Zickmund Susan L, Hess Rachel, Bryce Cindy L, McTigue Kathleen, Olshansky Ellen, Fitzgerald Katharine, Fischer Gary S
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 151C-U, University Drive C, Pittsburgh, PA 15240, USA.
J Gen Intern Med. 2008 Jan;23 Suppl 1(Suppl 1):20-6. doi: 10.1007/s11606-007-0273-6.
Bioinformatics experts are developing interactive patient portals to help those living with diabetes and other chronic diseases to better manage their conditions. However, little is known about what influences patients' desires to use this technology.
To discern the impact of the provider-patient relationship on interest in using a web-based patient portal.
Qualitative analysis of focus groups.
Ten focus groups involving 39 patients (range 2-7) recruited from four primary care practices.
A qualitative approach was used, which involved reading transcribed texts until a consensus was reached on data interpretation. An intercoder reliability kappa score (0.89) was determined by comparing the provider-patient relationship talk selected by the two coders. A conceptual framework was developed, which involved the development and refinement of a codebook and the application of it to the transcripts.
Interest in the portal was linked to dissatisfaction with the provider-patient relationship, including dissatisfaction with provider communication/responsiveness, the inability to obtain medical information, and logistical problems with the office. Disinterest in the portal was linked to satisfaction with the provider-patient relationship, including provider communication/responsiveness, difficulty in using the portal, and fear of losing relationships and e-mail contact with the provider. No patient identified encrypted e-mail communication through the portal as an advantage.
Promoting the use of computerized portals requires patient-based adaptations. These should include ease of use, direct provider e-mail, and reassurances that access and interpersonal relationships will not be lost. Education is needed about privacy concerns regarding traditional e-mail communication.
生物信息学专家正在开发交互式患者门户，以帮助糖尿病患者和其他慢性病患者更好地管理自身病情。然而，对于影响患者使用这项技术意愿的因素却知之甚少。
探讨医患关系对使用基于网络的患者门户的兴趣的影响。
焦点小组的定性分析。
从四个初级保健机构招募了10个焦点小组，共39名患者（每组2 - 7人）。
采用定性方法，即阅读转录文本，直至就数据解释达成共识。通过比较两位编码员选择的医患关系谈话内容，确定了编码员间信度kappa分数（0.89）。开发了一个概念框架，包括制定和完善编码手册并将其应用于转录文本。
对门户的兴趣与对医患关系的不满有关，包括对医生沟通/响应能力的不满、无法获取医疗信息以及诊所的后勤问题。对门户不感兴趣与对医患关系的满意有关，包括医生的沟通/响应能力、使用门户的困难以及担心失去与医生的关系和电子邮件联系。没有患者认为通过门户进行加密电子邮件通信是一项优势。
推广使用计算机化门户需要根据患者进行调整。这些调整应包括易于使用、医生直接发送电子邮件，并保证不会失去联系和人际关系。需要对传统电子邮件通信的隐私问题进行教育。
