Irfan Khan Anum, Gill Ashlinder, Cott Cheryl, Hans Parminder Kaur, Steele Gray Carolyn
Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
JMIR Mhealth Uhealth. 2018 Aug 28;6(8):e171. doi: 10.2196/mhealth.8593.
Given the complex and evolving needs of individuals with multimorbidity, the adoption of mHealth tools to support self-management efforts is increasingly being explored, particularly in primary care settings. The electronic patient-reported outcomes (ePRO) tool was codeveloped with patients and providers in an interdisciplinary primary care team in Toronto, Canada, to help facilitate self-management in community-dwelling adults with multiple chronic conditions.
The objective of study is to explore the experience and expectations of patients with multimorbidity and their providers around the use of the ePRO tool in supporting self-management efforts.
We conducted a 4-week pilot study of the ePRO tool. Patients' and providers' experiences and expectations were explored through focus groups that were conducted at the end of the study. In addition, thematic analyses were used to assess the shared and contrasting perspectives of patients and providers on the role of the ePRO tool in facilitating self-management. Coded data were then mapped onto the Individual and Family Self-Management Theory using the framework method.
In this pilot study, 12 patients and 6 providers participated. Both patients and providers emphasized the need for a more explicit recognition of self-management context, including greater customizability of content to better adapt to the complexity and fluidity of self-management in this particular patient population. Patients and providers highlighted gaps in the extent to which the tool enables self-management processes, including how limited progress toward self-management goals and the absence of direct provider engagement through the ePRO tool inhibited patients from meeting their self-management goals. Providers highlighted proximal outcomes based on their experience of the tool and specifically, they indicated that the tool offered valuable insights into the broader patient context, which helps to inform the self-management approach and activities they recommend to patients, whereas patients recognized the tool's potential in helping to improve access to different providers in a team-based primary care setting.
This study identifies a more explicit recognition of the contextual factors that influence patients' ability to self-manage and greater adaptability to accommodate patient complexity and provider workflow as next steps in refining the ePRO tool to better support self-management efforts in primary care ahead of its application in a full-scale randomized pragmatic trial.
鉴于患有多种疾病的个体的复杂且不断变化的需求，人们越来越多地探索采用移动健康工具来支持自我管理工作，尤其是在初级保健环境中。电子患者报告结局（ePRO）工具是与加拿大多伦多一个跨学科初级保健团队中的患者和提供者共同开发的，旨在帮助社区居住的患有多种慢性病的成年人进行自我管理。
本研究的目的是探讨患有多种疾病的患者及其提供者在使用ePRO工具支持自我管理工作方面的经验和期望。
我们对ePRO工具进行了为期4周的试点研究。通过在研究结束时进行的焦点小组探讨了患者和提供者的经验与期望。此外，采用主题分析来评估患者和提供者对ePRO工具在促进自我管理中的作用的共同和不同观点。然后使用框架方法将编码数据映射到个人和家庭自我管理理论上。
在这项试点研究中，有12名患者和6名提供者参与。患者和提供者都强调需要更明确地认识自我管理背景，包括内容的更大可定制性，以更好地适应这一特定患者群体自我管理的复杂性和流动性。患者和提供者强调了该工具在实现自我管理过程方面存在的差距，包括在实现自我管理目标方面进展有限，以及通过ePRO工具缺乏提供者的直接参与如何阻碍患者实现其自我管理目标。提供者根据他们对该工具的体验强调了近端结局，具体而言，他们表示该工具提供了有关更广泛患者背景的宝贵见解，这有助于为他们向患者推荐的自我管理方法和活动提供信息，而患者认识到该工具在基于团队的初级保健环境中有助于改善与不同提供者联系的潜力。
本研究确定，在将ePRO工具完善以更好地支持初级保健中的自我管理工作并随后应用于全面随机实用试验之前，下一步需要更明确地认识影响患者自我管理能力的背景因素，并提高适应性以适应患者的复杂性和提供者的工作流程。
