6 research outputs found

    The challenge of involving elderly patients in primary care by using an electronic communication tool with their professionals: a mixed methods study

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    Background: Elderly patients in primary care often have multiple health problems,with different healthcare professionals involved. For consistency in care, it is required that communication amongst professionals and patient-systems (patient and informal-carers) be well tuned. Electronic-communication can make it easier for patient-system to be active in care.Objective: To examine whether an e-communication tool (Congredi) designed for professionals, including a care plan and secure e-mail, is usable for patient-systems and what their experiences are.Methods: In a multi-method study, home-dwelling elderly patients with two or more professionals were invited to use Congredi; data were gathered from the system after 42 weeks. Also semi-structured interviews were undertaken with patient-systems with topics retrieved from literature. Analysis took place by two researchers independently; the themes were extracted together by consensus.Results: Data about actual use of the tool were gathered from 22 patients. Four profiles of Congredi-users were distinguished, varying in intensity of use. Data from  interviews with members of patient-systems (n = 7) showed that they were motivated and able to use Congredi. Barriers in daily use were limited participation of professionals, unanswered e-mail and not being alerted about actions. Despite limitations, patient-systems retained their motivation.Conclusion: Congredi was usable for patient-systems. The barriers found seem not to be tool-related but primarily user-related. An important barrier for daily use was limited active participation of involved professionals in a complete feedback loop. Potential for future implementation was found, as patient-systems were intrinsically motivated for better feedback with the professionals, even though in this study it only partly met their expectations

    The challenge of involving elderly patients in primary care using an electronic communication tool with their professionals : A mixed methods study

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    Background: Elderly patients in primary care often have multiple health problems, with different healthcare professionals involved. For consistency in care, it is required that communication amongst professionals and patient-systems (patient and informal-carers) be well tuned. Electronic-communication can make it easier for patient-system to be active in care. Objective: To examine whether an e-communication tool (Congredi) designed for professionals, including a care plan and secure e-mail, is usable for patient-systems and what their experiences are. Methods: In a multi-method study, home-dwelling elderly patients with two or more professionals were invited to use Congredi; data were gathered from the system after 42 weeks. Also semi-structured interviews were undertaken with patient-systems with topics retrieved from literature. Analysis took place by two researchers independently; the themes were extracted together by consensus. Results: Data about actual use of the tool were gathered from 22 patients. Four profiles of Congredi-users were distinguished, varying in intensity of use. Data from interviews with members of patient-systems (n = 7) showed that they were motivated and able to use Congredi. Barriers in daily use were limited participation of professionals, unanswered e-mail and not being alerted about actions. Despite limitations, patient-systems retained their motivation. Conclusion: Congredi was usable for patient-systems. The barriers found seem not to be tool-related but primarily user-related. An important barrier for daily use was limited active participation of involved professionals in a complete feedback loop. Potential for future implementation was found, as patient-systems were intrinsically motivated for better feedback with the professionals, even though in this study it only partly met their expectations

    MyUMC Patient Portal: patient and professional perspectives

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    INTRODUCTION: In 2010 the UMC Utrecht started with the introduction of patient portals for patients with chronic conditions. The evaluation concerned portals of three patient groups: adults with HIV, adolescents with CF and parents of children with CF. The portals had six modules: ‘overview treatment appointments’, ‘overview of medication and test results’, ‘e-consult (a-synchronous)’, ‘request for medical prescription’, ‘diaries’ and ‘questionnaires’. AIM AND OBJECTIVES: To evaluate patient’s use, their experiences and to detect factors that influence use and appreciation of the portal. METHOD: One hundred and nine patients were followed during seven months. They completed a digital questionnaire at baseline, and at 2 and 7 months. The questionnaire contains items with fixed response categories on personal characteristics (including internet use and computer skills), actual use of the portal (frequency and modules), total websites’ ease-of-use (attractiveness, controllability, efficiency, helpfulness and learnability with WAMMI), patients’ experiences with the modules and overall appreciation of the portal (10-point scale). Two open questions were add on specific positive and specific negative experiences. RESULTS: Most respondents were regular (almost daily) users of the internet and considered themselves competent computer users. Over 80% of the patients used the portal at least once. More than half of them used the portal recently, i.e. the last month. Reasons for not using the portal were lack of actual health problems, problems with login procedures, too busy with other things. Related to regular care, most patients used the portal complementary to regular care for the same questions. However, about half of the patients stated that they used the portal as a substitution for regular consultations (face to face or telephone). On the other hand, one-third stated that they used the portal in addition to regular care. The users find the portal useful and easy to use. Almost all users visited the modules ‘medication overview and test results’ (92%) and ‘overview treatment appointments’ (82%). Also the modules ‘e-consult’ (58%) and ‘request for medical prescription’ (35%) were well attended. There were differences between patient groups. Adults with HIV evaluate the module ‘medication overview and test results’ as most important; parents of children with CF the module ‘e-consult’. Patient’s characteristics were not related to the use of the portal. Websites’ ease-to-use and overall appreciation of the portal were related to actual use. The results of the open questions show that patients appreciate the permanent (24/7) accessibility of the portal. They do not have to call several times to the hospital. Moreover, they do not have to feel troubled anymore to disturb their health care professionals for non urgent matters. CONCLUSIONS: Patients appreciate the availability of a patient portal, especially for non-urgent matters. They use a portal instead of regular contacts, but also as a source of additional information. Websites’ ease-to-use and overall appreciation are related to actual use. Age and gender are not related to actual use, however, disease-related characteristics are

    Implementation of patient portals: the perspective of the professional care provider

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    INTRODUCTION: A few hospitals in the Netherlands have been introducing digital patient portals. Patient portals are secured internet environments for patients to log into from their homes to exchange information with their care provider. Such portals can be seen as an application of e-health that encourages patient’s self management. User acceptance is an important precondition for successful implementation. Research on patient user acceptance has already occurred. This project is about the user acceptance of the professional healthcare provider. The focus is on nurses, because in the Netherlands nurses play a crucial role in developing and implementing a portal, as well as in introducing the portal to the patient. Besides that, they have to integrate the portal tasks with their other work. AIM: This qualitative research describes the extent to which and the manner in which nurses accept digital patient portals. It is investigated how the portals are developed and implemented, how nurses use and appreciate the portals and which factors are important for realizing user acceptance of professional health care providers. METHOD: In-depth interviews were executed with 18 respondents of two University Medical Centers in the Netherlands. The group consisted of 12 nurses and nursing specialists, 2 doctors, 2 researchers, 1 communication officer and 1 manager. Interview topics were derived from the Technology Acceptance Model (TAM) and the Innovation Diffusion Theory (IDT). RESULTS: The results show that the degree of acceptance among nurses is great. Nurses see the introduction of patient portals as an inevitable development. Essential for nurses’ acceptance is the ‘perceived usefulness’, especially from patient’s perspective. Perceived usefulness from their own perspective (ease-to-use) also plays a role but this is of less importance. The e-consult is relevant. However, it will not substitute usual (face-to-face or telephone) contacts, unless e-consult is part of the scheduled treatment plan. But this is still rarely the case and actually a cultural change in professional practice, a digital revolution is needed. Moreover, the work is not yet designed for e-health; time and costs for e-health are not yet reimbursed in the Dutch context. Nurses see the portal as an additional service for patients, because it offers them the possibility for asking questions at any time and place suitable for the patient. Some nurses experience an increase in work load, because patients ask more non-urgent questions that otherwise would not be asked. Other nurses observe a decrease of workload, because of a decrease of consultations about laboratory test results. CONCLUSION: The user acceptance from nurses is great. Most important motive is the perceived usefulness for the patient. The patient portal is seen as an extra service for the patient, and the nurses are prepared to deliver this service. There is a risk of increased workload. Exploiting the potentials for greater efficiency requires a cultural change in professional practice

    Cancer-related fatigue and rehabilitation: a randomized controlled multicenter trial comparing physical training combined with cognitive-behavioral therapy with physical training only and with no intervention

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    Background. Research suggests that cancer rehabilitation reduces fatigue in survivors of cancer. To date, it is unclear what type of rehabilitation is most beneficial. Objective. This randomized controlled trial compared the effect on cancer-related fatigue of physical training combined with cognitive behavioral therapy with physical training alone and with no intervention. Design. In this multicenter randomized controlled trial, 147 survivors of cancer were randomly assigned to a group that received physical training combined with cognitive-behavioral therapy (PT + CBT group, n = 76) or to a group that received physical training alone (PT group, n = 71). In addition, a nonintervention control group (WLC group) consisting of 62 survivors of cancer who were on the waiting lists of rehabilitation centers elsewhere was included. Setting. The study was conducted at 4 rehabilitation centers in the Netherlands. Patients. All patients were survivors of cancer. Intervention. Physical training consisting of 2 hours of individual training and group sports took place twice weekly, and cognitive-behavioral therapy took place once weekly for 2 hours. Measurements. Fatigue was assessed with the Multidimensional Fatigue Inventory before and immediately after intervention (12 weeks after enrollment). The WLC group completed questionnaires at the same time points. Results. Baseline fatigue did not differ significantly among the 3 groups. Over time, levels of fatigue significantly decreased in all domains in all groups, except in mental fatigue in the WLC group. Analyses of variance of postintervention fatigue showed statistically significant group effects on general fatigue, on physical and mental fatigue, and on reduced activation but not on reduced motivation. Compared with the WLC group, the PT group reported significantly greater decline in 4 domains of fatigue, whereas the PT + CBT group reported significantly greater decline in physical fatigue only. No significant differences in decline in fatigue were found between the PT + CBT and PT groups. Conclusions. Physical training combined with cognitive-behavioral therapy and physical training alone had significant and beneficial effects on fatigue compared with no intervention. Physical training was equally effective as or more effective than physical training combined with cognitive-behavioral therapy in reducing cancer-related fatigue, suggesting that cognitive-behavioral therapy did not have additional beneficial effects beyond the benefits of physical training
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