Khoong Elaine C, Wong Jeanette, Garcia Faviola, Olazo Kristan, Miles Mahal, Zeng Billy, Lyles Courtney R, Sarkar Urmimala
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94110, United States.
Division of Clinical Informatics and Digital Transformation, Department of Medicine, University of California, San Francisco, San Francisco, CA 94110, United States.
J Am Med Inform Assoc. 2025 Aug 1;32(8):1276-1285. doi: 10.1093/jamia/ocaf079.
To characterize patient and clinician perceived barriers and facilitators to using electronic patient-generated data (PGD) in safety-net systems.
We conducted 43 semi-structured interviews (18 clinicians and 25 patients) and observed 15 patient-clinician interactions. Clinical observations were conducted in an integrated urban safety-net system. Patients who spoke English, Spanish, or Cantonese were recruited from this system. Pharmacists, nurses, and clinicians treating chronic diseases were sampled from multiple California safety-net systems. Interview guides were developed based on the Consolidated Framework for Implementation Research (CFIR) and the Behavior Change Wheel (BCW). We conducted thematic analysis through a combination of inductive and deductive coding.
Themes most frequently identified by both clinicians and patients as impacting electronic PGD use were capability-related (knowledge about collecting and using PGD), motivation-related (preference for data sharing; attitude toward digital tools and learning how to use them; the importance of measuring the outcome for health; privacy; and patient-clinician relationship), and opportunity-related (social support). Non-English speakers expressed concerns about inconveniencing others. Clinicians also identified additional opportunity-related themes (resource availability; implementation process; external incentives).
Despite the growth in electronic PGD and its potential to improve chronic disease care and outcomes, implementation in safety-net systems would benefit from consideration of capability, motivation, and opportunity-related barriers.
PGD is an increasingly vital part of clinical care. If implementation is pursued without concurrently addressing factors at the patient, clinician, health system, and policy levels, barriers to adoption will persist, especially in under-resourced settings.
描述患者和临床医生所感知到的在安全网系统中使用电子患者生成数据（PGD）的障碍和促进因素。
我们进行了43次半结构化访谈（18名临床医生和25名患者），并观察了15次患者与临床医生的互动。临床观察在一个城市综合安全网系统中进行。从该系统中招募说英语、西班牙语或粤语的患者。从加利福尼亚州多个安全网系统中抽取治疗慢性病的药剂师、护士和临床医生作为样本。访谈指南是基于实施研究综合框架（CFIR）和行为改变轮（BCW）制定的。我们通过归纳编码和演绎编码相结合的方式进行主题分析。
临床医生和患者最常提到的影响电子PGD使用的主题与能力相关（关于收集和使用PGD的知识）、与动机相关（对数据共享的偏好；对数字工具的态度以及学习如何使用它们；衡量健康结果的重要性；隐私；以及患者与临床医生的关系）和与机会相关（社会支持）。非英语使用者担心给他人带来不便。临床医生还确定了其他与机会相关的主题（资源可用性；实施过程；外部激励）。
尽管电子PGD有所增长，且有改善慢性病护理和结果的潜力，但在安全网系统中的实施将受益于对与能力、动机和机会相关的障碍的考虑。
PGD在临床护理中越来越重要。如果在实施过程中不同时解决患者、临床医生、卫生系统和政策层面的因素，采用的障碍将持续存在，尤其是在资源不足的环境中。
