Hubbard School of Journalism and Mass Communication, University of Minnesota, Twin Cities, Minneapolis, MN, United States.
Department of Communication, Seoul National University, Gwanak-gu, Seoul, Republic of Korea.
J Med Internet Res. 2024 Nov 25;26:e50476. doi: 10.2196/50476.
Patient-centered communication refers to interaction between patients and health professionals that considers patients' preferences and empowers patients to contribute to their own care. Research suggests that patient-centered communication promotes patients' satisfaction with care, trust in physicians, and competence in their abilities to manage their health.
The study aims to explore the role of patients' use of electronic health records (EHRs) in promoting patient-centered communication. Specifically, we investigated how health information efficacy mediates the association of EHR use with patient-centered communication and whether and how the relationship between EHR use and health information efficacy varies according to patients' perceived social support levels.
We conducted mediation and multigroup analyses using nationally representative data from the Health Information National Trends Survey 5 cycle 1 conducted in the United States (N=3285). Among respondents, we analyzed those who received care from health professionals over the previous year (2823/3285, 85.94%).
EHR use by patients was associated with high levels of health information efficacy (unstandardized coefficient=0.050, SE 0.024; P=.04). In turn, health information efficacy was positively related to patient-centered communication (unstandardized coefficient=0.154, SE 0.024; P<.001). The indirect pathway from EHR use to patient-centered communication, mediated by health information efficacy, was statistically significant (unstandardized coefficient=0.008, SE 0.004; P=.04). Among patients with high social support (2349/2823, 83.21%), EHR use was not significantly associated with health information efficacy (unstandardized coefficient=0.038, SE 0.026; P=.15), although health information efficacy was linked to high levels of patient-centered communication (unstandardized coefficient=0.151, SE 0.030; P<.001). The indirect relationship in this group was not significant (unstandardized coefficient=0.006, SE 0.004; P=.11). However, among those with low social support (474/2823, 16.79%), EHR use was positively associated with health information efficacy (unstandardized coefficient=0.155, SE 0.048; P=.001), which in turn relates to high levels of patient-centered communication (unstandardized coefficient=0.137, SE 0.050; P=.01). The indirect pathway was also significant (unstandardized coefficient=0.021, SE 0.010; P=.03).
Patients who use EHRs may build health information efficacy, which seems to promote communication between patients and health care providers. This indirect pathway was not detected among patients with high social support. However, among those with low social support, EHR use seems to enhance health information efficacy, which may in turn facilitate patient-centered communication. Given the nature of the dataset used, the findings of this study are more relevant to the United States than other contexts.
以患者为中心的沟通是指患者与卫生专业人员之间的互动，考虑到患者的偏好，并赋予患者为自己的护理做出贡献的能力。研究表明，以患者为中心的沟通可以提高患者对护理的满意度、对医生的信任度以及他们管理自己健康的能力。
本研究旨在探讨患者使用电子健康记录（EHR）在促进以患者为中心的沟通中的作用。具体来说，我们调查了健康信息效能如何在 EHR 使用与以患者为中心的沟通之间起中介作用，以及 EHR 使用与健康信息效能之间的关系是否以及如何根据患者感知的社会支持水平而变化。
我们使用美国全国代表性数据（Health Information National Trends Survey 5 cycle 1）进行中介和多组分析（N=3285）。在受访者中，我们分析了过去一年接受卫生专业人员护理的人群（2823/3285，85.94%）。
患者使用 EHR 与高水平的健康信息效能相关（未标准化系数=0.050，SE 0.024；P=.04）。反过来，健康信息效能与以患者为中心的沟通呈正相关（未标准化系数=0.154，SE 0.024；P<.001）。通过健康信息效能中介的 EHR 使用到以患者为中心的沟通的间接途径具有统计学意义（未标准化系数=0.008，SE 0.004；P=.04）。在高社会支持（2349/2823，83.21%）的患者中，EHR 使用与健康信息效能无显著关联（未标准化系数=0.038，SE 0.026；P=.15），尽管健康信息效能与高水平的以患者为中心的沟通相关（未标准化系数=0.151，SE 0.030；P<.001）。该组的间接关系不显著（未标准化系数=0.006，SE 0.004；P=.11）。然而，在低社会支持（474/2823，16.79%）的患者中，EHR 使用与健康信息效能呈正相关（未标准化系数=0.155，SE 0.048；P=.001），这反过来又与高水平的以患者为中心的沟通相关（未标准化系数=0.137，SE 0.050；P=.01）。间接途径也具有统计学意义（未标准化系数=0.021，SE 0.010；P=.03）。
使用 EHR 的患者可能会建立健康信息效能，这似乎可以促进患者与医疗保健提供者之间的沟通。在高社会支持的患者中未发现这种间接途径。然而，在低社会支持的患者中，EHR 使用似乎增强了健康信息效能，这可能进而促进以患者为中心的沟通。鉴于使用的数据集的性质，本研究的结果与美国比其他环境更相关。
