McInnes D Keith, Solomon Jeffrey L, Bokhour Barbara G, Asch Steven M, Ross David, Nazi Kim M, Gifford Allen L
Center for Health Quality, Outcomes & Economic Research, ENRM VA Medical Center, Bedford, MA, USA.
BMC Res Notes. 2011 Aug 15;4:295. doi: 10.1186/1756-0500-4-295.
When detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs) become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA) health care system.
We conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory.Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising methods to smooth the flow of patients getting screened. When provided a choice between unsecured emails versus PHRs as the delivery mechanism for disease screening messages, both patients and providers preferred PHRs.
There is considerable potential to use PHR systems for electronic outreach and social marketing to communicate to patients about, and increase rates of, disease screening, including for HIV. Planning for direct-to-patient communications through PHRs should include providers and address provider reservations, especially about workload increases.
检测出感染艾滋病毒后，可通过抗逆转录病毒疗法进行有效治疗。然而在美国，约25%的艾滋病毒感染者并不知道自己已感染。关于如何提高艾滋病毒检测率，仍有许多未知之处。新的互联网宣传方法有可能提高患者对疾病的认知并增加筛查，特别是随着电子个人健康记录（PHR）的普及。在美国退伍军人事务部医疗系统中，90万名退伍军人表示有兴趣通过PHR接收与健康相关的电子通信。因此，我们试图评估开展艾滋病毒筛查宣传的最佳情况和条件。在一项探索性的定性研究中，我们调查了使用退伍军人健康管理局（VHA）医疗系统的退伍军人以及医疗服务提供者对基于互联网的宣传以增加艾滋病毒筛查的看法。
我们在VHA医疗中心与退伍军人和医疗服务提供者进行了两轮焦点小组讨论。研究的第一阶段引发了对旨在增加艾滋病毒、糖尿病和高胆固醇筛查的电子宣传项目的总体看法。利用第一阶段的结果，起草了宣传信息文本，然后在第二阶段向参与者展示。分析采用了改良的扎根理论。患者和提供者表示，通过PHR进行电子宣传将提供有用信息，并会促使患者接受艾滋病毒筛查。患者认为电子信息比口头提供的信息更方便、易懂。患者认为关于艾滋病毒的信息与关于糖尿病和胆固醇的信息没有太大区别。然而，提供者认为患者会因污名化而不赞成与艾滋病毒相关的信息。提供者预计电子宣传会增加工作量，因此建议增加初级保健资源并设计方法以顺畅患者的筛查流程。当在不安全电子邮件和PHR之间选择作为疾病筛查信息的传递机制时，患者和提供者都更喜欢PHR。
利用PHR系统进行电子宣传和社会营销，向患者传达疾病筛查信息并提高筛查率，包括艾滋病毒筛查率，具有相当大的潜力。通过PHR进行直接面向患者的沟通规划应包括医疗服务提供者，并解决他们的顾虑，特别是关于工作量增加的问题。
