Sakaguchi-Tang Dawn K, Bosold Alyssa L, Choi Yong K, Turner Anne M
Department of Human Centered Design and Engineering, College of Engineering, University of Washington, Seattle, WA, United States.
Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.
JMIR Med Inform. 2017 Oct 16;5(4):e38. doi: 10.2196/medinform.8092.
BACKGROUND: The older adult population (65 years or older) in the United States is growing, and it is important for communities to consider ways to support the aging population. Patient portals and electronic personal health records (ePHRs) are technologies that could better serve populations with the highest health care needs, such as older adults. OBJECTIVE: The aim of this study was to assess the existing research landscape related to patient portal and ePHR use and experience among older adults and to understand the benefits and barriers to older adults' use and adoption of patient portals and ePHRs. METHODS: We searched six pertinent bibliographic databases for papers, published from 2006 to 2016 and written in English, that focused on adults 60 years or older and their use of or experience with patient portals or ePHRs. We adapted preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to review papers based on exclusion and inclusion criteria. We then applied thematic analysis to identify key themes around use, experience, and adoption. RESULTS: We retrieved 199 papers after an initial screening and removal of duplicate papers. Then we applied an inclusion and exclusion criteria, resulting in a final set of 17 papers that focused on 15 separate projects. The majority of papers described studies involving qualitative research, including interviews and focus groups. They looked at the experience and use of ePHRs and patient portals. Overall, we found 2 main barriers to use: (1) privacy and security and (2) access to and ability to use technology and the Internet. We found 2 facilitators: (1) technical assistance and (2) family and provider advice. We also reported on older adults' experience, including satisfaction with the system and improvement of the quality of their health care. Several studies captured features that older adults wanted from these systems such as further assistance managing health-related tasks and contextual health advice and tips. CONCLUSIONS: More research is needed to better understand the patient portal experience among older adults from initial use to adoption. There are also opportunities to explore the role of design in addressing barriers and supporting facilitators to patient portal and ePHR use. Finally, the future use of these systems by older adults should be anticipated and considered in the design process.
背景:美国老年人口(65岁及以上)正在增长,社区考虑支持老龄人口的方式很重要。患者门户网站和电子个人健康记录(ePHR)是能够更好地服务于医疗保健需求最高人群(如老年人)的技术。 目的:本研究旨在评估与老年人使用患者门户网站和ePHR及相关体验有关的现有研究情况,并了解老年人使用和采用患者门户网站和ePHR的益处及障碍。 方法:我们在六个相关的书目数据库中搜索了2006年至2016年发表的英文论文,这些论文聚焦于60岁及以上成年人及其对患者门户网站或ePHR的使用或体验。我们采用系统评价和荟萃分析的首选报告项目(PRISMA)指南,根据排除和纳入标准对论文进行审查。然后我们应用主题分析来确定围绕使用、体验和采用的关键主题。 结果:经过初步筛选和去除重复论文后,我们检索到199篇论文。然后我们应用纳入和排除标准,最终得到一组17篇论文,这些论文聚焦于15个独立项目。大多数论文描述了涉及定性研究的研究,包括访谈和焦点小组。它们研究了ePHR和患者门户网站的体验与使用情况。总体而言,我们发现了2个主要使用障碍:(1)隐私和安全,以及(2)获取和使用技术及互联网的能力。我们发现了2个促进因素:(1)技术援助,以及(2)家庭和提供者的建议。我们还报告了老年人的体验,包括对系统的满意度以及医疗保健质量的改善。几项研究记录了老年人希望从这些系统中获得的功能,例如在管理与健康相关任务方面获得更多帮助以及获得情境健康建议和提示。 结论:需要更多研究来更好地了解老年人从初次使用到采用患者门户网站的体验。在解决障碍和支持促进患者门户网站和ePHR使用方面,还有机会探索设计的作用。最后,在设计过程中应预期并考虑老年人对这些系统的未来使用情况。
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