Department of Family Medicine, Winchester Hospital, Winchester, MA, United States.
Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States.
JMIR Form Res. 2024 Aug 29;8:e56332. doi: 10.2196/56332.
Persons with multiple chronic conditions face complex medical regimens and clinicians may not focus on what matters most to these patients who vary widely in their health priorities. Patient Priorities Care is a facilitator-led process designed to identify patients' priorities and align decision-making and care, but the need for a facilitator has limited its widespread adoption.
The aims of this study are to design and test mechanisms for patients to complete a self-directed process for identifying priorities and providing their priorities to clinicians.
The study involved patients of at least 65 years of age at 2 family medicine practices with 5 physicians each. We first tested 2 versions of an interactive website and asked patients to bring their results to their visit. We then tested an Epic previsit questionnaire derived from the website's questions and included standard previsit materials. We completed postintervention phone interviews and an online survey with participating patients and collected informal feedback and conducted a focus group with participating physicians.
In the test of the first website version, 17.3% (35/202) of invited patients went to the website, 11.4% (23/202) completed all of the questions, 2.5% (5/202) brought results to their visits, and the median session time was 43.0 (IQR 28.0) minutes. Patients expressed confusion about bringing results to the visit. After clarifying that issue in the second version, 15.1% (32/212) of patients went to the website, 14.6% (31/212) completed the questions, 1.9% (4/212) brought results to the visit, and the median session time was 35.0 (IQR 35.0) minutes. In the test of the Epic questionnaire, 26.4% (198/750) of patients completed the questionnaire before at least 1 visit, and the median completion time was 14.0 (IQR 23.0) minutes. The 8 main questions were answered 62.9% (129/205) to 95.6% (196/205) of the time. Patients who completed questionnaires were younger than those who did not (72.3 vs 76.1 years) and were more likely to complete at least 1 of their other assigned questionnaires (99.5%, 197/198) than those who did not (10.3%, 57/552). A total of 140 of 198 (70.7%) patients responded to a survey, and 86 remembered completing the questionnaire; 78 (90.7%) did not remember having difficulty answering the questions and 57 (68.7%) agreed or somewhat agreed that it helped them and their clinicians to understand their priorities. Doctors noted that the sickest patients did not complete the questionnaire and that the discussion provided a good segue into end-of-life care.
Embedding questionnaires assaying patient priorities into patient portals holds promise for expanding access to priorities-concordant care.
患有多种慢性病的患者面临着复杂的医疗方案，临床医生可能不会关注这些患者的需求，因为他们的健康优先事项差异很大。患者优先护理是一种由协调员主导的流程，旨在确定患者的优先事项，并协调决策和护理，但协调员的需求限制了其广泛采用。
本研究旨在设计并测试患者自行完成确定优先事项并向临床医生提供其优先事项的自我指导流程的机制。
该研究涉及 2 家家庭医学诊所的至少 65 岁的患者，每家诊所各有 5 名医生。我们首先测试了 2 个版本的交互式网站，并要求患者将其结果带到就诊时。然后，我们测试了源自网站问题的 Epic 就诊前问卷，并包括了标准就诊前材料。我们对参与患者进行了就诊后电话访谈和在线调查，并收集了非正式反馈意见，还对参与医生进行了焦点小组讨论。
在第一个网站版本的测试中，受邀患者中有 17.3%（202 人中有 35 人）访问了网站，11.4%（202 人中有 23 人）完成了所有问题，2.5%（202 人中有 5 人）将结果带到就诊时，中位会话时间为 43.0（IQR 28.0）分钟。患者在就诊时带来结果方面存在困惑。在第二个版本中澄清了这一问题后，有 15.1%（212 人中有 32 人）的患者访问了网站，14.6%（212 人中有 31 人）完成了问题，1.9%（212 人中有 4 人）将结果带到就诊时，中位会话时间为 35.0（IQR 35.0）分钟。在 Epic 问卷的测试中，有 26.4%（750 人中有 198 人）的患者在至少 1 次就诊前完成了问卷，中位完成时间为 14.0（IQR 23.0）分钟。8 个主要问题的回答率为 62.9%（205 人中有 129 人）至 95.6%（205 人中有 196 人）。完成问卷的患者比未完成问卷的患者更年轻（72.3 岁 vs 76.1 岁），并且更有可能完成至少 1 份其他指定问卷（99.5%，197/198），而未完成问卷的患者则为 10.3%（552 人中有 57 人）。在 198 名患者中，共有 140 名（70.7%）对调查做出了回应，其中 86 名患者记得完成了问卷；78 名（90.7%）患者表示回答问题没有困难，57 名（68.7%）患者表示问卷有助于他们和他们的临床医生了解他们的优先事项。医生指出，最病重的患者没有完成问卷，而且讨论为临终关怀提供了一个很好的切入点。
将评估患者优先事项的问卷嵌入患者门户中，有望扩大优先事项一致的护理的机会。
