Patient Portal to Support Treatment Adherence

支持治疗依从性的患者门户

• 批准号: 8225351
• 负责人: SHERYL L CATZ
• 金额: $ 69.93万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-03-06 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8225351
• 关键词: Access to Information; Adherence; Adopted; Anti-Retroviral Agents; Appointments and Schedules; Attention; Behavior; Behavior Therapy; Behavioral; California; Caring; Characteristics; Chronic Disease; Clinical; Clinical Nursing; Clinical Research; Clinical Trials; Communication; Computerized Medical Record; Data; Development; Disease; Disease Management; Dose; Effectiveness; Effectiveness of Interventions; Electronics; Enrollment; Goals; HIV; Health; Health Services; Health system; Healthcare; Healthcare Systems; Home environment; Individual; Information Technology; Intake; Interactive Communication; Internet; Intervention; Interview; Investigation; Knowledge; Laboratories; Life; Link; Measures; Mediating; Medical; Medication Management; Modeling; Motivation; NIH Program Announcements; Nurses; Observational Study; Office Visits; Online Systems; Outcome; Participant; Patient Care; Patient Education; Patient Self-Report; Patients; Pattern; Persons; Pharmaceutical Preparations; Pharmacy facility; Positioning Attribute; Procedures; Process; Provider; Publishing; Randomized; Randomized Controlled Trials; Records; Relative (related person); Request for Applications; Research; Research Infrastructure; Secure; Series; Staging; Surveys; System; Techniques; Technology; Telephone; Test Result; Testing; Time; Treatment outcome; Use Effectiveness; Work; antiretroviral therapy; arm; base; clinical care; compliance behavior; design; follow-up; health care service organization; health information technology; improved; medication compliance; meetings; member; motivational enhancement therapy; multi-component intervention; multidisciplinary; new technology; post intervention; primary outcome; public health relevance; response; secondary outcome; service intervention; service utilization; skills; skills training; theories; therapy adherence; tool; treatment adherence; trend; uptake; web site

DESCRIPTION (provided by applicant): Development and implementation of health information technology (HIT) to improve healthcare is a national priority. Web-based shared patient and provider access to electronic medical records (EMR) has the potential of pushing the boundaries of traditional communication and patient care and becoming an essential tool in disease management. Due to the relative newness of this HIT, little is known about the use or application of EMR web portals for individual disease management. Disease management is important in any chronic illness but particularly in HIV, where 20-50% of patients have inadequate adherence to life prolonging antiretroviral therapy (ART). The Information-Motivation-Behavioral Skills (IMB) model suggests that ART adherence is influenced by the extent to which HIV+ patients are well-informed, motivated, and possess skills to act effectively. Use of a web portal that provides patients access to their medical information and a secure way to directly communicate with providers may provide unique opportunities to increase adherence-related information, motivation and behavioral skills. We are seeking to characterize the use of an EMR patient web portal by HIV+ patients, and to design and field test an individual behavioral intervention using this HIT and guided by IMB theory. Our team is in a unique position to conduct this research in two large affiliated health systems (Group Health Cooperative and Kaiser Permanente, Northern California) who have already adopted this new technology into clinical care. The project will be conducted in three related stages over five years. Stage 1 is an observational study using automated data among HIV+ patients to describe EMR web portal use patterns over time and the characteristics of frequent, infrequent and non-users of the web portal. Stage 2 is a randomized pilot with 30 HIV+ persons to examine acceptability/ feasibility issues and refine procedures and measures. In Stage 2, procedures for the nurse-facilitated individual adherence intervention delivered via EMR patient web portal (n=20) and the attention control arm (patient web portal enrollment and informational contacts; n=10) planned for Stage 3 will be piloted. Stage 3 is an RCT of an IMB-based individual intervention delivered by nurses via EMR patient web portal (N=150) as compared to an attention control arm (N=150). Primary outcomes will be ART adherence as measured by automated pharmacy records and self report at post-intervention, 3- and 9-month follow-up. Hypothesized adherence-related IMB intervention change process variables (adherence-related information, motivation, and behavioral skills) will be assessed over time and tested for mediating effects on ART adherence. Secondary outcomes also include 12-month EMR patient web portal utilization and in-person service utilization. This work will enhance our understanding of how patients use EMR patient web portals and highlight the complexities involved in delivering care via this system. It will allow us to evaluate the effectiveness of using HIT as an intervention delivery vehicle to improve patient treatment outcomes, which has relevance beyond HIV disease management. PUBLIC HEALTH RELEVANCE Web-based shared patient and provider access to electronic medical records (EMR) has the potential of pushing the boundaries of traditional communication and patient care and becoming an essential tool in chronic disease management. This project will enhance our understanding of how HIV+ patients use web access to an EMR, and test the effectiveness of such a system as an intervention delivery tool to improve patient outcomes such as medication adherence. Findings from this research will have relevance beyond HIV care to the management of many other chronic diseases.

描述（由申请人提供）：健康信息技术的开发和实施以改善医疗保健是国家优先事项。基于Web的共享患者和提供者访问电子病历（EMR）具有突破传统沟通和患者护理的界限，并成为疾病管理中必不可少的工具。由于这一命中的相对新颖性，关于EMR Web门户在个体疾病管理中的使用或应用知之甚少。疾病的管理在任何慢性疾病中都很重要，尤其是在HIV中，有20-50％的患者不足以遵守延长抗逆转录病毒疗法（ART）的生命。信息动机 - 行为技能（IMB）模型表明，艺术依从性受艾滋病毒+患者的信息良好，动机和具有有效行动的技能的影响。使用Web门户网站，该网站为患者提供了访问其医疗信息的访问以及与提供者直接通信的安全方法可能会提供独特的机会，以提高与依从性相关的信息，动机和行为技能。我们试图通过HIV+患者来表征使用EMR患者网络门户的使用，并使用IMB理论设计和现场测试单个行为干预措施。我们的团队处于独特的位置，可以在两个大型关联卫生系统（集团健康合作社和北加州的Kaiser Permanente）中进行这项研究，他们已经将这项新技术用于临床护理。该项目将在五年内在三个相关阶段进行。第1阶段是一项使用HIV+患者中自动数据的观察性研究，以描述随着时间的流逝，以及Web门户的频繁，不经常和非用户的特征。第2阶段是一个随机飞行员，有30名HIV+人，可以检查可接受性/可行性问题以及完善的程序和措施。在第2阶段，通过EMR患者Web门户（n = 20）提供了护士 - 智利的个人依从性干预措施，并计划针对第3阶段的注意力控制组（患者Web门户网站注册和信息接触； n = 10）。第3阶段是护士通过EMR患者Web门户（n = 150）提供的基于IMB的个人干预的RCT，而注意力控制组（n = 150）。主要结果将是由自动化药房记录和自我报告衡量的3个月和9个月的随访时衡量的艺术依从性。假设与依从性相关的IMB干预变化过程变量（与依从性相关的信息，动机和行为技能）将随着时间的流逝而随着时间的流逝进行评估，并测试对艺术依从性的中介作用。次要结果还包括12个月的EMR患者Web Portal Pertal利用率和亲自服务利用率。这项工作将增强我们对患者如何使用EMR患者网络门户网站的理解，并突出通过该系统提供护理所涉及的复杂性。它将使我们能够评估使用HIT用作干预输送工具以改善患者治疗结果的有效性，这超出了HIV疾病管理。 公共卫生相关性的基于网络的共享患者和提供者访问电子病历（EMR）具有突破传统沟通和患者护理的界限，并成为慢性疾病管理中必不可少的工具。该项目将增强我们对HIV+患者如何使用Web访问EMR的理解，并测试该系统作为干预输送工具的有效性，以改善患者的预后，例如药物依从性。这项研究的发现将使艾滋病毒护理与管理许多其他慢性疾病的管理有关。