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互联患者项目:迈向基于人群的初级卫生保健研究登记系统。

The connected patient project: moving towards a population-based primary health care research registry.

作者信息

Coe Dorothy, Birt Angela, Forbes Gareth, Ling Jonathan, Foster Michael, Robson Stephen, McDonald Joe, Yiannakou Yan

机构信息

National Institute for Health Research, Clinical Research Network North East North Cumbria, Newcastle Upon Tyne, UK.

Leadgate Medical Practice, Consett, UK.

出版信息

BMC Health Serv Res. 2021 May 31;21(1):533. doi: 10.1186/s12913-021-06486-1.

Abstract

BACKGROUND

The NHS pledges to give all patients access to clinical research. In England, 32% of General Practices are research active and only 14% of patients engage in research. This project aimed to evaluate consent-for-contact and communication in primary care patients.

METHODS

An explanatory mixed methods study of patients and staff within a single general practice. The study included all patients over the age of 18 years, and excluded those on the palliative care register and those unable to give informed consent. The questionnaire asked recipients to indicate their preferred contact method and data-sharing permissions with three organisations: NHS, Universities and Commercial Companies. Survey recipients and staff were invited to take part in a semi-structured interview. Interviews explored project acceptability, feasibility and reasoning behind choices made. Statistical data were triangulated with interview data.

RESULTS

The target patient population was 4678, 24% (n = 1148) responded. Seven hundred and three gave permission for at least one of the organisations to contact them. Older people were more likely to respond than young people, (p < 0.001). There was a trend for more women than men to give permissions however, in the 70 years plus age group this was reversed. Short message service was the preferred method of communication (48% n = 330), but those aged 70 years and over, preferred letter (p = 0.001). Interviews suggested patients felt the project was primarily about improving communication and secondly access to research. Patients trusted the NHS and university researchers. Staff interviewees found the project was less onerous than expected. Barriers to wider rollout included workload and the fragmented nature of NHS digital systems.

CONCLUSIONS

A registry of patients was established; however, the response rate of 24% needs increasing before wider adoption. Health promotion and chronic disease-based research may recruit better when based in primary health care. Older demographics would be more likely to volunteer for research. NHS and academic researchers are trusted, commercial organisations less so. The move to digitalise communication methods has the potential to marginalise older women. Findings were used to drive forward two novel developments: a consent registry (Research+Me) and a federation-wide participant identification process.

摘要

背景

英国国家医疗服务体系(NHS)承诺让所有患者都能参与临床研究。在英格兰,32%的全科诊所积极开展研究,但只有14%的患者参与研究。该项目旨在评估基层医疗患者的接触同意和沟通情况。

方法

在一家单一的全科诊所内对患者和工作人员进行一项解释性混合方法研究。该研究纳入了所有18岁以上的患者,排除了姑息治疗登记册上的患者以及那些无法给予知情同意的患者。问卷要求受访者指出他们与三个组织(NHS、大学和商业公司)首选的联系方法和数据共享权限。调查受访者和工作人员被邀请参加半结构化访谈。访谈探讨了项目的可接受性、可行性以及做出选择背后的理由。统计数据与访谈数据相互印证。

结果

目标患者群体为4678人,24%(n = 1148)做出了回应。703人允许至少一个组织与他们联系。老年人比年轻人更有可能做出回应(p < 0.001)。女性比男性更倾向于给予许可,但在70岁及以上年龄组中情况则相反。短信服务是首选的沟通方式(48%,n = 330),但70岁及以上的人更喜欢信件(p = 0.001)。访谈表明患者认为该项目主要是关于改善沟通,其次是参与研究的机会。患者信任NHS和大学研究人员。接受访谈的工作人员发现该项目比预期的负担要小。推广该项目的障碍包括工作量和NHS数字系统的碎片化性质。

结论

建立了患者登记册;然而,在更广泛采用之前,24%的回应率需要提高。基于初级卫生保健开展健康促进和慢性病研究可能招募效果更好。年龄较大的人群更有可能自愿参与研究。患者信任NHS和学术研究人员,对商业组织的信任度较低。向数字化沟通方式的转变有可能使老年女性边缘化。研究结果被用于推动两项新的发展:一个同意登记册(Research+Me)和全联盟范围内的参与者识别过程。

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