Hansen Anne Helen, Broz Jan, Claudi Tor, Årsand Eirik
Centre for Quality Improvement and Development, University Hospital of North Norway, Tromsø, Norway.
Department of Community Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.
J Med Internet Res. 2018 Nov 7;20(11):e11322. doi: 10.2196/11322.
The prevalence of diabetes and the use of electronic health (eHealth) are increasing. People with diabetes need frequent monitoring and follow-up of health parameters, and eHealth services can be of great value. However, little is known about the association between the use of eHealth and provider-based health care services among people with diabetes.
The objective of this study was to investigate the use of 4 different eHealth platforms (apps, search engines, video services, and social media sites) and associations with the use of provider-based health care visits among people diagnosed with type 1 diabetes mellitus (T1DM).
We used email survey data collected from 1250 members of the Norwegian Diabetes Association (aged 18 to 89 years) in 2018. Eligible for analyses were the 523 respondents with T1DM. Using descriptive statistics, we estimated the use of eHealth and the use of general practitioners (GPs) and somatic specialist outpatient services. By logistic regressions, we studied the associations between the use of these provider-based health services and the use of eHealth, adjusted for gender, age, education, and self-rated health.
Of the sample of 523 people with T1DM, 90.7% (441/486) had visited a GP once or more, and 61.0% (289/474) had visited specialist services during the previous year. Internet search engines (such as Google) were used for health purposes sometimes or often by 84.0% (431/513), apps by 55.4% (285/514), social media (such as Facebook) by 45.2% (232/513), and video services (such as YouTube) by 23.3% (118/506). Participants aged from 18 to 39 years used all forms of eHealth more than people aged 40 years and older, with the exception of social media. The use of search engines was positively associated with the use of somatic specialist services (odds ratio 2.43, 95% CI 1.33-4.45). GP visits were not associated with any kind of eHealth use.
eHealth services are now widely used for health support and health information by people with T1DM, primarily in the form of search engines but often in the form of apps and social media as well. We found a positive association between the use of search engines and specialist visits and that people with T1DM are frequent users of eHealth, GPs, and specialist services. We found no evidence that eHealth reduces the use of provider-based health care; these services seem to be additional rather than alternative. Future research should focus on how health care services can meet and adapt to the high prevalence of eHealth use. Our results also indicate that many patients with T1DM do not visit specialist clinics once a year as recommended. This raises questions about collaboration in health care services and needs to be followed up in future research.
糖尿病的患病率以及电子健康（eHealth）的使用正在增加。糖尿病患者需要频繁监测和跟踪健康参数，而电子健康服务可能具有巨大价值。然而，对于糖尿病患者中电子健康的使用与基于医疗机构的医疗服务之间的关联，我们知之甚少。
本研究的目的是调查4种不同电子健康平台（应用程序、搜索引擎、视频服务和社交媒体网站）的使用情况，以及与1型糖尿病（T1DM）患者使用基于医疗机构的医疗就诊之间的关联。
我们使用了2018年从挪威糖尿病协会1250名成员（年龄在18至89岁之间）收集的电子邮件调查数据。符合分析条件的是523名T1DM受访者。通过描述性统计，我们估计了电子健康的使用情况以及全科医生（GP）和躯体专科门诊服务的使用情况。通过逻辑回归，我们研究了这些基于医疗机构的医疗服务的使用与电子健康使用之间的关联，并对性别、年龄、教育程度和自我评估健康状况进行了调整。
在523名T1DM患者样本中，90.7%（441/486）曾就诊过全科医生一次或多次，61.0%（289/474）在前一年就诊过专科服务。84.0%（431/513）的人有时或经常将互联网搜索引擎（如谷歌）用于健康目的，55.4%（285/514）的人使用应用程序，45.2%（232/513）的人使用社交媒体（如脸书），23.3%（118/506）的人使用视频服务（如YouTube）。18至39岁的参与者使用所有形式的电子健康比40岁及以上的人更多，但社交媒体除外。搜索引擎的使用与躯体专科服务的使用呈正相关（优势比2.43，95%CI 1.33 - 4.45）。全科医生就诊与任何类型的电子健康使用均无关联。
电子健康服务目前被T1DM患者广泛用于健康支持和健康信息获取，主要形式是搜索引擎，但应用程序和社交媒体的使用也很常见。我们发现搜索引擎的使用与专科就诊之间存在正相关，且T1DM患者是电子健康、全科医生和专科服务的频繁使用者。我们没有发现证据表明电子健康会减少基于医疗机构的医疗服务的使用；这些服务似乎是互补而非替代的。未来的研究应关注医疗服务如何满足并适应电子健康使用的高普及率。我们的结果还表明，许多T1DM患者并未按照建议每年就诊专科诊所。这引发了关于医疗服务协作的问题，需要在未来的研究中跟进。
