The impact of sharing audio recorded clinic visits on self-management in older adults: a multisite trial

项目总结 高达80%的就诊信息在就诊后立即被患者遗忘。这是一个意义重大的 自我管理的障碍，特别是患有多发病导致健康结果不佳的老年人。 访问后摘要(AVS)可以提高召回率，但其布局、准确性和患者人数较低仍存在担忧 领悟。患者和临床医生已经开始录音诊所就诊。当患者收到音频时 71%的人会倾听，68%的人会与照顾者分享，这会导致更大的回忆。尽管它的 越来越多的人使用，到目前为止还没有关于记录和分享患者自己的门诊访问的影响的研究 管理能力、健康结果或医疗保健利用。这项提议的目标是进行一项 评估在老年人日常护理中增加门诊(音频)录音的影响的多点试验 与单独的AVS相比，患有多种疾病的成年人(通常护理；UC)。具体目标是：目标1进行a 初级保健中的三点试验，其中患有多发病的老年患者(n=540)将随机接受 AVS加录音(音频)与单独AVS(UC)相比，超过12个月的所有预定诊所就诊； 患者将在基线、1周、6个月和12个月进行评估；目标2调查和描述 在患者、照顾者、临床医生和 诊所工作人员。申请者假设：(1A)与仅接受AVS治疗的患者(UC)相比，患者 随机接收诊所就诊的录音(音频)将报告更强的自我管理 12个月时的能力(通过患者激活度测量-简表)。申请者还将探索 音频对诊所就诊、健康结果、医疗保健利用的影响，以及这些影响是否 由PAM-SF调解；(1b)与UC相比，音频对自我管理的影响将更大 健康素养较低的患者高于健康素养较高的患者。申请者将探索是否 录音对有照顾者支持或自我意识差风险最高的个人的影响更大 管理，例如，高疾病负担，中度到重度抑郁症。在目标2中，申请者将调查 与实施录音有关的因素，并为实施提出建议 指导今后传播录音的工具包。这项研究具有创新性，因为：i)它寻求转移电流 通过增加录音，通过AVS提供访问信息的临床实践；ii)常规提供 随着时间的推移，对探视录音的研究超越了以前侧重于专门探视的单一录音的研究；以及 三)经常被排除在试验之外的在现实世界环境中对多发病患者进行的试验是新颖的，并已 更大的外部效度。预计结果将产生重大的积极影响，因为它们将增加临床 了解录音的影响和实施对改进的重大挑战 患者自我管理，特别是在面对多发病的公共卫生负担时。

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. Patients and clinicians have begun audio recording clinic visits. When patients receive an audio recording of the visit, 71% listen and 68% share it with a caregiver, resulting in greater recall. Despite its growing use, to date there is no research on the impact of recording and sharing clinic visits of patient self- management ability, health outcomes or healthcare utilization. The objective of this proposal is to conduct a multi-site trial evaluating the impact of adding an audio recording of clinic visits (AUDIO) to usual care in older adults with multimorbidity, 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 (n=540) will be randomized to receive an AVS plus audio recording (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 Investigate and describe barriers and facilitators of the implementation of audio recordings among patients, caregivers, clinicians and clinic staff. Applicants hypothesize: (1a) Compared to those receiving the AVS alone (UC), patients randomized to also receive audio recordings (AUDIO) of clinic visits will report a greater self-management ability (measured by the Patient Activation Measure–Short Form) at 12 months. Applicants will also explore the impact of AUDIO on the clinic visit, health outcomes, healthcare utilization and whether these impacts are mediated by PAM-SF; (1b) The effect of AUDIO on self-management compared to UC will be greater for patients with low health literacy than for those with high health literacy. Applicants will explore whether the impact of audio recordings is greater for individuals with caregiver support or at highest risk of poor self- management, e.g., high disease burden, moderate to severe depression. In Aim 2, applicants will investigate factors related to the implementation of audio recording and develop recommendations for an implementation toolkit to guide future dissemination of recording. The research is innovative because: i) it seeks to shift current clinical practice where visit information is provided via AVS, by adding audio recording; ii) the routine provision of visit recordings over time moves beyond prior studies that focus on single recordings of specialty visits; and iii) a trial in real-world settings of patients with multimorbidity, regularly excluded from trials, is novel and has greater external validity. The 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 especially in the face of the public health burden of multimorbidity.