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Objectives To determine the impact of tethered personal health record (PHR) use on patient engagement and intermediate health outcomes among patients with coronary artery disease (CAD).
Methods Adult CAD patients ( N = 200) were enrolled in this prospective, quasi-experimental observational study. Each patient received a PHR account and training on...
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A personal health record (PHR) is not only a collection of personal health data but also a personal healthcare and disease management tool for individual patients. Recently, PHRs have been considered indispensable tools for patient engagement in the area of noncommunicable diseases (NCDs) and have gained a special importance. Unfortunately, similar...
Citations
... Six studies reported about the role of educational level regarding portal use or interest in a portal [26,46,47,63,68,95]. Five of these studies reported an association between a higher level of education and interest in or actual use of a portal [26,46,47,68,95]. ...
... Clarke et al [103] reported a significantly higher computer self-efficacy in PHR users than in nonusers, but no difference regarding health literacy. Toscos et al [63] reported no significant difference between users and nonusers regarding internet use and ability to understand internet information. ...
... ,50,63,66,67,98,101,106]. However, 2 studies reported a significant increase in the use of functions such as ordering medications, viewing laboratory results, and a health diary[63,79]. ...
Background:
Patient portals have the potential to improve care for chronically ill patients by engaging them in their treatment. These platforms can work, for example, as a standalone self-management intervention or a tethered link to treatment providers in routine care. Many different types of portals are available for different patient groups, providing various features.
Objective:
This scoping review aims to summarize the current literature on patient portals for patients with diabetes mellitus and chronic heart disease regarding usage behavior and usability.
Methods:
We conducted this review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for scoping reviews. We performed database searches using PubMed, PsycInfo, and CINAHL, as well as additional searches in reviews and reference lists. We restricted our search to 2010. Qualitative and quantitative studies, and studies using both approaches that analyzed usage behavior or usability of patient portals were eligible. We mapped portal features according to broad thematic categories and summarized the results of the included studies separately according to outcome and research design.
Results:
After screening, we finally included 85 studies. Most studies were about patients with diabetes, included patients younger than 65 years, and were conducted in the United States. Portal features were categorized into educational/general information, reminder, monitoring, interactivity, personal health information, electronic/personal health record, and communication. Portals mostly provided educational, monitoring, and communication-related features. Studies reported on usage behavior including associated variables, usability dimensions, and suggestions for improvement. Various ways of reporting usage frequency were identified. A noticeable decline in portal usage over time was reported frequently. Age was most frequently studied in association with portal use, followed by gender, education, and eHealth literacy. Younger age and higher education were often associated with higher portal use. In two-thirds of studies reporting on portal usability, the portals were rated as user friendly and comprehensible, although measurement and reporting were heterogeneous. Portals were considered helpful for self-management through positive influences on motivation, health awareness, and behavioral changes. Helpful features for self-management were educational/general information and monitoring. Barriers to portal use were general (eg, aspects of design or general usability), related to specific situations during portal use (eg, login procedure), or not portal specific (eg, user skills and preferences). Frequent themes were aspects of design, usability, and technology. Suggestions for improvement were mainly related to technical issues and need for support.
Conclusions:
The current state of research emphasizes the importance of involving patients in the development and evaluation of patient portals. The consideration of various research designs in a scoping review is helpful for a deeper understanding of usage behavior and usability. Future research should focus on the role of disease burden, and usage behavior and usability among older patients.
... 37 The association between engagement and portal use provides convincing evidence for the predictive validity of the PHE-8a, as evidence for this association has been mixed in prior research using activation as a proxy for engagement. 38,39 Finally, as healthcare engagement scores increased, there was a proportional increase in the likelihood of better performance on HEDIS quality measures for diabetes and hypertension control and for statin adherence. Prior research has demonstrated improvements in these engagement-sensitive outcomes after VHA primary care redesign, 40 which included organizational and systems-level strategies designed to promote engagement through better access, continuity, and communication. ...
Background
Healthcare engagement is a key measurement target for value-based healthcare, but a reliable and valid patient-reported measure has not yet been widely adopted.Objective
To assess the validity of a newly developed patient-reported measure of healthcare engagement, the 8-item PROMIS Healthcare Engagement (PHE-8a).DesignProspective cohort study of the association between healthcare engagement and quality of care over 1 year. We fit mixed effects models of quality indicators as a function of engagement scores, adjusting for age, race/ethnicity, rural residence, and risk scores.ParticipantsNational stratified random sample of 9552 Veterans receiving Veterans Health Administration care for chronic conditions (hypertension, diabetes) or mental health conditions (depression, post-traumatic stress disorder).Main MeasuresPatient experience: Consumer Assessment of Health Plans and Systems communication and self-management support composites; no-show rates for primary care and mental health appointments; use of patient portal My HealtheVet; and Healthcare Effectiveness Data and Information Set electronic quality measures: HbA1c poor control, controlling high blood pressure, and hyperlipidemia therapy adherence.Key ResultsHigher engagement scores were associated with better healthcare quality across all outcomes, with each 5-point increase (1/2 standard deviation) in engagement scores associated with statistically significant and clinically meaningful gains in quality. Across the continuum of low to high engagement scores, we observed a concomitant reduction in primary care no-show rates of 37% and 24% for mental health clinics; an increased likelihood of My HealtheVet use of 15.4%; and a decreased likelihood of poor diabetes control of 44%.Conclusions
The PHE-8a is a brief, reliable, and valid patient-reported measure of healthcare engagement. These results confirm previously untested hypotheses that patient engagement can promote healthcare quality.
... Boosting self-care and patient involvement in care management have progressively become key components of efforts to enhance health service delivery and care quality for chronic disease (2). Electronic personal health records (ePHRs) offer a tool to empower patients and self-care advocates (3). ...
Introduction
Electronic personal health record (e-PHR) system enables individuals to access their health information and manage it themselves. It helps patient engagement management of health information that is accessed and shared with their healthcare providers using the platform. This improves individual healthcare through the exchange of health information between patients and healthcare providers. However, less is known about e-PHRs among healthcare professionals.
Objective
Therefore, this study aimed to assess Health professionals' Knowledge and attitude and its associated factors toward e-PHR at the teaching hospital in northwest Ethiopia.
Methods
An institution-based cross-sectional study design was used to determine healthcare professionals' knowledge and attitude and their associated factors toward e-PHR systems in teaching hospitals of Amhara regional state, Ethiopia, from 20 July to 20 August 2022. Pretested structured self-administered questionnaires were used to collect the data. Descriptive statistic was computed based on sociodemographic and other variables presented in the form of table graphs and texts. Bivariable and multivariable logistic analyses were performed with an adjusted odds ratio (AOR) and 95% CI to identify predictor variables.
Result
Of the total study participants, 57% were males and nearly half of the respondents had a bachelor's degree. Out of 402 participants, ~65.7% [61–70%] and 55.5% [50–60%] had good knowledge and favorable attitude toward e-PHR systems, respectively. Having a social media account 4.3 [AOR = 4.3, 95% CI (2.3–7.9)], having a smartphone 4.4 [AOR = 4.4, 95% CI (2.2–8.6)], digital literacy 8.8 [(AOR = 8.8, 95% CI (4.6–15.9)], being male 2.7 [AOR = 2.7, 95% CI (1.4–5.0)], and perceived usefulness 4.5 [(AOR = 4.5, 95% CI (2.5–8.5)] were positively associated with knowledge toward e-PHR systems. Similarly, having a personal computer 1.9 [AOR = 1.9, 95% CI (1.1–3.5)], computer training 3.9 [AOR = 3.9, 95% CI (1.8–8.3)], computer skill 19.8 [AOR = 19.8, 95% CI (10.7–36.9)], and Internet access 6.0 [AOR = 6.0, 95% CI (3.0–12.0)] were predictors for attitude toward e-PHR systems.
Conclusion
The findings from the study showed that healthcare professionals have good knowledge and a favorable attitude toward e-PHRs. Providing comprehensive basic computer training to improve healthcare professionals' expectation on the usefulness of e-PHR systems has a paramount contribution to the advancement of their knowledge and attitude toward successfully implementing e-PHRs.
... Studies report, for example, that under certain conditions, portals indeed contribute to higher adherence to treatment and engagement in care, as well as a decrease in office visits and direct clinical outcomes such as hospital readmissions. 2,15,16 When it comes to physicians 1 , a variety of attitudes toward portals have been documented. Some studies highlight outright resistance to portals, while others find more ambivalent views, reporting that physicians appreciate some portal functionality but remain apprehensive about their effects on patients' emotions and physicians' workloads. ...
Existing studies on patient data portals are informative with respect to the patient and physician perspectives, yet relatively little attention has been paid to the role of developers. This case study focuses on how developers view the meaning and purpose of patient portals and how their perspective differs from that of physicians. The findings show that developers and physicians have different views on whether and how the portals can help achieve transparency, efficiency, and patient empowerment. This misalignment emerges because each group makes sense of the portal through a different frame of how they see patient data, medical work, and patient behavior. The study also finds that developers cope with the frame differences by engaging in practices of coproducing, bypassing, and reframing. The implication of the study is that technological frame analysis needs to incorporate the growing complexity and institutional character of modern technology, the diversity of target groups it serves, and their corresponding frames. The study also suggests that developers, instead of being seen as mere operational IT support, may need to be seen as strategically important actor groups for healthcare organizations-since their practices matter for the strategic agenda of transforming healthcare into a more patient-centric practice.
... For example, studies have found that patients who use web-based patient portals for diabetes had improved glycemic control (Lau et al., 2014;Osborn et al., 2010). Use of electronic health records has been shown to improve patient activation and empowerment among HIV (Crouch et al., 2015) and cardiac patients (Toscos et al., 2016). However, only a few studies have assessed the effectiveness of different mobile app components on enhancing engagement and, consequently, on improving health outcomes. ...
Adequate adherence is a necessary condition for success with any intervention, including for computerized cognitive training designed to mitigate age-related cognitive decline. Tailored prompting systems offer promise for promoting adherence and facilitating intervention success. However, developing adherence support systems capable of just-in-time adaptive reminders requires understanding the factors that predict adherence, particularly an imminent adherence lapse. In this study we built machine learning models to predict participants’ adherence at different levels (overall and weekly) using data collected from a previous cognitive training intervention. We then built machine learning models to predict adherence using a variety of baseline measures (demographic, attitudinal, and cognitive ability variables), as well as deep learning models to predict the next week's adherence using variables derived from training interactions in the previous week. Logistic regression models with selected baseline variables were able to predict overall adherence with moderate accuracy (AUROC: 0.71), while some recurrent neural network models were able to predict weekly adherence with high accuracy (AUROC: 0.84-0.86) based on daily interactions. Analysis of the post hoc explanation of machine learning models revealed that general self-efficacy, objective memory measures, and technology self-efficacy were most predictive of participants’ overall adherence, while time of training, sessions played, and game outcomes were predictive of the next week's adherence. Machine-learning based approaches revealed that both individual difference characteristics and previous intervention interactions provide useful information for predicting adherence, and these insights can provide initial clues as to who to target with adherence support strategies and when to provide support. This information will inform the development of a technology-based, just-in-time adherence support systems.
... For instance, greater patient activation in their health care improved patient adherence to treatment prescriptions. 5 Participants' use of web portals to augment treatment of diabetes demonstrated improved glycemic control across multiple studies. [6][7][8] Other studies have seen improvements in participants with HIV, 9 with coronary artery disease, 10 and with depression, [11][12][13] highlighting how impactful the implementation of these tools can be across different clinical populations. ...
Background
Despite the growing popularity of mobile app interventions, specific engagement components of mobile apps have not been well studied.
Methods
The objectives of this scoping review are to determine which components of mobile health intervention apps encouraged or hindered engagement, and examine how studies measured engagement.
Results
A PubMed search on March 5, 2020 yielded 239 articles that featured the terms engagement, mobile app/mobile health, and adult. After applying exclusion criteria, only 54 studies were included in the final analysis.
Discussion
Common app components associated with increased engagement included: personalized content/feedback, data visualization, reminders/push notifications, educational information/material, logging/self-monitoring functions, and goal-setting features. On the other hand, social media integration, social forums, poor app navigation, and technical difficulties appeared to contribute to lower engagement rates or decreased usage. Notably, the review revealed a great variability in how engagement with mobile health apps is measured due to lack of established processes.
Conclusion
There is a critical need for controlled studies to provide guidelines and standards to help facilitate engagement and its measurement in research and clinical trial work using mobile health intervention apps.
... In one study of 200 patients with coronary artery disease, hemoglobin A1c (HbA1c) levels improved significantly (À0.19%) in the active and super user groups at 6 months over a 12-month period. 23 However, this improvement was not found at 12 months and other physiologic measures (cholesterol, blood pressure [BP], body mass index) did not improve at either 6 or 12 months. Another study of 453 hypertensive patients found that among portal users, the most active users had greater reductions in diastolic BP (À5.25 mm Hg) compared with patients using the portal less frequently. ...
Objective:
The study sought to investigate whether consistent use of the Veterans Health Administration's My HealtheVet (MHV) online patient portal is associated with improvement in diabetes-related physiological measures among new portal users.
Materials and methods:
We conducted a retrospective cohort study of new portal users with type 2 diabetes that registered for MHV between 2012 and 2016. We used random-effect linear regression models to examine associations between months of portal use in a year (consistency) and annual means of the physiological measures (hemoglobin A1c [HbA1c], low-density lipoproteins [LDLs], and blood pressure [BP]) in the first 3 years of portal use.
Results:
For patients with uncontrolled HbA1c, LDL, or BP at baseline, more months of portal use in a year was associated with greater improvement. Compared with 1 month of use, using the portal 12 months in a year was associated with annual declines in HbA1c of -0.41% (95% confidence interval [CI], -0.46% to -0.36%) and in LDL of -6.25 (95% CI, -7.15 to -5.36) mg/dL. Twelve months of portal use was associated with minimal improvements in BP: systolic BP of -1.01 (95% CI, -1.33 to -0.68) mm Hg and diastolic BP of -0.67 (95% CI, -0.85 to -0.49) mm Hg. All associations were smaller or not present for patients in control of these measures at baseline.
Conclusions:
We found consistent use of the patient portal among new portal users to be associated with modest improvements in mean HbA1c and LDL for patients at increased risk at baseline. For patients with type 2 diabetes, self-management supported by online patient portals may help control HbA1c, LDL, and BP.
... 27,28 In addition, patient portals were found to improve self-reported levels of engagement, knowledge or activation related to self-management, [29][30][31] improve engagement in care and caregiver-provider communication, 32 improve recovery scores, and reduce hospital admissions. 33 However, some studies did not find statistical effect of patient portals on health outcomes. 19,[34][35][36][37] Several research papers emphasized the importance of sharing clinical notes with patients via the patient portal. ...
Patient access to their own electronic health records (EHRs) is likely to become an integral part of healthcare systems worldwide. It has the potential to decrease the healthcare provision costs, improve access to healthcare data, self-care, quality of care, and health and patient-centered outcomes. This systematic literature review is aimed at identifying the impact in terms of benefits and issues that have so far been demonstrated by providing patients access to their own EHRs, via providers’ secure patient portals from primary healthcare centers and hospitals. Searches were conducted in PubMed, MEDLINE, CINHAL, and Google scholar. Over 2000 papers were screened and were filtered based on duplicates, then by reading the titles and finally based on their abstracts or full text. In total, 74 papers were retained, analyzed, and summarized. Papers were included if providing patient access to their own EHRs was the primary intervention used in the study and its impact or outcome was evaluated. The search technique used to identify relevant literature for this paper involved input from five experts. While findings from 54 of the 74 papers showed positive outcome or benefits of patient access to their EHRs via patient portals, 10 papers have highlighted concerns, 8 papers have highlighted both and 2 have highlighted absence of negative outcomes. The benefits range from re-assurance, reduced anxiety, positive impact on consultations, better doctor–patient relationship, increased awareness and adherence to medication, and improved patient outcomes (e.g., improving blood pressure and glycemic control in a range of study populations). In addition, patient access to their health information was found to improve self-reported levels of engagement or activation related to self-management, enhanced knowledge, and improve recovery scores, and organizational efficiencies in a tertiary level mental health care facility. However, three studies did not find any statistically significant effect of patient portals on health outcomes. The main concerns have been around security, privacy and confidentiality of the health records, and the anxiety it may cause amongst patients. This literature review identified some benefits, concerns, and attitudes demonstrated by providing patients’ access to their own EHRs. This access is often part of government strategies when developing patient-centric self-management elements of a sustainable healthcare system. The findings of this review will give healthcare providers a framework to analyze the benefits offered by promoting patient access to EHRs and decide on the best approach for their own specialties and clinical setup. A robust cost-benefit evaluation of such initiatives along with its impact on major stakeholders within the healthcare system would be essential in understanding the overall impact of such initiatives. Implementation of patient access to their EHRs could help governments to appropriately prioritize the development or adoption of national standards, whilst taking care of local variations and fulfilling the healthcare needs of the population, e.g., UK Government is aiming to make full primary care records available online to every patient. Ultimately, increasing transparency and promoting personal responsibility are key elements of a sustainable healthcare system for future generations.
... However, the results of four studies [29][30][31][32] showed no changes in the life and health condition of patients following access to the PHR. ...
Introduction:
The personal health record (PHR) makes it possible for patients to access, manage, track, and share their health information. By engaging patients in chronic disease care, they will be active members in decision-making and healthcare management.
Objectives:
This study aimed to identify the functions and outcomes of PHR for patients with four major groups of chronic diseases (cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases).
Method:
A systematic review was conducted on studies published in PubMed, Scopus, Web of Science, and Embase. Searching and screening were performed using the keyword of "Personal Health Record" without time limitation, and ended in August 2018.
Results:
In total, 3742 studies were retrieved, 35 of which met the inclusion criteria. Out of these 35, 18 studies were conducted in the United States, 24 studies were related to patients with diabetes, and 32 studies focused on tethered PHRs. Moreover, in 25 studies, the function of viewing and reading medical records and personal health information was provided for three groups of chronic patients. Results showed that the use of PHRs helps the management and control of chronic diseases (10 studies).
Conclusion:
It is recommended that integrated PHRs with comprehensive functions and features were designed in order to support patient independence and empowerment in self-management, decrease the number of referrals to health centers, and reduce the costs imposed on families and society.
... Of the 9 studies included in this review, 4 were qualitative studies [37][38][39][40], 2 were RCTs [41,42], 2 were mixed methods studies [43,44], and 1 was a quasi-experimental controlled study [45]. Overall, 8 studies were conducted in the United States [37][38][39][40][41][42]44,45], whereas 1 was a multinational study conducted in Western Europe [43]. ...
... Of the 9 studies included in this review, 4 were qualitative studies [37][38][39][40], 2 were RCTs [41,42], 2 were mixed methods studies [43,44], and 1 was a quasi-experimental controlled study [45]. Overall, 8 studies were conducted in the United States [37][38][39][40][41][42]44,45], whereas 1 was a multinational study conducted in Western Europe [43]. All 9 studies included in this systematic review were published between 2015 and 2019. ...
... The sample size of the studies ranged considerably, with qualitative studies ranging from 24 to 44 participants [37][38][39][40] and the RCTs ranging from 50 to 272 participants [41][42][43]. The mixed methods study ranged from 88 (47 for the focus group and 41 for the pilot trial) [43] to 123 participants (23 for the focus group and 100 for the phone survey) [44], whereas the quasi-experimental study had 200 participants [45]. In addition, 4 studies evaluated the attitudes and experiences of older adults with patient portals [38,39,44,45], 2 studies tested web-based apps developed to deliver condition-specific (eg, cancer, cardiovascular disease) interventions [37,43], 1 study tested a user interface for a home health website [40], 1 tested a web-based decision aid [42], and 1 tested a theory-based patient portal training program [41]. ...
Background
Cancer is a disease that predominantly affects older adults, and several organizations recommend the completion of a geriatric assessment to help with cancer treatment decision-making. Owing to a shortage of geriatric teams and the vast number of older adults diagnosed with cancer each year, a web-based geriatric assessment may improve access to geriatric assessment for older adults. We systematically reviewed the literature to obtain the latest evidence for the design of our web-based geriatric assessment tool Comprehensive Health Assessment for My Plan.
Objective
This review aimed to probe the following questions: what is the impact of providing health test results to older adults in a web-based environment without the presence of a health care provider for patient-centered outcomes, including satisfaction, perceived harm, empowerment, quality of life, and health care use (eg, hospitalization, physician visits, emergency room visits, and costs), and what recommendations do older adults and developers have for designing future apps or websites for older adults?
Methods
This systematic review was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement. Studies were limited to publications in English that examined a web-based tool that provided test results to older adults (aged ≥65 years) without the presence of a health care provider. A health sciences librarian performed the search on November 29, 2019, on the following electronic databases: MEDLINE, Embase, CINAHL, PsycINFO, and the Cochrane Library. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool Version 2018. The findings are summarized narratively and in tabular format.
Results
A total of 26,898 titles and abstracts were screened by 2 independent reviewers, of which 94 studies were selected for a full-text review, and 9 studies were included in this review. There were only 2 randomized controlled trials of high quality that explored the effects of receiving health care results on the web via eHealth tools for older adults or provided evidence-based recommendations for designing such tools. Older adults were generally satisfied with receiving screening results via eHealth tools, and several studies suggested that receiving health screening results electronically improved participants’ quality of life. However, user interfaces that were not designed with older adults in mind and older adults’ lack of confidence in navigating eHealth tools proved challenging to eHealth uptake and use. All 9 studies included in this systematic review made recommendations on how to design eHealth tools that are intuitive and useful for older adults.
Conclusions
eHealth tools should incorporate specific elements to ensure usability for older adults. However, more research is required to fully elucidate the impact of receiving screening and results via eHealth tools without the presence of a health care provider for patient-centered outcomes in this target population.
