在初级保健机构中与老年人在线共享门诊数字录音的可行性：一项多中心试验。
The feasibility of sharing digital audio-recordings of clinic visits online with older adults in primary care settings: A multisite trial.
作者信息
Barr Paul J, Masel Meredith, Bratches Reed W, Carpenter-Song Elizabeth, O'Malley A James, Bruce Martha L, Goodwin James S, Kripalani Sunil, Tarczewski Susan, Williams Sonya, Ortiz Isamar, Wright Adam, Raji Mukaila A, Hong Hyunouk, Goyal Parul M, Cavanaugh Kerri L
机构信息
The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; The Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
Oliver Center for Patient Safety and Quality Healthcare, The University of Texas Medical Branch, Galveston, TX, USA; Department of Population Health & Health Disparities, UTMB School of Public & Population Health, Galveston, TX, USA; Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA.
出版信息
Patient Educ Couns. 2025 Feb;131:108574. doi: 10.1016/j.pec.2024.108574. Epub 2024 Nov 29.
OBJECTIVE
The objective of this trial was to determine the feasibility, acceptability, and preliminary effectiveness of sharing audio recordings of primary care visits with older adults with multimorbidity.
METHODS
We used a two-arm, randomized, controlled, feasibility trial with 3-month follow-up. Patients aged ≥ 65 years-with diabetes and hypertension-were recruited from academic primary care settings in New Hampshire, Tennessee, and Texas. Patients were randomized to receive online access to audio recordings of scheduled visits for three-months or care as usual (after visit summaries). Primary outcomes were acceptability and feasibility assessed using several indicators: acceptabilityrecruitment of 90 patients; recording use; and the Appropriateness of Intervention Measure (AIM; >3), feasibility- retention rate; protocol adherence; and the Feasibility of Intervention Measure (FIM; >3). Interviews were conducted with clinicians (n = 14) and patients (n = 19). Exploratory outcomes included patient activation, satisfaction, adherence, and quality of life.
RESULTS
We met recruitment (n = 91) and retention (98 %) targets and exceeded feasibility (Median FIM 4; IQR 3 - 4) and acceptability (Median AIM 4; IQR 3 - 4) metrics. Fidelity to protocol was high (92 %), and 40 of 45 patients (85 %) accessed their recordings. Interviewees noted the benefits of visit recording, including greater recall, understanding, and family engagement. Recording had little perceived impact on the visit interaction, and concerns about visit recording were minimal. Exploratory outcomes revealed better PROMIS Mental Health Scores for patients receiving Audio compared to Usual Care at 3 months: 51.5 (SD 7.7) vs. 47.7 (SD 9.9), P = 0.04.
CONCLUSIONS
Sharing visit recordings online with older adults is feasible and acceptable. A larger trial is needed to determine the impact of sharing recordings on patient health outcomes.
PRACTICE IMPLICATIONS
Recording is a highly scalable approach to supporting older adults and their care partners in managing care. Advances in natural language processing may unlock further opportunities for this innovative strategy.
目的
本试验的目的是确定与患有多种疾病的老年人分享初级保健就诊录音的可行性、可接受性和初步有效性。
方法
我们采用双臂随机对照可行性试验，并进行3个月的随访。年龄≥65岁且患有糖尿病和高血压的患者从新罕布什尔州、田纳西州和得克萨斯州的学术初级保健机构招募。患者被随机分配接受为期三个月的在线访问预定就诊录音或照常护理（在就诊总结之后）。主要结局通过几个指标评估可接受性和可行性：可接受性——招募90名患者；录音使用情况；以及干预措施适宜性量表（AIM；>3），可行性——保留率；方案依从性；以及干预措施可行性量表（FIM；>3）。对临床医生（n = 14）和患者（n = 19）进行了访谈。探索性结局包括患者激活、满意度、依从性和生活质量。
结果
我们达到了招募（n = 91）和保留（98%）目标，并超过了可行性（FIM中位数4；四分位距3 - 4）和可接受性（AIM中位数4；四分位距3 - 4）指标。方案依从性很高（92%），45名患者中有40名（85%）访问了他们的录音。受访者指出了就诊录音的好处，包括更好的回忆、理解和家庭参与。录音对就诊互动的感知影响很小，对就诊录音的担忧也很少。探索性结局显示，与常规护理相比，接受录音的患者在3个月时的PROMIS心理健康评分更高：51.5（标准差7.7）对47.7（标准差9.9），P = 0.04。
结论
与老年人在线分享就诊录音是可行且可接受的。需要进行更大规模的试验来确定分享录音对患者健康结局的影响。
实践意义
录音是一种高度可扩展的方法，可用于支持老年人及其护理伙伴管理护理。自然语言处理的进展可能为这一创新策略带来更多机会。
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