Encouraging Patient-Centered Communication in Clinical Video Telehealth Visits

鼓励临床视频远程医疗就诊中以患者为中心的沟通

• 批准号: 10176568
• 负责人: Howard S. Gordon
• 金额: --
• 依托单位: JESSE BROWN VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-01 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10176568
• 关键词: Adherence; Affect; Age; Amputation; Behavior; Blindness; Cardiovascular Diseases; Caring; Characteristics; Chronic; Clinical; Communication; Communication Research; Consultations; Control Locus; Development; Diabetes Mellitus; Educational Intervention; Elements; End stage renal failure; Ensure; Focus Groups; Funding; Gender; Geography; Glycosylated hemoglobin A; Goals; Human Resources; Improve Access; Intervention; Intervention Trial; Interview; Knowledge; Measures; Mediating; Mediator of activation protein; Medical; Medical center; Methods; Mission; Modeling; Nature; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Pamphlets; Patient Care; Patient-Centered Care; Patients; Persons; Pharmaceutical Preparations; Phase; Pilot Projects; Play; Preparation; Prevalence; Provider; Race; Recommendation; Regimen; Reporting; Research; Research Design; Research Personnel; Resources; Role; Schedule; Self Efficacy; Services; Specialist; Technology; Testing; Time; Training Programs; Trust; Veterans; Visit; Work; arm; base; care providers; communication aid; communication behavior; design; diet and exercise; experience; group intervention; health care availability; health care delivery; improved; lifestyle factors; literacy; medication compliance; patient oriented; patient-clinician communication; patient-level barriers; prevent; randomized effectiveness trial; randomized trial; role model; satisfaction; skills; success; telehealth; tool

DESCRIPTION (provided by applicant): Background: Clinical video telehealth (CVT) offers the opportunity for more efficient access to high quality primary and specialist care for Veterans. Enthusiasm for CVT is especially high in the VA given geographical separation between many Veterans and their providers at VA Medical Centers. However, because CVT encounters are by nature less personal than in-person visits, communication during CVT visits may be more challenging for both patients and providers resulting in less patient-centered communication. Less personal visits may have less exchange of information, lower satisfaction, less trust, and poorer outcomes. Indeed, research comparing CVT with in-person consultations found that patients in CVT visits were more passive and that CVT interactions were dominated by providers when compared with in-person visits. This project will leverage our prior work from two HSR&D-funded pilot projects to improve provider - patient communication for Veterans with type 2 diabetes mellitus. In a short-term project, SHP-08-182, we conducted focus groups to elicit and understand patients' barriers to communicating with their providers. This qualitative work was used in a subsequent pilot project, PPO-08-402 to develop an educational video to encourage Veterans to use active participatory communication in their visits to providers. This work was successfully completed and the product is a 10-minute video that, in testing, was found to be acceptable and feasible to show to VA patients immediately preceding their medical encounters. Objectives: Our goal in this project is develop and test a video intervention and to also develop pamphlets for patients and providers to encourage active and positive communication in CVT medical interactions. Our goal was developed with and is supported by our operational partner the Office of Telehealth Services and is integral to the goals of the HINES VA-based CREATE to ensure patient-centered care in new models of care. Patient-centered communication in medical interactions is critical and plays an important, but often overlooked, role in the delivery of health services. There are two aims. First we propose to develop educational interventions to encourage patients and providers to use active communication behaviors during CVT visits. Second, we propose to conduct a randomized trial of the video and pamphlet (intervention) vs. pamphlet alone (comparison) in a two-arm randomized effectiveness trial. We would then evaluate for improvement in visit outcomes including patient and provider measures of patient-centered care and communication, reduction in several common barriers to clinical improvement, and improved medication adherence measures and hemoglobin A1c. In addition, we propose to assess the mediators and moderators of the relationship of the intervention condition to outcomes. Methods: The project will have two phases. In the initial phase (18 months) of the proposed project we will develop the video intervention. We have experience developing this type of intervention and will build on that experience. Video development will include qualitative interviews with stakeholders and patients regarding CVT barriers and perceived benefits. We will use several existing resources and our expert panel of co- investigators and consultants to bring these elements together and produce the intervention. In phase 2 we will conduct a randomized trial of the intervention, evaluating for improvement in a number of outcomes. Impacts: Our educational tools will be deliverables that could be used prior to CVT visits to improve communication and could serve as a paradigm for developing communication aids for other medical conditions and other clinical settings. We believe that use of our educational intervention will help improve communication and will be associated with better visit and intermediate outcomes. In addition, educational tools that encourage more patient-centered communication during CVT encounters may allow more rapid acceptance of CVT, thereby improving access to healthcare and enhancing the operational mission of our partner.

描述（由申请人提供）： 背景：临床视频远程医疗 (CVT) 为退伍军人提供了更有效地获得高质量初级和专科护理的机会。鉴于许多退伍军人及其在退伍军人管理局医疗中心的提供者之间的地理隔离，退伍军人管理局对 CVT 的热情尤其高涨。然而，由于 CVT 就诊本质上不像面对面就诊那样个性化，因此 CVT 就诊期间的沟通对于患者和提供者来说可能更具挑战性，从而导致以患者为中心的沟通较少。较少的个人访问可能会导致信息交流减少、满意度降低、信任度降低以及结果较差。事实上，比较 ​​CVT 与面对面咨询的研究发现，与面对面就诊相比，接受 CVT 就诊的患者更加被动，并且 CVT 互动主要由提供者主导。该项目将利用我们之前在两个 HSR&D 资助的试点项目中所做的工作来改善患有 2 型糖尿病的退伍军人的医疗服务提供者与患者之间的沟通。在一个短期项目 SHP-08-182 中，我们进行了焦点小组讨论，以找出并了解患者与医疗服务提供者沟通时遇到的障碍。这项定性工作被用于随后的试点项目 PPO-08-402 中，以开发教育视频，鼓励退伍军人在访问提供者时使用积极的参与式沟通。这项工作已成功完成，产品是一个 10 分钟的视频，经过测试，发现可以接受且可行，可以在 VA 患者就医之前立即播放。 目标：我们在该项目中的目标是开发和测试视频干预，并为患者和提供者开发小册子，以鼓励 CVT 医疗互动中积极和积极的沟通。我们的目标是与我们的运营合作伙伴远程医疗服务办公室共同制定并得到支持，并且是基于弗吉尼亚州海因斯的 CREATE 目标的组成部分，以确保新护理模式中以患者为中心的护理。 在医疗互动中以患者为中心的沟通至关重要，在提供卫生服务中发挥着重要但经常被忽视的作用。 有两个目标。首先，我们建议制定教育干预措施，鼓励患者和提供者在 CVT 就诊期间采取积极的沟通行为。其次，我们建议在双臂随机有效性试验中对视频和小册子（干预）与单独小册子（比较）进行随机试验。然后，我们将评估就诊结果的改善情况，包括患者和提供者对以患者为中心的护理和沟通的衡量，减少临床改善的几个常见障碍，以及改善药物依从性衡量和血红蛋白 A1c。此外，我们建议评估干预条件与结果关系的中介因素和调节因素。 方法：该项目将分两个阶段进行。在拟议项目的初始阶段（18 个月），我们将开发视频干预。我们拥有开发此类干预措施的经验，并将以此为基础。视频开发将包括对利益相关者和患者进行有关 CVT 障碍和感知益处的定性访谈。我们将利用一些现有资源以及我们的联合调查员和顾问专家小组将这些要素整合在一起并制定干预措施。在第二阶段，我们将对干预措施进行随机试验，评估许多结果的改善情况。 影响：我们的教育工具将是可在 CVT 就诊之前使用的交付品，以改善沟通，并可作为开发其他医疗状况和其他临床环境的沟通辅助工具的范例。我们相信，使用我们的教育干预措施将有助于改善沟通，并将带来更好的访问和中间结果。此外，鼓励在 CVT 接触过程中进行更多以患者为中心的沟通的教育工具可能会更快地接受 CVT，从而改善获得医疗保健的机会并增强我们合作伙伴的运营使命。

项目成果

Provider, Staff, and Patient Perspectives on medical Visits Using Clinical Video Telehealth: A Foundation for Educational Initiatives to Improve Medical Care in Telehealth.

• DOI: 10.1016/j.nurpra.2021.02.020
• 发表时间: 2021-05
• 期刊: The journal for nurse practitioners : JNP
• 作者: Gopal RK;Solanki P;Bokhour BG;Skorohod N;Hernandez Lujan DA;Choi W;Gordon HS
• 通讯作者: Gordon HS

"They are talking from the Encyclopedia Britannica brain": diabetes patients' perceptions of barriers to communicating with physicians.

“他们正在从大英百科全书大脑中说话”：糖尿病患者对与医生沟通障碍的看法。

• DOI: 10.1186/s12913-020-5063-4
• 发表时间: 2020
• 期刊: BMC health services research
• 影响因子: 2.8
• 作者: Gordon,HowardS;Sharp,LisaK;Schoenthaler,Antoinette
• 通讯作者: Schoenthaler,Antoinette