HIV Care Providers' Attitudes regarding Mobile Phone Applications and Web-Based Dashboards to support Patient Self-Management and Care Coordination: Results from a Qualitative Feasibility Study.

Swendeman D

doi:10.16966/2380-5536.127

Abstract

In-depth qualitative interviews were conducted with healthcare providers (HCPs) from five HIV medical care coordination teams in a large Los Angeles County HIV clinic, including physicians, nurses, and psychosocial services providers. HCPs reported on the potential utility, acceptability, and barriers for patient self-monitoring and notifications via mobile phones, and web-based dashboards for HCPs. Potential benefits included: 1) enhancing patient engagement, motivation, adherence, and self-management; and 2) improving provider-patient relationships and HCP care coordination. Newly diagnosed and patients with co-morbidities were highest priorities for mobile application support. Facilitators included universal mobile phone ownership and use of smartphones or text messaging. Patient-level barriers included concerns about low motivation and financial instability for consistent use by some patients. Organizational barriers, cited primarily by physicians, included concerns about privacy protections, easy dashboard access, non-integrated electronic records, and competing burdens in limited appointment times. Psychosocial services providers were most supportive of the proposed mobile tools.

Highlights

Mobile phones offer new opportunities for patients with chronic conditions to engage in selfmanagement activities between clinical visits while enabling real-time availability of data for health care providers (HCPs) to monitor patients’ status, provide more timely intervention, and coordinate care [1]
Recent research has identified the potential efficacy of mobile phone self-monitoring and messaging for addressing common behavioral challenges and comorbidities for people living with HIV (PLH) to support self-management of mental health, reduction of substance use, decrease in sexual risk behaviors, and enhanced medication adherence [18,19]
Supporting patient engagement, motivation, and self-management through self-monitoring and feedback—HCPs thought that mobile technologies could be useful to enhance patient engagement, self-management, and satisfaction, as one physician noted: “I think that, you know, if you’re able to....accomplish....developing the tool, that it will improve the patient’s engagement because if they engage with this, and we look at it and we address it, that will be validation for the patient that, ‘Oh, my input is important and they’re trying to do something about it.’

Summary

Introduction

Mobile phones offer new opportunities for patients with chronic conditions to engage in selfmanagement activities between clinical visits while enabling real-time availability of data for health care providers (HCPs) to monitor patients’ status, provide more timely intervention, and coordinate care [1]. Studies have examined HCPs’ attitudes regarding mobile phone applications for patient monitoring, self-management and clinical dashboards for asthma [5,6], diabetes [7], high blood pressure [8,9], and heart disease and failure [10,11,12]. These studies identify several perceived benefits by HCPs, including more timely data that is otherwise unavailable, the ability to respond more quickly than scheduled visits allow, and improved adherence and self-management by patients. The MCC program has an ultimate aim of supporting HIV-positive patients to become “self-managed” (i.e., achieve undetectable viral load and retention in care) by providing comprehensive and coordinated medical care and behavioral interventions for medication adherence, substance abuse, and mental health care [16,17]

Objectives

Methods

Results

Discussion

Conclusion