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: 8485061
• 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/8485061
• 关键词: Adherence; Adherence; Affect; Affect; Age; Age; Amputation; Amputation; Behavior; Behavior; Blindness; Blindness; Cardiovascular Diseases; Cardiovascular Diseases; Caring; Caring; Characteristics; Characteristics; Chronic; Chronic; Clinical; Clinical; Communication; Communication; Communication Research; Communication Research; Consultations; Consultations; Control Locus; Control Locus; Development; Development; Diabetes Mellitus; Diabetes Mellitus; Educational Intervention; Educational Intervention; Elements; Elements; End stage renal failure; End stage renal failure; Ensure; Ensure; Focus Groups; Focus Groups; Funding; Funding; Gender; Gender; Geography; Glycosylated hemoglobin A; Glycosylated hemoglobin A; Goals; Goals; Health Services Accessibility; Human Resources; Human Resources; Improve Access; Improve Access; Intervention; Intervention; Intervention Trial; Interview; Interview; Knowledge; Knowledge; Measures; Measures; Mediating; Mediating; Mediator of activation protein; Mediator of activation protein; Medical; Medical; Medical center; Medical center; Methods; Methods; Mission; Mission; Modeling; Modeling; Nature; Nature; Non-Insulin-Dependent Diabetes Mellitus; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Outcome; Pamphlets; Pamphlets; Patient Care; Patient Care; Patient-Centered Care; Patient-Centered Care; Patients; Patients; Persons; Persons; Pharmaceutical Preparations; Pharmaceutical Preparations; Phase; Phase; Pilot Projects; Pilot Projects; Play; Play; Preparation; Preparation; Prevalence; Prevalence; Primary Health Care; Provider; Provider; Race; Race; Randomized; Randomized; Recommendation; Recommendation; Regimen; Regimen; Reporting; Reporting; Research; Research; Research Design; Research Design; Research Personnel; Research Personnel; Resources; Resources; Role; Role; Schedule; Schedule; Self Efficacy; Self Efficacy; Services; Services; Specialist; Specialist; Technology; Technology; Testing; Testing; Time; Time; Training Programs; Training Programs; Trust; Trust; Veterans; Veterans; Visit; Visit; Work; Work; arm; arm; base; base; care providers; communication aid; communication aid; communication behavior; communication behavior; design; design; diabetes control; diet and exercise; diet and exercise; effectiveness trial; effectiveness trial; experience; experience; group intervention; group intervention; health care availability; health care delivery; health care delivery; improved; improved; lifestyle factors; lifestyle factors; literacy; literacy; medication compliance; medication compliance; patient oriented; patient oriented; patient-clinician communication; patient-level barriers; prevent; prevent; randomized trial; randomized trial; role model; role model; satisfaction; satisfaction; skills; skills; success; success; telehealth; telehealth; tool; 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。对CVT的热情在VA特别高，因为许多退伍军人和他们在VA医疗中心的供应商之间存在地理隔离。然而，由于CVT接触本质上比亲自访问更不私人化，因此CVT访问期间的通信对于患者和提供者而言可能更具挑战性，从而导致较少的以患者为中心的通信。较少的个人访问可能会减少信息交换，降低满意度，减少信任，以及更差的结果。事实上，比较CVT与面对面咨询的研究发现，CVT访问中的患者更加被动，并且与面对面访问相比，CVT互动由提供者主导。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，以改善患有2型糖尿病的退伍军人的医疗服务提供者与患者的沟通。在一个短期项目SHP-08-182中，我们进行了焦点小组调查，以了解患者与医疗服务提供者沟通的障碍。这项定性工作被用于随后的试点项目PPO-08-402，以开发一个教育视频，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，该产品是一个10分钟的视频，在测试中，被认为是可接受的，并可行的显示给退伍军人事务部患者之前，他们的医疗遭遇。 目的：我们在这个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，以鼓励在CVT医疗互动中进行积极和积极的沟通。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一起制定的，并得到了该办公室的支持，并且是HINES基于VA的CREATE的目标的组成部分，以确保在新的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，在提供医疗服务中发挥着重要但往往被忽视的作用。 有两个目标。首先，我们建议制定教育干预措施，以鼓励患者和提供者在CVT访问期间使用积极的沟通行为。其次，我们建议在一项两组随机有效性试验中进行一项随机试验，比较视频和小册子（干预）与单独的小册子（比较）。然后，我们将评估访视结果的改善，包括患者和提供者以患者为中心的护理和沟通措施，减少临床改善的几个常见障碍，以及改善药物依从性措施和血红蛋白A1 c。此外，我们建议评估中介和调解人的关系的干预条件的结果。 方法：该项目将分为两个阶段。在拟议项目的初始阶段（18个月），我们将开发视频干预。我们在发展这类干预措施方面有经验，并将在此基础上再接再厉。视频开发将包括与利益相关者和患者就CVT障碍和感知益处进行的定性访谈。我们将利用几个现有的资源和我们的专家小组的共同调查员和顾问，以汇集这些要素，并产生干预。在第二阶段，我们将进行一项干预的随机试验，评估一些结果的改善。 影响：我们的教育工具将是可交付的，可以在CVT访问之前使用，以改善沟通，并可以作为开发其他医疗条件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将有助于改善沟通，并将与更好的访问和中间结果。此外，在CVT治疗过程中，鼓励更多以患者为中心的沟通的教育工具可能会使CVT更快地被接受，从而改善医疗保健的可及性并增强我们合作伙伴的运营使命。