Barriers and facilitators for the usage of a personal health record for medication reconciliation: a qualitative study among patients (Preprint)

2021 ◽  
Author(s):  
Denise van der Nat ◽  
Victor J B Huiskes ◽  
Margot Taks ◽  
Bart J F van den Bemt ◽  
Hein A W van Onzenoort
Keyword(s):  
Qualitative Study ◽  
Medication Reconciliation ◽  
Data Exchange ◽  
Personal Health Record ◽  
Healthcare Providers ◽  
Theoretical Domains Framework ◽  
Information Provision ◽  
Perceived Usefulness ◽  
Barriers And Facilitators ◽  
Personal Health

BACKGROUND Transitions in care are a risk factor for medication discrepancies, which can be identified and solved with medication reconciliation (MR). However, MR is a time consuming process, its effect on clinical outcomes is limited and a central role for patients is missing. As multiple organizations stimulate a more central role for patients in healthcare, personal health records (PHRs) are more often applied in medical care. However, patients’ adoption rate of using a PHR for MR is low. OBJECTIVE Therefore, the aim of this study was to provide insight into patients’ barriers and facilitators for the usage of a PHR for MR prior to an in- or outpatient visit. METHODS A qualitative study was conducted among PHR users and non-users who had a planned visit at the in- or outpatient clinic. About one week after the visit, patients were interviewed about barriers and facilitators for the use of a PHR for MR using a semi-structured interview guide based on the theoretical domains framework. Afterwards, data were analysed following thematic content analysis. RESULTS In total, 10 PHR users and 10 PHR non-users were interviewed. The barriers and facilitators were classified in four domains: 1) patient, consisting of the barriers: limited (health) literacy and/or computer skills, limited perceived usefulness and/or motivation, concerns about data safety, no computer/smartphone, and poor memory, and the facilitators: perceived importance/usefulness and place and time independent; 2) application, consisting of the barriers: practical and technical issues, poor usability and missing functionalities, and the facilitators: improve usability and add functionalities; 3) process, consisting of the barrier: ambiguity about who is responsible, the patient or the healthcare provider, and the facilitators: check by healthcare providers, more frequent update of medication list by healthcare providers and target patients who benefit most and/or have sufficient skills; 4) context, consisting of the barriers: lack of data exchange and connectivity between ICT applications, privacy concerns, healthcare professional do not use the requested data, insufficient information provision and bad (timing) of invitations and reminders, and the facilitators: integration of different applications, information provision by healthcare providers and support of professionals and/or family. CONCLUSIONS Patients reported barriers and facilitators for using a PHR to perform MR are identified at the patient, application, process and context level. Furthermore, patients indicated that they become more engagement in their own healthcare when they use a PHR. To improve the implementation of MR by using PHRs, the barriers and facilitators need to be addressed to effectively develop and implement PHRs in the MR process.

scholarly journals Patient empowerment through a user-centered design of an electronic personal health record: a qualitative study of user requirements in chronic kidney disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Esmaeel Toni ◽  
Habibollah Pirnejad ◽  
Khadijeh Makhdoomi ◽  
Azam Mivefroshan ◽  
Zahra Niazkhani
Keyword(s):  
Chronic Kidney Disease ◽  
Health Literacy ◽  
Kidney Disease ◽  
Qualitative Study ◽  
Personal Health Record ◽  
Self Management ◽  
Personal Health ◽  
Health Record ◽  
User Centered Design ◽  
Electronic Personal Health Record

Abstract Background To improve chronic disease outcomes, self-management is an effective strategy. An electronic personal health record (ePHR) is a promising tool with the potential to support chronic patient’s education, counseling, and self-management. Fitting ePHRs within the daily practices of chronic care providers and chronic patients requires user-centered design approaches. We aimed to understand users’ needs and requirements in chronic kidney disease (CKD) care to consider in the design of an ePHR to facilitate its implementation, adoption, and use. Methods A qualitative study was conducted in a major Iranian nephrology center including inpatient and outpatient settings in 2019. We conducted 28 semi-structured interviews with CKD patients, nurses, and adult nephrologists. To confirm or modify the requirements extracted from the interviews, a focus group was also held. Data were analyzed to extract especially those requirements that can facilitate implementation, adoption, and sustained use based on the PHR adoption model and the unified theory of acceptance and use of technology. Results Participants requested an ePHR that provides access to up to date patient information, facilitates patient-provider communication, and increases awareness about patient individualized conditions. Participants expected a system that is able to cater to low patient e-health literacy and high provider workload. They requested the ePHR to include purposeful documentation of medical history, diagnostic and therapeutic procedures, tailored educational content, and scheduled care reminders. Messaging function, tailored educational content to individual patients’ conditions, and controlled access to information were highly valued in order to facilitate its implementation, adoption, and use. Conclusions We focused on the ePHR’s content and functionalities in the face of facilitators and/or barriers envisioned for its adoption in nephrology care. Designers and implementers should value CKD patients’ needs and requirements for self-management such as providing personalized education and counseling (on the basis of their condition and risk factors), health literacy, and disease progression levels. The socio-technical aspects of care also need further attention to facilitate ePHR’s adoption.

scholarly journals Barriers and facilitators to orthopaedic surgeons’ uptake of decision aids for total knee arthroplasty: a qualitative study

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018614 ◽  
Author(s):  
Samantha Bunzli ◽  
Elizabeth Nelson ◽  
Anthony Scott ◽  
Simon French ◽  
Peter Choong ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Qualitative Study ◽  
Knee Arthroplasty ◽  
Decision Aid ◽  
Decision Aids ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Meaningful Improvement ◽  
Orthopaedic Surgeons ◽  
Total Knee

ObjectivesThe demand for total knee arthroplasty (TKA) is increasing. Differentiating who will derive a clinically meaningful improvement from TKA from others is a key challenge for orthopaedic surgeons. Decision aids can help surgeons select appropriate candidates for surgery, but their uptake has been low. The aim of this study was to explore the barriers and facilitators to decision aid uptake among orthopaedic surgeons.DesignA qualitative study involving face-to-face interviews. Questions were constructed on the Theoretical Domains Framework to systematically explore barriers and facilitators.SettingOne tertiary hospital in Australia.ParticipantsTwenty orthopaedic surgeons performing TKA.Outcome measuresBeliefs underlying similar interview responses were identified and grouped together as themes describing relevant barriers and facilitators to uptake of decision aids.ResultsWhile prioritising their clinical acumen, surgeons believed a decision aid could enhance communication and patient informed consent. Barriers identified included the perception that one’s patient outcomes were already optimal; a perceived lack of non-operative alternatives for the management of end-stage osteoarthritis, concerns about mandatory cut-offs for patient-centred care and concerns about the medicolegal implications of using a decision aid.ConclusionsMultifaceted implementation interventions are required to ensure that orthopaedic surgeons are ready, willing and able to use a TKA decision aid. Audit/feedback to address current decision-making biases such as overconfidence may enhance readiness to uptake. Policy changes and/or incentives may enhance willingness to uptake. Finally, the design/implementation of effective non-operative treatments may enhance ability to uptake by ensuring that surgeons have the resources they need to carry out decisions.

scholarly journals Erratum to: Providing Patients with Implantable Cardiac Device Data through a Personal Health Record: A Qualitative Study

2017 ◽  
Vol 08 (04) ◽  
pp. e1-e1
Author(s):  
Carly Daley ◽  
Elizabeth Chen ◽  
Amelia Roebuck ◽  
Romisa Ghahari ◽  
Areej Sami ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Personal Health Record ◽  
Personal Health ◽  
Health Record ◽  
Cardiac Device ◽  
Implantable Cardiac Device

A Context-Aware Authorization Model for Process-Oriented Personal Health Record Systems

2011 ◽  
pp. 46-65
Author(s):  
Eleni Mytilinaiou ◽  
Vassiliki Koufi ◽  
Flora Matamateniou ◽  
George Vassilacopoulos
Keyword(s):  
Care Delivery ◽  
Personal Health Record ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Information Support ◽  
Personal Health ◽  
Health Record ◽  
Healthcare Organizations ◽  
Process Oriented

Healthcare delivery is a highly complex process involving a broad range of healthcare services, typically performed by a number of geographically distributed and organizationally disparate healthcare providers requiring increased collaboration and coordination of their activities in order to provide shared and integrated care. Under an IT-enabled, patient-centric model, health systems can integrate care delivery across the continuum of services, from prevention to follow-up, and also coordinate care across all settings. In particular, much potential can be realized if cooperation among disparate healthcare organizations is expressed in terms of cross-organizational healthcare processes, where information support is provided by means of Personal Health Record (PHR) systems. This chapter assumes a process-oriented PHR system and presents a security framework that addresses the authorization and access control issues arisen in these systems. The proposed framework ensures provision of tight, just-in-time permissions so that authorized users get access to specific objects according to the current context. These permissions are subject to continuous adjustments triggered by the changing context. Thus, the risk of compromising information integrity during task executions is reduced.

scholarly journals m-Health adoption by healthcare professionals: a systematic review

2015 ◽  
Vol 23 (1) ◽  
pp. 212-220 ◽  
Author(s):  
Marie-Pierre Gagnon ◽  
Patrice Ngangue ◽  
Julie Payne-Gagnon ◽  
Marie Desmartis
Keyword(s):  
Systematic Review ◽  
Healthcare Professionals ◽  
Current Knowledge ◽  
Healthcare Providers ◽  
Ease Of Use ◽  
Perceived Usefulness ◽  
Barriers And Facilitators ◽  
Health Utilization ◽  
Privacy And Security ◽  
Security Issues

Abstract Objective The aim of this systematic review was to synthesize current knowledge of the factors influencing healthcare professional adoption of mobile health (m-health) applications. Methods Covering a period from 2000 to 2014, we conducted a systematic literature search on four electronic databases (PubMed, EMBASE, CINAHL, PsychInfo). We also consulted references from included studies. We included studies if they reported the perceptions of healthcare professionals regarding barriers and facilitators to m-health utilization, if they were published in English, Spanish, or French and if they presented an empirical study design (qualitative, quantitative, or mixed methods). Two authors independently assessed study quality and performed content analysis using a validated extraction grid with pre-established categorization of barriers and facilitators. Results The search strategy led to a total of 4223 potentially relevant papers, of which 33 met the inclusion criteria. Main perceived adoption factors to m-health at the individual, organizational, and contextual levels were the following: perceived usefulness and ease of use, design and technical concerns, cost, time, privacy and security issues, familiarity with the technology, risk-benefit assessment, and interaction with others (colleagues, patients, and management). Conclusion This systematic review provides a set of key elements making it possible to understand the challenges and opportunities for m-health utilization by healthcare providers.

scholarly journals Barriers and facilitators to implementing the CURE stop smoking project: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Angela Wearn ◽  
Anna Haste ◽  
Catherine Haighton ◽  
Verity Mallion ◽  
Angela M. Rodrigues
Keyword(s):  
Qualitative Study ◽  
Intervention Development ◽  
Theoretical Domains Framework ◽  
Tobacco Dependence ◽  
Preliminary Evidence ◽  
Environmental Context ◽  
Barriers And Facilitators ◽  
Theoretical Frameworks ◽  
Targeted Interventions ◽  
Treatment Services

Abstract Background The Conversation, Understand, Replace, Experts and evidence-based treatment (CURE) project aims to provide a comprehensive offer of both pharmacotherapy and specialist support for tobacco dependence to all smokers admitted to hospital and after discharge. CURE was recently piloted within a single trust in Greater Manchester, with preliminary evidence suggesting this intervention may be successful in improving patient outcomes. Plans are currently underway to pilot a model based upon CURE in other sites across England. To inform implementation, we conducted a qualitative study, which aimed to identify factors influencing healthcare professionals’ implementation behaviour within the pilot site. Methods Individual, semi-structured telephone interviews were conducted with 10 purposively sampled health professionals involved in the delivery and implementation of the CURE project pilot. Topic guides were informed by the Theoretical Domains Framework (TDF). Transcripts were analysed in line with the framework method, with data coded to TDF domains to highlight important areas of influence and then mapped to the COM-B to support future intervention development. Results Eight TDF domains were identified as important areas influencing CURE implementation; ‘environmental context and resources’ (physical opportunity), ‘social influence’ (social opportunity), ‘goals’, ‘professional role and identity’ and ‘beliefs about consequences’ (reflective motivation), ‘reinforcement’ (automatic motivation), ‘skills’ and ‘knowledge’ (psychological capability). Most domains had the potential to both hinder and/or facilitate implementation, with the exception of ‘beliefs about consequences’ and ‘knowledge’, which were highlighted as facilitators of CURE. Participants suggested that ‘environmental context and resources’ was the most important factor influencing implementation; with barriers most often related to challenges integrating into the wider healthcare context. Conclusions This qualitative study identified multi-level barriers and facilitators to CURE implementation. The use of theoretical frameworks allowed for the identification of domains known to influence behaviour change, and thus can be taken forward to develop targeted interventions to support future service implementation. Future work should focus on discussing these findings with a broad range of stakeholders, to ensure resultant intervention strategies are feasible and practicable within a healthcare context. These findings complement wider evaluative work to support nationwide roll out of NHS funded tobacco dependence treatment services in acute care trusts.

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