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消除差距:社会弱势群体采用数字健康干预措施的促进因素和障碍

Stop the Divide: Facilitators and Barriers to Uptake of Digital Health Interventions Among Socially Disadvantaged Populations.

作者信息

Price-Haywood Eboni G, Arnold Connie, Harden-Barrios Jewel, Davis Terry

机构信息

Ochsner-Xavier Institute for Health Equity and Research, New Orleans, LA.

Department of Research, Ochsner Clinic Foundation, New Orleans, LA.

出版信息

Ochsner J. 2023 Spring;23(1):34-42. doi: 10.31486/toj.22.0101.

Abstract

The coronavirus disease 2019 pandemic ushered in rapid adoption of telehealth services. This study examines patient and provider experience and provides recommendations for facilitating the use of digital health interventions among socially disadvantaged populations. This qualitative study was conducted from May to July 2021 via semistructured interviews. Forty patients and 30 primary care providers (PCPs) in Louisiana were recruited within an integrated delivery health system and a rural health center. Technology acceptance models were used to develop a thematic coding scheme. Most patients self-identified as Black (67.5%) and female (72.5%), had a mean age of 51 years, lived in an urban area (76.9%), and had Medicaid (57.9%). Most PCPs were White (79.3%) and male (51.7%), had a mean age of 39 years, and reported Medicaid as the predominant insurer (58.6%). Patient use of smartphones for internet access to health and nonhealth activities was common. PCPs noted the need to address misinformation or misinterpretation of information on the internet. Most patients had used a patient portal (72.5%) and noted the convenience of messaging. PCPs reported large increases in messaging workloads. Most patients had had telemedicine visits (65.6%); however, Wi-Fi/broadband problems limited video visits. PCPs expressed concerns regarding the types of chief complaints that are appropriate for telemedicine visits and reported workflow inefficiencies when clinic sessions had mixed visit types. Patients and PCPs valued remote telemonitoring as adjuncts to care; however, limited service availability and insurance coverage were barriers. Infrastructure barriers (broadband, insurance) and workload imbalance temper enthusiasm for using digital health solutions. Health systems should implement complementary patient and provider user-centric strategies for facilitating uptake of technology.

摘要

2019年冠状病毒病大流行促使远程医疗服务迅速得到采用。本研究调查了患者和医疗服务提供者的体验,并为促进社会弱势群体使用数字健康干预措施提供建议。这项定性研究于2021年5月至7月通过半结构化访谈进行。在一个综合医疗服务体系和一个农村医疗中心招募了路易斯安那州的40名患者和30名初级保健提供者(PCP)。使用技术接受模型制定了一个主题编码方案。大多数患者自我认定为黑人(67.5%)和女性(72.5%),平均年龄为51岁,居住在城市地区(76.9%),并拥有医疗补助(57.9%)。大多数初级保健提供者为白人(79.3%)和男性(51.7%),平均年龄为39岁,并报告医疗补助是主要保险(58.6%)。患者使用智能手机上网获取健康和非健康活动信息很常见。初级保健提供者指出有必要解决互联网上信息的错误信息或误解问题。大多数患者使用过患者门户网站(72.5%),并提到了信息传递的便利性。初级保健提供者报告说信息传递工作量大幅增加。大多数患者进行过远程医疗就诊(65.6%);然而,Wi-Fi/宽带问题限制了视频就诊。初级保健提供者对适合远程医疗就诊的主要症状类型表示担忧,并报告当门诊有混合就诊类型时工作流程效率低下。患者和初级保健提供者重视远程远程监测作为护理的辅助手段;然而,服务可用性有限和保险覆盖不足是障碍。基础设施障碍(宽带、保险)和工作量不平衡削弱了对使用数字健康解决方案的热情。卫生系统应实施以患者和提供者为中心的互补策略,以促进技术的采用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fb0/10016217/cb02fca7fc36/toj-22-0101-figure1.jpg

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