Integrating an internet-mediated walking program into family medicine clinical practice: a pilot feasibility study

Abstract

BackgroundRegular participation in physical activity can prevent many chronic health conditions. Computerized self-management programs are effective clinical tools to support patient participation in physical activity. This pilot study sought to develop and evaluate an online interface for primary care providers to refer patients to an Internet-mediated walking program called Stepping Up to Health (SUH) and to monitor participant progress in the program.MethodsIn Phase I of the study, we recruited six pairs of physicians and medical assistants from two family practice clinics to assist with the design of a clinical interface. During Phase II, providers used the developed interface to refer patients to a six-week pilot intervention. Provider perspectives were assessed regarding the feasibility of integrating the program into routine care. Assessment tools included quantitative and qualitative data gathered from semi-structured interviews, surveys, and online usage logs.ResultsIn Phase I, 13 providers used SUH and participated in two interviews. Providers emphasized the need for alerts flagging patients who were not doing well and the ability to review participant progress. Additionally, providers asked for summary views of data across all enrolled clinic patients as well as advertising materials for intervention recruitment. In response to this input, an interface was developed containing three pages: 1) a recruitment page, 2) a summary page, and 3) a detailed patient page. In Phase II, providers used the interface to refer 139 patients to SUH and 37 (27%) enrolled in the intervention. Providers rarely used the interface to monitor enrolled patients. Barriers to regular use of the intervention included lack of integration with the medical record system, competing priorities, patient disinterest, and physician unease with exercise referrals. Intention-to-treat analyses showed that patients increased walking by an average of 1493 steps/day from pre- to post-intervention (t = (36) = 4.13, p < 0.01).ConclusionsProviders successfully referred patients using the SUH provider interface, but were less willing to monitor patient compliance in the program. Patients who completed the program significantly increased their step counts. Future research is needed to test the effectiveness of integrating SUH with clinical information systems over a longer evaluation period.

A Systematic Review of Clinician and Staff Views on the Acceptability of Incorporating Remote Monitoring Technology into Primary Care

“…Although clinicians noted that the graphical display of patients' walking progress was informative, they found it inconvenient that data were not integrated into their EHR. 16 The extra time required to locate the Web site, remember passwords, and log-in as well as lack of time for physical activity discussions during patient visits presented barriers to using the interface. Langstrup 20 had patients with asthma record daily peak flow readings in an online diary that could be accessed by healthcare personnel.…”

“…11,16,17,[19][20][21][22][23][25][26][27] Three studies were conducted in the United States, 11,16,19 one in Canada, 21 one in Denmark, 20 two in Germany, 22,23 and one in Korea, 25 and two studies in the United Kingdom were published in three reports. 17,26,27 Clinicians in several studies conveyed positive views about RMT, and some reported RMT resulted in a decrease in workload due to delegation of activities to ancillary staff.…”

“…Clinicians expressed unfavorable views of RMT use in two studies. 16,20 Goodrich et al 16 studied an intervention in which sedentary adult patients wore a pedometer for 6 weeks and uploaded data to a Web-based system accessible by patients and clinicians. Although clinicians noted that the graphical display of patients' walking progress was informative, they found it inconvenient that data were not integrated into their EHR.…”

“…16,[19][20][21][22][23] Four studies published in five reports provided perspectives from clinical specialties including but not limited to primary care. 11,17,[25][26][27] Seven studies reported perspectives from primary care staff, administrators, or unspecified healthcare professionals.…”

“…1). 11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Six studies provided perspectives from primary care…”