Patient-Facing Clinical Decision Support for High Blood Pressure Control: Patient Survey.
Patient-Facing Clinical Decision Support for High Blood Pressure Control: Patient Survey.
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DOI：
10.2196/39490
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发表时间：
2023-01-23
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影响因子：
--
通讯作者：
Rope, Robert
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作者：
Dorr, David;D'Autremont, Chris;Richardson, Joshua E;Bobo, Michelle;Terndrup, Christopher;Dunne, M J;Cheng, Anthony;Rope, Robert
高血压（HBP）影响了美国近一半的成年人，是心脏病发作、中风、肾病和其他疾病的主要因素。为了降低风险，HBP指南包含了70多条建议，其中包括许多与患者行为有关的建议，如家庭监测和生活方式的改变。因此，患者在控制血压中的作用是至关重要的。面向患者的临床决策支持（CDS）工具可以帮助患者坚持循证护理，但需要定制。我们的目标是了解如何调整CDS以最好地使患者参与控制HBP。我们进行了一项混合方法研究，分为两个阶段：(1)有限队列的调查指导访谈和(2)全国网络调查。每个阶段的参与仅限于年龄在18岁至85岁之间、被诊断患有高血压的成年人。调查包括评估目标设定、治疗优先级、药物负荷、合并症、血压（BP）管理满意度和对CDS的态度的一般问题，以及一系列关于使用配对信息显示的a /B偏好的问题，以评估潜在CDS用户界面选项的感知可信度。我们进行了17次调查导向访谈，从CDS中收集患者需求，然后分析结果，并对519名临床诊断为HBP的成年人进行了第二次调查。绝大多数参与者报告说，血压控制是高度优先的（83%），在家里监测过血压（82%），对使用技术感到舒服（88%）。调查受访者发现，更详细的建议更值得信赖（56%-77%的人更喜欢更简单的显示），特别是在纳入社会信任和来自提供者和患者的优先事项时，但采取的行动没有差异。调查的受访者认为CDS功能可以帮助他们控制HBP。BP显示和推荐信息的更详细的设计选项被认为是最值得信赖的，但不能区分感知行为。
High blood pressure (HBP) affects nearly half of adults in the United States and is a major factor in heart attacks, strokes, kidney disease, and other morbidities. To reduce risk, guidelines for HBP contain more than 70 recommendations, including many related to patient behaviors, such as home monitoring and lifestyle changes. Thus, the patient’s role in controlling HBP is crucial. Patient-facing clinical decision support (CDS) tools may help patients adhere to evidence-based care, but customization is required. Our objective was to understand how to adapt CDS to best engage patients in controlling HBP. We conducted a mixed methods study with two phases: (1) survey-guided interviews with a limited cohort and (2) a nationwide web-based survey. Participation in each phase was limited to adults aged between 18 and 85 years who had been diagnosed with hypertension. The survey included general questions that assessed goal setting, treatment priorities, medication load, comorbid conditions, satisfaction with blood pressure (BP) management, and attitudes toward CDS, and also a series of questions regarding A/B preferences using paired information displays to assess perceived trustworthiness of potential CDS user interface options. We conducted 17 survey-guided interviews to gather patient needs from CDS, then analyzed results and created a second survey of 519 adults with clinically diagnosed HBP. A large majority of participants reported that BP control was a high priority (83%), had monitored BP at home (82%), and felt comfortable using technology (88%). Survey respondents found displays with more detailed recommendations more trustworthy (56%-77% of them preferred simpler displays), especially when incorporating social trust and priorities from providers and patients like them, but had no differences in action taken. Respondents to the survey felt that CDS capabilities could help them with HBP control. The more detailed design options for BP display and recommendations messaging were considered the most trustworthy yet did not differentiate perceived actions.