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: 9982086
• 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/9982086
• 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; Randomized; 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; effectiveness trial; 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 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。考虑到退伍军人和他们在退伍军人医疗中心的提供者之间的地理分隔，退伍军人对CVT的热情在退伍军人中尤其高。然而，由于CVT的接触本质上不像面对面的拜访那样私人，因此CVT拜访期间的沟通对患者和提供者来说都可能更具挑战性，导致以患者为中心的沟通较少。较少的私人访问可能会导致较少的信息交换、较低的满意度、较少的信任和较差的结果。事实上，比较CVT和面对面会诊的研究发现，CVT就诊的患者更被动，与面对面就诊相比，CVT互动由提供者主导。这个项目将利用我们之前从两个高铁和研发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提供者与患者之间的沟通。在一个名为SHP-08-182的短期项目中，我们进行了焦点小组，以引出和了解患者与提供者沟通的障碍。在随后的试点项目PPO-08-402中使用了这项定性工作，以制作教育视频，鼓励退伍军人在访问提供者时使用积极的参与性沟通。这项工作已经成功完成，该产品是一段10分钟的视频，在测试中，发现可以在退伍军人管理局患者就医之前向他们展示，这是可以接受和可行的。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的，并得到了该办公室的支持，并且是基于Hines VA的Create的目标不可或缺的一部分，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是至关重要的，在提供卫生服务方面发挥着重要但往往被忽视的作用。有两个目标。首先，我们建议开发教育干预措施，鼓励患者和提供者在CVT就诊期间使用积极的沟通行为。其次，我们建议在双臂随机有效性试验中进行视频和小册子(干预)与单独使用小册子(对照)的随机试验。然后，我们将评估就诊结果的改善，包括患者和提供者以患者为中心的护理和沟通措施，临床改善的几个常见障碍的减少，以及改善用药依从性措施和血红蛋白A1c。此外，我们建议评估干预条件与结果的关系的调解人和调节者。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。我们有开发这类干预的经验，并将在此经验的基础上再接再厉。视频开发将包括就CVT障碍和感知的好处对利益相关者和患者进行定性采访。我们将利用现有的几个资源以及我们的联合调查员和顾问专家小组，将这些因素结合在一起，进行干预。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，可在CVT访问之前用于改善沟通，并可作为开发适用于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相关。此外，教育工具鼓励在CVT治疗期间进行更多以患者为中心的交流，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。