Mollestad Maria Aadland, Jensen Annesofie Lunde, Holmen Heidi, Singstad Tone, Årsand Eirik, Winther Jacob Andreas, Torbjørnsen Astrid
Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Postboks 4, St Olavs plass, Oslo, 0130, Norway, +4767235266.
SDCA-Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
JMIR Hum Factors. 2025 Jul 8;12:e70301. doi: 10.2196/70301.
With the increasing prevalence of type 1 diabetes alongside limited health care resources, the need for more sustainable health care services is apparent. Central to ensuring the standard of diabetes care while simultaneously optimizing resource utilization is improved patient-clinician communication and the provision of individualized care. Digital outpatient solutions incorporating patient-reported outcome measures (PROMs) have been introduced in diabetes outpatient care over recent years; however, features and delivery methods differ, and existing studies on their use and perceived clinical value are limited. Furthermore, clinicians' acceptance has been suggested as a key factor in the sustainability of digital solutions. Thus, to support the implementation of digital outpatient solutions perceived as valuable by clinicians and patients, we need more knowledge about how they are accepted and utilized in clinical practice.
This study investigates how clinicians and patients with type 1 diabetes accept and utilize a digital outpatient solution to support individualized care in the context of full-scale implementation at a diabetes specialist outpatient clinic. Furthermore, we aim to explore the synchronous interaction between patients and clinicians when they are allowed to prepare through the filling and reviewing of asynchronous PROMs before consultations.
This qualitative study uses interpretive description as a methodological approach. The digital outpatient solution features various components, including PROM questionnaires, asynchronous chat, remote consultations, e-learning, and information distribution. Data were collected through semistructured interviews with 10 clinicians and 20 patients with type 1 diabetes and observations of consultations. The data from the patient and clinician interviews (267 A4 pages) were analyzed separately before being jointly analyzed in the context of the findings from the observations (40 A4 pages).
Our analysis resulted in the following three main themes that describe the interplay between clinicians' and patients' acceptance, utilization, and perceived clinical value of a digital outpatient solution: (1) clinicians' acceptance of the digital outpatient solution influences patients' acceptance, (2) variations in the use of different features influence the extent of individualized care, and (3) clinicians' and patients' utilization influences perceived care efficiency and quality. Those who demonstrated higher acceptance and more extensive utilization reported that the solution was more valuable in enhancing individualized care efficiency and quality.
This study highlights the interplay between clinicians' and patients' acceptance, utilization, and perceived clinical value of a digital outpatient solution in diabetes specialist outpatient care. Our findings suggest that when clinicians and patients understand why and how digital solutions are used, such solutions can enhance care efficiency and quality, contributing to sustainable health care. Future research should aim to gain an in-depth understanding of clinicians' and patients' acceptance, as well as the effectiveness of change management strategies when implementing digital outpatient solutions in diabetes specialist outpatient care.
随着1型糖尿病患病率的不断上升以及医疗保健资源的有限，对更可持续的医疗保健服务的需求显而易见。在确保糖尿病护理标准的同时优化资源利用的核心是改善患者与临床医生之间的沟通以及提供个性化护理。近年来，糖尿病门诊护理中引入了包含患者报告结局指标（PROMs）的数字门诊解决方案；然而，其功能和交付方式各不相同，关于其使用和感知临床价值的现有研究有限。此外，临床医生的接受度被认为是数字解决方案可持续性的关键因素。因此，为了支持实施临床医生和患者认为有价值的数字门诊解决方案，我们需要更多关于它们在临床实践中如何被接受和利用的知识。
本研究调查了1型糖尿病临床医生和患者如何接受和利用数字门诊解决方案，以在糖尿病专科门诊全面实施的背景下支持个性化护理。此外，我们旨在探索患者和临床医生在会诊前通过填写和审查异步PROMs进行准备时的同步互动。
本定性研究采用解释性描述作为方法论方法。数字门诊解决方案具有各种组件，包括PROM问卷、异步聊天、远程会诊、电子学习和信息分发。通过对10名临床医生和20名1型糖尿病患者进行半结构化访谈以及观察会诊来收集数据。在结合观察结果（40页A4纸）进行联合分析之前，分别对患者和临床医生访谈的数据（267页A4纸）进行分析。
我们的分析得出以下三个主要主题，描述了临床医生和患者对数字门诊解决方案的接受、利用和感知临床价值之间的相互作用：（1）临床医生对数字门诊解决方案的接受影响患者的接受，（2）不同功能的使用差异影响个性化护理的程度，（3）临床医生和患者的利用影响感知的护理效率和质量。那些表现出更高接受度和更广泛利用率的人报告说，该解决方案在提高个性化护理效率和质量方面更有价值。
本研究强调了糖尿病专科门诊护理中临床医生和患者对数字门诊解决方案的接受、利用和感知临床价值之间的相互作用。我们的研究结果表明，当临床医生和患者理解数字解决方案为何以及如何使用时，此类解决方案可以提高护理效率和质量，有助于实现可持续的医疗保健。未来的研究应旨在深入了解临床医生和患者的接受度，以及在糖尿病专科门诊护理中实施数字门诊解决方案时变革管理策略的有效性。
