荷兰通过个人健康记录让患者获取全科医疗记录的使用情况及效果：一项混合方法研究的方案

Use and Effects of Patient Access to Medical Records in General Practice Through a Personal Health Record in the Netherlands: Protocol for a Mixed-Methods Study.

作者信息

Vreugdenhil Maria Mt, Kool Rudolf B, van Boven Kees, Assendelft Willem Jj, Kremer Jan Am

机构信息

Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.

Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.

出版信息

JMIR Res Protoc. 2018 Sep 21;7(9):e10193. doi: 10.2196/10193.

DOI:10.2196/10193

PMID:30249593

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6231730/

Abstract

BACKGROUND

In the Dutch health care system, general practitioners hold a central position. They store information from all health care providers who are involved with their patients in their electronic health records. Web-based access to the summary record in general practice through a personal health record (PHR) may increase patients' insight into their medical conditions and help them to be involved in their care.

OBJECTIVE

We describe the protocol that we will use to investigate the utilization of patients' digital access to the summary of their medical records in general practice through a PHR and its effects on the involvement of patients in their care.

METHODS

We will conduct a multilevel mixed-methods study in which the PHR and Web-based access to the summary record will be offered for 6 months to a random sample of 500 polypharmacy patients, 500 parents of children aged <4 years, and 500 adults who do not belong to the former two groups. At the patient level, a controlled before-after study will be conducted using surveys, and concurrently, qualitative data will be collected from focus group discussions, think-aloud observations, and semistructured interviews. At the general practice staff (GP staff) level, focus group discussions will be conducted at baseline and Q-methodology inquiries at the end of the study period. The primary outcomes at the patient level are barriers and facilitators for using the PHR and summary records and changes in taking an active role in decision making and care management and medication adherence. Outcomes at the GP staff level are attitudes before and opinions after the implementation of the intervention. Patient characteristics and changes in outcomes related to patient involvement during the study period will be compared between the users and nonusers of the intervention using chi-square tests and t tests. A thematic content analysis of the qualitative data will be performed, and the results will be used to interpret quantitative findings.

RESULTS

Enrollment was completed in May 2017 and the possibility to view GP records through the PHR was implemented in December 2017. Data analysis is currently underway and the first results are expected to be submitted for publication in autumn 2019.

CONCLUSIONS

We expect that the findings of this study will be useful to health care providers and health care organizations that consider introducing the use of PHR and Web-based access to records and to those who have recently started using these.

TRIAL REGISTRATION

Netherlands Trial Registry NTR6395; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6395 (Archived by WebCite at http://www.webcitation.org/71nc8jzwM).

REGISTERED REPORT IDENTIFIER

RR1-10.2196/10193.

摘要

背景

在荷兰医疗保健系统中，全科医生占据核心地位。他们将与患者相关的所有医疗保健提供者的信息存储在其电子健康记录中。通过个人健康记录（PHR）基于网络访问全科医疗中的摘要记录，可能会增强患者对自身病情的了解，并帮助他们参与自身护理。

目的

我们描述了将用于调查患者通过PHR数字访问其全科医疗病历摘要的利用率及其对患者参与自身护理的影响的方案。

方法

我们将进行一项多层次混合方法研究，其中将向500名多重用药患者、500名4岁以下儿童的父母以及500名不属于前两组的成年人的随机样本提供PHR和基于网络访问摘要记录，为期6个月。在患者层面，将使用调查问卷进行前后对照研究，同时，将从焦点小组讨论、出声思考观察和半结构化访谈中收集定性数据。在全科医疗工作人员（全科医生工作人员）层面，将在基线时进行焦点小组讨论，并在研究期结束时进行Q方法调查。患者层面的主要结局是使用PHR和摘要记录的障碍与促进因素，以及在决策制定、护理管理和药物依从性方面积极参与的变化。全科医生工作人员层面的结局是干预实施前后的态度和意见。将使用卡方检验和t检验比较干预使用者和非使用者之间的患者特征以及研究期间与患者参与相关的结局变化。将对定性数据进行主题内容分析，结果将用于解释定量研究结果。