Solomon Michael, Wagner Stephen L, Goes James
Point-of-Care Partners, Coral Springs, FL 33076, USA.
J Med Internet Res. 2012 Feb 21;14(1):e32. doi: 10.2196/jmir.1924.
With almost one-half of Americans projected to have at least one chronic condition before 2020, a vital role of the health care system is to develop informed, engaged individuals who are effective self-managers of their health. Self-management interventions (SMIs) delivered face-to-face or by telephone (traditional SMIs) are associated with improved self-management knowledge, skills, and self-efficacy, which are expressed by the composite construct of patient activation, a predictor of health outcomes. Web-based interventions to support self-management across the spectrum of chronic diseases have the potential to reach a broader population of patients for extended periods than do traditional SMIs. However, evidence of the effectiveness of Web-based interventions on patient activation is sparse. High-quality studies featuring controlled comparisons of patients with different chronic conditions are needed to explore the interaction of Web-based interventions and patient activation.
To explore the effect of a Web-based intervention on the patient activation levels of patients with chronic health conditions, measured as attitudes toward knowledge, skills, and confidence in self-managing health.
For this 12-week study, prospective participants were selected from the patient panel of a regional health care system in the United States. The 201 eligible participants were randomly assigned to two groups. Intervention group participants had access to MyHealth Online, a patient portal featuring interactive health applications accessible via the Internet. Control participants had access to a health education website featuring various topics. Patient activation was assessed pre- and posttest using the 13-item patient activation measure. Parametric statistical models (t test, analysis of variance, analysis of covariance) were applied to draw inferences.
The Web-based intervention demonstrated a positive and significant effect on the patient activation levels of participants in the intervention group. A significant difference in posttest patient activation scores was found between the two groups (F(1,123) = 4.438, P = .04, r = .196). Patients starting at the most advanced development of patient activation (stage 4) in the intervention group did not demonstrate significant change compared with participants beginning at earlier stages.
To our knowledge, this is the first study to measure change in patient activation when a Web-based intervention is used by patients living with different chronic conditions. Results suggest that Web-based interventions increase patient activation and have the potential to enhance the self-management capabilities of the growing population of chronically ill people. Activated patients are more likely to adhere to recommended health care practices, which in turn leads to improved health outcomes. Designing Web-based interventions to target a specific stage of patient activation may optimize their effectiveness. For Web-based interventions to reach their potential as a key component of chronic disease management, evidence is needed that this technology produces benefits for a sustained period among a diverse population.
预计到2020年，近一半的美国人将至少患有一种慢性病，医疗保健系统的一项重要作用是培养有见识、积极参与且能有效自我管理健康的个体。面对面或通过电话提供的自我管理干预措施（传统自我管理干预措施）与自我管理知识、技能和自我效能的提高相关，这些通过患者激活这一综合指标来体现，而患者激活是健康结果的一个预测因素。与传统自我管理干预措施相比，基于网络的干预措施有潜力在更长时间内覆盖更广泛的患者群体，以支持各类慢性病患者的自我管理。然而，关于基于网络的干预措施对患者激活效果的证据却很少。需要开展高质量研究，对患有不同慢性病的患者进行对照比较，以探究基于网络的干预措施与患者激活之间的相互作用。
探讨基于网络的干预措施对患有慢性健康问题患者的患者激活水平的影响，以对自我管理健康的知识、技能和信心的态度来衡量。
在这项为期12周的研究中，前瞻性参与者从美国一个地区医疗保健系统的患者库中选取。201名符合条件的参与者被随机分为两组。干预组参与者可以使用MyHealth Online，这是一个通过互联网访问的具有交互式健康应用程序的患者门户网站。对照组参与者可以访问一个包含各种主题的健康教育网站。使用13项患者激活量表在测试前和测试后对患者激活情况进行评估。应用参数统计模型（t检验、方差分析、协方差分析）进行推断。
基于网络的干预措施对干预组参与者的患者激活水平产生了积极且显著的影响。两组在测试后患者激活得分上存在显著差异（F(1,123) = 4.438，P = 0.04，r = 0.196）。干预组中初始处于患者激活最先进阶段（第4阶段）的患者与处于较早阶段开始的参与者相比，未显示出显著变化。
据我们所知，这是第一项测量患有不同慢性病的患者使用基于网络的干预措施时患者激活变化的研究。结果表明，基于网络的干预措施可提高患者激活水平，并有可能增强日益增多的慢性病患者的自我管理能力。被激活的患者更有可能坚持推荐的医疗保健做法，进而改善健康结果。针对患者激活的特定阶段设计基于网络的干预措施可能会优化其效果。为使基于网络的干预措施发挥其作为慢性病管理关键组成部分的潜力，需要有证据表明该技术能在不同人群中长期产生益处。
