Barriers and Facilitators to Online Portal Use Among Patients and Caregivers in a Safety Net Health Care System: A Qualitative Study.
Barriers and Facilitators to Online Portal Use Among Patients and Caregivers in a Safety Net Health Care System: A Qualitative Study.
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DOI：
10.2196/jmir.4847
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发表时间：
2015-12-03
影响因子：
7.4
通讯作者：
Lyles CR
中科院分区：
文献类型：
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作者：
Tieu L;Sarkar U;Schillinger D;Ralston JD;Ratanawongsa N;Pasick R;Lyles CR
患者门户具有支持慢性病自我管理和改善健康结果的潜力。由于安全网卫生系统(向低收入、未参保和弱势人群提供高水平护理的卫生系统或医院)中有意义的使用激励措施刺激了患者门户的采用，了解安全网环境中患者和护理人员在线访问其个人健康记录的准备和意愿非常重要。在旧金山综合医院(一家安全网医院)实施在线患者门户之前，探索患者和照顾者对在线患者门户使用的看法。我们对慢性病患者和护理人员进行了16次深入访谈，他们表示有兴趣使用互联网来管理自己的健康。讨论的重点是医疗保健体验、技术使用以及使用在线门户管理医疗任务的兴趣。我们使用开放编码对门户使用的所有障碍和促进者进行分类，然后进行第二轮编码，将分类与之前发布的发现进行比较。在二次分析中，我们还检查了两个亚组中的特定障碍：那些健康素养有限的人和照顾者。我们采访了11名患者和5名照顾者。患者主要为男性(82%，9/11)和非裔美国人(45%，5/11)。所有患者都被诊断为糖尿病，大多数人的健康素养有限(73%，8/11)。大多数照顾者是女性(80%，4/5)，非裔美国人(60%，3/5)，糖尿病患者的照顾者(60%，3/5)，并具有足够的健康素养(60%，3/5)。共有88%(14/16)的参与者报告在观看原型后有兴趣使用门户网站。主要的感知障碍包括安全顾虑、缺乏技术技能/兴趣以及对面对面交流的偏好。促进门户使用的因素包括便利性、健康监控和改善患者与提供者之间的沟通。健康素养有限的参与者讨论了使用门户网站的更基本障碍，包括阅读和打字方面的挑战、个人对在线安全漏洞/病毒的体验以及对潜在安全措施的不信任。护理者对门户网站的使用表示了高度的兴趣，以支持他们在解释健康信息、倡导高质量护理以及管理健康行为和医疗保健方面的作用。尽管担心安全性、难以理解医疗信息以及对当前沟通流程的满意度，但受访者普遍表示对门户网站的使用热情高涨。我们的发现表明，迫切需要培训和支持，以帮助弱势患者进行门户注册和使用，特别是那些健康素养有限的患者。鼓励弱势患者使用门户网站的努力应直接解决健康素养和安全/隐私问题，并支持护理人员使用门户网站。
Patient portals have the potential to support self-management for chronic diseases and improve health outcomes. With the rapid rise in adoption of patient portals spurred by meaningful use incentives among safety net health systems (a health system or hospital providing a significant level of care to low-income, uninsured, and vulnerable populations), it is important to understand the readiness and willingness of patients and caregivers in safety net settings to access their personal health records online. To explore patient and caregiver perspectives on online patient portal use before its implementation at San Francisco General Hospital, a safety net hospital. We conducted 16 in-depth interviews with chronic disease patients and caregivers who expressed interest in using the Internet to manage their health. Discussions focused on health care experiences, technology use, and interest in using an online portal to manage health tasks. We used open coding to categorize all the barriers and facilitators to portal use, followed by a second round of coding that compared the categories to previously published findings. In secondary analyses, we also examined specific barriers among 2 subgroups: those with limited health literacy and caregivers. We interviewed 11 patients and 5 caregivers. Patients were predominantly male (82%, 9/11) and African American (45%, 5/11). All patients had been diagnosed with diabetes and the majority had limited health literacy (73%, 8/11). The majority of caregivers were female (80%, 4/5), African American (60%, 3/5), caregivers of individuals with diabetes (60%, 3/5), and had adequate health literacy (60%, 3/5). A total of 88% (14/16) of participants reported interest in using the portal after viewing a prototype. Major perceived barriers included security concerns, lack of technical skills/interest, and preference for in-person communication. Facilitators to portal use included convenience, health monitoring, and improvements in patient-provider communication. Participants with limited health literacy discussed more fundamental barriers to portal use, including challenges with reading and typing, personal experience with online security breaches/viruses, and distrust of potential security measures. Caregivers expressed high interest in portal use to support their roles in interpreting health information, advocating for quality care, and managing health behaviors and medical care. Despite concerns about security, difficulty understanding medical information, and satisfaction with current communication processes, respondents generally expressed enthusiasm about portal use. Our findings suggest a strong need for training and support to assist vulnerable patients with portal registration and use, particularly those with limited health literacy. Efforts to encourage portal use among vulnerable patients should directly address health literacy and security/privacy issues and support access for caregivers.