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）：开发和实施健康信息技术（HIT）以改善医疗保健是国家优先事项。基于网络的患者和提供者对电子病历 (EMR) 的共享访问有可能突破传统通信和患者护理的界限，并成为疾病管理的重要工具。由于该 HIT 相对较新，人们对 EMR 门户网站在个体疾病管理中的使用或应用知之甚少。疾病管理对于任何慢性疾病都很重要，尤其是艾滋病毒，其中 20-50% 的患者没有充分坚持延长生命的抗逆转录病毒治疗 (ART)。信息-动机-行为技能（IMB）模型表明，ART 依从性受到 HIV+ 患者知情程度、积极性和拥有有效行动技能程度的影响。使用为患者提供医疗信息访问权限以及直接与提供者沟通的安全方式的门户网站，可以提供独特的机会来增加依从性相关的信息、动机和行为技能。我们正在寻求描述 HIV+ 患者对 EMR 患者门户网站的使用情况，并使用此 HIT 并以 IMB 理论为指导来设计和现场测试个人行为干预措施。我们的团队处于独特的地位，可以在两个大型附属卫生系统（北加州的 Group Health Cooperative 和 Kaiser Permanente）中开展这项研究，这些系统已经将这项新技术应用于临床护理。该项目将在五年内分三个相关阶段进行。第一阶段是一项观察性研究，使用 HIV+ 患者的自动化数据来描述 EMR 门户网站随时间的使用模式以及频繁、不频繁和非门户用户的特征。第二阶段是一项随机试点，有 30 名 HIV 感染者参与，以检查可接受性/可行性问题并完善程序和措施。在第 2 阶段，将试行计划在第 3 阶段通过 EMR 患者门户网站 (n=20) 和注意力控制臂（患者门户网站注册和信息联系人；n=10）提供的护士协助的个人依从性干预程序。第 3 阶段是护士通过 EMR 患者门户网站 (N=150) 与注意力控制臂 (N=150) 进行比较的基于 IMB 的个体干预的随机对照试验。主要结果是通过自动药房记录和干预后、3 个月和 9 个月随访时的自我报告来衡量 ART 依从性。假设的与依从性相关的 IMB 干预改变过程变量（与依从性相关的信息、动机和行为技能）将随着时间的推移进行评估，并测试对 ART 依从性的中介作用。次要结果还包括 12 个月的 EMR 患者门户网站利用率和现场服务利用率。这项工作将加深我们对患者如何使用 EMR 患者门户网站的理解，并强调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 作为干预手段来改善患者治疗结果的有效性，这不仅与艾滋病毒疾病管理有关。 公共健康相关性基于网络的患者和提供者共享电子病历 (EMR) 具有突破传统通信和患者护理界限的潜力，并成为慢性病管理的重要工具。该项目将加深我们对 HIV+ 患者如何使用网络访问 EMR 的理解，并测试该系统作为干预交付工具的有效性，以改善患者的治疗结果，例如药物依从性。这项研究的结果不仅与艾滋病毒护理有关，还与许多其他慢性病的管理有关。