Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Pediatrics (S Allende-Richter, KP Gray, F Bourgeois) Harvard Medical School, Boston, Mass.
Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Community Health (AD Benitez, M Ramirez), Tufts University, Boston, Mass.
Acad Pediatr. 2023 Aug;23(6):1252-1258. doi: 10.1016/j.acap.2023.02.003. Epub 2023 Feb 9.
Failure to transfer care to adult medicine is associated with gaps in health care access and poor health outcomes among young adults. We examined whether a patient portal educational intervention is acceptable and can improve adolescent and young adult (AYA) self-management skills toward transition readiness to adult care.
We conducted a single site feasibility study using a mixed research method consisting of 1) a patient portal one-on-one educational intervention with pre- and postsurveys adapted from the Transition Readiness Assessment Questionnaire to assess participant self-management skills and portal user activity; 2) portal user experience was assessed through semistructured interviews until thematic saturation was reached. Study participants were 13 to 25 years old and received care at an academic-affiliated community pediatric clinic. Descriptive statistics were used to describe participant characteristics, paired t tests, or Wilcoxon signed-rank tests to assess outcomes of survey response changes pre- versus postintervention.
Sixty percent of enrolled participants (N = 78) completed the surveys. Following the educational intervention, we observed an increase in participants self-reporting knowing how to access their protected health information P < .0001, (95%, confidence interval [CI], 1-2) and in the proportion of participants self-reporting to strongly agree to know their medication P = .025 (95%, CI 0-1). We also observed an increase in portal user access at 3 weeks; the median number of logins was 2 per participant (range 1-36, P < .0001). The Portal user experience was strongly positive.
Our patient portal educational intervention suggests that AYAs welcome a patient portal to access protected health information and is associated with an increase in the proportion of participants self-reporting to strongly agree with knowing their medication. While these results are encouraging, this is a quasiexperimental study designed on the frame of feasibility. Our study was not adequately powered, limiting our findings' significance. Future interventions would benefit from a larger sample size with a comparison group to ascertain the effect of a patient portal on self-management skills in a diverse AYA population and inform best practices.
未能将医疗服务转至成人医学领域与年轻人在获得医疗服务和健康结果方面存在的差距有关。我们研究了患者门户教育干预措施是否具有可接受性，以及是否可以提高青少年和年轻成年人（AYA）的自我管理技能，使其为向成人护理过渡做好准备。
我们进行了一项单站点可行性研究，使用混合研究方法，包括：1）使用从过渡准备评估问卷改编而来的患者门户一对一教育干预措施，包括前后调查，以评估参与者的自我管理技能和门户用户活动；2）通过半结构化访谈评估门户用户体验，直到达到主题饱和。研究参与者年龄在 13 至 25 岁之间，在一家学术附属社区儿科诊所接受治疗。使用描述性统计数据来描述参与者特征，使用配对 t 检验或 Wilcoxon 符号秩检验来评估干预前后调查反应变化的结果。
60%（78 名）入组的参与者完成了调查。在教育干预措施之后，我们观察到参与者自我报告的能够访问其受保护健康信息的比例有所增加（P<0.0001，95%置信区间[CI]，1-2），并且报告强烈同意了解其药物的参与者比例有所增加（P=0.025，95%CI，0-1）。我们还观察到在 3 周时门户用户访问量增加；每位参与者的登录中位数为 2 次（范围为 1-36，P<0.0001）。门户用户体验非常积极。
我们的患者门户教育干预措施表明，AYA 欢迎使用患者门户来访问受保护的健康信息，并且与报告强烈同意了解其药物的参与者比例增加有关。虽然这些结果令人鼓舞，但这是一项基于可行性框架的准实验研究。我们的研究没有足够的效力，限制了我们研究结果的意义。未来的干预措施将受益于更大的样本量和对照组，以确定患者门户对不同 AYA 人群自我管理技能的影响，并为最佳实践提供信息。
