Download Your Doctor: Implementation of a Digitally Mediated Personal Physician Presence to Enhance Patient Engagement With a Health-Promoting Internet Application

Lygidakis, Charilaos; Wallace, Paul; Tersar, Costanza; Marcatto, Francesco; Ferrante, Donatella; Vedova, Roberto Della; Scafuri, Francesca; Scafato, Emanuele; Struzzo, Pierluigi

doi:10.2196/resprot.5232

Cited by 11 publications

(12 citation statements)

References 51 publications

(55 reference statements)

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“…Furthermore, our participants agree that the holistic needs of patients with chronic illness demand technologies that facilitate a person-based rather than disease-based model of care [ 4 ]. Tools such as online patient diaries that bring the patient experience closer to the HCP [ 7 , 8 ] have the potential to help create the conditions for office visits to incorporate the relational ethics of person-centered care into practice by creating the space for a more effective meaningful exchange of information and negotiation and support of behavior change between patients and HCPs. Some of the frustrations with systems, such as electronic medical records that were not integrated across institutional boundaries, or worries about being inundated with requests if electronic communications were opened up to patients suggest an element of moral distress.…”

Section: Discussionmentioning

confidence: 99%

“…For example, in a study of patient-physician communication through a Web-based eHealth portal, patients had the opportunity to create and share narratives outside of the allotted time of their consultations, and these narratives helped physicians develop a better understanding of their patients’ situations [ 7 ]. In a study on the use of a digitally mediated personal physician presence online, it was found that both patients and HCPs welcomed using the platform and benefited from Web-based interaction [ 8 ]. Lygidakis et al identified that HCPs’ perceived barriers to use were usually dispelled upon becoming familiar with the tools and suggest that training is key to addressing this issue [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…In a study on the use of a digitally mediated personal physician presence online, it was found that both patients and HCPs welcomed using the platform and benefited from Web-based interaction [ 8 ]. Lygidakis et al identified that HCPs’ perceived barriers to use were usually dispelled upon becoming familiar with the tools and suggest that training is key to addressing this issue [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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eHealth Technologies, Multimorbidity, and the Office Visit: Qualitative Interview Study on the Perspectives of Physicians and Nurses

Macdonald¹,

Townsend²,

Adam³

et al. 2018

J Med Internet Res

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BackgroundeHealth is a broad term referring to the application of information and communication technologies in the health sector, ranging from health records to telemedicine and multiple forms of health education and digital tools. By providing increased and anytime access to information, opportunities to exchange experiences with others, and self-management support, eHealth has been heralded as transformational. It has created a group of informed, engaged, and empowered patients as partners, equipped to take part in shared decision making and effectively self-manage chronic illness. Less attention has been given to health care professionals’ (HCPs) experiences of the role of eHealth in patient encounters.ObjectiveThe objective of this study was to examine HCPs’ perspectives on how eHealth affects their relationships with patients living with multiple chronic conditions, as well as its ethical and practical ramifications.MethodsWe interviewed HCPs about their experiences with eHealth and its impact on the office visit. Eligible participants needed to report a caseload of ≥25% of patients with multimorbidity to address issues of managing complex chronic conditions and coordination of care. We used a semistructured discussion guide for in-depth interviews, and follow-up interviews served to clarify and expand upon initial discussions. Constant comparisons and a narrative approach guided the analyses, and a relational ethics conceptual lens was applied to the data to identify emergent themes.ResultsA total of 12 physicians and nurses (6 male, 6 female; median years of practice=13) participated. eHealth tools most frequently described were Web-based educational resources for patients and Web-based resources for HCPs such as curated scientific summaries on diagnostic criteria, clinical therapies, and dosage calculators. Analysis centered on a grand theme of the two-way conversation between HCPs and patients, which addresses a general recentering of the ethical relationship between HCPs and patients around engagement. Subthemes explain the evolution of the two-way conversation, and having, using, and supporting the two-way conversation with patients, primarily as this relates to achieving adherence and health outcomes.ConclusionsEmerging ethical concerns were related to the ambiguity of the ideal of empowered patients and the ways in which health professionals described enacting those ideals in practice, showing how the cultural shift toward truly mutually respectful and collaborative practice is in transition. HCPs aim to act in the best interests of their patients; the challenge is to benefit from emergent technologies that may enhance patient-HCP interactions and effective care, while abiding by regulations, dealing with the strictures of the technology itself, and managing changing demands on their time.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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eHealth Technologies, Multimorbidity, and the Office Visit: Qualitative Interview Study on the Perspectives of Physicians and Nurses

Macdonald¹,

Townsend²,

Adam³

et al. 2018

J Med Internet Res

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“…These were available at four key points in the programme, and included options to customise written text, add photographs and insert audio/video recorded messages. 18 An example of a screenshot of tailored feedback with GP personalisation is shown in figure 1 .…”

Section: Methodsmentioning

confidence: 99%

Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website

et al. 2017

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BackgroundBrief interventions (BIs) delivered in primary care have been shown to be effective in reducing risky drinking, but implementation is limited. Facilitated access to a digital application offers a novel alternative to face-to-face intervention, but its relative effectiveness is unknown.MethodsPrimary care-based, non-inferiority, randomised controlled trial comparing general practitioner (GP) facilitated access to an interactive alcohol reduction website (FA) with face-to-face BI for risky drinking. Patients screening positive on the short Alcohol Use Disorders Identification Test (AUDIT-C) were invited to participate in the trial. Assessment at baseline, 3 months and 12 months was carried out using AUDIT and EQ-5D-5L questionnaires.Findings58 participating GPs approached 9080 patients of whom 4529 (49.9%) logged on, 3841 (84.8%) undertook screening, 822 (21.4%) screened positive and 763 (19·9%) were recruited. 347 (45.5%) were allocated to FA and 416 (54.5%) to BI. At 3 months, subjects in FA group with an AUDIT score of ≥8 reduced from 95 (27.5%) to 85 (26.8%) while those in BI group increased from 123 (20.6%) to 141 (37%). Differences between groups were principally due to responses to AUDIT question 10. Analysis of primary outcome indicated non-inferiority of FA compared with BI, and prespecified subgroup analysis indicated benefits for older patients and those with higher levels of computer literacy and lower baseline severity. Additional analyses undertaken to take account of bias in response to AUDIT question 10 failed to support non-inferiority within the prespecified 10% boundary.InterpretationPrespecified protocol-driven analyses of the trial indicate that FA is non-inferior to BI; however, identified bias in the outcome measure and further supportive analyses question the robustness of this finding. It is therefore not possible to draw firm conclusions from this trial, and further research is needed to determine whether the findings can be replicated using more robust outcome measures.Trial registration number NCT01638338; Results.

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“…In the vast scientific literature on telemedicine systems, we have found only a few reports of systems that use data and information coming directly from patients [ 22 - 27 ], although several systems, as for example Philips’ eCareCompanion and eCareCoordinator [ 28 ], are now moving on to collecting this information through tablets or smartphones [ 29 , 30 ]. Surely researchers are exploring the implications of how and when these subjective data are collected, their utility for effective monitoring, and, more relevant from our point of view, whether there is a quality control process for this subjective information and how it works, but results have not reached the publication stage.…”

Section: Introductionmentioning

confidence: 99%

Web Health Monitoring Survey: A New Approach to Enhance the Effectiveness of Telemedicine Systems

Romano

Sardella²,

Alboni³

2016

JMIR Res Protoc

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BackgroundAging of the European population and interest in a healthy population in western countries have contributed to an increase in the number of health surveys, where the role of survey design, data collection, and data analysis methodology is clear and recognized by the whole scientific community. Survey methodology has had to couple with the challenges deriving from data collection through information and communications technology (ICT). Telemedicine systems have not used patients as a source of information, often limiting them to collecting only biometric data. A more effective telemonitoring system would be able to collect objective and subjective data (biometric parameters and symptoms reported by the patients themselves), and to control the quality of subjective data collected: this goal be achieved only by using and merging competencies from both survey methodology and health research.ObjectiveThe objective of our study was to propose new metrics to control the quality of data, along with the well-known indicators of survey methodology. Web questionnaires administered daily to a group of patients for an extended length of time are a Web health monitoring survey (WHMS) in a telemedicine system.MethodsWe calculated indicators based on paradata collected during a WHMS study involving 12 patients, who signed in to the website daily for 2 months.ResultsThe patients’ involvement was very high: the patients’ response rate ranged between 1.00 and 0.82, with an outlier of 0.65. Item nonresponse rate was very low, ranging between 0.0% and 7.4%. We propose adherence to the chosen time to connect to the website as a measure of involvement and cooperation by the patients: the difference from the median time ranged between 11 and 24 minutes, demonstrating very good cooperation and involvement from all patients. To measure habituation to the questionnaire, we also compared nonresponse rates to the items between the first and the second month of the study, and found no significant difference. We computed the time to complete the questionnaire both as a measure of possible burden for patient, and to detect the risk of automatic responses. Neither of these hypothesis was confirmed, and differences in time to completion seemed to depend on health conditions. Focus groups with patients confirmed their appreciation for this “new” active role in a telemonitoring system.ConclusionsThe main and innovative aspect of our proposal is the use of a Web questionnaire to virtually recreate a checkup visit, integrating subjective (patient’s information) with objective data (biometric information). Our results, although preliminary and if need of further study, appear promising in proposing more effective telemedicine systems. Survey methodology could have an effective role in this growing field of research and applications.

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Download Your Doctor: Implementation of a Digitally Mediated Personal Physician Presence to Enhance Patient Engagement With a Health-Promoting Internet Application

Cited by 11 publications

References 51 publications

eHealth Technologies, Multimorbidity, and the Office Visit: Qualitative Interview Study on the Perspectives of Physicians and Nurses

eHealth Technologies, Multimorbidity, and the Office Visit: Qualitative Interview Study on the Perspectives of Physicians and Nurses

Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website

Web Health Monitoring Survey: A New Approach to Enhance the Effectiveness of Telemedicine Systems

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