Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers.
Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers.
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DOI：
10.2196/mental.9600
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发表时间：
2018-05-18
影响因子：
5.2
通讯作者：
Rowe M
中科院分区：
文献类型：
--
作者：
Hermes E;Burrone L;Perez E;Martino S;Rowe M
由于地理距离、时间安排、耻辱和提供者的可用性，获得针对常见精神健康状况的循证干预措施的机会有限。基于互联网的自我保健计划可以减轻这些障碍。然而，很少有人知道基于互联网的自我保健计划在美国医疗保健系统的实施。本研究的目的是通过引出提供者和管理者对基于互联网的自我护理计划实施的观点，确定在初级保健中使用基于互联网的自我护理计划的实践决定因素。通过对来自退伍军人健康管理局的初级保健提供者和管理者的半结构化访谈进行定性分析，探讨了这一目标。参与者是使用基于声誉的雪球设计确定的。采访的重点是确定在退伍军人健康管理局初级保健护理点使用基于互联网的自我保健计划的实践决定因素。使用主题编码的成绩单进行定性分析。共有20名医生、心理学家、社会工作者和护士参加了访谈。在这一组中，基于互联网的自我护理计划的使用相对较低，但对平台的支持被评估为相对较高。主题被组织成活跃在患者和提供者层面的决定因素。患者层面的决定因素包括文化程度、年龄、互联网接入、患者期望、基于互联网的自我护理计划与患者经验的契合度、兴趣和动机以及面对面的人际接触。感知提供者层面的决定因素包括熟悉基于互联网的自我护理计划，改变传统的护理服务，面对面的人际接触，竞争的需求和年龄。这种对退伍军人健康管理局提供者和管理者实施基于互联网的自我保健计划的观点的探索揭示了实践的关键决定因素，这些决定因素可用于制定在初级保健环境中实施基于互联网的自我保健计划的综合战略。
Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems. The objective of this study was to identify determinants of practice for internet-based self-care program use in primary care by eliciting provider and administrator perspectives on internet-based self-care program implementation. The objective was explored through qualitative analysis of semistructured interviews with primary care providers and administrators from the Veterans Health Administration. Participants were identified using a reputation-based snowball design. Interviews focused on identifying determinants of practice for the use of internet-based self-care programs at the point of care in Veterans Health Administration primary care. Qualitative analysis of transcripts was performed using thematic coding. A total of 20 physicians, psychologists, social workers, and nurses participated in interviews. Among this group, internet-based self-care program use was relatively low, but support for the platform was assessed as relatively high. Themes were organized into determinants active at patient and provider levels. Perceived patient-level determinants included literacy, age, internet access, patient expectations, internet-based self-care program fit with patient experiences, interest and motivation, and face-to-face human contact. Perceived provider-level determinants included familiarity with internet-based self-care programs, changes to traditional care delivery, face-to-face human contact, competing demands, and age. This exploration of perspectives on internet-based self-care program implementation among Veterans Health Administration providers and administrators revealed key determinants of practice, which can be used to develop comprehensive strategies for the implementation of internet-based self-care programs in primary care settings.