J. Med. Internet Res. - Which frail older patients use online health communities and why? A mixed methods process evaluation of use of the Health and Welfare portal.

Tópicos

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Resumo

CKGROUND: Frail older people often receive fragmented care from multiple providers. According to the literature, there is an urgent need for coordination of care. Online and eHealth tools are increasingly used to improve coordination. However, there are significant barriers to their implementation in frail older people.OBJECTIVE: Our aim was to (1) evaluate differences in use of a personal online health community (POHC) for frail older people in relation to personal characteristics, and (2) explore barriers and facilitators for use as experienced by older people and their informal caregivers, using the case of the Health and Welfare Information Portal (ZWIP).METHODS: This is a mixed methods study. For the quantitative analysis, we used POHC usage information (2 years follow-up) and baseline characteristics of frail older people. For the qualitative analysis, we used semistructured interviews with older people and their informal caregivers. Participants were recruited from 11 family practices in the east of the Netherlands and frail older people over 70 years. The ZWIP intervention is a personal online health community for frail older people, their informal caregivers, and their providers. ZWIP was developed at the Geriatrics Department of Radboud University Medical Center. We collected data on POHC use for 2 years as well as relevant patient characteristics. Interview topics were description of use, reasons for use and non-use, and user profiles.RESULTS: Of 622 frail patients in the intervention group, 290 were connected to ZWIP; 79 used ZWIP regularly (at least monthly). Main predictors for use were having an informal caregiver, having problems with activities of daily living, and having a large number of providers. Family practice level predictors were being located in a village, and whether the family practitioners had previously used electronic consultation and cared for a large percentage of frail older people. From 23 interviews, main reasons for use were perceiving ZWIP to be a good, quick, and easy way of communicating with providers and the presence of active health problems. Important reasons for non-use were lack of computer skills and preferring traditional means of consultation.CONCLUSIONS: Only 27.2% (79/290) of frail older enrolled in the POHC intervention used the POHC frequently. For implementation of personal online health communities, older people with active health problems and a sizable number of health care providers should be targeted, and the informal caregiver, if present, should be involved in the implementation process.TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 11165483; http://www.controlled-trials.com/isrctn/pf/11165483 (Archived by WebCite at http://www.webcitation.org/6U3fZovoU).

Resumo Limpo

ckground frail older peopl often receiv fragment care multipl provid accord literatur urgent need coordin care onlin ehealth tool increas use improv coordin howev signific barrier implement frail older peopleobject aim evalu differ use person onlin health communiti pohc frail older peopl relat person characterist explor barrier facilit use experienc older peopl inform caregiv use case health welfar inform portal zwipmethod mix method studi quantit analysi use pohc usag inform year followup baselin characterist frail older peopl qualit analysi use semistructur interview older peopl inform caregiv particip recruit famili practic east netherland frail older peopl year zwip intervent person onlin health communiti frail older peopl inform caregiv provid zwip develop geriatr depart radboud univers medic center collect data pohc use year well relev patient characterist interview topic descript use reason use nonus user profilesresult frail patient intervent group connect zwip use zwip regular least month main predictor use inform caregiv problem activ daili live larg number provid famili practic level predictor locat villag whether famili practition previous use electron consult care larg percentag frail older peopl interview main reason use perceiv zwip good quick easi way communic provid presenc activ health problem import reason nonus lack comput skill prefer tradit mean consultationconclus frail older enrol pohc intervent use pohc frequent implement person onlin health communiti older peopl activ health problem sizabl number health care provid target inform caregiv present involv implement processtri registr intern standard random control trial number isrctn httpwwwcontrolledtrialscomisrctnpf archiv webcit httpwwwwebcitationorgufzovou

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