Access to peer networks through online support groups can convey health information and coping strategies, thus assisting patients to develop self-management skills. Social networking sites, such as Facebook and Internet blogs, provide a forum in which they can support others and discuss strategies for self-management.
Peer leaders, accessed through Internet links embedded in PHRs, although not considered a replacement for healthcare providers, can augment care. Although Internet links embedded in a PHR can facilitate access to a plethora of health information, they may impose new challenges for patients. New literacy skills are required that will enable patients to work with technology, navigate the Internet, and judge the relevance and validity of information regarding appropriate and safe self-management information.
Critical health literacy reflects cognitive skills that are directed toward supporting not only individual but also social action Nutbeam, Health education targets improving individual and community capacity to support healthy lifestyle choices and use health services effectively.
Nutbeam noted that empowerment is attained through the development of interactive and critical health literacy skills. However, for patients to reach this level they must first build a strong foundation of functional literacy that is strengthened by a supportive and educated provider network. Unfortunately, there is a dearth of literature on the effectiveness of PHRs and none of the benefits have been well studied.
Vocabulary, readability, numeracy, and data issues need further investigation; software needs validation through usability testing. We need to better understand how PHRs can meet the health information needs of patients and help providers to deliver care.
Many questions regarding the effectiveness of using PHRs to support chronic disease remain unanswered. Priority areas for research include evaluation of the impact of electronic PHRs on clinical, safety, economic, and psychosocial outcomes.
Studies comparing responses to alternative models of personal health records in diverse consumer groups and also ethnographic studies of usage by patients with different clinical and access needs will be of value.
Applications offer software decision-support tools; facilitate access to a wide variety of sources of information and community online networks; and, when integrated with providers, support collaboration and communication.
This is important because simply having access to self-management tools does not ensure effective usage of the tools. Health literacy is a critical consideration for the safe and appropriate use of PHRs that include self-management programs.
The authors of this article urge caution regarding the use of technology without first ensuring that patients have the basic, functional literacy skills that can be built upon to enhance knowledge and ultimately gain the critical literacy skills needed for empowerment. To do so would be putting our patients at unnecessary risk and inadvertently increasing health inequalities.
While the risk of unequal access is real and challenges of new technologies need to be overcome, the opportunity is upon us to advance health education for patients, particularly those imposed with the burden of self-managing a chronic illness. Deborah L. Begoray , PhD E-mail: dbegoray uvic. She does interdisciplinary research on health literacy with scholars from Nursing, Medicine, Health Education, Counseling Psychology, and Health Promotion and Medicine.
She works, nationally and internationally, with colleagues in Britain and the United States as well as across Canada. Apter , A. Baker , D. Birru , M. Journal of Medical Internet Research, 6 3 , e Bourbeau , J. Ottawa: Author. CCL b Media literacy for children in the Internet age.
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Mannino , D. McGowan , P. University of Victoria: Centre on Aging. National Health Service The expert patient: A new approach to chronic disease management for the 21 st century. London, UK: Department of Health. Neri , M. People with COPD often experience persistent respiratory symptoms such as dyspnoea shortness of breath. They are also vulnerable to episodic COPD exacerbations an acute worsening of respiratory symptoms requiring a change in treatment , triggered by various factors such as air pollution and infections 2.
Because of the severity of symptoms, the care for patients with COPD needs to be extended from the in-patient care for acute events at the hospital to the outpatient care for long-term ongoing self-management of COPD in the community 4 , 5. Delivery of such extensive COPD care is practically time-consuming and resource-intensive, especially under traditional care settings relying on paper-based records and face-to-face visits.
Thus, there is a need for innovative care models for improving the efficiency and effectiveness of COPD care. Its initial endeavours aimed to improve access to care for people living in remote and rural areas by bridging the geographical barriers.
The use of ICT for the provision of healthcare is referred to as telemedicine 6 , often interchangeable with telehealth 7. Three main types of telemedicine have been described: synchronous e. With the increasing popularity of smartphones, it has become possible to provide some parts of COPD care through smartphone applications apps. The use of mobile devices for the provision of healthcare is called Mobile Health or mHealth 10 , a subset of telemedicine.
Accordingly, digital health broadly include telemedicine applications, digital healthcare systems, electronic health records, and other applications using digital technologies for health. This overarching term hence encompasses electronic health eHealth , telehealth, and mHealth. The terminology of this field is ambiguous and different terms are being used interchangeably Through digital health applications, care providers in both hospital and primary care settings are able to easily share and review patients' data and, accordingly, provide optimal care plans and a personalized intervention.
In addition, numerous analysis tools and parallel computing systems have also been made available to analyse the big data from the patients and care processes for improving care intervention and outcomes Therefore, digital health transformation has been recognized as a promising driving force to empower individual patients, reduce health inequalities, and deliver innovative high-quality health care The aim of this review is to highlight the evidence base of digital health approaches for COPD care.
We accordingly reviewed some typical studies and outcomes along the pathway from I ongoing self-management of stable COPD at home, II in-hospital care for acute illness and conditions under medical treatment, and III short-term post-discharge care programs for recovery through clinical follow-up, education and training, and IV hospital-at-home programs for moderate acute conditions and early discharge Figure 1.
We also reviewed several leading studies on impacts of environmental factors and public health surveillance, in which emerging environmental sensors, satellite images, wearable devices, and social media were used.
We finally discussed the gaps and opportunities to improve COPD care outcomes for future studies. People with COPD need to effectively manage their health condition on a daily basis, such as controlling COPD symptoms, modifying risk factors, and engaging with a multidisciplinary care team for timely interventions 4 , 5. This is essential to improve health-related quality of life, and reduce hospitalizations 14 and mortality 5 , To improve the self-management of COPD, various digital health approaches such as mHealth 18 , 19 , telemonitoring 20 , and telemedicine or telehealth have been studied.
These solutions enable care providers to remotely assess patients and provide intervention. Patients can also use various personal healthcare devices and Internet applications to access health information, monitor their conditions, and engage with the care team 18 , 19 , A large cluster randomised trial, named the Whole System Demonstrator, evaluated a telehealth-enabled program in people with diabetes A potential reason for the non-significant effects was that the telemonitoring study used existing care services to support the telemonitoring intervention, whereas the telehealth intervention in the Whole System Demonstrator was supported by specialist care services and well-arranged general practices Several reviews demonstrated positive effects on reducing hospitalizations.
Small sample sizes, moderate qualities, and heterogeneity were frequently reported by reviews 27 , 28 , 30 , underscoring a need to further confirm hospitalization outcomes in future studies. Clinical evidence on mortality from reviews remains limited and inconsistent. It is evident that, among digital health applications, electronic medical record EMR represents the greatest potential for improving healthcare quality.
Using the EMR, care providers can efficiently share and access entire medical records of each patient for conducting urgent medical treatments or making optimal care plans. Besides care providers, patients can also easily review their records. This is essential for them to effectively adhere to the care plan and actively engage with a collaborative care team for optimal treatment However, for general in-hospital care, the use of EMR has been shown to be beneficial.
For example, studies have demonstrated potential advantages of using EMR in hospital care for efficient documentation, review, prescription, referral, and care management with reminders and messaging 35 , An overview of clinical and organisational impact of digital technology in hospital practice demonstrated moderate-quality evidence for EMR on reducing hospitalisations and length of stay The overview also showed an improvement in organisational efficiency, accuracy of information, documentation and turnaround times, although the evidence was of low-quality Ann Intern Med.
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Diabetes Technol Ther. If we offer it, will they accept? Factors affecting patient use intentions of personal health records and secure messaging. A holistic framework to improve the uptake and impact of eHealth technologies. Download references. Furthermore, the authors would like to thank Stefan Olde Olthof and Anita Borgerink for their contribution in the data collection and analyses of the interview studies.
The funder had no role in the design of the study and the data collection, analysis, and interpretation, and in writing the manuscript. Box , AE, Enschede, the Netherlands. You can also search for this author in PubMed Google Scholar.
FS drafted the manuscript and participated in the design and coordination of the studies. SK and JvG-P participated in the design and analyses of all studies and helped to draft the manuscript. AB-J participated in the design and analyses of the interview studies and helped to draft the manuscript.
All authors substantially in the revision and interpretation of the study findings. All authors read and approved the final version of the manuscript. Correspondence to Floor Sieverink. Ethical approval for all data collection was obtained by the ethics committee of the University of Twente reference numbers ; ; and All participants in the focus group study, interview studies, and usability studies gave written informed consent to participate.
Informed consent for collecting the log data was obtained online via accepting the general conditions that contained a paragraph about anonymously tracking the usage for research purposes. All participants in the qualitative studies interviews, focus groups, usability tests gave written consent for using their anonymized data in scientific publications.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions. Sieverink, F. Evaluating the implementation of a personal health record for chronic primary and secondary care: a mixed methods approach. Download citation. Received : 31 July Accepted : 06 November Published : 27 November Anyone you share the following link with will be able to read this content:.
Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Methods A convergent parallel mixed methods design was used, where qualitative and quantitative data were collected in parallel, analyzed separately, and finally merged. Results The results of the focus groups showed that services for coaching are strongly associated with monitoring health values and education.
Conclusions In this study, actual use of the PHRs by patients was influenced by the responsiveness of caregivers. The research questions are as follows: 1 How did the responsiveness of care providers regarding the PHR influence the actual use exposure or dose by patients? Methods To gain a more complete understanding of what difference the PHR can make in the context of self-management support for the patients and the working routines of caregivers and why, a mixed-methods evaluation approach will be applied combining quantitative and qualitative data on multiple levels [ 22 ].
Table 2 An overview of the used quantitative Quan and qualitative Qual data sources Full size table. Results Log data analysis In the Figs. Full size image.
Table 3 Topics influencing the implementation of the PHR, according to care providers, including examples Full size table. Conclusions The results of this study showed that the lacking effects of a PHR for patients with chronic diseases can be explained by assessing the fidelity. References 1. Article Google Scholar 5. Article Google Scholar 8. Article Google Scholar 9. Google Scholar Article Google Scholar PubMed Google Scholar Article Google Scholar Download references.
View author publications. Ethics declarations Ethics approval and consent to participate Ethical approval for all data collection was obtained by the ethics committee of the University of Twente reference numbers ; ; and Consent for publication All participants in the qualitative studies interviews, focus groups, usability tests gave written consent for using their anonymized data in scientific publications.
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