The effect of clinic visit audio recordings for self-management in older adults

项目摘要 高达80%的门诊访视信息在访视后立即被患者遗忘。这是一个重大 自我管理的障碍，特别是在老年人与多morphis导致健康状况不佳的结果。 访视后摘要（AVS）可以提高回忆率，但存在布局，准确性和低患者 摄取。增强AVS的新策略是与患者共享访视记录。当患者接受 71%的受访者会听录音，68%的受访者会与护理人员分享，从而产生更大的回忆。尽管 越来越多的兴趣，有有限的研究记录和共享病人自我诊所访问的影响， 老年人的管理能力、健康结果或医疗保健利用率。本提案的目的是 进行一项多中心试验，评估在常规门诊访视中添加音频记录（AUDIO）的影响， 与单独的AVS相比，患有多种疾病（包括糖尿病）的老年人的护理（患者护理; UC）。的 具体目标是：目标1在初级保健中进行三点试验， 包括糖尿病患者（n=336）将随机接受音频记录以及AVS（AUDIO）， 12个月内所有计划门诊访视的AVS单药治疗（UC）;将在基线、1周、6 目标2确定影响访问音频的实施和可持续使用的因素 录音.申请人假设（主效应）：与接受UC的患者相比，随机分配至 也收到录音（音频）的诊所访问将报告更大的自我管理能力（主要 结果），12岁时生活质量、药物依从性和满意度（次要结果）得到改善 个月申请人将探索AUDIO对一般医疗方案依从性、糖尿病质量 护理指标、医疗保健利用率和临床医生实践行为。他们还将探索潜力 AUDIO的主持人，询问其对自我管理的影响是否对高风险个体更大 自我管理不佳，包括那些照顾者支持较少的人，中度至重度抑郁症， 卫生知识普及和高疾病负担。在目标2中，申请人将采访患者，护理人员，临床医生， 诊所工作人员使用 实施研究综合框架。该研究是创新的：i）它寻求转变 通过AVS提供访视信息的当前临床实践，通过添加记录; ii）常规 随着时间的推移，提供访视记录超越了以往侧重于专科一次性记录的研究 护理访问;和iii）在现实世界中对患有多发性硬化症的患者进行的试验，这些患者通常被排除在 试验，是新颖的，具有更大的外部效度。预计这些结果将产生重大的积极影响， 将增加临床对录音的影响和实施的理解， 面对多重死亡的公共卫生负担，改善患者自我管理的挑战。

PROJECT SUMMARY Up to eighty percent of clinic visit information is forgotten by patients immediately post visit. This is a significant barrier to self-management, especially in older adults with multimorbidity leading to poor health outcomes. After visit summaries (AVS) can improve recall, yet concerns exist about their layout, accuracy and low patient uptake. A new strategy to augment the AVS is to share visit recordings with patients. When patients receive an audio recording of the visit, 71% listen and 68% share it with a caregiver, resulting in greater recall. Despite growing interest, there is limited research on the impact of recording and sharing clinic visits of patient self- management ability, health outcomes or healthcare utilization of older adults. The objective of this proposal is to conduct a multisite trial evaluating the impact of adding an audio recording of clinic visits (AUDIO) to usual care in older adults with multimorbidity, including diabetes, compared to AVS alone (Usual Care; UC). The specific aims are: Aim 1 Conduct a three-site trial in primary care where older patients with multimorbidity including diabetes (n=336) will be randomized to receive an audio recording as well as AVS (AUDIO) versus AVS alone (UC) for all scheduled clinic visits over 12 months; patients will be assessed at baseline, 1 week, 6 months and 12 months; Aim 2 Identify factors that impact the implementation and sustainable use of visit audio recordings. Applicants Hypothesize (Main Effect) that: compared to those receiving UC, patients randomized to also receive audio recordings (AUDIO) of clinic visits will report a greater self-management ability (Primary Outcome), with improved quality of life, medication adherence, and satisfaction (Secondary Outcomes) at 12 months. Applicants will explore the impact of AUDIO on general medical regimen adherence, diabetes quality of care indicators, healthcare utilization and clinician practice behavior. They will also explore potential moderators of AUDIO, asking whether its impact on self-management is greater for individuals at highest risk of poor self-management including those with less caregiver support, moderate to severe depression, lower health literacy, and high disease burden. In Aim 2, applicants will interview patients, caregivers, clinicians, and clinic staff to identify barriers and facilitators to the implementation and sustainable use of recordings using the Consolidated Framework for Implementation Research (CFIR). The research is innovative: i) it seeks to shift current clinical practice where visit information is provided via AVS, by adding recordings; ii) the routine provision of visit recordings over time moves beyond prior studies focused on one-off recordings of specialty care visits; and iii) a trial in real-world settings of patients with multimorbidity, who are often excluded from trials, is novel and has greater external validity. Results are expected to have a major positive impact as they will increase clinical understanding of the impact and implementation of audio recording on the significant challenge of improving patient self-management in the face of the public health burden of multimorbidity.