肝硬化住院患者和护理人员对使用健康信息技术的看法：横断面多中心研究。
Perspectives of Inpatients With Cirrhosis and Caregivers on Using Health Information Technology: Cross-sectional Multicenter Study.
机构信息
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, United States.
McGuire VA Medical Center, Richmond, VA, United States.
出版信息
J Med Internet Res. 2021 Apr 9;23(4):e24639. doi: 10.2196/24639.
BACKGROUND
Health information technology (IT) interventions to decrease readmissions for cirrhosis may be limited by patient-associated factors.
OBJECTIVE
The aim of this study was to determine perspectives regarding adoption versus refusal of health IT interventions among patient-caregiver dyads.
METHODS
Inpatients with cirrhosis and their caregivers were approached to participate in a randomized health IT intervention trial requiring daily contact with research teams via the Patient Buddy app. This app focuses on ascites, medications, and hepatic encephalopathy over 30 days. Regression analyses for characteristics associated with acceptance were performed. For those who declined, a semistructured interview was performed with themes focused on caregivers, protocol, transport/logistics, technology demands, and privacy.
RESULTS
A total of 349 patient-caregiver dyads were approached (191 from Virginia Commonwealth University, 56 from Richmond Veterans Affairs Medical Center, and 102 from Mayo Clinic), 87 of which (25%) agreed to participate. On regression, dyads agreeing included a male patient (odds ratio [OR] 2.08, P=.01), gastrointestinal bleeding (OR 2.3, P=.006), or hepatic encephalopathy admission (OR 2.0, P=.01), whereas opioid use (OR 0.46, P=.03) and alcohol-related etiology (OR 0.54, P=.02) were associated with refusal. Race, study site, and other admission reasons did not contribute to refusing participation. Among the 262 dyads who declined randomization, caregiver reluctance (43%), perceived burden (31%), technology-related issues (14%), transportation/logistics (10%), and others (4%), but not privacy, were highlighted as major concerns.
CONCLUSIONS
Patients with cirrhosis admitted with hepatic encephalopathy and gastrointestinal bleeding without opioid use or alcohol-related etiologies were more likely to participate in a health IT intervention focused on preventing readmissions. Caregiver and study burden but not privacy were major reasons to decline participation. Reducing perceived patient-caregiver burden and improving communication may improve participation.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03564626; https://www.clinicaltrials.gov/ct2/show/NCT03564626.
背景
健康信息技术（IT）干预措施可能会受到患者相关因素的限制，以减少肝硬化患者的再入院率。
目的
本研究旨在确定患者-照护者对子在接受或拒绝健康 IT 干预措施方面的观点。
方法
将肝硬化住院患者及其照护者纳入一项随机健康 IT 干预试验，该试验要求患者通过 Patient Buddy 应用程序每天与研究团队联系，该应用程序专注于腹水、药物和肝性脑病 30 天。对与接受性相关的特征进行回归分析。对于那些拒绝的人，我们对他们进行了半结构化访谈，主题集中在照护者、方案、运输/物流、技术需求和隐私方面。
结果
共对 349 对患者-照护者对子进行了接触（弗吉尼亚联邦大学 191 对，里士满退伍军人事务医疗中心 56 对，梅奥诊所 102 对），其中 87 对（25%）同意参与。在回归分析中，同意的对子包括男性患者（比值比[OR]2.08，P=.01）、胃肠道出血（OR 2.3，P=.006）或肝性脑病入院（OR 2.0，P=.01），而阿片类药物使用（OR 0.46，P=.03）和酒精相关病因（OR 0.54，P=.02）与拒绝参与有关。种族、研究地点和其他入院原因对拒绝参与没有影响。在 262 对拒绝随机分组的对子中，照护者不愿意（43%）、感知负担（31%）、技术相关问题（14%）、运输/物流（10%）和其他问题（4%），但不是隐私问题，是主要关注点。
结论
患有肝硬化且无阿片类药物使用或酒精相关病因的肝性脑病和胃肠道出血患者更有可能参与预防再入院的健康 IT 干预措施。照护者和研究负担而不是隐私是拒绝参与的主要原因。减少患者-照护者的感知负担和改善沟通可能会提高参与度。
试验注册
ClinicalTrials.gov NCT03564626；https://www.clinicaltrials.gov/ct2/show/NCT03564626。
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