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The Next Step: Achieving Health Behavior Change Through Technology

The Next Step: Achieving Health Behavior Change Through Technology. Name the movie & the meme…. If you build it , will they come?. Research Questions. RWJ: RFP to evaluate patient portals (MyGeisinger) For patients with chronic conditions (DM, CVD, CHF), do e-health interventions influence:

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The Next Step: Achieving Health Behavior Change Through Technology

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  1. The Next Step: Achieving Health Behavior Change Through Technology

  2. Name the movie & the meme… If you build it, will they come?

  3. Research Questions • RWJ: RFP to evaluate patient portals (MyGeisinger) • For patients with chronic conditions (DM, CVD, CHF), do e-health interventions influence: • Measures of: • patient activation • patient self-management • treatment adherence • patient satisfaction with care • disease specific knowledge • Processmeasures of appropriate CVD/DM/CHF care • HbA1c, LDL tests • Prescribed meds • Clinical markers of cardiovascular/DM morbidity & risk • SBP, HbA1c, LDL

  4. Intervention • Web-based health behavior change program • Care For Your Health (HealthMedia, Inc) • Objective: • create “expert patients” with the confidence, skills, and knowledge to self-manage • Method: • Patient completes initial assessment online (~80 items) • Customized “plan” that helps patients focus on: • acceptance of condition • communication with providers • lifestyle choices • goal setting • medication/treatment adherence • planning skills • Visit the site initially to complete assessment, return to review plan and use additional tools

  5. Study Design

  6. Recruitment Model • First phase: • Initial letter from director of Geisinger’s ambulatory clinics • Follow-up letters (2) • Follow-up emails (2) • Second phase: • Letter from PCP • Follow-up PCP letter (2) • Follow-up PCP email (2) • Letter content: • General info about the study and intervention • Instructions on how to log into MyGeisinger & click the link to Care For Your Health

  7. Results: Overall • Primary Endpoints (6 and 12 month f/u): • No effect on process measures • No difference in rates of appropriate testing (e.g. A1c, foot exams) or appropriate use of medications (e.g. ACE-I for CHF) • No effect on clinical measures • No difference in SBP, DBP, LDL, Total Chol, A1c • No effect on patient-reported outcomes • Patient activation, adherence, satisfaction

  8. What happened? • Enrollment problems: • Only 247 (~) 17%patients enrolled in CFYH • Were patients unaware of the intervention? • Interim survey • Are patients just not interested in e-health? • Analysis of MyGeisinger vs. HMI use

  9. Results: Interim Phone Survey • Surveyed 30 random non-enrollees to identify reasons for non-enrollment (~11%) • Findings: • 90% use the Internet at least once per week • 100% recalled receiving the invitation letter • 67% did not recognize the physician signing the letter • 42% said recognizing physician mattered • 47% - wanted more information • 67% - technical problems • Conclusion: • they know about the intervention

  10. Results: MyGeisinger Use • Analyzed 12 months of MyGeisinger use • Analyzed log files • Results: • 86% used the Internet for at least 3 sessions during the 12-month period • Most popular functions: • Lab results, Messaging, Proxy access • Clear presence of user “clusters” • Portal use for specific purposes: Proxy users, lab trackers, appointment “preppers”, etc. • Conclusions: • Patients like, and actively use, electronic tools for health-related purposes

  11. Conclusions • Study participants WERE aware of and using “e-health” “E-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and informationdelivered or enhanced through the Internet and related technologies.” – Eysenbach, J Med Internet Res 2001 • There is a fundamental difference in the process of engaging patient in accessing information (i.e. EHR, lab data) vs. health behavior change • Immediate gratification vs. long-term health

  12. Conclusions (cont’d) • “Simple” solutions: • Need to make it simple for patients • Patients need better information • The primary care physician is important • Complex solutions • Not all e-health is created equal… • Accessing data vs. behavior change • Health behavior change is difficult on the web, just as it is in a paper-based world • If you build it, “they” won’t necessarily come • Who are “they” • Need to understand who, why, how to develop better approaches to engaging patients

  13. Questions?

  14. Future Research • Understanding patient engagement and activation • Eysenbach (2001) – the law of “attrition” • Important, but how do we engage them (non-early adopters) in the first place? • Current studies • “Risk-informed engagement” • eCVD-II • eAspirin

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