Makai Peter, Perry Marieke, Robben Sarah H M, Schers Henk, Heinen Maud, Olde Rikkert Marcel G M, Melis René J F
Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands.
J Med Internet Res. 2014 Dec 17;16(12):e278. doi: 10.2196/jmir.3609.
Frail older people often receive fragmented care from multiple providers. According to the literature, there is an urgent need for coordination of care. Online and eHealth tools are increasingly used to improve coordination. However, there are significant barriers to their implementation in frail older people.
Our aim was to (1) evaluate differences in use of a personal online health community (POHC) for frail older people in relation to personal characteristics, and (2) explore barriers and facilitators for use as experienced by older people and their informal caregivers, using the case of the Health and Welfare Information Portal (ZWIP).
This is a mixed methods study. For the quantitative analysis, we used POHC usage information (2 years follow-up) and baseline characteristics of frail older people. For the qualitative analysis, we used semistructured interviews with older people and their informal caregivers. Participants were recruited from 11 family practices in the east of the Netherlands and frail older people over 70 years. The ZWIP intervention is a personal online health community for frail older people, their informal caregivers, and their providers. ZWIP was developed at the Geriatrics Department of Radboud University Medical Center. We collected data on POHC use for 2 years as well as relevant patient characteristics. Interview topics were description of use, reasons for use and non-use, and user profiles.
Of 622 frail patients in the intervention group, 290 were connected to ZWIP; 79 used ZWIP regularly (at least monthly). Main predictors for use were having an informal caregiver, having problems with activities of daily living, and having a large number of providers. Family practice level predictors were being located in a village, and whether the family practitioners had previously used electronic consultation and cared for a large percentage of frail older people. From 23 interviews, main reasons for use were perceiving ZWIP to be a good, quick, and easy way of communicating with providers and the presence of active health problems. Important reasons for non-use were lack of computer skills and preferring traditional means of consultation.
Only 27.2% (79/290) of frail older enrolled in the POHC intervention used the POHC frequently. For implementation of personal online health communities, older people with active health problems and a sizable number of health care providers should be targeted, and the informal caregiver, if present, should be involved in the implementation process.
International Standard Randomized Controlled Trial Number (ISRCTN): 11165483; http://www.controlled-trials.com/isrctn/pf/11165483 (Archived by WebCite at http://www.webcitation.org/6U3fZovoU).
体弱的老年人常常从多个提供者那里接受碎片化的护理。根据文献，迫切需要协调护理。在线和电子健康工具越来越多地被用于改善协调。然而，在体弱的老年人中实施这些工具存在重大障碍。
我们的目标是（1）评估体弱老年人使用个人在线健康社区（POHC）与个人特征之间的差异，以及（2）以健康与福利信息门户（ZWIP）为例，探索老年人及其非正式护理者在使用过程中遇到的障碍和促进因素。
这是一项混合方法研究。对于定量分析，我们使用了POHC的使用信息（2年随访）和体弱老年人的基线特征。对于定性分析，我们对老年人及其非正式护理者进行了半结构化访谈。参与者从荷兰东部的11个家庭医疗诊所招募，年龄在70岁以上的体弱老年人。ZWIP干预是一个针对体弱老年人、他们的非正式护理者及其提供者的个人在线健康社区。ZWIP由拉德堡德大学医学中心老年医学部开发。我们收集了2年的POHC使用数据以及相关患者特征。访谈主题包括使用描述、使用和不使用的原因以及用户概况。
在干预组的622名体弱患者中，290人与ZWIP建立了连接；79人经常使用ZWIP（至少每月一次）。使用的主要预测因素是有非正式护理者、日常生活活动有问题以及有大量提供者。家庭医疗诊所层面的预测因素是位于村庄以及家庭医生以前是否使用过电子咨询并照顾了很大比例的体弱老年人。从23次访谈中得出，使用的主要原因是认为ZWIP是与提供者沟通的好方法、快捷且容易，以及存在活跃的健康问题。不使用的重要原因是缺乏计算机技能以及更喜欢传统的咨询方式。
在参与POHC干预的体弱老年人中，只有27.2%（79/290）经常使用POHC。对于个人在线健康社区的实施，应针对有活跃健康问题且有大量医疗保健提供者的老年人，并且如果有非正式护理者，应让其参与实施过程。
国际标准随机对照试验编号（ISRCTN）：11165483；http://www.controlled-trials.com/isrctn/pf/11165483（由WebCite存档于http://www.webcitation.org/6U3fZovoU）。
