Patient Portal to Support Treatment Adherence

描述（由申请人提供）：开发和实施健康信息技术（HIT）以改善医疗保健是国家的优先事项。基于Web的共享患者和提供者访问电子病历（EMR）有可能推动传统通信和患者护理的界限，并成为疾病管理的重要工具。由于这个HIT相对较新，很少有人知道使用或应用电子病历门户网站的个人疾病管理。疾病管理在任何慢性疾病中都很重要，尤其是在艾滋病毒中，20-50%的患者没有充分坚持延长生命的抗逆转录病毒治疗（ART）。信息-动机-行为技能（IMB）模型表明，抗逆转录病毒疗法的依从性受到艾滋病毒阳性患者信息灵通、积极主动和拥有有效行动技能的程度的影响。使用一个门户网站，为患者提供访问他们的医疗信息和一个安全的方式直接与供应商沟通，可以提供独特的机会，以增加依从性相关的信息，动机和行为技能。我们正在寻求使用EMR患者门户网站的HIV+患者的特点，并设计和现场测试个人的行为干预使用此HIT和IMB理论的指导。我们的团队在两个大型附属卫生系统（北方加州的Group Health Cooperative和Kaiser Permanente）中进行这项研究具有独特的优势，他们已经将这项新技术应用于临床护理。该项目将在五年内分三个相关阶段进行。第1阶段是一项观察性研究，使用HIV+患者中的自动数据描述EMR门户网站随时间的使用模式以及门户网站频繁、不频繁和非用户的特征。第二阶段是一个随机试点，有30名艾滋病毒阳性者，以审查可接受性/可行性问题，并完善程序和措施。在第2阶段，将试行通过EMR患者门户网站（n=20）和计划用于第3阶段的注意力控制组（患者门户网站招募和信息联系人; n=10）提供的护士辅助个体依从性干预程序。第3阶段是护士通过EMR患者门户网站（N = 150）提供的基于IMB的个体干预与注意力控制组（N = 150）相比的RCT。主要结局将是通过干预后、3个月和9个月随访时的自动药房记录和自我报告衡量的抗逆转录病毒治疗依从性。随着时间的推移，将评估假设的依从性相关IMB干预变化过程变量（依从性相关信息、动机和行为技能），并检测其对ART依从性的介导作用。次要结局还包括12个月EMR患者门户网站利用率和面对面服务利用率。这项工作将提高我们对患者如何使用EMR患者门户网站的理解，并强调通过该系统提供护理所涉及的复杂性。它将使我们能够评估使用HIT作为干预交付工具的有效性，以改善患者的治疗结果，这与艾滋病毒疾病管理无关。 公共卫生相关性基于网络的共享患者和提供者访问电子医疗记录（EMR）有可能推动传统通信和患者护理的界限，并成为慢性病管理的重要工具。该项目将提高我们对HIV+患者如何使用网络访问EMR的理解，并测试这种系统作为干预交付工具的有效性，以改善患者的治疗效果，如药物依从性。这项研究的结果将与艾滋病毒护理以外的许多其他慢性病的管理有关。

DESCRIPTION (provided by applicant): Development and implementation of health information technology (HIT) to improve healthcare is a national priority. Web-based shared patient and provider access to electronic medical records (EMR) has the potential of pushing the boundaries of traditional communication and patient care and becoming an essential tool in disease management. Due to the relative newness of this HIT, little is known about the use or application of EMR web portals for individual disease management. Disease management is important in any chronic illness but particularly in HIV, where 20-50% of patients have inadequate adherence to life prolonging antiretroviral therapy (ART). The Information-Motivation-Behavioral Skills (IMB) model suggests that ART adherence is influenced by the extent to which HIV+ patients are well-informed, motivated, and possess skills to act effectively. Use of a web portal that provides patients access to their medical information and a secure way to directly communicate with providers may provide unique opportunities to increase adherence-related information, motivation and behavioral skills. We are seeking to characterize the use of an EMR patient web portal by HIV+ patients, and to design and field test an individual behavioral intervention using this HIT and guided by IMB theory. Our team is in a unique position to conduct this research in two large affiliated health systems (Group Health Cooperative and Kaiser Permanente, Northern California) who have already adopted this new technology into clinical care. The project will be conducted in three related stages over five years. Stage 1 is an observational study using automated data among HIV+ patients to describe EMR web portal use patterns over time and the characteristics of frequent, infrequent and non-users of the web portal. Stage 2 is a randomized pilot with 30 HIV+ persons to examine acceptability/ feasibility issues and refine procedures and measures. In Stage 2, procedures for the nurse-facilitated individual adherence intervention delivered via EMR patient web portal (n=20) and the attention control arm (patient web portal enrollment and informational contacts; n=10) planned for Stage 3 will be piloted. Stage 3 is an RCT of an IMB-based individual intervention delivered by nurses via EMR patient web portal (N=150) as compared to an attention control arm (N=150). Primary outcomes will be ART adherence as measured by automated pharmacy records and self report at post-intervention, 3- and 9-month follow-up. Hypothesized adherence-related IMB intervention change process variables (adherence-related information, motivation, and behavioral skills) will be assessed over time and tested for mediating effects on ART adherence. Secondary outcomes also include 12-month EMR patient web portal utilization and in-person service utilization. This work will enhance our understanding of how patients use EMR patient web portals and highlight the complexities involved in delivering care via this system. It will allow us to evaluate the effectiveness of using HIT as an intervention delivery vehicle to improve patient treatment outcomes, which has relevance beyond HIV disease management. PUBLIC HEALTH RELEVANCE Web-based shared patient and provider access to electronic medical records (EMR) has the potential of pushing the boundaries of traditional communication and patient care and becoming an essential tool in chronic disease management. This project will enhance our understanding of how HIV+ patients use web access to an EMR, and test the effectiveness of such a system as an intervention delivery tool to improve patient outcomes such as medication adherence. Findings from this research will have relevance beyond HIV care to the management of many other chronic diseases.