Schick-Makaroff Kara, Klarenbach Scott, Kwon Jae-Yung, Cohen S Robin, Czupryn Joanna, Lee Loretta, Pauly Robert, MacRae Jennifer M, Forde Bruce, Sawatzky Richard
Faculty of Nursing, University of Alberta, 4-116 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada.
Division of Nephrology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
Ther Adv Chronic Dis. 2023 Jun 12;14:20406223231173624. doi: 10.1177/20406223231173624. eCollection 2023.
Patient-reported outcomes (PROs) are increasingly mandated in kidney care to incorporate patients' perspectives.
We assessed whether educational support for clinicians using electronic (e)PROs could enhance person-centered care.
A process evaluation, using a mixed methods longitudinal comparative concurrent design was undertaken of educational support to clinicians on routine use of ePROs. In two urban home dialysis clinics in Alberta, Canada, patients completed ePROs. At the implementation site, clinicians were provided with ePROs and clinician-oriented education via voluntary workshops. At the non-implementation site, neither were provided. Person-centered care was measured using the Patient Assessment of Chronic Illness Care-20 (PACIC-20).
Longitudinal structural equation models (SEMs) compared change in overall PACIC scores. The interpretive description approach, using thematic analysis of qualitative data, further evaluated processes of implementation.
Data were collected from questionnaires completed by 543 patients, 4 workshops, 15 focus groups, and 37 interviews. There was no overall difference in person-centered care throughout the study, including after delivery of workshops. The longitudinal SEMs revealed substantial individual-level variability in overall PACIC trajectories. However, there was no improvement at the implementation site and no difference between the sites during both the pre- and post-workshop periods. Similar results were obtained for each PACIC domain. Qualitative analysis provided insights into why there was no substantial difference between sites: (1) clinicians wanted to see kidney symptoms, not quality of life, (2) workshops were tailored to clinicians' educational needs, not patients' needs, and (3) variable use of ePRO data by clinicians.
Training clinicians on use of ePROs is complex and likely only part of what is required to enhance person-centered care.
NCT03149328. https://clinicaltrials.gov/ct2/show/NCT03149328.
在肾脏护理中，患者报告结局（PROs）越来越多地被要求纳入患者的观点。
我们评估了对使用电子（e）PROs的临床医生的教育支持是否能加强以患者为中心的护理。
采用混合方法纵向比较并行设计对临床医生进行关于ePROs常规使用的教育支持进行过程评估。在加拿大艾伯塔省的两家城市家庭透析诊所，患者完成ePROs。在实施地点，通过自愿参加的研讨会为临床医生提供ePROs和以临床医生为导向的教育。在非实施地点，两者均未提供。使用慢性病护理患者评估-20（PACIC-20）来衡量以患者为中心的护理。
纵向结构方程模型（SEMs）比较了PACIC总分的变化。采用定性数据主题分析的解释性描述方法进一步评估实施过程。
收集了543名患者填写的问卷、4次研讨会、15个焦点小组和37次访谈的数据。在整个研究过程中，包括研讨会结束后，以患者为中心的护理没有总体差异。纵向SEMs显示PACIC总体轨迹在个体层面存在很大差异。然而，实施地点没有改善，在研讨会前和后期间，两个地点之间也没有差异。每个PACIC领域都得到了类似的结果。定性分析揭示了为什么两个地点之间没有实质性差异的原因：（1）临床医生想看肾脏症状，而不是生活质量；（2）研讨会是根据临床医生的教育需求而非患者需求量身定制的；（3）临床医生对ePRO数据的使用存在差异。
对临床医生进行ePROs使用培训很复杂，可能只是加强以患者为中心护理所需的一部分。
NCT03149328。https://clinicaltrials.gov/ct2/show/NCT03149328。
