OS, Escobedo de la Peña J. The diabetes education material on diabetes for website: Results of a validation process. J Healthc Qual Res 2023; 38:346-353. [PMID: 37567853 DOI: 10.1016/j.jhqr.2023.07.001] [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: 04/25/2022] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE To validate an educational material on diabetes through an expert consensus for its implementation into a web site. MATERIAL AND METHODS An observational study was carried out in a group of health professionals, for which an educational material was developed for patients with diabetes. Topics included nutrition, physical exercise, control indicators, complications, pharmacological treatment, among others. The language, text and figures were focused on easy comprehension, additionally, a section of didactic activities to be answered by the patient with diabetes at the end of each module was included. To evaluate the educational material by health professionals, an instrument was designed and validated. Once all the educational material was available, each of the modules was sent by e-mail to at least three clinical experts in the assigned topic, as well as the instrument for the evaluation of the module. RESULTS Thirty-seven experts were included in the study, 76% rated the educational modules evaluated as highly adequate, while only 24% rated them as adequate. The instrument used obtained a good level of internal consistency, with a Cronbach's alpha coefficient of 0.92. In the dimensions of the instrument, the lowest Cronbach's alpha score was that of "call-to-action", with a value of 0.71. CONCLUSION The diabetes educational material was rated as highly appropriate by the clinical experts. The developed instrument has an adequate content validity, as well as a good level of internal consistency.
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Affiliation(s)
- L Velázquez López
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional No 1, "Dr. Carlos Mac Gregor Sánchez Navarro" Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
| | - R Achar de la Macorra
- Departamento de Salud, Universidad Iberoamericana, sede Santa Fe, Ciudad de México, Mexico
| | - E Colin Ramirez
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac, México Campus Norte, Huixquilucan Edo. de México 52786, Mexico
| | - A V Muñoz Torres
- Departmento de Salud Publica, Escuela de Medicina, Universidad Nacional Autónoma de México, 04510 Mexico City, Mexico
| | - I Pineda Del Aguila
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional No 1, "Dr. Carlos Mac Gregor Sánchez Navarro" Instituto Mexicano del Seguro Social, 03100 Mexico City, Mexico
| | - P G Medina Bravo
- Departamento de Endocrinología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - M Klünder Klünder
- Departamento de Investigación, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - O S Medina Gómez
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional No 1, "Dr. Carlos Mac Gregor Sánchez Navarro" Instituto Mexicano del Seguro Social, 03100 Mexico City, Mexico
| | - J Escobedo de la Peña
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional No 1, "Dr. Carlos Mac Gregor Sánchez Navarro" Instituto Mexicano del Seguro Social, 03100 Mexico City, Mexico
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de Wildt KK, van de Loo B, Linn AJ, Medlock SK, Groos SS, Ploegmakers KJ, Seppala LJ, Bosmans JE, Abu-Hanna A, van Weert JCM, van Schoor NM, van der Velde N. Effects of a clinical decision support system and patient portal for preventing medication-related falls in older fallers: Protocol of a cluster randomized controlled trial with embedded process and economic evaluations (ADFICE_IT). PLoS One 2023; 18:e0289385. [PMID: 37751429 PMCID: PMC10522018 DOI: 10.1371/journal.pone.0289385] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Falls are the leading cause of injury-related mortality and hospitalization among adults aged ≥ 65 years. An important modifiable fall-risk factor is use of fall-risk increasing drugs (FRIDs). However, deprescribing is not always attempted or performed successfully. The ADFICE_IT trial evaluates the combined use of a clinical decision support system (CDSS) and a patient portal for optimizing the deprescribing of FRIDs in older fallers. The intervention aims to optimize and enhance shared decision making (SDM) and consequently prevent injurious falls and reduce healthcare-related costs. METHODS A multicenter, cluster-randomized controlled trial with process evaluation will be conducted among hospitals in the Netherlands. We aim to include 856 individuals aged ≥ 65 years that visit the falls clinic due to a fall. The intervention comprises the combined use of a CDSS and a patient portal. The CDSS provides guideline-based advice with regard to deprescribing and an individual fall-risk estimation, as calculated by an embedded prediction model. The patient portal provides educational information and a summary of the patient's consultation. Hospitals in the control arm will provide care-as-usual. Fall-calendars will be used for measuring the time to first injurious fall (primary outcome) and secondary fall outcomes during one year. Other measurements will be conducted at baseline, 3, 6, and 12 months and include quality of life, cost-effectiveness, feasibility, and shared decision-making measures. Data will be analyzed according to the intention-to-treat principle. Difference in time to injurious fall between the intervention and control group will be analyzed using multilevel Cox regression. DISCUSSION The findings of this study will add valuable insights about how digital health informatics tools that target physicians and older adults can optimize deprescribing and support SDM. We expect the CDSS and patient portal to aid in deprescribing of FRIDs, resulting in a reduction in falls and related injuries. TRIAL REGISTRATION ClinicalTrials.gov NCT05449470 (7-7-2022).
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Affiliation(s)
- Kelly K. de Wildt
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Bob van de Loo
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
| | - Annemiek J. Linn
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephanie K. Medlock
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Department of Medical Informatics, Amsterdam, Netherlands
| | - Sara S. Groos
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Kim J. Ploegmakers
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Lotta J. Seppala
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Department of Medical Informatics, Amsterdam, Netherlands
| | - Julia C. M. van Weert
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Natasja M. van Schoor
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
| | - Nathalie van der Velde
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
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Scheckel B, Schmidt K, Stock S, Redaèlli M. Patient Portals as Facilitators of Engagement in Patients With Diabetes and Chronic Heart Disease: Scoping Review of Usage and Usability. J Med Internet Res 2023; 25:e38447. [PMID: 37624629 PMCID: PMC10492174 DOI: 10.2196/38447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 02/08/2023] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patient portals have the potential to improve care for chronically ill patients by engaging them in their treatment. These platforms can work, for example, as a standalone self-management intervention or a tethered link to treatment providers in routine care. Many different types of portals are available for different patient groups, providing various features. OBJECTIVE This scoping review aims to summarize the current literature on patient portals for patients with diabetes mellitus and chronic heart disease regarding usage behavior and usability. METHODS We conducted this review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for scoping reviews. We performed database searches using PubMed, PsycInfo, and CINAHL, as well as additional searches in reviews and reference lists. We restricted our search to 2010. Qualitative and quantitative studies, and studies using both approaches that analyzed usage behavior or usability of patient portals were eligible. We mapped portal features according to broad thematic categories and summarized the results of the included studies separately according to outcome and research design. RESULTS After screening, we finally included 85 studies. Most studies were about patients with diabetes, included patients younger than 65 years, and were conducted in the United States. Portal features were categorized into educational/general information, reminder, monitoring, interactivity, personal health information, electronic/personal health record, and communication. Portals mostly provided educational, monitoring, and communication-related features. Studies reported on usage behavior including associated variables, usability dimensions, and suggestions for improvement. Various ways of reporting usage frequency were identified. A noticeable decline in portal usage over time was reported frequently. Age was most frequently studied in association with portal use, followed by gender, education, and eHealth literacy. Younger age and higher education were often associated with higher portal use. In two-thirds of studies reporting on portal usability, the portals were rated as user friendly and comprehensible, although measurement and reporting were heterogeneous. Portals were considered helpful for self-management through positive influences on motivation, health awareness, and behavioral changes. Helpful features for self-management were educational/general information and monitoring. Barriers to portal use were general (eg, aspects of design or general usability), related to specific situations during portal use (eg, login procedure), or not portal specific (eg, user skills and preferences). Frequent themes were aspects of design, usability, and technology. Suggestions for improvement were mainly related to technical issues and need for support. CONCLUSIONS The current state of research emphasizes the importance of involving patients in the development and evaluation of patient portals. The consideration of various research designs in a scoping review is helpful for a deeper understanding of usage behavior and usability. Future research should focus on the role of disease burden, and usage behavior and usability among older patients.
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Affiliation(s)
- Benjamin Scheckel
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katharina Schmidt
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Nelson LA, Reale C, Anders S, Beebe R, Rosenbloom ST, Hackstadt A, Harper KJ, Mayberry LS, Cobb JG, Peterson N, Elasy T, Yu Z, Martinez W. Empowering patients to address diabetes care gaps: formative usability testing of a novel patient portal intervention. JAMIA Open 2023; 6:ooad030. [PMID: 37124675 PMCID: PMC10139764 DOI: 10.1093/jamiaopen/ooad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/22/2023] [Accepted: 04/13/2023] [Indexed: 05/02/2023] Open
Abstract
Objective The aim of this study was to design and assess the formative usability of a novel patient portal intervention designed to empower patients with diabetes to initiate orders for diabetes-related monitoring and preventive services. Materials and Methods We used a user-centered Design Sprint methodology to create our intervention prototype and assess its usability with 3 rounds of iterative testing. Participants (5/round) were presented with the prototype and asked to perform common, standardized tasks using think-aloud procedures. A facilitator rated task performance using a scale: (1) completed with ease, (2) completed with difficulty, and (3) failed. Participants completed the System Usability Scale (SUS) scored 0-worst to 100-best. All testing occurred remotely via Zoom. Results We identified 3 main categories of usability issues: distrust about the automated system, content concerns, and layout difficulties. Changes included improving clarity about the ordering process and simplifying language; however, design constraints inherent to the electronic health record system limited our ability to respond to all usability issues (eg, could not modify fixed elements in layout). Percent of tasks completed with ease across each round were 67%, 60%, and 80%, respectively. Average SUS scores were 87, 74, and 93, respectively. Across rounds, participants found the intervention valuable and appreciated the concept of patient-initiated ordering. Conclusions Through iterative user-centered design and testing, we improved the usability of the patient portal intervention. A tool that empowers patients to initiate orders for disease-specific services as part of their existing patient portal account has potential to enhance the completion of recommended health services and improve clinical outcomes.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carrie Reale
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shilo Anders
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Russ Beebe
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - S Trent Rosenbloom
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amber Hackstadt
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kryseana J Harper
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jared G Cobb
- HealthIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Neeraja Peterson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tom Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zhihong Yu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William Martinez
- Corresponding Author: William Martinez, MD, MSc, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave., Suite 450, Nashville, TN 37203, USA;
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11
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Ahmed N, Brown J, Parau C, McCullers A, Sanghavi K, Littlejohn R, Wesley DB. Bridging the Digital Health Divide: Characterizing Patient Portal Users and Nonusers in the U.S. Med Care 2023; 61:448-455. [PMID: 37289563 DOI: 10.1097/mlr.0000000000001869] [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] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objectives of this study were to (1) examine demographic differences between patient portal users and nonusers; and (2) examine health literacy, patient self-efficacy, and technology usage and attitudes between patient portal users and nonusers. METHODS Data were collected from Amazon Mechanical Turk (MTurk) workers from December 2021 to January 2022. MTurk workers completed an online survey, which asked about their health, access to technology, health literacy, patient self-efficacy, media and technology attitudes, and patient portal use for those with an account. A total of 489 MTurk workers completed the survey. Data were analyzed using latent class analysis (LCA) and multivariate logistic regression models. RESULTS Latent class analysis models revealed some qualitative differences between users and nonusers of patient portals in relation to neighborhood type, education, income, disability status, comorbidity of any type, insurance type, and the presence or absence of primary care providers. These results were partially confirmed by logistic regression models, which showed that participants with insurance, a primary care provider, or a disability or comorbid condition were more likely to have a patient portal account. CONCLUSIONS Our study findings suggest that access to health care, along with ongoing patient health needs, influence the usage of patient portal platforms. Patients with health insurance have the opportunity to access health care services, including establishing a relationship with a primary care provider. This relationship can be critical to a patient ever creating a patient portal account and actively engaging in their care, including communicating with their care team.
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Affiliation(s)
| | - Jason Brown
- MedStar Health Research Institute, Hyattsville, MD
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12
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Ray EM, Teal RW, Carda-Auten J, Coffman E, Sanoff HK. Qualitative evaluation of barriers and facilitators to hepatocellular carcinoma care in North Carolina. PLoS One 2023; 18:e0287338. [PMID: 37347754 PMCID: PMC10287003 DOI: 10.1371/journal.pone.0287338] [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: 12/19/2022] [Accepted: 06/02/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Many patients with hepatocellular carcinoma (HCC) never receive cancer-directed therapy. In order to tailor interventions to increase access to appropriate therapy, we sought to understand the barriers and facilitators to HCC care. METHODS Patients with recently diagnosed HCC were identified through the University of North Carolina (UNC) HCC clinic or local hospital cancer registrars (rapid case ascertainment, RCA). Two qualitative researchers conducted in-depth, semi-structured interviews. Interviews were audiotaped, transcribed, and coded. RESULTS Nineteen interviews were conducted (10 UNC, 9 RCA). Key facilitators of care were: physician knowledge; effective communication regarding test results, plan of care, and prognosis; social support; and financial support. Barriers included: lack of transportation; cost of care; provider lack of knowledge about HCC; delays in scheduling; or poor communication with the medical team. Participants suggested better coordination of appointments and having a primary contact within the healthcare team. LIMITATIONS We primarily captured the perspectives of those HCC patients who, despite the challenges they describe, were ultimately able to receive HCC care. CONCLUSIONS This study identifies key facilitators and barriers to accessing care for HCC in North Carolina. Use of the RCA system to identify patients from a variety of settings, treated and untreated, enabled us to capture a broad range of perspectives. Reducing barriers through improving communication and care coordination, assisting with out-of-pocket costs, and engaging caregivers and other medical providers may improve access. This study should serve as the basis for tailored interventions aimed at improving access to appropriate, life-prolonging care for patients with HCC.
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Affiliation(s)
- Emily M Ray
- Department of Medicine, Division of Oncology, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Randall W Teal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Connected Health Applications and Interventions Core, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Jessica Carda-Auten
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Connected Health Applications and Interventions Core, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Erin Coffman
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Hanna K Sanoff
- Department of Medicine, Division of Oncology, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
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13
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Foumakoye M, Britton MC, Ansari E, Saunders M, McCall T, Wang EA, Puglisi LB, Workman TE, Zeng-Treitler Q, Ying Y, Shavit S, Brandt CA, Wang KH. Personal Health Libraries for People Returning From Incarceration: Protocol for a Qualitative Study. JMIR Res Protoc 2023; 12:e44748. [PMID: 37133907 PMCID: PMC10193212 DOI: 10.2196/44748] [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: 12/12/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Individuals released from carceral facilities have high rates of hospitalization and death, especially in the weeks immediately after their return to community settings. During this transitional process, individuals leaving incarceration are expected to engage with multiple providers working in separate, complex systems, including health care clinics, social service agencies, community-based organizations, and probation and parole services. This navigation is often complicated by individuals' physical and mental health, literacy and fluency, and socioeconomic status. Personal health information technology, which can help people access and organize their health information, could improve the transition from carceral systems to the community and mitigate health risks upon release. Yet, personal health information technologies have not been designed to meet the needs and preferences of this population nor tested for acceptability or use. OBJECTIVE The objective of our study is to develop a mobile app to create personal health libraries for individuals returning from incarceration to help bridge the transition from carceral settings to community living. METHODS Participants were recruited through Transitions Clinic Network clinic encounters and professional networking with justice-involved organizations. We used qualitative research methods to assess the facilitators and barriers to developing and using personal health information technology for individuals returning from incarceration. We conducted individual interviews with people just released from carceral facilities (n=~20) and providers (n=~10) from the local community and carceral facilities involved with the transition for returning community members. We used rigorous rapid qualitative analysis to generate thematic output characterizing the unique circumstances impacting the development and use of personal health information technology for individuals returning from incarceration and to identify content and features for the mobile app based on the preferences and needs of our participants. RESULTS As of February 2023, we have completed 27 qualitative interviews with individuals recently released from carceral systems (n=20) and stakeholders (n=7) who support justice-involved individuals from various organizations in the community. CONCLUSIONS We anticipate that the study will characterize the experiences of people transitioning from prison and jails to community settings; describe the information, technology resources, and needs upon reentry to the community; and create potential pathways for fostering engagement with personal health information technology. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44748.
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Affiliation(s)
- Marisol Foumakoye
- SEICHE Center for Health Justice, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Meredith Campbell Britton
- Equity Research and Innovation Center, Yale School of Medicine, Yale University, New Haven, CT, United States
- Community Alliance for Research & Engagement, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Emile Ansari
- Equity Research and Innovation Center, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Monya Saunders
- SEICHE Center for Health Justice, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Terika McCall
- Division of Health Informatics, Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, United States
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, Yale University, New Haven, CT, United States
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Emily A Wang
- SEICHE Center for Health Justice, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Lisa B Puglisi
- SEICHE Center for Health Justice, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - T Elizabeth Workman
- Center for Biomedical Informatics, George Washington University, Washington, DC, United States
- Department of Veterans Affairs, VA Healthcare Systems, West Haven, CT, United States
| | - Qing Zeng-Treitler
- Center for Biomedical Informatics, George Washington University, Washington, DC, United States
- Department of Veterans Affairs, VA Healthcare Systems, West Haven, CT, United States
| | - Yin Ying
- Center for Biomedical Informatics, George Washington University, Washington, DC, United States
| | - Shira Shavit
- Transitions Clinic Network, San Francisco, CA, United States
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Cynthia A Brandt
- Division of Health Informatics, Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, United States
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, Yale University, New Haven, CT, United States
- Department of Veterans Affairs, VA Healthcare Systems, West Haven, CT, United States
| | - Karen H Wang
- SEICHE Center for Health Justice, Yale School of Medicine, Yale University, New Haven, CT, United States
- Equity Research and Innovation Center, Yale School of Medicine, Yale University, New Haven, CT, United States
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, Yale University, New Haven, CT, United States
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14
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Rathbone A, Stumpf S, Claisse C, Sillence E, Coventry L, Brown RD, Durrant AC. People with long-term conditions sharing personal health data via digital health technologies: A scoping review to inform design. PLOS DIGITAL HEALTH 2023; 2:e0000264. [PMID: 37224154 DOI: 10.1371/journal.pdig.0000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/27/2023] [Indexed: 05/26/2023]
Abstract
The use of digital technology amongst people living with a range of long-term health conditions to support self-management has increased dramatically. More recently, digital health technologies to share and exchange personal health data with others have been investigated. Sharing personal health data with others is not without its risks: sharing data creates threats to the privacy and security of personal data and plays a role in trust, adoption and continued use of digital health technology. Our work aims to inform the design of these digital health technologies by investigating the reported intentions of sharing health data with others, the associated user experiences when using these digital health technologies and the trust, identity, privacy and security (TIPS) considerations for designing digital health technologies that support the trusted sharing of personal health data to support the self-management of long-term health conditions. To address these aims, we conducted a scoping review, analysing over 12,000 papers in the area of digital health technologies. We conducted a reflexive thematic analysis of 17 papers that described digital health technologies that support sharing of personal health data, and extracted design implications that could enhance the future development of trusted, private and secure digital health technologies.
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Affiliation(s)
- Amy Rathbone
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Simone Stumpf
- School of Computing Science, University of Glasgow, Glasgow, United Kingdom
| | - Caroline Claisse
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elizabeth Sillence
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Lynne Coventry
- School of Design and Informatics, Abertay University, Dundee, United Kingdom
| | - Richard D Brown
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Abigail C Durrant
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
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15
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Sarabu C, Sharko M, Petersen C, Galvin H. Shifting into Action: from Data Segmentation to Equitable Interoperability for Adolescents (and Everyone Else). Appl Clin Inform 2023; 14:544-554. [PMID: 37467783 PMCID: PMC10356185 DOI: 10.1055/s-0043-1769924] [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: 01/17/2023] [Accepted: 04/19/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Technological improvements and, subsequently, the federal 21st Century Cures Act have resulted in increased access to and interoperability of electronic protected health information (ePHI). These not only have many benefits, but also have created unique challenges for privacy and confidentiality for adolescent patients. The inability to granularly protect sensitive data and a lack of standards have resulted in limited confidentiality protection and inequitable access to health information. OBJECTIVES This study aimed to understand the challenges to safe, equitable access, and interoperability of ePHI for adolescents and to identify strategies that have been developed, ongoing needs, and work in progress. METHODS Shift, a national task force formalized in 2020, is a group of more than 200 expert stakeholder members working to improve functionality to standardize efforts to granularly identify and protect sensitive ePHI to promote equitable interoperability. RESULTS Shift has created high-priority clinical use cases and organized challenges into the areas of Standards and Terminology; Usability and Implementation; and Ethics, Legal, and Policy. CONCLUSION Current technical standards and value sets of terminology for sensitive data have been immature and inconsistent. Shift, a national diverse working group of stakeholders, is addressing challenges inherent in the protection of privacy and confidentiality for adolescent patients. The diversity of expertise and perspectives has been essential to identify and address these challenges.
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Affiliation(s)
- Chethan Sarabu
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Marianne Sharko
- Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medical College, New York, New York, United States
| | - Carolyn Petersen
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Hannah Galvin
- Department of Information Technology, Cambridge Health Alliance, Tufts University School of Medicine, Cambridge, Massachusetts, United States
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16
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Amirkiai S, Obadan-Udoh E. Dental patients' perceptions of and desired content from patient health portals. J Am Dent Assoc 2023; 154:330-339.e3. [PMID: 36822909 DOI: 10.1016/j.adaj.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/04/2022] [Accepted: 12/27/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND Patient health portals (PHPs) encourage patient engagement to achieve the quadruple aim of health care: to improve the patient's experience of care, improve population health, reduce health care costs, and improve the work life of health care providers. The purpose of this study was to capture dental patients' perspectives on PHPs and their desired content. Specifically, the authors examined the important features for dental patients to have as well as the barriers and facilitators of PHPs. METHODS The authors conducted a cross-sectional study of adult patients attending the predoctoral, faculty, and resident clinics at an academic dental center from July through October 2020. Patients were invited to complete an 18-item self-administered survey. The survey captured patient demographics, preferences, desired content, and facilitators and barriers of PHPs. The authors performed descriptive statistical analysis and bivariate analysis. RESULTS A total of 325 people participated. Most participants had a bachelor's degree, internet access, government insurance, and a combined household income of more than $50,000 per year. Completed procedures, past visit summaries, and date of last visit were the top 3 types of information patients desired in dental health PHPs. The top 3 desired oral health topics in PHPs included signs of gingival disease and proper management, caries prevention, and proper toothbrushing and flossing techniques. Highest perceived barriers included high cost and privacy and security concerns. Highest perceived facilitators included user-friendly portals and monitoring personal health. CONCLUSIONS This study highlights dental patients' preferences for a PHP and can inform the development of dental PHPs. Dentists must overcome identified barriers to increase patient engagement in using dental PHPs. PRACTICAL IMPLICATIONS Implementing the patient-identified features in a dental PHP will help improve the quality of oral health care delivery by increasing patient engagement and improving the patient's experience.
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17
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Gleason KT, Peereboom D, Wec A, Wolff JL. Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations: A Scoping Review. JAMA Netw Open 2022; 5:e2248696. [PMID: 36576738 PMCID: PMC9857556 DOI: 10.1001/jamanetworkopen.2022.48696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Family and other unpaid care partners may bridge accessibility challenges in interacting with the patient portal, but the extent and nature of this involvement is not well understood. OBJECTIVE To inform an emerging research agenda directed at more purposeful inclusion of care partners within the context of digital health equity by (1) quantifying care partners' uptake and use of the patient portal in adolescent and adult patients, (2) identifying factors involving care partners' portal use across domains of the System Engineering Initiative for Patient Safety model, and (3) assessing evidence of perceived or actual outcomes of care partners' portal use. EVIDENCE REVIEW Following Arksey and O'Malley's methodologic framework, a scoping review of manuscripts published February 1 and March 22, 2022, was conducted by hand and a systematic search of PubMed, PsycInfo, Embase, and Web of Science. The search yielded 278 articles; 125 were selected for full-text review and 41 were included. FINDINGS Few adult patient portal accounts had 1 or more formally registered care partners (<3% in 7 of 7 articles), but care partners commonly used the portal (8 of 13 contributing articles reported >30% use). Care partners less often authored portal messages with their own identity credentials (<3% of portal messages in 3 of 3 articles) than with patient credentials (20%-60% of portal messages in 3 of 5 articles). Facilitators of care partner portal use included markers of patient vulnerability (13 articles), care partner characteristics (15 articles; being female, family, and competent in health system navigation), and task-based factors pertaining to ease of information access and care coordination. Environmental (26 articles) and process factors (19 articles, eg, organizational portal registration procedures, protection of privacy, and functionality) were identified as influential to care partner portal use, but findings were nuanced and precluded reporting on effects. Care partner portal use was identified as contributing to both patient and care partner insight into patient health (9 articles), activation (7 articles), continuity of care (8 articles), and convenience (6 articles). CONCLUSIONS AND RELEVANCE In this scoping review, care partners were found to be infrequently registered for the patient portal and more often engaged in portal use with patient identity credentials. Formally registering care partners for the portal was identified as conferring potential benefits for patients, care partners, and care quality.
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Affiliation(s)
| | | | - Aleksandra Wec
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer L. Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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18
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Aydin G, Kumru S. Paving the way for increased e-health record use: elaborating intentions of Gen-Z. Health Syst (Basingstoke) 2022; 12:281-298. [PMID: 37860594 PMCID: PMC10583638 DOI: 10.1080/20476965.2022.2129471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/21/2022] [Indexed: 10/10/2022] Open
Abstract
This paper presents the determinants of personal e-health records adoption by the Gen-Z population and reveals barriers to use. Gen-Z members are one of the most prominent users of digital health services that have an influence on older generations' technology adoption but have often been overlooked in scholarly research. A survey of 1,000 Gen-Z university students based on modified UTAUT was used to address this research gap. The analysis revealed the vital role of social influence in paving the way for higher adoption among Gen-Z. Moreover, significant influences of performance expectancy, facilitating conditions, and e-health literacy on behavioural intentions were detected. Effort expectancy was found to be insignificant in impacting Gen-Z's intentions to adopt electronic health record systems. Moreover, privacy concerns acted as a barrier to adoption, yet the offsetting effect of users' trust in health systems was shown to be instrumental in overcoming such privacy-related barriers.
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Affiliation(s)
- Gökhan Aydin
- School of Business and Law, University of Brighton, Brighton, UK
- Health Management, Istanbul Medipol University, Istanbul, Turkey
| | - Seda Kumru
- Health Management, Bakircay University, Izmir, Turkey
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19
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McAlearney AS, Walker DM, Sieck CJ, Fareed N, MacEwan SR, Hefner JL, Di Tosto G, Gaughan A, Sova LN, Rush LJ, Moffatt-Bruce S, Rizer MK, Huerta TR. Effect of In-Person vs Video Training and Access to All Functions vs a Limited Subset of Functions on Portal Use Among Inpatients: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2231321. [PMID: 36098967 PMCID: PMC9471980 DOI: 10.1001/jamanetworkopen.2022.31321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/22/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Inpatient portals provide patients with clinical data and information about their care and have the potential to influence patient engagement and experience. Although significant resources have been devoted to implementing these portals, evaluation of their effects has been limited. Objective To assess the effects of patient training and portal functionality on use of an inpatient portal and on patient satisfaction and involvement with care. Design, Setting, and Participants This randomized clinical trial was conducted from December 15, 2016, to August 31, 2019, at 6 noncancer hospitals that were part of a single health care system. Patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay were eligible for participation. Data were analyzed from May 1, 2019, to March 15, 2021. Interventions A 2 × 2 factorial intervention design was used to compare 2 levels of a training intervention (touch intervention, consisting of in-person training vs built-in video tutorial) and 2 levels of portal function availability (tech intervention) within an inpatient portal (all functions operational vs a limited subset of functions). Main Outcomes and Measures The primary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and patients' satisfaction and involvement with their care. Results Of 2892 participants, 1641 were women (56.7%) with a median age of 47.0 (95% CI, 46.0-48.0) years. Most patients were White (2221 [76.8%]). The median Charlson Comorbidity Index was 1 (95% CI, 1-1) and the median length of stay was 6 (95% CI, 6-7) days. Notably, the in-person training intervention was found to significantly increase inpatient portal use (incidence rate ratio, 1.34 [95% CI, 1.25-1.44]) compared with the video tutorial. Patients who received in-person training had significantly higher odds of being comprehensive portal users than those who received the video tutorial (odds ratio, 20.75 [95% CI, 16.49-26.10]). Among patients who received the full-tech intervention, those who also received the in-person intervention used the portal more frequently (incidence rate ratio, 1.36 [95% CI, 1.25-1.48]) and more comprehensively (odds ratio, 22.52; [95% CI, 17.13-29.62]) than those who received the video tutorial. Patients who received in-person training had higher odds (OR, 2.01 [95% CI, 1.16-3.50]) of reporting being satisfied in the 6-month postdischarge survey. Similarly, patients who received the full-tech intervention had higher odds (OR, 2.06 [95%CI, 1.42-2.99]) of reporting being satisfied in the 6-month postdischarge survey. Conclusions and Relevance Providing in-person training or robust portal functionality increased inpatient engagement with the portal during the hospital stay. The effects of the training intervention suggest that providing personalized training to support use of this health information technology can be a powerful approach to increase patient engagement via portals. Trial Registration ClinicalTrials.gov Identifier: NCT02943109.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Cynthia J. Sieck
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Dayton Children’s Hospital Center for Health Equity, Dayton, Ohio
| | - Naleef Fareed
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
| | - Sarah R. MacEwan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus
| | - Jennifer L. Hefner
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Gennaro Di Tosto
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Alice Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Lindsey N. Sova
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Laura J. Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | | | - Milisa K. Rizer
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
| | - Timothy R. Huerta
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
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Müller J, Weinert L, Svensson L, Rivinius R, Kreusser MM, Heinze O. Mobile Access to Medical Records in Heart Transplantation Aftercare: Mixed-Methods Study Assessing Usability, Feasibility and Effects of a Mobile Application. Life (Basel) 2022; 12:1204. [PMID: 36013383 PMCID: PMC9410472 DOI: 10.3390/life12081204] [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: 06/30/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Patient access to medical records can improve quality of care. The phellow application (app) was developed to provide patients access to selected content of their medical record. It was tested at a heart transplantation (HTx) outpatient clinic. The aims of this study were (1) to assess usability of phellow, (2) to determine feasibility of implementation in routine care, and (3) to study the effects app use had on patients' self-management. METHODS Usability was measured quantitatively through the System Usability Scale (SUS). Furthermore, usability, feasibility, and effects on self-management were qualitatively assessed through interviews with users, non-users, and health care providers. RESULTS The SUS rating (n = 31) was 79.9, indicating good usability. Twenty-three interviews were conducted. Although appreciation and willingness-to-use were high, usability problems such as incompleteness of record, technical issues, and complex registration procedures were reported. Improved technical support infrastructure, clearly defined responsibilities, and app-specific trainings were suggested for further implementation. Patients described positive effects on their self-management. CONCLUSIONS To be feasible for implementation in routine care, usability problems should be addressed. Feedback on the effect of app use was encouraging. Accompanying research is crucial to monitor usability improvements and to further assess effects of app use on patients.
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Affiliation(s)
- Julia Müller
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Lina Weinert
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
- Section for Translational Health Economics, Department for Conservative Dentistry, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Laura Svensson
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Michael M. Kreusser
- Department of Cardiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Oliver Heinze
- Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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Sung M, He J, Zhou Q, Chen Y, Ji JS, Chen H, Li Z. Using an Integrated Framework to Investigate the Facilitators and Barriers of Health Information Technology Implementation in Noncommunicable Disease Management: Systematic Review. J Med Internet Res 2022; 24:e37338. [PMID: 35857364 PMCID: PMC9350822 DOI: 10.2196/37338] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Noncommunicable disease (NCD) management is critical for reducing attributable health burdens. Although health information technology (HIT) is a crucial strategy to improve chronic disease management, many health care systems have failed in implementing HIT. There has been a lack of research on the implementation process of HIT for chronic disease management. OBJECTIVE We aimed to identify the barriers and facilitators of HIT implementation, analyze how these factors influence the implementation process, and identify key areas for future action. We will develop a framework for understanding implementation determinants to synthesize available evidence. METHODS We conducted a systematic review to understand the barriers and facilitators of the implementation process. We searched MEDLINE, Cochrane, Embase, Scopus, and CINAHL for studies published between database inception and May 5, 2022. Original studies involving HIT-related interventions for NCD management published in peer-reviewed journals were included. Studies that did not discuss relevant outcome measures or did not have direct contact with or observation of stakeholders were excluded. The analysis was conducted in 2 parts. In part 1, we analyzed how the intrinsic attributes of HIT interventions affect the successfulness of implementation by using the intervention domain of the Consolidated Framework for Implementation Research (CFIR). In part 2, we focused on the extrinsic factors of HIT using an integrated framework, which was developed based on the CFIR and the levels of change framework by Ferlie and Shortell. RESULTS We identified 51 papers with qualitative, mixed-method, and cross-sectional methodologies. Included studies were heterogeneous regarding disease populations and HIT interventions. In part 1, having a relative advantage over existing health care systems was the most prominent intrinsic facilitator (eg, convenience, improvement in quality of care, and increase in access). Poor usability was the most noted intrinsic barrier of HIT. In part 2, we mapped the various factors of implementation to the integrated framework (the coordinates are shown as level of change-CFIR). The key barriers to the extrinsic factors of HIT included health literacy and lack of digital skills (individual-characteristics of individuals). The key facilitators included physicians' suggestions, cooperation (interpersonal-process), integration into a workflow, and adequate management of data (organizational-inner setting). The importance of health data security was identified. Self-efficacy issues of patients and organizational readiness for implementation were highlighted. CONCLUSIONS Internal factors of HIT and external human factors of implementation interplay in HIT implementation for chronic disease management. Strategies for improvement include ensuring HIT has a relative advantage over existing health care; tackling usability issues; and addressing underlying socioeconomic, interpersonal, and organizational conditions. Further research should focus on studying various stakeholders, such as service providers and administrative workforces; various disease populations, such as those with obesity and mental diseases; and various countries, including low- and middle-income countries.
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Affiliation(s)
- Meekang Sung
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - Jinyu He
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Qi Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Haotian Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China.,Institute for Healthy China, Tsinghua Universtiy, Beijing, China
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22
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Leach B, Parkinson S, Gkousis E, Abel G, Atherton H, Campbell J, Clark C, Cockcroft E, Marriott C, Pitchforth E, Sussex J. Digital Facilitation to Support Patient Access to Web-Based Primary Care Services: Scoping Literature Review. J Med Internet Res 2022; 24:e33911. [PMID: 35834301 PMCID: PMC9335178 DOI: 10.2196/33911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/15/2022] [Accepted: 04/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of web-based services within primary care (PC) in the National Health Service in England is increasing, with medically underserved populations being less likely to engage with web-based services than other patient groups. Digital facilitation-referring to a range of processes, procedures, and personnel that seek to support patients in the uptake and use of web-based services-may be a way of addressing these challenges. However, the models and impact of digital facilitation currently in use are unclear. OBJECTIVE This study aimed to identify, characterize, and differentiate between different approaches to digital facilitation in PC; establish what is known about the effectiveness of different approaches; and understand the enablers of digital facilitation. METHODS Adopting scoping review methodology, we searched academic databases (PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library) and gray literature published between 2015 and 2020. We conducted snowball searches of reference lists of included articles and articles identified during screening as relevant to digital facilitation, but which did not meet the inclusion criteria because of article type restrictions. Titles and abstracts were independently screened by 2 reviewers. Data from eligible studies were analyzed using a narrative synthesis approach. RESULTS A total of 85 publications were included. Most (71/85, 84%) were concerned with digital facilitation approaches targeted at patients (promotion of services, training patients to improve their technical skills, or other guidance and support). Further identified approaches targeted PC staff to help patients (eg, improving staff knowledge of web-based services and enhancing their technical or communication skills). Qualitative evidence suggests that some digital facilitation may be effective in promoting the uptake and use of web-based services by patients (eg, recommendation of web-based services by practice staff and coaching). We found little evidence that providing patients with initial assistance in registering for or accessing web-based services leads to increased long-term use. Few studies have addressed the effects of digital facilitation on health care inequalities. Those that addressed this suggested that providing technical training for patients could be effective, at least in part, in reducing inequalities, although not entirely. Factors affecting the success of digital facilitation include perceptions of the usefulness of the web-based service, trust in the service, patients' trust in providers, the capacity of PC staff, guidelines or regulations supporting facilitation efforts, and staff buy-in and motivation. CONCLUSIONS Digital facilitation has the potential to increase the uptake and use of web-based services by PC patients. Understanding the approaches that are most effective and cost-effective, for whom, and under what circumstances requires further research, including rigorous evaluations of longer-term impacts. As efforts continue to increase the use of web-based services in PC in England and elsewhere, we offer an early typology to inform conceptual development and evaluations. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020189019; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019.
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Affiliation(s)
| | | | | | - Gary Abel
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - John Campbell
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - Emma Cockcroft
- University of Exeter Medical School, Exeter, United Kingdom
| | - Christine Marriott
- National Institute of Health and Care Research Collaboration South West Peninsula Patient Engagement Group, University of Exeter Medical School, Exeter, United Kingdom
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23
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Yang K, Hu Y, Qi H. Digital Health Literacy: Bibliometric Analysis. J Med Internet Res 2022; 24:e35816. [PMID: 35793141 PMCID: PMC9301558 DOI: 10.2196/35816] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/19/2022] [Accepted: 06/20/2022] [Indexed: 01/04/2023] Open
Abstract
Background Digital health is growing at a rapid pace, and digital health literacy has attracted increasing attention from the academic community. Objective The purposes of this study are to conduct a systematic bibliometric analysis on the field of digital health literacy and to understand the research context and trends in this field. Methods Methods: A total of 1955 scientific publications were collected from the Web of Science core collection. Institutional co-operation, journal co-citation, theme bursting, keyword co-occurrence, author co-operation, author co-citation, literature co-citation, and references in the field of digital health literacy were analyzed using the VOSviewer and CiteSpace knowledge mapping tools. Results The results demonstrate that the United States has the highest number of publications and citations in this field. The University of California System was first in terms of institutional contributions. The Journal of Medical Internet Research led in the number of publications, citations, and co-citations. Research areas of highly cited articles in the field of digital health literacy mainly include the definition and scale of health literacy, health literacy and health outcomes, health literacy and the digital divide, and the influencing factors of health literacy. Conclusions We summarized research progress in the field of digital health literacy and reveal the context, trends, and trending topics of digital health literacy research through statistical analysis and network visualization. We found that digital health literacy has a significant potential to improve health outcomes, bridge the digital divide, and reduce health inequalities. Our work can serve as a fundamental reference and directional guide for future research in this field.
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Affiliation(s)
- Keng Yang
- Institute of Economics, Tsinghua University, Beijing, China
- One Belt-One Road Strategy Institute, Tsinghua University, Beijing, China
| | - Yekang Hu
- China National Health Development Research Center, Beijing, China
| | - Hanying Qi
- The New Type Key Think Tank of Zhejiang Province "Research Institute of Regulation and Public Policy", Zhejiang University of Finance and Economics, Hangzhou, China
- China Institute of Regulation Research, Zhejiang University of Finance and Economics, Hangzhou, China
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24
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Narindrarangkura P, Boren SA, Khan U, Day M, Simoes EJ, Kim MS. SEE-Diabetes, a patient-centered diabetes self-management education and support for older adults: Findings and information needs from patients' perspectives. Prim Care Diabetes 2022; 16:395-403. [PMID: 35227635 PMCID: PMC9133060 DOI: 10.1016/j.pcd.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/26/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022]
Abstract
AIMS This study identified the information needs of people with diabetes aged 65 and older through surveys and focus groups to inform the development of a patient-centered educational decision aid for diabetes care, SEE-Diabetes (Support-Engage-Empower-Diabetes). METHODS We conducted survey (N = 37) and three focus groups (N = 9). The survey collected demographics, diabetes duration, insulin usage, and clinic notes accessibility through a patient portal. In focus groups, participants evaluated the Assessment and Plan section of three selected deidentified clinic notes to assess readability and helpfulness for diabetes care. RESULTS The mean age of participants was 66 (24-82, SD = 12), and 22 were female (60%). The mean diabetes duration was 20.9 years (1-63, SD=15). Most participants (80%) read their clinical notes via patient portal. In the focus groups, the readability of clinic notes was noted as a primary concern because of medical abbreviations and poor formatting. Participants found the helpfulness of clinic notes was negatively impacted by vague or insufficient self-care information. CONCLUSIONS We found the high use of patient portal for reading clinic notes, which offers a use case opportunity for the proposed SEE-Diabetes educational aid. Feedback about the readability and helpfulness of clinic notes will be considered during the design process.
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Affiliation(s)
- Ploypun Narindrarangkura
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Suzanne A Boren
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Uzma Khan
- Cosmopolitan International Diabetes and Endocrinology Center, University of Missouri, Columbia, 3315 Berrywood Dr, Suite 201, Columbia, MO 65201, United States; Department of Medicine, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Margaret Day
- Department of Family and Community Medicine, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Eduardo J Simoes
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Min Soon Kim
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
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25
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Korngiebel DM, West KM. Patient Recommendations for the Content and Design of Electronic Returns of Genetic Test Results: Interview Study Among Patients Who Accessed Their Genetic Test Results via the Internet. JMIRX MED 2022; 3:e29706. [PMID: 37725563 PMCID: PMC10414314 DOI: 10.2196/29706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/26/2021] [Accepted: 01/29/2022] [Indexed: 09/21/2023]
Abstract
BACKGROUND Genetic test results will be increasingly made available electronically as more patient-facing tools are developed; however, little research has been done that collects data on patient preferences for content and design before creating results templates. OBJECTIVE This study identifies patient preferences for the electronic return of genetic test results, including what considerations should be prioritized for content and design. METHODS Following user-centered design methods, 59 interviews were conducted by using semistructured protocols. The interviews explored the content and design issues of patient portals that facilitated the return of test results to patients. We interviewed patients who received electronic results for specific types of genetics tests (pharmacogenetic tests, hereditary blood disorder tests, and tests for the risk of heritable cancers) or electronically received any type of genetic or nongenetic test results. RESULTS In general, many of participants felt that there always needed to be some clinician involvement in electronic result returns and that electronic coversheets with simple summaries would be helpful for facilitating this. Coversheet summaries could accompany, but not replace, the more detailed report. Participants had specific suggestions for such results summaries, such as only reporting the information that was the most important for patients to understand, including next steps, and doing so by using clear language that is free of medical jargon. Electronic result returns should also include explicit encouragement for patients to contact health care providers about questions. Finally, many participants preferred to manage their care by using their smartphones, particularly in instances when they needed to access health information on the go. CONCLUSIONS Participants recommended that a patient-friendly front section should accompany the more detailed report and made suggestions for organization, content, and wording. Many used their smartphones regularly to access test results; therefore, health systems and patient portal software vendors should accommodate smartphone app design and web portal design concomitantly when developing platforms for returning results.
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Huang M, Khurana A, Mastorakos G, Wen A, He H, Wang L, Liu S, Wang Y, Zong N, Prigge J, Costello B, Shah N, Ting H, Fan J, Patten C, Liu H. Patient Portal Messaging for Asynchronous Virtual Care During the COVID-19 Pandemic: Retrospective Analysis. JMIR Hum Factors 2022; 9:e35187. [PMID: 35171108 PMCID: PMC9084445 DOI: 10.2196/35187] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/09/2022] [Accepted: 02/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, patient portals and their message platforms allowed remote access to health care. Utilization patterns in patient messaging during the COVID-19 crisis have not been studied thoroughly. In this work, we propose characterizing patients and their use of asynchronous virtual care for COVID-19 via a retrospective analysis of patient portal messages. OBJECTIVE This study aimed to perform a retrospective analysis of portal messages to probe asynchronous patient responses to the COVID-19 crisis. METHODS We collected over 2 million patient-generated messages (PGMs) at Mayo Clinic during February 1 to August 31, 2020. We analyzed descriptive statistics on PGMs related to COVID-19 and incorporated patients' sociodemographic factors into the analysis. We analyzed the PGMs on COVID-19 in terms of COVID-19-related care (eg, COVID-19 symptom self-assessment and COVID-19 tests and results) and other health issues (eg, appointment cancellation, anxiety, and depression). RESULTS The majority of PGMs on COVID-19 pertained to COVID-19 symptom self-assessment (42.50%) and COVID-19 tests and results (30.84%). The PGMs related to COVID-19 symptom self-assessment and COVID-19 test results had dynamic patterns and peaks similar to the newly confirmed cases in the United States and in Minnesota. The trend of PGMs related to COVID-19 care plans paralleled trends in newly hospitalized cases and deaths. After an initial peak in March, the PGMs on issues such as appointment cancellations and anxiety regarding COVID-19 displayed a declining trend. The majority of message senders were 30-64 years old, married, female, White, or urban residents. This majority was an even higher proportion among patients who sent portal messages on COVID-19. CONCLUSIONS During the COVID-19 pandemic, patients increased portal messaging utilization to address health care issues about COVID-19 (in particular, symptom self-assessment and tests and results). Trends in message usage closely followed national trends in new cases and hospitalizations. There is a wide disparity for minority and rural populations in the use of PGMs for addressing the COVID-19 crisis.
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Affiliation(s)
- Ming Huang
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Aditya Khurana
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - George Mastorakos
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - Andrew Wen
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Huan He
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Liwei Wang
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Sijia Liu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Yanshan Wang
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Nansu Zong
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Julie Prigge
- Center for Connected Care, Mayo Clinic, Rochester, MN, United States
| | - Brian Costello
- Center for Connected Care, Mayo Clinic, Rochester, MN, United States
| | - Nilay Shah
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Henry Ting
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jungwei Fan
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Christi Patten
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, United States
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Hongfang Liu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
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Acholonu RG, Raphael JL. The Influence of the Electronic Health Record on Achieving Equity and Eliminating Health Disparities for Children. Pediatr Ann 2022; 51:e112-e117. [PMID: 35293812 DOI: 10.3928/19382359-20220215-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The electronic health record (EHR) has been heralded as a transformative approach to modernizing health care and advancing health equity. Access to the EHR can facilitate shared clinical decision-making and improved communication with patients, families, and among health care providers. Recent legislative and regulatory efforts have been passed to increase the transparency as well as the initiatives to increase the meaningful use of the EHR. Yet despite these well-intended efforts, challenges to addressing health equity through the EHR persist. This article reviews three distinct challenges to addressing health equity related to the EHR. We discuss (1) both the implicit and explicit bias that exist in EHR documentation, (2) the gaps that remain between screening for social determinants of health and the effective inclusion and billing of that screening into the EHR, and (3) the disparities that exist with the use of patient portals. Addressing these three areas will enhance the opportunities to advance health equity through the use of the EHR and bring us one step closer to eliminating health disparities in pediatric health care. [Pediatr Ann. 2022;51(3):e112-e117.].
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28
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Khurshid A, Oliveira E, Nordquist E, Lakshminarayanan V, Abrol V. FHIRedApp: a LEAP in health information technology for promoting patient access to their medical information. JAMIA Open 2022; 4:ooab109. [PMID: 35155997 PMCID: PMC8826978 DOI: 10.1093/jamiaopen/ooab109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/28/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Our aim is to develop a patient engagement technology that makes it easy for patients to access their own medical information and share it with others. Materials and Methods This paper describes our design through an adapted Community Engagement Studio methodology to identify the needs and preferences of a diverse group of Latinx, African–American, and Asian–American individuals in the community. We use Human-Centered Design to interpret these needs and preferences to build a digital app platform, using national data standards, clinical data aggregators, and privacy-preserving solutions while maintaining the security and confidentiality of patients. Results We designed and developed FHIRedApp, an app platform, that allows patients to access their data and to share that access as HL7® FHIR® application programming interfaces with third-party app developers. We accomplished 2 major tasks: first, to demonstrate the use of interoperability and authentication standards, such as HL7® FHIR and OAuth2, to help develop patient engagement technologies, and second, to co-develop and co-design FHIRedApp with active involvement of African–American, Latinx, and Asian–American community members. Usability results show high satisfaction rates for FHIRedApp. Conclusion The development of FHIRedApp demonstrates how technology innovations using national interoperability standards can be informed through a methodology of community engagement and human-centered design that involves local racial and ethnic groups. Our aim is to develop a patient engagement technology (PET) that makes it easy for patients to access their own medical information and share it with others. We adapted a methodology to identify the needs and preferences of a diverse group of Latinx, African–American, and Asian–American patients. We used Human-Centered Design to interpret these needs and preferences to build a digital app platform, using national data standards, clinical data aggregators, and privacy-preserving solutions while maintaining the security and confidentiality of patients. We designed and developed FHIRedApp, a platform that allows other applications to work on it. Patients showed high satisfaction with the use of FHIRedApp. The development of FHIRedApp demonstrates how technology innovations using national standards for exchanging data can be informed through a methodology of community engagement and human-centered design.
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Affiliation(s)
- Anjum Khurshid
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Texas, USA
| | - Eliel Oliveira
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Texas, USA
| | - Eric Nordquist
- School of Information, The University of Texas at Austin, Texas, USA
| | - Vidya Lakshminarayanan
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Texas, USA
| | - Vishal Abrol
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Texas, USA
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29
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Kaihlanen AM, Virtanen L, Buchert U, Safarov N, Valkonen P, Hietapakka L, Hörhammer I, Kujala S, Kouvonen A, Heponiemi T. Towards digital health equity - a qualitative study of the challenges experienced by vulnerable groups in using digital health services in the COVID-19 era. BMC Health Serv Res 2022; 22:188. [PMID: 35151302 PMCID: PMC8840681 DOI: 10.1186/s12913-022-07584-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background The COVID-19 pandemic has given an unprecedented boost to already increased digital health services, which can place many vulnerable groups at risk of digital exclusion. To improve the likelihood of achieving digital health equity, it is necessary to identify and address the elements that may prevent vulnerable groups from benefiting from digital health services. This study examined the challenges experienced by vulnerable groups in using digital health services during the COVID-19 pandemic. Methods Qualitative descriptive design was utilized. Semi-structured interviews were conducted between October 2020 and May 2021. The participants (N = 74) were older adults, migrants, mental health service users, high users of health services, and the unemployed. Qualitative content analysis with both inductive and deductive approach was used to analyze the data. Challenges related to the use of digital health services were interpreted through digital determinants of health from the Digital Health Equity Framework. Results For most of the participants the access to digital health services was hampered by insufficient digital, and / or local language skills. The lack of support and training, poor health, as well as the lack of strong e-identification or suitable devices also prevented the access. Digital services were not perceived to be applicable for all situations or capable of replacing face-to-face services due to the poor communication in the digital environment. Fears and the lack of trust regarding digital platforms were expressed as well as concerns related to the security of the services. Contact with a health care professional was also considered less personal and more prone to misunderstandings in the digital environment than in face-to-face services. Finally, digital alternatives were not always available as desired by participants, or participants were unaware of existing digital services and their value. Conclusion Several development needs in the implementation of digital health services were identified that could improve equal access to and benefits gained from digital services in the future. While digital health services are increasing, traditional face-to-face services will still need to be offered alongside the digital ones to ensure equal access to services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07584-4.
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Jackson SL, Shucard H, Liao JM, Bell SK, Fossa A, Payne TH, Reisch LM, Radick AC, DesRoches CM, Fitzgerald P, Leveille S, Walker J, Elmore JG. Care partners reading patients' visit notes via patient portals: Characteristics and perceptions. PATIENT EDUCATION AND COUNSELING 2022; 105:290-296. [PMID: 34481675 DOI: 10.1016/j.pec.2021.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 07/23/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Care partners are key members of patients' health care teams, yet little is known about their experiences accessing patient information via electronic portals. OBJECTIVE To better understand the characteristics and perceptions of care partners who read patients' electronic visit notes. PATIENT INVOLVEMENT Focus groups with diverse patients from a community health center provided input into survey development. METHODS We contacted patient portal users at 3 geographically distinct sites in the US via email in 2017 for an online survey including open ended questions which we qualitatively analyzed. RESULTS Respondents chose whether to answer as care partners (N = 874) or patients (N = 28,782). Among care partner respondents, 44% were spouses, 43% children/other family members, and 14% friends/neighbors/other. Both care partners and patients reported that access to electronic notes was very important for promoting positive health behaviors, but care partners' perceptions of importance were consistently more positive than patients' perceptions of engagement behaviors. Open-ended comments included positive benefits such as: help with remembering the plan for care, coordinating care with other doctors, decreasing stress of care giving, improving efficiency of visits, and supporting patients from a geographical distance. They also offered suggestions for improving electronic portal and note experience for care partners such as having a separate log on for care partners; having doctors avoid judgmental language in their notes; and the ability to prompt needed medical care for patients. DISCUSSION Care partners value electronic access to patients' health information even more than patients. The majority of care partners were family members, whose feedback is important for improving portal design that effectively engages these care team members. PRACTICAL VALUE Patient care in the time of COVID-19 increasingly requires social distancing which may place additional burden on care partners supporting vulnerable patients. Access to patient notes may promote quality of care by keeping care partners informed, and care partner's input should be used to optimize portal design and electronic access to patient information.
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Affiliation(s)
- Sara L Jackson
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Hannah Shucard
- Department of Biostatistics, University of Washington School of Medicine, Seattle, WA, USA
| | - Joshua M Liao
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alan Fossa
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Thomas H Payne
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Lisa M Reisch
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Andrea C Radick
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Patricia Fitzgerald
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Suzanne Leveille
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jan Walker
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joann G Elmore
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Price JC, Simpson DC. Telemedicine and Health Disparities. Clin Liver Dis (Hoboken) 2022; 19:144-147. [PMID: 35505914 PMCID: PMC9053673 DOI: 10.1002/cld.1171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/28/2021] [Accepted: 09/22/2021] [Indexed: 02/04/2023] Open
Abstract
Content available: Author Audio Recording.
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Affiliation(s)
- Jennifer C. Price
- Department of MedicineUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Dinee C. Simpson
- Department of SurgeryFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
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Egan KJ, Clark P, Deen Z, Paputa Dutu C, Wilson G, McCann L, Lennon M, Maguire R. Understanding Current Needs and Future Expectations of Informal Caregivers for Technology to Support Health and Well-being: National Survey Study. JMIR Aging 2022; 5:e15413. [PMID: 35084339 PMCID: PMC8832269 DOI: 10.2196/15413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 03/23/2020] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background There are approximately 6.5 million informal (unpaid) caregivers in the United Kingdom. Each caregiver plays a critical role in the society, supporting the health and well-being of those who are ill, disabled, or older and who need frequent support. Digital technologies are becoming a ubiquitous part of everyday life for many, but little is known about the real-world impact of technology for those in a caring role, including the abilities of technologies to address the mental and physical impacts of caregiving. Objective This study aims to understand the current and future technology use of caregivers, including digital technologies used to care for themselves and the person they look after. Methods We codeveloped a wide range of questions with caregivers and care professionals and delivered this survey both on the web and in paper format (eg, using social networks such as Twitter alongside in-person events). Questions were focused on providing care and looking after caregiver health and well-being. Analyses focused on both quantitative outcomes (frequency counts and Likert questions) and explored free text entries (thematic analysis). Results From 356 respondents, we identified that caregivers were receptive to, and largely positive about current and future use of technology both for their own care and their caring role (eg, checking in from distance). There were notable concerns, including the risk that technology could replace human contact. We identified several key areas for future work, including communication with health and social care professionals, and the potential for technology to help caregivers with their own health. We also identified several stakeholders (eg, care workers, pharmacy staff, and general practitioners) who could act as suitable points for technology signposting and support. Conclusions Caregivers are a transient, often difficult to reach population, and this work has collated a large body of knowledge across a diverse group of individuals. Many caregivers, like the rest of society, are realizing the benefits of using everyday technology to help deliver care. It is clear that there is already a high level of dependency on technologies, where future expectations will grow. However, many barriers to digital technology use remain, including a lack of ongoing technology support. Preventive measures linked to technology that can help look after a caregiver’s own health appear acceptable, particularly for communicative tools. This collated caregiver knowledge is a call for all stakeholders—academics, policy makers, and practitioners—to take note of these specific challenges, and to ensure that caregiver voices are both heard and fully integrated within the emerging digital health agenda.
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Affiliation(s)
- Kieren J Egan
- Digital Health and Wellness Group, Department of Computing and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | | | - Zahid Deen
- The Health and Social Care Alliance Scotland, Glasgow, United Kingdom
| | | | - Graham Wilson
- Digital Health and Wellness Group, Department of Computing and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Lisa McCann
- Digital Health and Wellness Group, Department of Computing and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Marilyn Lennon
- Digital Health and Wellness Group, Department of Computing and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Roma Maguire
- Digital Health and Wellness Group, Department of Computing and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
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Haggstrom DA, Carr T. Uses of Personal Health Records for Communication Among Colorectal Cancer Survivors, Caregivers, and Providers: Interview and Observational Study in a Human-Computer Interaction Laboratory. JMIR Hum Factors 2022; 9:e16447. [PMID: 35076406 PMCID: PMC8826153 DOI: 10.2196/16447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/07/2021] [Accepted: 09/11/2021] [Indexed: 01/05/2023] Open
Abstract
Background Personal health records (PHRs) may be useful for patient self-management and participation in communication with their caregivers and health care providers. As each potential participant’s role is different, their perception of the best uses of a PHR may vary. Objective The perspectives of patients, caregivers, and providers were all evaluated concurrently in relation to a PHR developed for colorectal cancer (CRC) survivors. Methods We explored group perceptions of a CRC PHR prototype. Scenario-based testing across eight use cases, with semistructured follow-up interviews, was videotaped in a human-computer interaction laboratory with patients, caregivers, and health care providers. Providers included oncologists, gastroenterologists, and primary care physicians. Discrete observations underwent grounded theory visual affinity analysis to identify emergent themes. Results Observations fell into three major themes: the network (who should be granted access to the PHR by the patient), functions (helpful activities the PHR enabled), and implementation (how to adopt the PHR into workflow). Patients wanted physician access to their PHR, as well as family member access, especially when they lived at a distance. All groups noted the added value of linking the PHR to an electronic health record, self-tracking, self-management, and secure messaging. Patients and caregivers also saw information in the PHR as a useful memory tool given their visits to multiple doctors. Providers had reservations about patients viewing raw data, which they were not prepared to interpret or might be inaccurate; patients and caregivers did not express any reservations about having access to more information. Patients saw PHR communication functions as a potential tool for relationship building. Patients and caregivers valued the journal as a tool for reflection and delivery of emotional support. Providers felt the PHR would facilitate patient-physician communication but worried that sharing journal access would make the doctor-patient relationship less professional and had reservations about the time burden of reviewing. Strategies suggested for efficient adoption into workflow included team delegation. Establishment of parameters for patient uses and provider responses was perceived as good standard practice. Conclusions PHR perceptions differed by role, with providers seeing the PHR as informational, while patients and caregivers viewed the tool as more relational. Personal health records should be linked to electronic health records for ease of use. Tailoring access, content, and implementation of the PHR is essential. Technology changes have the potential to change the nature of the patient-physician relationship. Patients and providers should establish shared expectations about the optimal use of the PHR and explore how emerging patient-centered technologies can be successfully implemented in modern medical practice to improve the relational quality of care.
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Affiliation(s)
- David A Haggstrom
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States.,Division of General Internal Medicine & Geriatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
| | - Thomas Carr
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States
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Huang M, Fan J, Prigge J, Shah ND, Costello BA, Yao L. Characterizing Patient-Clinician Communication in Secure Medical Messages: Retrospective Study. J Med Internet Res 2022; 24:e17273. [PMID: 35014964 PMCID: PMC8790696 DOI: 10.2196/17273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/23/2021] [Accepted: 11/18/2021] [Indexed: 01/19/2023] Open
Abstract
Background Patient-clinician secure messaging is an important function in patient portals and enables patients and clinicians to communicate on a wide spectrum of issues in a timely manner. With its growing adoption and patient engagement, it is time to comprehensively study the secure messages and user behaviors in order to improve patient-centered care. Objective The aim of this paper was to analyze the secure messages sent by patients and clinicians in a large multispecialty health system at Mayo Clinic, Rochester. Methods We performed message-based, sender-based, and thread-based analyses of more than 5 million secure messages between 2010 and 2017. We summarized the message volumes, patient and clinician population sizes, message counts per patient or clinician, as well as the trends of message volumes and user counts over the years. In addition, we calculated the time distribution of clinician-sent messages to understand their workloads at different times of a day. We also analyzed the time delay in clinician responses to patient messages to assess their communication efficiency and the back-and-forth rounds to estimate the communication complexity. Results During 2010-2017, the patient portal at Mayo Clinic, Rochester experienced a significant growth in terms of the count of patient users and the total number of secure messages sent by patients and clinicians. Three clinician categories, namely “physician—primary care,” “registered nurse—specialty,” and “physician—specialty,” bore the majority of message volume increase. The patient portal also demonstrated growing trends in message counts per patient and clinician. The “nurse practitioner or physician assistant—primary care” and “physician—primary care” categories had the heaviest per-clinician workload each year. Most messages by the clinicians were sent from 7 AM to 5 PM during a day. Yet, between 5 PM and 7 PM, the physicians sent 7.0% (95,785/1,377,006) of their daily messages, and the nurse practitioner or physician assistant sent 5.4% (22,121/408,526) of their daily messages. The clinicians replied to 72.2% (1,272,069/1,761,739) patient messages within 1 day and 90.6% (1,595,702/1,761,739) within 3 days. In 95.1% (1,499,316/1,576,205) of the message threads, the patients communicated with their clinicians back and forth for no more than 4 rounds. Conclusions Our study found steady increases in patient adoption of the secure messaging system and the average workload per clinician over 8 years. However, most clinicians responded timely to meet the patients’ needs. Our study also revealed differential patient-clinician communication patterns across different practice roles and care settings. These findings suggest opportunities for care teams to optimize messaging tasks and to balance the workload for optimal efficiency.
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Affiliation(s)
- Ming Huang
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Jungwei Fan
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States.,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Julie Prigge
- Center for Connected Care, Mayo Clinic, Rochester, MN, United States
| | - Nilay D Shah
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.,Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Brian A Costello
- Center for Connected Care, Mayo Clinic, Rochester, MN, United States
| | - Lixia Yao
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
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35
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Ayatollahi H. PATIENTS' AND PHYSICIANS' PERSPECTIVES ABOUT USING HEALTH INFORMATION TECHNOLOGY IN DIABETES MANAGEMENT IN IRAN: A QUALITATIVE STUDY. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2022; 18:1i. [PMID: 34975358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
Introduction Diabetes mellitus is known as a major chronic disease that has a number of consequences affecting individuals' health conditions and socioeconomic aspects of life. These challenges require innovative interventions, such as self-management to improve patients' health condition and reduce the economic burden of healthcare systems. The current research aimed to identify patients' and physicians' perspectives about the use of health information technology in diabetes management in Iran. Methods This was a qualitative study conducted in 2019. In order to collect data, semi-structured interviews were conducted with eight patients and 10 specialists in an endocrine and metabolism research center and in a teaching hospital. The interviews were digitally recorded and transcribed verbatim. Finally, data were analyzed by using framework analysis method and MAXQDA version 10. Results According to the results, both patients and physicians believed that while using health information technology can improve access to healthcare services, the high cost of technology may hinder its usage. Factors such as government and health system support can motivate users to use the technology, and factors such as lack of user training and technical problems may have a negative impact on technology usage. Conclusion As a number of motivational and inhibitory factors may influence the use of health information technology in diabetes management, it is imperative to take each of these factors into account before designing and implementing new technologies, especially for diabetes management.
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Perez H, Neubauer N, Marshall S, Philip S, Miguel-Cruz A, Liu L. Barriers and Benefits of Information Communication Technologies Used by Health Care Aides. Appl Clin Inform 2022; 13:270-286. [PMID: 35263800 PMCID: PMC8906996 DOI: 10.1055/s-0042-1743238] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although information and communication technologies (ICT) are becoming more common among health care providers, there is little evidence on how ICT can support health care aides. Health care aides, also known as personal care workers, are unlicensed service providers who encompass the second largest workforce, next to nurses, that provide care to older adults in Canada. OBJECTIVE The purpose of this literature review is to examine the range and extent of barriers and benefits of ICT used by health care workers to manage and coordinate the care-delivery workflow for their clients. METHODS We conducted a literature review to examine the range and extent of ICT used by health care aides to manage and coordinate their care delivery, workflow, and activities. We identified 8,958 studies of which 40 were included for descriptive analyses. RESULTS We distinguished the following five different purposes for the use and implementation of ICT by health care aides: (1) improve everyday work, (2) access electronic health records for home care, (3) facilitate client assessment and care planning, (4) enhance communication, and (5) provide care remotely. We identified 128 barriers and 130 benefits related to adopting ICT. Most of the barriers referred to incomplete hardware and software features, time-consuming ICT adoption, heavy or increased workloads, perceived lack of usefulness of ICT, cost or budget restrictions, security and privacy concerns, and lack of integration with technologies. The benefits for health care aides' adoption of ICT were improvements in communication, support to workflows and processes, improvements in resource planning and health care aides' services, and improvements in access to information and documentation. CONCLUSION Health care aides are an essential part of the health care system. They provide one-on-one care to their clients in everyday tasks. Despite the scarce information related to health care aides, we identified many benefits of ICT adoption.
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Affiliation(s)
- Hector Perez
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Noelannah Neubauer
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Samantha Marshall
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Serrina Philip
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
| | - Antonio Miguel-Cruz
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada.,Glenrose Rehabilitation Hospital, Edmonton (AB), Canada.,Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton (AB), Canada
| | - Lili Liu
- School of Publich Health Sciences, Faculty of Health, University of Waterloo, Waterloo (ON), Canada
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Wang P, Li T, Yu L, Zhou L, Yan T. Towards an effective framework for integrating patient-reported outcomes in electronic health records. Digit Health 2022; 8:20552076221112152. [PMID: 35860613 PMCID: PMC9290150 DOI: 10.1177/20552076221112152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background In the past decade, electronic modalities are increasingly deployed to integrate patient-reported outcomes into electronic health records. Most popularly, patient portals are used for remote questionnaires, and tablets are provided to patients in-office in case they need help. They are both useful. But some barriers are still in the way, which place burdens on patients and clinicians in the process of routine data collection. Objective This study aims to describe a portable and scalable framework which can simplify the patient-reported outcome integration by mitigating the related burdens. Methods A framework was proposed to use a modular approach to replace the tethered approach. The framework was open-sourced on GitHub. After development and testing, it was evaluated on an instrument with 24 questions in a real clinical setting. Patients were randomly selected in every modality-based group. For objective analysis, completion time and response rate were collected. No-show data was collected and analyzed. For subjective analysis, the NASA Task Load Index was used to measure workload, and the Net Promoter Score was used to assess user satisfaction. Results The model could contain 46,656 questions. A quick response code could store 1120 encoded items. For remote visits, the response rate was improved compared to the portal group (76.6% vs. 61.1%). The completion time was reduced by 37.5% when compared to the tablet group and was reduced by 43.4% when compared to the portal group. The workload for clinicians and patients was both reduced significantly (p < 0.001). A higher Net Promoter Score was rated by both clinicians (89.3%) and patients (86.5%). Compared to the portal group, the no-show rate was reduced (11.7% vs. 8.6%). Conclusions Collecting patient-reported outcomes over a quick response code appears to be an alternative modality to enable a simplified integration. This study provides new insights to collect patient-reported outcomes with interoperability and substitutability in mind.
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Affiliation(s)
- Panzhang Wang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Li
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lei Yu
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Liang Zhou
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Yan
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Hajjar L, Kragen B. Timely Communication Through Telehealth: Added Value for a Caregiver During COVID-19. Front Public Health 2021; 9:755391. [PMID: 34912769 PMCID: PMC8666719 DOI: 10.3389/fpubh.2021.755391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: This caregiver case study applies the lens of relational coordination theory (RC) to examine the value of telehealth as a medium of care coordination for a pediatric patient with hypermobile Ehlers-Danlos Syndrome (hEDS) during the COVID-19 pandemic. Background: The COVID-19 pandemic has placed an unprecedented burden on the delivery of healthcare around the globe and has increased the reliance on telehealth services. Delivering telehealth requires a high level of communication and coordination within and across providers as well as between providers, patients and their families. However, it is less clear how telehealth impacts the coordination of care. In this paper, we provide insight into the quality of care coordination between providers and an informal caregiver following policy changes to the provider payment structure in Massachusetts. Methods: This paper employs a single-case, autoethnographic study design where one of the authors uses their experiential insights, as mother of the patient, to inform a wider cultural and political understanding of the shift to remote caregiving for a pediatric patient with hEDS. Data was collected using reflective journaling, interactive interviews, and participant observation and analyzed using content analysis. Results: Findings revealed four interrelating roles of the caregiver including, logistics support, boundary spanner, home health aide, and cultural translator. The adoption of telehealth was associated with improved timeliness and frequency of communication between the caregiver and providers. Findings about the impact of telehealth adoption on accuracy of communication were mixed. Mutual respect between the caregiver and providers remained unchanged during the study period. Conclusions: This paper highlights areas where payer policy may be modified to incentivize timely communication and improve coordination of care through telehealth services. Additional insight from the perspective of an informal caregiver of a patient with a rare chronic disease provides an understudied vantage to the care coordination process. We contribute to relational coordination theory by observing the ways that caregivers function as boundary spanners, and how this process was facilitated by the adoption of telehealth. Insights from this research will inform the development of telehealth workflows to engage caregivers in a way that adds value and strengthens relational coordination in the management of chronic disease.
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Affiliation(s)
- Lauren Hajjar
- Institute for Public Service, Suffolk University, Boston, MA, United States
| | - Ben Kragen
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
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Mandhana DM, Glowacki EM, Sun MC. Promoting Patient Portals: An Application of Social Cognitive Theory to Post-Adoption Patient Portal Use. HEALTH COMMUNICATION 2021; 36:1990-2001. [PMID: 32847409 DOI: 10.1080/10410236.2020.1811024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Many healthcare clinics encourage the use of online patient portals so that patients can have easier access to their health information, yet some patients are hesitant to interact with these portals. We used social cognitive theory to develop and test a theoretically grounded model that incorporates several (1) technological factors, (2) individual factors, and (3) social factors that influence individuals' post-adoption, active use of patient portals. Based on cross-sectional survey data from a sample of healthcare clinic patients (N = 431), we found that individuals' severity of illness predicted active use of patient portals and that trust in doctors predicted attitudes toward patient portals. Moreover, attitudes toward patient portals mediated the relationship between technology factors (i.e., perceived usefulness, ease of use, customization, and interactivity), and active use of patient portals. The paper concludes with a discussion of key findings, implications, and directions for future research.
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Affiliation(s)
- Dron M Mandhana
- Department of Communication, College of Liberal Arts and Sciences, Villanova University
| | - Elizabeth M Glowacki
- Department of Communication Studies, College of Arts, Media and Design, Northeastern University
| | - Mao-Chia Sun
- Department of Journalism, Fu Hsing Kang College, National Defense University
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40
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Toni E, Pirnejad H, Makhdoomi K, Mivefroshan A, Niazkhani Z. Patient empowerment through a user-centered design of an electronic personal health record: a qualitative study of user requirements in chronic kidney disease. BMC Med Inform Decis Mak 2021; 21:329. [PMID: 34819050 PMCID: PMC8611831 DOI: 10.1186/s12911-021-01689-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 11/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background To improve chronic disease outcomes, self-management is an effective strategy. An electronic personal health record (ePHR) is a promising tool with the potential to support chronic patient’s education, counseling, and self-management. Fitting ePHRs within the daily practices of chronic care providers and chronic patients requires user-centered design approaches. We aimed to understand users’ needs and requirements in chronic kidney disease (CKD) care to consider in the design of an ePHR to facilitate its implementation, adoption, and use. Methods A qualitative study was conducted in a major Iranian nephrology center including inpatient and outpatient settings in 2019. We conducted 28 semi-structured interviews with CKD patients, nurses, and adult nephrologists. To confirm or modify the requirements extracted from the interviews, a focus group was also held. Data were analyzed to extract especially those requirements that can facilitate implementation, adoption, and sustained use based on the PHR adoption model and the unified theory of acceptance and use of technology. Results Participants requested an ePHR that provides access to up to date patient information, facilitates patient-provider communication, and increases awareness about patient individualized conditions. Participants expected a system that is able to cater to low patient e-health literacy and high provider workload. They requested the ePHR to include purposeful documentation of medical history, diagnostic and therapeutic procedures, tailored educational content, and scheduled care reminders. Messaging function, tailored educational content to individual patients’ conditions, and controlled access to information were highly valued in order to facilitate its implementation, adoption, and use. Conclusions We focused on the ePHR’s content and functionalities in the face of facilitators and/or barriers envisioned for its adoption in nephrology care. Designers and implementers should value CKD patients’ needs and requirements for self-management such as providing personalized education and counseling (on the basis of their condition and risk factors), health literacy, and disease progression levels. The socio-technical aspects of care also need further attention to facilitate ePHR’s adoption. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01689-2.
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Affiliation(s)
- Esmaeel Toni
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran.,Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran
| | - Habibollah Pirnejad
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran.,Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Khadijeh Makhdoomi
- Department of Adult Nephrology, Urmia University of Medical Sciences, Urmia, Iran.,Nephrology and Kidney Transplant Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Azam Mivefroshan
- Department of Adult Nephrology, Urmia University of Medical Sciences, Urmia, Iran
| | - Zahra Niazkhani
- Nephrology and Kidney Transplant Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran.
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Yin R, Law K, Neyens D. Examining How Internet Users Trust and Access Electronic Health Record Patient Portals: Survey Study. JMIR Hum Factors 2021; 8:e28501. [PMID: 34546182 PMCID: PMC8493465 DOI: 10.2196/28501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/18/2021] [Accepted: 07/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Electronic health record (EHR) patient portals are designed to provide medical health records to patients. Using an EHR portal is expected to contribute to positive health outcomes and facilitate patient-provider communication. Objective Our objective was to examine how portal users report using their portals and the factors associated with obtaining health information from the internet. We also examined the desired portal features, factors impacting users’ trust in portals, and barriers to using portals. Methods An internet-based survey study was conducted using Amazon Mechanical Turk. All the participants were adults in the United States who used patient portals. The survey included questions about how the participants used their portals, what factors acted as barriers to using their portals, and how they used and how much they trusted other web-based health information sources as well as their portals. A logistic regression model was used to examine the factors influencing the participants’ trust in their portals. Additionally, the desired features and design characteristics were identified to support the design of future portals. Results A total of 394 participants completed the survey. Most of the participants were less than 35 years old (212/394, 53.8%), with 36.3% (143/394) aged between 35 and 55 years, and 9.9% (39/394) aged above 55 years. Women accounted for 48.5% (191/394) of the survey participants. More than 78% (307/394) of the participants reported using portals at least monthly. The most common portal features used were viewing lab results, making appointments, and paying bills. Participants reported some barriers to portal use including data security and limited access to the internet. The results of a logistic regression model used to predict the trust in their portals suggest that those comfortable using their portals (odds ratio [OR] 7.97, 95% CI 1.11-57.32) thought that their portals were easy to use (OR 7.4, 95% CI 1.12-48.84), and frequent internet users (OR 43.72, 95% CI 1.83-1046.43) were more likely to trust their portals. Participants reporting that the portals were important in managing their health (OR 28.13, 95% CI 5.31-148.85) and that their portals were a valuable part of their health care (OR 6.75, 95% CI 1.51-30.11) were also more likely to trust their portals. Conclusions There are several factors that impact the trust of EHR patient portal users in their portals. Designing easily usable portals and considering these factors may be the most effective approach to improving trust in patient portals. The desired features and usability of portals are critical factors that contribute to users’ trust in EHR portals.
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Affiliation(s)
- Rong Yin
- Department of Industrial Engineering, Clemson University, Clemson, SC, United States
| | - Katherine Law
- Human Factors and User Experience, Medtronic, Mounds View, MN, United States
| | - David Neyens
- Department of Industrial Engineering, Clemson University, Clemson, SC, United States.,Department of Bioengineering, Clemson University, Clemson, SC, United States
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Anaya YBM, Hernandez GD, Hernandez SA, Hayes-Bautista DE. Meeting them where they are on the web: addressing structural barriers for Latinos in telehealth care. J Am Med Inform Assoc 2021; 28:2301-2305. [PMID: 34313774 PMCID: PMC8449624 DOI: 10.1093/jamia/ocab155] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 11/14/2022] Open
Abstract
As we enter an era of health care that incorporates telehealth for routine provision of care, we can build a system that consciously and proactively includes vulnerable patients, thereby avoiding further exacerbation of health disparities. A practical way to reach out to Latino patients is to use media they already widely use. Rather than expect patients to adapt to suboptimal systems of telehealth care, we can improve telehealth for Latinos by using platforms already familiar to them and thereby refocus telehealth delivery systems to provide patient-centered care. Such care is responsive to patients' needs and preferences; for Latinos, this includes using digital devices that they actually own (ie, smartphones). Equity-centered telehealth is accessible for all, regardless of linguistic, literacy, and socioeconomic barriers.
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Affiliation(s)
- Yohualli Balderas-Medina Anaya
- Department of Family of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | - Giselle D Hernandez
- Center for the Study of Latino Health and Culture, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA, and
| | - Stephanie A Hernandez
- David Geffen School of Medicine at the University of California, Los Angeles, California, USA
- Charles R. Drew/UCLA Medical Education Program, Charles R. Drew University of Medicine and Science, California, USA
| | - David E Hayes-Bautista
- David Geffen School of Medicine at the University of California, Los Angeles, California, USA
- Center for the Study of Latino Health and Culture, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA, and
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43
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Jackson DN, Trivedi N, Baur C. Re-Prioritizing Digital Health and Health Literacy in Healthy People 2030 to Affect Health Equity. HEALTH COMMUNICATION 2021; 36:1155-1162. [PMID: 32354233 DOI: 10.1080/10410236.2020.1748828] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The U.S. Healthy People 2030 health objective-setting process has taken place in an inequitable social structure with significant implications for health literacy, health equity, and population health. The draft 2030 objectives have greatly reduced the number of digital health and health literacy objectives, meaning our national agenda is poised to capture only a fraction of what will evolve in digital and health literacy between 2020 and 2030. This paper synthesizes two decades of Healthy People data on health literacy and digital health objectives, highlights the digital health and health literacy trends and disparities that persist and proposes remedies to ensure that health literacy and digital health issues receive the attention they deserve in the next decade. These remedies can inform policies, research, and interventions that touch health communication and digital health issues.
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Affiliation(s)
- Devlon N Jackson
- Center for Health Literacy, School of Public Health, University of Maryland
- Maryland Center for Health Equity, School of Public Health, University of Maryland
- Department of Behavioral and Community Health, School of Public Health, University of Maryland
| | - Neha Trivedi
- Department of Behavioral and Community Health, School of Public Health, University of Maryland
| | - Cynthia Baur
- Center for Health Literacy, School of Public Health, University of Maryland
- Department of Behavioral and Community Health, School of Public Health, University of Maryland
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44
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Visscher BB, Vervloet M, Te Paske R, van Dijk L, Heerdink ER, Rademakers J. Implementation of an animated medication information tool in community pharmacies, with a special focus on patients with limited health literacy. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:566-572. [PMID: 34427591 DOI: 10.1093/ijpp/riab038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/10/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The animated medication information tool 'Watchyourmeds' provides information in an accessible manner through animated videos and therefore appears to be especially suitable for people with limited health literacy. This study aimed to assess the implementation of this animated medication information tool in Dutch community pharmacies, with a special focus on patients with limited health literacy. METHODS A cross-sectional survey based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was sent to approximately 75% of the ±1900 community pharmacies in the Netherlands through email newsletters of pharmacy networks. KEY FINDINGS 140 pharmacists (⁓10%) completed the survey and 125 of them (89%) indicated that they offered the animated medication information tool to their patients. 108 pharmacists indicated that the tool was offered to all patients, not only to patients with limited health literacy. The distribution method was primarily passive (patients were given a leaflet and were not explicitly pointed to or informed about the tool). Two frequently cited motivations for offering the tool were that it complemented other sources of information and that the health insurer provided a financial incentive. The main reasons patients refused to use the tool were that they had no access to or no affinity for the required technology. CONCLUSIONS This study demonstrated that the tool is used in community pharmacies and that it is offered to all patients, regardless of their presumed health literacy level. A more active method of offering the tool may be warranted to better reach patients with limited health literacy.
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Affiliation(s)
- Boudewijn B Visscher
- Researchgroup Innovations in Pharmaceutical Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Roland Te Paske
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,Department of PharmacoTherapy, -Epidemiology, and -Economics (PTEE), Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, the Netherlands
| | - Eibert R Heerdink
- Researchgroup Innovations in Pharmaceutical Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Jany Rademakers
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,CAPHRI, Care and Public Health Research Institute, Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
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45
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De A, Huang M, Feng T, Yue X, Yao L. Analyzing Patient Secure Messages Using a Fast Health Care Interoperability Resources (FIHR)-Based Data Model: Development and Topic Modeling Study. J Med Internet Res 2021; 23:e26770. [PMID: 34328444 PMCID: PMC8367168 DOI: 10.2196/26770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/10/2021] [Accepted: 05/24/2021] [Indexed: 01/26/2023] Open
Abstract
Background Patient portals tethered to electronic health records systems have become attractive web platforms since the enacting of the Medicare Access and Children’s Health Insurance Program Reauthorization Act and the introduction of the Meaningful Use program in the United States. Patients can conveniently access their health records and seek consultation from providers through secure web portals. With increasing adoption and patient engagement, the volume of patient secure messages has risen substantially, which opens up new research and development opportunities for patient-centered care. Objective This study aims to develop a data model for patient secure messages based on the Fast Healthcare Interoperability Resources (FHIR) standard to identify and extract significant information. Methods We initiated the first draft of the data model by analyzing FHIR and manually reviewing 100 sentences randomly sampled from more than 2 million patient-generated secure messages obtained from the online patient portal at the Mayo Clinic Rochester between February 18, 2010, and December 31, 2017. We then annotated additional sets of 100 randomly selected sentences using the Multi-purpose Annotation Environment tool and updated the data model and annotation guideline iteratively until the interannotator agreement was satisfactory. We then created a larger corpus by annotating 1200 randomly selected sentences and calculated the frequency of the identified medical concepts in these sentences. Finally, we performed topic modeling analysis to learn the hidden topics of patient secure messages related to 3 highly mentioned microconcepts, namely, fatigue, prednisone, and patient visit, and to evaluate the proposed data model independently. Results The proposed data model has a 3-level hierarchical structure of health system concepts, including 3 macroconcepts, 28 mesoconcepts, and 85 microconcepts. Foundation and base macroconcepts comprise 33.99% (841/2474), clinical macroconcepts comprise 64.38% (1593/2474), and financial macroconcepts comprise 1.61% (40/2474) of the annotated corpus. The top 3 mesoconcepts among the 28 mesoconcepts are condition (505/2474, 20.41%), medication (424/2474, 17.13%), and practitioner (243/2474, 9.82%). Topic modeling identified hidden topics of patient secure messages related to fatigue, prednisone, and patient visit. A total of 89.2% (107/120) of the top-ranked topic keywords are actually the health concepts of the data model. Conclusions Our data model and annotated corpus enable us to identify and understand important medical concepts in patient secure messages and prepare us for further natural language processing analysis of such free texts. The data model could be potentially used to automatically identify other types of patient narratives, such as those in various social media and patient forums. In the future, we plan to develop a machine learning and natural language processing solution to enable automatic triaging solutions to reduce the workload of clinicians and perform more granular content analysis to understand patients’ needs and improve patient-centered care.
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Affiliation(s)
- Amrita De
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Ming Huang
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Tinghao Feng
- Department of Computer Science, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Xiaomeng Yue
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, United States
| | - Lixia Yao
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States
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Harahap NC, Handayani PW, Hidayanto AN. Functionalities and Issues in the Implementation of Personal Health Records: Systematic Review. J Med Internet Res 2021; 23:e26236. [PMID: 34287210 PMCID: PMC8339989 DOI: 10.2196/26236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/07/2021] [Accepted: 05/24/2021] [Indexed: 12/28/2022] Open
Abstract
Background Functionalities of personal health record (PHR) are evolving, and continued discussions about PHR functionalities need to be performed to keep it up-to-date. Technological issues such as nonfunctional requirements should also be discussed in the implementation of PHR. Objective This study systematically reviewed the main functionalities and issues in implementing the PHR. Methods This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search is performed using the online databases Scopus, ScienceDirect, IEEE, MEDLINE, CINAHL, and PubMed for English journal articles and conference proceedings published between 2015 and 2020. Results A total of 105 articles were selected in the review. Seven function categories were identified in this review, which is grouped into basic and advanced functions. Health records and administrative records were grouped into basic functions. Medication management, communication, appointment management, education, and self-health monitoring were grouped into advanced functions. The issues found in this study include interoperability, security and privacy, usability, data quality, and personalization. Conclusions In addition to PHR basic and advanced functions, other supporting functionalities may also need to be developed based on the issues identified in this study. This paper provides an integrated PHR architectural model that describes the functional requirements and data sources of PHRs.
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47
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Khoong EC, Butler BA, Mesina O, Su G, DeFries TB, Nijagal M, Lyles CR. Patient interest in and barriers to telemedicine video visits in a multilingual urban safety-net system. J Am Med Inform Assoc 2021; 28:349-353. [PMID: 33164063 DOI: 10.1093/jamia/ocaa234] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine interest in and barriers to video visits in safety-net patients with diverse age, racial/ethnic, or linguistic background. MATERIALS AND METHODS We surveyed patients in an urban safety-net system to assess: interest in video visits; ability to successfully complete test video visits; and barriers to successful completion of test video visits. RESULTS Among 202 participants, of which 177 (87.6%) were persons of color and 113 (55.9%) preferred non-English languages, 132 (65.3%) were interested in and 109 (54.0%) successfully completed a test video visit. Younger age, non-English preference, and prior smartphone application use were associated with interest. Over half (n = 112) reported barriers to video visits; Internet/data access was the most common barrier (n = 50, 24.8%). CONCLUSION Safety-net patients are interested in video visits and able to successfully complete test visits. Internet or mobile data access is a common barrier in even urban safety-net settings and may impact equitable telemedicine access.
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Affiliation(s)
- Elaine C Khoong
- Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA.,UCSF Center for Vulnerable Populations, University of California San Francisco, San Francisco, California, USA
| | - Blythe A Butler
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Omar Mesina
- School of Medicine, University of California San Francisco, San Francisco, California, USA.,Department of Obstetrics and Gynecology, University of California San Diego, San Diego, California, USA
| | - George Su
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Francisco, San Francisco, California, USA
| | - Triveni B DeFries
- Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - Malini Nijagal
- Department of Obstetrics and Gynecology, University of California, San Francisco, California, USA
| | - Courtney R Lyles
- Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA.,UCSF Center for Vulnerable Populations, University of California San Francisco, San Francisco, California, USA
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Swoboda CM, DePuccio MJ, Fareed N, McAlearney AS, Walker DM. Patient Portals: Useful for Whom and for What? A Cross-Sectional Analysis of National Survey Data. Appl Clin Inform 2021; 12:573-581. [PMID: 34233367 DOI: 10.1055/s-0041-1731339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Patients who use patient portals may be more engaged and empowered in their care; however, differences in who accesses patient portals remain. The characteristics of who uses patient portals more frequently and who perceives them as useful may also differ, as well as which functions people use. OBJECTIVE We assessed the characteristics of patient portal users to examine who uses them more frequently and who perceives them as useful. In addition, we wanted to see if those who use them more frequently or perceive them to be more useful use different functions or more functions of patient portals. METHODS Pooled cross-sectional data from 2017 to 2018 Health Information National Trends Survey (HINTS) were used. Ordinal regression models were developed to assess frequency of use and perceived usefulness by demographics, and multivariable logistic regression models were used to examine the association between the use of 10 patient portal functions and frequency of use and perceived usefulness of patient portals. RESULTS The odds of using patient portals more frequently were higher among those with Bachelor's degrees, incomes between $35,000 and $75,000, and those with two or more chronic conditions. Respondents with three or more chronic conditions had higher odds of rating patient portals as useful. Those who used their patient portal 10 or more times in the past year had higher odds of using all functions except for viewing test results compared with those who used their patient portal one to two times per year. Those who rated patient portals as "very useful" had higher odds of using seven of the functions compared with those who rated them "not very"/"not at all useful." CONCLUSION It is important to continue to assess usefulness, frequency of use, and overall patient portal function use to identify opportunities to increase patient engagement with patient portals.
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Affiliation(s)
- Christine M Swoboda
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
| | - Matthew J DePuccio
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
| | - Naleef Fareed
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
| | - Ann Scheck McAlearney
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
| | - Daniel M Walker
- CATALYST-The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Institute for Behavioral Medicine Research, Columbus, Ohio, United States
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Martinez W, Hackstadt AJ, Hickson GB, Knoerl T, Rosenbloom ST, Wallston KA, Elasy TA. The My Diabetes Care Patient Portal Intervention: Usability and Pre-Post Assessment. Appl Clin Inform 2021; 12:539-550. [PMID: 34192774 DOI: 10.1055/s-0041-1730324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND My Diabetes Care (MDC) is a novel, multifaceted patient portal intervention designed to help patients better understand their diabetes health data and support self-management. MDC uses infographics to visualize and summarize patients' diabetes health data, incorporates motivational strategies, and provides literacy level-appropriate educational resources. OBJECTIVES We aimed to assess the usability, acceptability, perceptions, and potential impact of MDC. METHODS We recruited 69 participants from four clinics affiliated with Vanderbilt University Medical Center. Participants were given 1 month of access to MDC and completed pre- and post-questionnaires including validated measures of usability and patient activation, and questions about user experience. RESULTS Sixty participants completed the study. Participants' mean age was 58, 55% were females, 68% were Caucasians, and 48% had limited health literacy (HL). Most participants (80%) visited MDC three or more times and 50% spent a total of ≥15 minutes on MDC. Participants' median System Usability Scale (SUS) score was 78.8 [Q1, Q3: 72.5, 87.5] and significantly greater than the threshold value of 68 indicative of "above average" usability (p < 0.001). The median SUS score of patients with limited HL was similar to those with adequate HL (77.5 [72.5, 85.0] vs. 82.5 [72.5, 92.5]; p = 0.41). Participants most commonly reported the literacy level-appropriate educational links and health data infographics as features that helped them better understand their diabetes health data (65%). All participants (100%) intended to continue to use MDC. Median Patient Activation Measure® scores increased postintervention (64.3 [55.6, 72.5] vs. 67.8 [60.6, 75.0]; p = 0.01). CONCLUSION Participants, including those with limited HL, rated the usability of MDC above average, anticipated continued use, and identified key features that improved their understanding of diabetes health data. Patient activation improved over the study period. Our findings suggest MDC may be a beneficial addition to existing patient portals.
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Affiliation(s)
- William Martinez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Amber J Hackstadt
- Department of Biostatistics, Vanderbilt University Medicine Center, Nashville, Tennessee, United States
| | - Gerald B Hickson
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Thomas Knoerl
- Upstate Medical University, State University of New York, Syracuse, New York, United States
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Kenneth A Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Tom A Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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50
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Silva T, Kadakia N, Aribo C, Gochi A, Kim GY, Solomon N, Molkara A, Molina DC, Plasencia A, Lum SS. Compliance With Surgical Oncology Specialty Care at a Safety Net Facility. Am Surg 2021; 87:1545-1550. [PMID: 34130523 DOI: 10.1177/00031348211024975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Social determinants of health challenge in at-risk patients seen in safety net facilities. STUDY DESIGN We performed a retrospective review of surgical oncology specialty clinic referrals at a safety net institution evaluating referral compliance and times to first appointment and initiation of definitive treatment. Main outcomes measured included completion of initial visit, initiation of definitive treatment, time from referral to first appointment, and time from first appointment to initiation of definitive treatment. RESULTS Of 189 new referrals, English was not spoken by 52.4% and 69.4% were Hispanic. Patients presented without insurance in 39.2% of cases. Electronic patient portal was accessed by 31.6% of patients. Of all new referrals, 55.0% arrived for initial consultation and 53.4% initiated definitive treatment. Malignant diagnosis (P < .0001) and lack of insurance (P = .01) were associated with completing initial consultation. Initiation of definitive treatment was associated with not speaking English (P = .03), malignant diagnosis (P < .0001), and lack of insurance (P = .03). Times to first appointment and initiation of definitive treatment were not significantly affected by race/ethnicity, language, insurance, treatment recommended, or electronic patient portal access. CONCLUSION Access to surgical oncology care for at-risk patients at a safety net facility is not adversely affected by lack of insurance, primary spoken language, or race/ethnicity. However, a significant proportion of all patients fail to complete the initial consultation and definitive treatment. Lessons learned from safety net facilities may help to inform disparities in health care found elsewhere.
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Affiliation(s)
- Trevor Silva
- Riverside University Health System, Moreno Valley, CA, USA
| | - Nikita Kadakia
- Department of Surgery, School of Medicine, University of California, Riverside, CA, USA
| | - Chade Aribo
- Department of Surgery, School of Medicine, University of California, Riverside, CA, USA
| | - Andrea Gochi
- Department of Surgery, School of Medicine, University of California, Riverside, CA, USA
| | - Gi Yoon Kim
- Riverside University Health System, Moreno Valley, CA, USA
| | - Naveen Solomon
- Riverside University Health System, Moreno Valley, CA, USA.,Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Afshin Molkara
- Riverside University Health System, Moreno Valley, CA, USA.,Department of Surgery, School of Medicine, University of California, Riverside, CA, USA
| | - David C Molina
- Riverside University Health System, Moreno Valley, CA, USA.,Department of Surgery, School of Medicine, University of California, Riverside, CA, USA.,Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Alexis Plasencia
- Riverside University Health System, Moreno Valley, CA, USA.,Department of Surgery, School of Medicine, University of California, Riverside, CA, USA.,Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Sharon S Lum
- Riverside University Health System, Moreno Valley, CA, USA.,Department of Surgery, School of Medicine, University of California, Riverside, CA, USA.,Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
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