Hermes Eric, Burrone Laura, Perez Elliottnell, Martino Steve, Rowe Michael
VA Connecticut Healthcare System, Veterans Health Administration, West Haven, CT, United States.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.
JMIR Ment Health. 2018 May 18;5(2):e42. doi: 10.2196/mental.9600.
Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems.
The objective of this study was to identify determinants of practice for internet-based self-care program use in primary care by eliciting provider and administrator perspectives on internet-based self-care program implementation.
The objective was explored through qualitative analysis of semistructured interviews with primary care providers and administrators from the Veterans Health Administration. Participants were identified using a reputation-based snowball design. Interviews focused on identifying determinants of practice for the use of internet-based self-care programs at the point of care in Veterans Health Administration primary care. Qualitative analysis of transcripts was performed using thematic coding.
A total of 20 physicians, psychologists, social workers, and nurses participated in interviews. Among this group, internet-based self-care program use was relatively low, but support for the platform was assessed as relatively high. Themes were organized into determinants active at patient and provider levels. Perceived patient-level determinants included literacy, age, internet access, patient expectations, internet-based self-care program fit with patient experiences, interest and motivation, and face-to-face human contact. Perceived provider-level determinants included familiarity with internet-based self-care programs, changes to traditional care delivery, face-to-face human contact, competing demands, and age.
This exploration of perspectives on internet-based self-care program implementation among Veterans Health Administration providers and administrators revealed key determinants of practice, which can be used to develop comprehensive strategies for the implementation of internet-based self-care programs in primary care settings.
由于地理距离、时间安排、耻辱感以及医疗服务提供者的可及性等因素，获得针对常见心理健康状况的循证干预措施受到限制。基于互联网的自我护理项目可能会减轻这些障碍。然而，对于美国医疗系统中基于互联网的自我护理项目的实施情况知之甚少。
本研究的目的是通过征集医疗服务提供者和管理人员对基于互联网的自我护理项目实施的看法，确定初级保健中基于互联网的自我护理项目使用的实践决定因素。
通过对退伍军人健康管理局的初级保健提供者和管理人员进行半结构化访谈的定性分析来探讨这一目标。采用基于声誉的滚雪球设计确定参与者。访谈重点是确定退伍军人健康管理局初级保健中在护理点使用基于互联网的自我护理项目的实践决定因素。使用主题编码对访谈记录进行定性分析。
共有20名医生、心理学家、社会工作者和护士参与了访谈。在这一组中，基于互联网的自我护理项目的使用率相对较低，但对该平台的支持率相对较高。主题被归纳为在患者和医疗服务提供者层面起作用的决定因素。在患者层面感知到的决定因素包括读写能力、年龄、互联网接入、患者期望、基于互联网的自我护理项目与患者经历的契合度、兴趣和动机以及面对面的人际接触。在医疗服务提供者层面感知到的决定因素包括对基于互联网的自我护理项目的熟悉程度、传统护理方式的改变、面对面的人际接触、相互竞争的需求以及年龄。
对退伍军人健康管理局的医疗服务提供者和管理人员关于基于互联网的自我护理项目实施的观点进行的这项探索揭示了实践的关键决定因素，这些因素可用于制定在初级保健环境中实施基于互联网的自我护理项目的综合策略。
