Pilot study of an Internet patient-physician communication tool for heart failure disease management.
Pilot study of an Internet patient-physician communication tool for heart failure disease management.
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DOI：
10.2196/jmir.7.1.e8
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发表时间：
2005-03-26
影响因子：
7.4
通讯作者：
Ross H
中科院分区：
文献类型：
--
作者：
Wu RC;Delgado D;Costigan J;Maciver J;Ross H
互联网疾病管理有望改善心力衰竭患者的护理，但支持其使用的证据有限。我们设计了一个心力衰竭互联网通信工具（HFICT），允许患者为临床医生输入信息，以及他们的日常症状，体重，血压和心率。临床医生在同一天审查信息并提供反馈。 本研究旨在评估使用互联网与症状性心力衰竭患者沟通的可行性和患者的可接受性。 指导有症状的心力衰竭患者如何使用互联网通信工具。主要结局指标是定期使用该系统的患者比例，平均每周至少输入一次信息，持续至少3个月。次要结局指标包括工具的安全性和可维护性。我们还对输入评论字段的患者和临床医生消息子集进行了内容分析。 1999年5月3日至2002年11月1日，62例患者（平均年龄48.7岁）入组。3个月时，58名患者存活，没有心脏移植。其中，26例患者（45%; 95%置信区间，0.33-0.58）在3个月时继续使用该系统。在所有参与者的条目中，97%包括体重; 68%的条目包括血压; 71%的条目包括心率。在所有5098例患者条目中的3386例条目（66%）中，输入了评论。未使用的功能包括跟踪利尿剂、药物和治疗目标。该工具似乎是安全和维护。临床医生对每个患者输入的响应的估计值从不到一分钟到5分钟或更长时间的详细响应。患者向心脏功能诊所发送了3386条评论。基于对100个患者条目的内容分析，确定了以下主要通信类别：患者信息;患者症状;患者关于其状况的问题;患者协调自己的护理;社会反应。患者和临床医生的评论数量随着时间的推移而减少。 虽然大多数患者停止使用，但45%的患者使用该系统并平均继续使用1.5年。互联网工具是一种可行的沟通方法，在相当大比例的心力衰竭患者。需要进一步的研究来确定临床结果，如生活质量或住院频率，是否得到改善。
Internet disease management has the promise of improving care in patients with heart failure but evidence supporting its use is limited. We have designed a Heart Failure Internet Communication Tool (HFICT), allowing patients to enter messages for clinicians, as well as their daily symptoms, weight, blood pressure and heart rate. Clinicians review the information on the same day and provide feedback. This pilot study evaluated the feasibility and patients' acceptability of using the Internet to communicate with patients with symptomatic heart failure. Patients with symptomatic heart failure were instructed how to use the Internet communication tool. The primary outcome measure was the proportion of patients who used the system regularly by entering information on average at least once per week for at least 3 months. Secondary outcomes measures included safety and maintainability of the tool. We also conducted a content analysis of a subset of the patient and clinician messages entered into the comments field. Between May 3, 1999 and November 1, 2002, 62 patients (mean age 48.7 years) were enrolled.. At 3 months 58 patients were alive and without a heart transplant. Of those, 26 patients (45%; 95% Confidence Interval, 0.33-0.58) continued using the system at 3 months. In 97% of all entries by participants weight was included; 68% of entries included blood pressure; and 71% of entries included heart rate. In 3386 entries out of all 5098 patient entries (66%), comments were entered. Functions that were not used included the tracking of diuretics, medications and treatment goals. The tool appeared to be safe and maintainable. Workload estimates for clinicians for entering a response to each patient's entry ranged from less than a minute to 5 minutes or longer for a detailed response. Patients sent 3386 comments to the Heart Function Clinic. Based on the content analysis of 100 patient entries, the following major categories of communication were identified: patient information; patient symptoms; patient questions regarding their condition; patient coordinating own care; social responses. The number of comments decreased over time for both patients and clinicians. While the majority of patients discontinued use, 45% of the patients used the system and continued to use it on average for 1.5 years. An Internet tool is a feasible method of communication in a substantial proportion of patients with heart failure. Further study is required to determine whether clinical outcomes, such as quality of life or frequency of hospitalization, are improved.