PDF(Pubmed)
Abstract：
BACKGROUND: Early identification and treatment of chronic disease is associated with better clinical outcomes, lower costs, and reduced hospitalisation. Primary care is ideally placed to identify patients at risk of, or in the early stages of, chronic disease and to implement prevention and early intervention measures. This paper evaluates the implementation of a technological intervention called Future Health Today that integrates with general practice EMRs to (1) identify patients at-risk of, or with undiagnosed or untreated, chronic kidney disease (CKD), and (2) provide guideline concordant recommendations for patient care. The evaluation aimed to identify the barriers and facilitators to successful implementation.
METHODS: Future Health Today was implemented in 12 general practices in Victoria, Australia. Fifty-two interviews with 30 practice staff were undertaken between July 2020 and April 2021. Practice characteristics were collected directly from practices via survey. Data were analysed using inductive and deductive qualitative analysis strategies, using Clinical Performance - Feedback Intervention Theory (CP-FIT) for theoretical guidance.
RESULTS: Future Health Today was acceptable, user friendly and useful to general practice staff, and supported clinical performance improvement in the identification and management of chronic kidney disease. CP-FIT variables supporting use of FHT included the simplicity of design and delivery of actionable feedback via FHT, good fit within existing workflow, strong engagement with practices and positive attitudes toward FHT. Context variables provided the main barriers to use and were largely situated in the external context of practices (including pressures arising from the COVID-19 pandemic) and technical glitches impacting installation and early use. Participants primarily utilised the point of care prompt rather than the patient management dashboard due to its continued presence, and immediacy and relevance of the recommendations on the prompt, suggesting mechanisms of compatibility, complexity, actionability and credibility influenced use. Most practices continued using FHT after the evaluation phase was complete.
CONCLUSIONS: This study demonstrates that FHT is a useful and acceptable software platform that provides direct support to general practice in identifying and managing patients with CKD. Further research is underway to explore the effectiveness of FHT, and to expand the conditions on the platform.
METHODS: Future Health Today was implemented in 12 general practices in Victoria, Australia. Fifty-two interviews with 30 practice staff were undertaken between July 2020 and April 2021. Practice characteristics were collected directly from practices via survey. Data were analysed using inductive and deductive qualitative analysis strategies, using Clinical Performance - Feedback Intervention Theory (CP-FIT) for theoretical guidance.
RESULTS: Future Health Today was acceptable, user friendly and useful to general practice staff, and supported clinical performance improvement in the identification and management of chronic kidney disease. CP-FIT variables supporting use of FHT included the simplicity of design and delivery of actionable feedback via FHT, good fit within existing workflow, strong engagement with practices and positive attitudes toward FHT. Context variables provided the main barriers to use and were largely situated in the external context of practices (including pressures arising from the COVID-19 pandemic) and technical glitches impacting installation and early use. Participants primarily utilised the point of care prompt rather than the patient management dashboard due to its continued presence, and immediacy and relevance of the recommendations on the prompt, suggesting mechanisms of compatibility, complexity, actionability and credibility influenced use. Most practices continued using FHT after the evaluation phase was complete.
CONCLUSIONS: This study demonstrates that FHT is a useful and acceptable software platform that provides direct support to general practice in identifying and managing patients with CKD. Further research is underway to explore the effectiveness of FHT, and to expand the conditions on the platform.
摘要：
背景：慢性疾病的早期识别和治疗与更好的临床结果相关，更低的成本,减少住院。初级保健是识别有风险的患者的理想场所，或者在早期阶段，慢性病的预防和早期干预措施。本文评估了一项名为“今日未来健康”的技术干预措施的实施情况，该干预措施与一般实践EMR相结合，以（1）识别处于以下风险的患者，或未经诊断或未经治疗，慢性肾脏病（CKD），（2）为患者护理提供指南一致的建议。评估旨在确定成功实施的障碍和促进因素。
方法：《今日未来健康》在维多利亚州的12个一般实践中实施，澳大利亚。在2020年7月至2021年4月期间，对30名实践人员进行了52次采访。通过调查直接从实践中收集实践特征。采用归纳和演绎定性分析策略对数据进行分析，以临床绩效-反馈干预理论(CP-FIT)为理论指导。
结果：今天的未来健康是可以接受的，用户友好，对一般执业人员有用，并支持在慢性肾脏病的识别和管理方面改善临床表现。支持FHT使用的CP-FIT变量包括简单的设计和通过FHT交付可操作的反馈。很好地适合现有的工作流程，强烈参与实践和对FHT的积极态度。上下文变量提供了使用的主要障碍，并且在很大程度上位于实践的外部环境（包括COVID-19大流行带来的压力）和影响安装和早期使用的技术故障。由于其持续存在，参与者主要利用护理提示点而不是患者管理仪表板，以及关于提示的建议的即时性和相关性，提出相容性机制，复杂性，可操作性和可信度影响使用。大多数实践在评估阶段完成后继续使用FHT。
结论：本研究表明，FHT是一个有用且可接受的软件平台，可为识别和管理CKD患者的一般实践提供直接支持。进一步的研究正在进行中，以探索FHT的有效性，并扩大平台上的条件。
方法：《今日未来健康》在维多利亚州的12个一般实践中实施，澳大利亚。在2020年7月至2021年4月期间，对30名实践人员进行了52次采访。通过调查直接从实践中收集实践特征。采用归纳和演绎定性分析策略对数据进行分析，以临床绩效-反馈干预理论(CP-FIT)为理论指导。
结果：今天的未来健康是可以接受的，用户友好，对一般执业人员有用，并支持在慢性肾脏病的识别和管理方面改善临床表现。支持FHT使用的CP-FIT变量包括简单的设计和通过FHT交付可操作的反馈。很好地适合现有的工作流程，强烈参与实践和对FHT的积极态度。上下文变量提供了使用的主要障碍，并且在很大程度上位于实践的外部环境（包括COVID-19大流行带来的压力）和影响安装和早期使用的技术故障。由于其持续存在，参与者主要利用护理提示点而不是患者管理仪表板，以及关于提示的建议的即时性和相关性，提出相容性机制，复杂性，可操作性和可信度影响使用。大多数实践在评估阶段完成后继续使用FHT。
结论：本研究表明，FHT是一个有用且可接受的软件平台，可为识别和管理CKD患者的一般实践提供直接支持。进一步的研究正在进行中，以探索FHT的有效性，并扩大平台上的条件。
