糖尿病患者間存在網路入口網站使用差異


  【24drs.com】根據一項線上發表於美國醫學會期刊的研究結果,特定種族/人種,以及教育程度較低的患者,由於比較不善於使用網路為主的健康資訊入口網站來管理他們的糖尿病,如果減少使用傳統照護方式而依賴網路進行疾病控制,可能會讓他們的預後更差。
  
  病患入口網站是提供慢性病患接受自我照護支持一個很好的方法,有證據顯示這些入口網站可能改善健康照護;然而,也有證據顯示某些種族/人種的糖尿病患者、以及教育程度較低的人們,反而預後更差;因為這些族群接收資訊科技的管道比較少。
  
  研究人員針對北卡羅萊納州凱薩醫療機構的糖尿病患進行研究,探討使用網路為主患者入口網站的狀況;研究對象是那些回覆調查、說或讀英文、非法定失明、在試驗期間收納到凱薩醫療機構北卡羅萊納州的患者。
  
  在研究的14,102位患者中,5,671位(40%)註冊網站密碼,其中4,311位(76%)激活帳號,3,922位(69%)至少使用該入口網站一次;使用該入口網站的功能包括瀏覽實驗室檢驗結果(2,990位[53%])、要求用藥調劑(2,132[38%])、傳送電子郵件訊息(2,093位[37%])以及約診(835位[15%])。
  
  研究人員校正年齡、性別、種族/人種、移民狀態、教育程度以及工作情形;在將這些因素納入考量後,他們發現,相較於白人,黑人與拉丁裔登入網站比例較低(黑人從未登入的勝算比[OR]為2.6[2.3-2.9];拉丁裔為2.3[1.9-2.6])。那些沒有大學學歷的患者也觀察到類似的趨勢(相較於大學畢業生的OR為2.3[1.9-2.7])。
  
  【要求密碼】
  高齡患者、教育程度較低、黑人、拉丁裔、菲裔人種要求密碼的比例較低,這代表有限的網路使用或是網際網路入口網站使用接受度差異可能導致社會上的差異;然而,即使使用管道增加以及有使用意願(例如透過註冊帳號密碼),這些少數種族團體以及教育程度較低的人們使用入口網站上各式功能的比例仍然較少。
  
  作者們認為這些發現有幾個可能的解釋。一個可能性是社會約束,包括缺乏上網管道或訓練、缺乏社會支持、以及有限的讀寫能力;另一個是健康入口網站所需瀏覽技巧超過某些使用者所擁有的。或是入口網站對少數種族/人種、與教育程度較低患者的廣告不夠。作者們相信在要求密碼後顯著的退出率代表提供更多上網機會以及訓練,將可以增加入口網站使用率。
  
  作者們寫到,網際網路有使用視覺/言語/多種語言技巧增加健康照護與健康促進可理解性的潛力,但是網路為主之健康照護服務的障礙,需要對社會地位低下團體投入更多的關注,並且量身訂做服務,以及擴展電腦與上網機會。
  
  這項研究的強度包括使用大型、接受相同照護的不同族群。研究人員能夠取得詳細的現實生活入口網站使用評估資料,但是仍然有許多限制,包括可能無法類推到其他的入口網站,因為這比美國大部分健康照護運送機構所提供的穩固,其他包括該項研究排除非英語系人種,且並未直接量測受試者使用電腦的比例。
  
  這項研究由國家糖尿病、消化與腎臟疾病機構、國家兒童健康與人類發展機構、國家癌症研究資源贊助。其中兩位作者接受健康照護研究與品質署的經費贊助,其中一位接受國家健康臨床與轉譯科學獎的經費贊助。作者們表示沒有相關資金上的往來。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6459&x_classno=0&x_chkdelpoint=Y
  

Disparity of Internet Portal Use Exists Among Patients With Diabetes

By Jim Kling
Medscape Medical News

February 11, 2011 — Certain racial/ethnic groups and those with less educational attainment are less likely to use an Internet-based health information portal to manage their diabetes. As a result, increasing reliance on such systems could lead to worse outcomes for patients with diabetes who already tend to do comparatively poorly, according to research published online January 24 in the Journal of the American Medical Informatics Association.

Patient portals are a good way for patients with chronic illnesses to receive support in their self-management efforts, and there is evidence that portals may improve healthcare. However, there is also evidence of worse outcomes in diabetes among some race/ethnicity groups and individuals with lower levels of education. These populations are also less likely to have access to information technology.

The researchers studied use of the Internet-based patient portal by a population of adults with diabetes in Northern California who were patients at Kaiser Permanente Northern California, which provides healthcare to 30% of the population of Northern California. Patients included were those who responded to a survey, spoke and read English, were not legally blind, and were enrolled at Kaiser Permanente Northern California throughout the study period.

Of the 14,102 patients studied, 5671 (40%) requested a password for the Internet site, 4311 members of that group (76%) went on to activate an account, and 3922 members (69%) made use of the portal at least once. Uses for the portal included viewing laboratory results (2990 [53%]), requesting medication refills (2132 [38%]), sending email messages (2093 [37%]), and making medical appointments (835 [15%]).

The researchers adjusted for age, sex, race/ethnicity, immigration status, educational attainment, and employment status. After these factors were taken into account, they found that compared with whites, blacks and Latinos were less likely to have logged on (odds ratio [OR] of never logging on for blacks, 2.6 [2.3 - 2.9]; OR for Latinos, 2.3 [1.9 - 2.6]). A similar trend was seen in those patients without a college degree (OR compared with college graduates, 2.3 [1.9 - 2.7]).

Request for Passwords

The percentage of patients who requested passwords was lower in older adults, patients with less educational attainment, and blacks, Latinos, and Filipinos. This suggests that limited Internet access or differences in acceptance of Internet portal use may lead to social disparities. However, even after gaining access and showing an intent to use the resource (ie, by signing up for a password), these ethnic minority groups and people with less education made less frequent use of the various functions available on the portal.

The authors suggest several possible explanations for the findings. One possibility is that social constraints are responsible, including lack of Internet access and training, a lack of social support, and limited literacy. Another possibility is that the health portal requires more navigation skill than some users possess. Another explanation could be inadequate marketing of the portal to racial/ethnic minorities and people with lower education attainment. The authors believe that the significant drop-off even after password requests were made suggests that that providing increased Internet access and training would increase portal use.

"The internet has potential to use visuals/spoken/multilingual techniques to enhance comprehensibility of healthcare and health promotion, but barriers to internet-based healthcare services require attention to disadvantaged groups and tailoring of services as well as expanded computer/internet access," the authors write.

Strengths of the study included that it used a large, diverse population that had uniform access to care. The researchers were also able to obtain detailed real-world assessments of portal use. There were several limitations, including that it may not be possible to generalize the results from this specific portal because it is more robust than what is offered at most US healthcare delivery settings, that the study excluded non-English speakers, and that participants' computer access was not directly measured.

The study was supported by the National Institute of Diabetes, Digestive and Kidney Diseases, and National Institute of Child Health and Human Development, and the National Center for Research Resources. Two study authors received grant funding from the Agency for Healthcare Research and Quality, one of whom also received grant funding from an National Institutes of Health Clinical and Translational Science Award. The authors have disclosed no relevant financial relationships.

J Am Med Inform Assoc. Published online January 24, 2011.

    
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