The effect of clinic visit audio recordings for self-management in older adults

就诊录音对老年人自我管理的影响

基本信息

批准号：
10703362
负责人：
PAUL JAMES BARR
金额：
$ 66.93万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-15 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10703362
关键词：
Address Adherence Adoption Agreement Award Behavior COVID-19 pandemic Caregiver support Caregivers Caring Chronic Chronic Disease Clinic Clinic Visits Clinical Complex Confusion Consolidated Framework for Implementation Research Data Diabetes Mellitus Diagnosis Elderly Emergency department visit Exclusion Expenditure Future Goals Health Health Care Quality Indicators Healthcare Hospitalization Hypersensitivity Individual Infrastructure Institution Interview Investments Knowledge Medical Medicare Mental Depression Modeling Non-Insulin-Dependent Diabetes Mellitus Outcome Patients Pharmaceutical Preparations Phenotype Policies Primary Care Public Health Quality of Care Quality of life Randomized Recommendation Regimen Reporting Research Resources Sampling Schedule Self Management Site Structure Testing Time United States National Institutes of Health Visit Work Writing burden of illness chronic care model clinical practice cognitive capacity comorbidity efficacy trial experience forgetting functional decline functional status future implementation health care service utilization high risk implementation determinants implementation facilitators implementation strategy improved innovation interest intervention delivery low health literacy medical specialties medication compliance multi-site trial multiple chronic conditions novel novel strategies older patient poor health outcome primary care practice primary outcome recruit retention rate routine care satisfaction secondary outcome skills systematic review treatment as usual treatment planning uptake

项目摘要

PROJECT SUMMARY Up to eighty percent of clinic visit information is forgotten by patients immediately post visit. This is a significant barrier to self-management, especially in older adults with multimorbidity leading to poor health outcomes. After visit summaries (AVS) can improve recall, yet concerns exist about their layout, accuracy and low patient uptake. A new strategy to augment the AVS is to share visit recordings with patients. When patients receive an audio recording of the visit, 71% listen and 68% share it with a caregiver, resulting in greater recall. Despite growing interest, there is limited research on the impact of recording and sharing clinic visits of patient self- management ability, health outcomes or healthcare utilization of older adults. The objective of this proposal is to conduct a multisite trial evaluating the impact of adding an audio recording of clinic visits (AUDIO) to usual care in older adults with multimorbidity, including diabetes, compared to AVS alone (Usual Care; UC). The specific aims are: Aim 1 Conduct a three-site trial in primary care where older patients with multimorbidity including diabetes (n=336) will be randomized to receive an audio recording as well as AVS (AUDIO) versus AVS alone (UC) for all scheduled clinic visits over 12 months; patients will be assessed at baseline, 1 week, 6 months and 12 months; Aim 2 Identify factors that impact the implementation and sustainable use of visit audio recordings. Applicants Hypothesize (Main Effect) that: compared to those receiving UC, patients randomized to also receive audio recordings (AUDIO) of clinic visits will report a greater self-management ability (Primary Outcome), with improved quality of life, medication adherence, and satisfaction (Secondary Outcomes) at 12 months. Applicants will explore the impact of AUDIO on general medical regimen adherence, diabetes quality of care indicators, healthcare utilization and clinician practice behavior. They will also explore potential moderators of AUDIO, asking whether its impact on self-management is greater for individuals at highest risk of poor self-management including those with less caregiver support, moderate to severe depression, lower health literacy, and high disease burden. In Aim 2, applicants will interview patients, caregivers, clinicians, and clinic staff to identify barriers and facilitators to the implementation and sustainable use of recordings using the Consolidated Framework for Implementation Research (CFIR). The research is innovative: i) it seeks to shift current clinical practice where visit information is provided via AVS, by adding recordings; ii) the routine provision of visit recordings over time moves beyond prior studies focused on one-off recordings of specialty care visits; and iii) a trial in real-world settings of patients with multimorbidity, who are often excluded from trials, is novel and has greater external validity. Results are expected to have a major positive impact as they will increase clinical understanding of the impact and implementation of audio recording on the significant challenge of improving patient self-management in the face of the public health burden of multimorbidity.

项目概要高达百分之八十的门诊信息在就诊后立即被患者遗忘。这是一个意义重大的自我管理的障碍，特别是对于患有多种疾病的老年人，导致健康结果不佳。访视后总结 (AVS) 可以提高回忆能力，但仍存在对其布局、准确性和患者人数少的担忧吸收。增强 AVS 的一项新策略是与患者共享就诊记录。当患者接受 71% 的人会聆听探访的录音，68% 的人会与看护者分享，从而更好地回忆起来。尽管尽管人们的兴趣日益浓厚，但关于记录和共享患者自我就诊的影响的研究有限。老年人的管理能力、健康结果或医疗保健利用。该提案的目标是进行多站点试验，评估在平常情况下添加诊所就诊音频记录 (AUDIO) 的影响与单独 AVS 相比，对患有多种疾病（包括糖尿病）的老年人进行护理（常规护理；UC）。这具体目标是：目标 1 在初级保健中进行三中心试验，其中患有多种疾病的老年患者包括糖尿病患者 (n=336) 将被随机分配接受录音以及 AVS (AUDIO) 与 12 个月内所有预定的就诊均仅使用 AVS (UC)；患者将在基线、第 1 周、第 6 周接受评估个月和12个月；目标 2 确定影响访问音频实施和可持续使用的因素录音。申请人假设（主效应）：与接受 UC 的患者相比，患者被随机分配到还收到诊所就诊的录音 (AUDIO) 将报告更强的自我管理能力（小学结果），12 岁时生活质量、用药依从性和满意度（次要结果）得到改善几个月。申请人将探讨音频对一般医疗方案依从性、糖尿病质量的影响护理指标、医疗保健利用和临床医生实践行为。他们还将探索潜力 AUDIO 的主持人询问其对自我管理的影响是否对风险最高的个人更大自我管理能力差，包括照顾者支持较少、中度至重度抑郁、较低健康素养低，疾病负担高。在目标 2 中，申请人将采访患者、护理人员、临床医生和诊所工作人员使用以下方法确定实施和可持续使用记录的障碍和促进因素实施研究综合框架（CFIR）。该研究具有创新性：i）它寻求改变目前的临床实践是通过 AVS 通过添加录音来提供就诊信息； ii) 常规随着时间的推移提供访问录音超出了以前专注于专业一次性录音的研究护理探访； iii) 在现实世界中对患有多种疾病的患者进行的试验，这些患者经常被排除在外试验新颖且具有更大的外部效度。预计结果将产生重大积极影响，因为它们将增加临床对录音的影响和实施对重大疾病的了解面对多发病的公共卫生负担，改善患者自我管理的挑战。