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: 9982688
• 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/9982688
• 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）为更有效地获得退伍军人的高质量初级和专业护理提供了机会。鉴于许多退伍军人与其在VA医疗中心的提供者之间的地理分离，对CVT的热情在VA中特别高。但是，由于CVT本质上的遇到的个人次数不如亲自访问，因此CVT访问期间的沟通对于患者和提供者而言可能更具挑战性，导致以患者为中心的沟通较低。较少的个人访问可能会较少提供信息的交换，较低的满意度，信任和较差的结果。实际上，将CVT与面对面咨询的研究发现，CVT访问中的患者更具被动性，并且与面对面访问相比，提供商控制了CVT相互作用。该项目将利用我们以前的工作中从两个由HSR＆D资助的试点项目中进行的工作来改善提供者 - 患有2型糖尿病的退伍军人的患者沟通。在SHP-08-182的短期项目中，我们进行了焦点小组，以引起和了解患者与提供者沟通的障碍。这项定性工作用于随后的试点项目PPO-08-402，以开发一个教育视频，以鼓励退伍军人在访问提供者时使用积极的参与性交流。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，可以接受且可行，可以向弗吉尼亚州的患者展示其医疗相遇。 目的：我们在该项目中的目标是开发和测试视频干预措施，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。我们的目标是由我们的运营合作伙伴开发的，并得到了远程医疗服务办公室的支持，并且是基于Hines VA的创建目标不可或缺的一部分，以确保在新的护理模型中以患者为中心的护理。 以患者为中心的医疗互动中以患者为中心的沟通至关重要，并且在提供卫生服务中起着重要但经常被忽视的作用。 有两个目标。首先，我们建议开发教育干预措施，以鼓励患者和提供者在CVT访问期间使用主动的沟通行为。其次，我们建议在两臂随机有效性试验中对视频和小册子（干预）与小册子（比较）进行随机试验。然后，我们将评估访问结果的改善，包括患者和提供者以患者为中心的护理和沟通，减少临床改善的几种常见障碍以及改善药物依从性测量和血红蛋白A1C。此外，我们建议评估干预条件与结果的关系的介体和主持人。 方法：该项目将有两个阶段。在拟议项目的初始阶段（18个月）中，我们将开发视频干预。我们具有开发这种干预措施的经验，并将基于这种经验。视频开发将包括与利益相关者和患者有关CVT障碍和感知益处的定性访谈。我们将使用一些现有资源和我们的合作社和顾问专家小组将这些要素聚集在一起并进行干预。在第2阶段，我们将对干预措施进行随机试验，以评估许多结果的改善。 影响：我们的教育工具将是可以在CVT访问之前使用的可交付成果，以改善沟通，并可以作为开发其他医疗状况和其他临床环境的通信辅助工具的范例。我们认为，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级结果相关联。此外，在CVT遇到期间鼓励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伴侣的运营任务。