Background
Methods
The e-Vita project
System and content of the PHR
Feature | Explanation |
---|---|
Insight in health-related measurements | Users of the PHR for T2DM were able to see an overview (both textually and graphically) of a selection of T2DM-related health measurements from the past years, as performed at the annual check-up. A short explanation of each item was provided to support the participants with the interpretation of the values. |
Education | All three PHRs contained disease- and lifestyle-related education. |
Coaching | The PHRs for T2DM and COPD offer the users the possibility to add health-related goals, action plans and evaluations of these action plans. The PHR for CHF did not contain this function. The coaching function of the T2DM PHR was based on existing theories for behavior change, literature research and previous experiences and described elsewhere [25] . |
Monitoring | CHF patients received equipment to monitor their weight, blood pressure, and heart rate on a daily basis (or individually adjusted in concordance with the heart failure nurse). When the monitored values were outside the pre-determined range or when no measurements were recorded, HF nurses received an alert and could subsequently contact the participant to possibly adjust the (medical) treatment. Patients with T2DM could track their health values using their own equipment (e.g., weight, blood pressure, waist circumference). Users with COPD could track their complaints and receive an advice on whether or not to consult their care provider. Furthermore, COPD users could regularly complete the Clinical COPD Questionnaire (CCQ) [31] to gain insight into the development of their clinical complaints. |
Medication and co-morbidities | Users with CHF were asked to complete a list of medication and co-morbidities and to keep this list up-to-date. For the HF nurses, this overview could serve as an extra tool for the interpretation of deviating measurements. |
Messaging | The COPD PHR contained an overview of caregivers with a service for sending and receiving messages to the caregivers. |
Mixed methods study
Data | Quan/Qual | Goal |
---|---|---|
Log data | Quan | Gaining insight into how the PHRs were actually used on the long term by patients with T2DM, CHF, or COPD (exposure or dose) |
Focus groups | Qual | Assessing how T2DM caregivers believe that the use of a PHR by patients adds value to their working routines (the intended use or program differentiation) |
Interviews | Qual | Understanding the differences and similarities between the intended and actual use of the PHRs from the caregiver perspective (quality of delivery) |
Usability tests | Qual | Understanding the differences and similarities between the intended and actual use of the PHRs from the patient perspective (potential responsiveness) |
Log data
Focus groups
Interviews and usability tests
Results
Log data analysis
Number of sessions
The services used
The use over time
Focus groups
Interview study
Topic | Example |
---|---|
Training and guidance | ‘Yes, that was not really difficult. The PHR, seeing health values, it is not very difficult.’ |
‘… No idea how I had to work, so we sat with the manual next to the patient, we went through it step by step. But then the patient also had enough of it, no matter how positively you started it, at some point you notice your own frustration.’ | |
‘It was still vague what exactly we had to do and what was expected from us.’ | |
‘Well, after training you still need to try it yourself and look at the platform and the PowerPoint again. You need to show initiative by yourself, otherwise it is difficult.’ | |
Compatibility with other systems | ‘At this time, we work with three different systems: the PHR, our own EHR, and the telemonitoring system. We constantly need to switch between these three systems, that is just difficult. It is just not workable that way.’ |
‘It should be user-friendly. You should not have four systems in which you have to fill the same information.’ | |
‘We must keep track of two systems, which is time consuming, it is not possible to have a link between the PHR and the EHR at the same time’ | |
Integration in daily care routines | ‘I must honestly say that we forget to look at the PHR. That is also because it is not in your daily routine.’ |
‘I don’t feel like going to look there every day, but maybe once every month to take a look at what I can improve and how. | |
Use by patients | ‘They are often also excited but in practice they still do not use it.’ |
‘Because he did not fill in the medication and co-morbidities, while we clearly stated during inclusion, that they had to fill in so we could take it into account when health values deviate. The first person did not do it, the second neither, then you fall back on your own system.’ | |
Usability | ‘There were a lot of things in this platform, that did not work. In addition, it was not really an enchanting site and especially in this hospital very slow. We did not really work with the PHR, I must say.’ |
‘You can see recent values, and the last 2 weeks. That is also a limitation, because sometimes you want to see for a longer term.’ | |
Communication via PHR | ‘Implement a certain learning element. For example, that the system indicates: ‘You have now gained two pounds, do you think that the care giver should take action or are you capable to do something on your own?’ |
‘For example, a digital contact with the patient. Especially with younger patients, or people who are used to e-mail. Contact them via this way.’ |