影响低收入孕妇使用患者门户网站的因素：混合方法试点研究。
Factors Affecting Patient Portal Use Among Low-Income Pregnant Women: Mixed-Methods Pilot Study.
作者信息
Kim Juhee, Mathews Holly, Cortright Lindsay M, Zeng Xiaoming, Newton Edward
机构信息
Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, United States.
Department of Anthropology, East Carolina University, Greenville, NC, United States.
出版信息
JMIR Form Res. 2018 Mar 22;2(1):e6. doi: 10.2196/formative.5322.
BACKGROUND
Patient portals offer patients personalized and secure Web access to their medical information and enable patients to manage their health care online. However, there is a lack of information about patient acceptance and use of patient portals among low-income pregnant women.
OBJECTIVE
This formative research aims to assess the potential of a patient portal, MyChart, for improving prenatal health care and pregnancy outcomes, and identify the barriers and facilitators of MyChart use among low-income pregnant women.
METHODS
A mixed-methods study was conducted with a convenience sample of 18 low-income pregnant women comprising low- and high-risk patients enrolled in a prenatal clinic in eastern North Carolina. MyChart use, patient demographics, and pregnancy information were collected by reviewing electronic medical charts. Health literacy was measured. Reported use and attitudes toward MyChart were collected using a semi-structured interview.
RESULTS
Although 39% (7/18) of participants interviewed signed up for MyChart, only 22% (4/18) of them became active users. Another 33% (6/18) had never heard of MyChart or was unsure of how to access it. Users primarily accessed test results and appointment schedules. The main facilitating factors for patient portal use were information and motivation from health care providers and concerns about pregnancy due to a history of miscarriage. Reported barriers were lack of educational resources, lack of care provider encouragement, and technical difficulties possibly exacerbated by low health literacy. Participants also suggested improvements for MyChart, especially the provision of discussion-based support for pregnant women.
CONCLUSIONS
The one-time verbal introduction of MyChart does not meet current patients' needs. Data reveal the need for more consistent patient education and support programs, tailored to patients' previous pregnancy histories. The clinic also needs to facilitate better provider-patient communication about the importance of MyChart use.
背景
患者门户网站为患者提供个性化且安全的网络途径，使其能够访问自己的医疗信息，并能在线管理自身的医疗保健。然而，关于低收入孕妇对患者门户网站的接受度和使用情况，目前缺乏相关信息。
目的
这项形成性研究旨在评估患者门户网站MyChart在改善产前保健和妊娠结局方面的潜力，并确定低收入孕妇使用MyChart的障碍和促进因素。
方法
采用混合方法进行研究，选取了18名低收入孕妇作为便利样本，这些孕妇包括北卡罗来纳州东部一家产前诊所登记的低风险和高风险患者。通过查阅电子病历收集MyChart的使用情况、患者人口统计学信息和妊娠信息。测量健康素养。使用半结构化访谈收集对MyChart的报告使用情况和态度。
结果
尽管接受访谈的参与者中有39%（7/18）注册了MyChart，但其中只有22%（4/18）成为活跃用户。另外33%（6/18）从未听说过MyChart，或者不确定如何访问它。用户主要访问检查结果和预约时间表。患者门户网站使用的主要促进因素是医疗保健提供者提供的信息和动力，以及因有流产史而对妊娠的担忧。报告的障碍包括缺乏教育资源、护理提供者缺乏鼓励，以及健康素养低可能加剧的技术困难。参与者还建议对MyChart进行改进，特别是为孕妇提供基于讨论的支持。
结论
对MyChart的一次性口头介绍无法满足当前患者的需求。数据表明，需要针对患者以前的妊娠史制定更一致的患者教育和支持计划。诊所还需要促进医护人员与患者就使用MyChart的重要性进行更好的沟通。
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