高触摸与低触摸策略实施CRC查数字健康干预:一个随机临床试验
David P Miller1,2, Anna C Snavely3, Ajay Dharod1,2
1Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
JAMA internal medicine
|May 5, 2025
概括
一个旨在增加结肠直肠癌 (CRC) 查的移动应用程序的患者使用率很低,即使采用了密集的实施策略,也没有提高查率. 克服员工流动和疲劳等障碍仍然是一个挑战.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 数字健康实施方案
- 预防癌症 预防癌症
背景情况:
- 低结肠直肠癌 (CRC) 查率是一个重大的公共卫生问题.
- 患者,临床医生和系统层面的障碍阻碍了CRC查的普及.
- 移动健康 (mHealth) 应用程序被探索为解决这些障碍的战略.
研究的目的:
- 评估是否更密集的实施策略增加了移动应用程序的使用,旨在克服CRC查的多层次障碍.
- 评估mHealth应用程序对CRC查完成率的影响.
主要方法:
- 一个混合型3有效性-实施实用试验,涉及18个初级保健实践.
- 实践被随机分配到一个低触摸或高触摸的实施策略.
- 主要结局包括应用程序覆盖率 (完成应用程序的合格患者的百分比) 和有效性 (在实施后16周内完成CRC测试).
主要成果:
- 总体而言,患者对CRC应用程序的使用率很低,在第一个月从大约5.5%下降到第六个月的1%,无论实施强度如何.
- 与低触摸相比,高触摸实现显示了CheckIn应用程序 (OR,2.8) 和CRC应用程序 (OR,1.7) 的使用增加的趋势,尽管对于CheckIn来说,这种趋势在统计学上并不显著.
- 在应用程序实施后,与实施前队列相比,CRC查完成率没有显著差异 (OR,0.9).
结论:
- 面向患者的mHealth应用程序用于CRC查的利用率很低,并且无论实施强度如何,都没有提高查完成率.
- 持续存在的挑战,如员工流动,流行后的疲劳,工作流程的复杂性和时间限制,可能会限制实施策略的有效性.
- 需要进一步的研究来确定更有效的策略,将数字健康工具整合到常规癌症查工作流程中.
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