College of Nursing, University of Colorado | Anschutz Medical Campus, Aurora, CO, United States.
Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States.
J Med Internet Res. 2021 Feb 25;23(2):e17590. doi: 10.2196/17590.
Management of chronic conditions entails numerous activities in both clinical and daily living settings. Activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily living environments.
The aim of this study is to characterize gaps (from the patient's perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an example. The causes, consequences, and mitigation strategies (reported by patients) were identified to understand these gaps. We conceptualized gaps as latent phenomena (ie, a break in continuity).
Patients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain health care system were recruited. Data were collected through primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data were analyzed qualitatively using a theory-driven approach and framework method of analysis.
The causes of gaps included clinician recommendations not fitting into patients' daily routines, recommendations not fitting into patients' living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised adherence to the therapy plan. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies.
Understanding gaps, their consequences, and mitigating strategies can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health systems and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily living settings due to the limited number and types of routines that are tracked.
慢性病管理需要在临床和日常生活环境中开展大量活动。这些环境中的活动相互作用，如果控制临床环境与复杂的日常生活环境之间存在不一致或脱节，就存在出现差距的巨大可能性。
本研究旨在以抗凝治疗为例，从患者角度描述家庭和临床环境中与健康相关的活动之间的差距（差距）。确定了导致这些差距的原因、后果和缓解策略（由患者报告），以了解这些差距。我们将差距概念化为潜在现象（即连续性中断）。
从城市西部山区医疗系统的抗凝诊所招募了 39 名患者和 4 名医务人员。通过对患者的初步访谈、患者使用平板电脑记录日记、对患者的结束访谈以及对医务人员的访谈收集数据。使用理论驱动的方法和框架分析方法对数据进行定性分析。
差距的原因包括临床医生的建议不符合患者的日常生活规律、建议不符合患者的生活环境以及信息未在不同环境中传递。这些差距的后果包括患者认知和体力工作负荷增加、患者满意度差以及对治疗计划的依从性降低。我们确定了克服这些后果的资源和策略，包括患者生成的策略、常规、协作管理、社会环境以及工具和技术。
了解差距、其后果和缓解策略可以促使开发帮助缩小这些差距的干预措施。此类干预措施可以采取协作式健康信息技术、新颖的患者和医务人员教育计划以及将卫生系统和社区资源紧密结合的方案的形式。由于跟踪的常规数量和类型有限，当前的技术不足以缩小临床和日常生活环境之间的差距。
