T患者对基于手机的心衰远程监测计划的依从性:卡塔尔世界杯8强波胆分析纵向混合方法研究%A Ware,Patrick %A Dorai,Mala %A Ross,Heather J %A Cafazzo,Joseph A Laporte,Audrey %A Boodoo,Chris %A Seto,Emily +卫生政策、管理和评估研究所，Dalla Lana公共卫生学院，多伦多，学院街155号，ON, M5T 3M6，加拿大，1 647 227 6015,patrick.ware@mail.utoronto.ca %K远程监测%K mHealth %K依从性%K心功能%D 2019 %7 26.02.2019 %9原始论文%J JMIR mHealth Uhealth %G英文%X背景:远程监测(TM)可以通过促进患者的自我护理和临床决策支持来改善心力衰竭(HF)的结果。然而，这些结果只有在患者坚持服用处方的家庭读数的情况下才有可能实现。目的:本研究的目的是:(1)量化患者在基于手机的TM项目中坚持带处方的家庭读数的程度;(2)解释基于项目注册持续时间、患者特征和患者对TM项目的感知的纵向坚持率。方法:采用混合方法解释序贯设计来满足2个研究目标，所有解释方法均以技术接受与使用统一理论(UTAUT2)为指导。总体坚持率计算为患者服用体重、血压、心率和症状读数的天数占他们参加该计划的总天数的比例，最长可达1年。每月坚持率也被计算为患者在项目注册后每30天内接受相同4个读数的天数的比例。接下来，进行简单回归和多元回归，以确定时间、年龄、性别和疾病严重程度对依从率的影响。其他解释方法包括在6个月和12个月时对患者进行问卷调查，了解TM计划的感知益处和易用性，分析患者退出该计划的原因，以及对患者进行有目的抽样(n=24)的半结构化访谈，包括坚持率和人口统计学范围。 Results: Overall average adherence was 73.6% (SD 25.0) with average adherence rates declining over time at a rate of 1.4% per month (P<.001). The multivariate regressions found no significant effect of sex and disease severity on adherence rates. When grouping patients’ ages by decade, age was a significant predictor (P=.04) whereby older patients had higher adherence rates over time. Adherence rates were further explained by patients’ perceptions with regard to the themes of (1) performance expectancy (improvements in HF management and peace of mind), (2) effort expectancy (ease of use and technical issues), (3) facilitating conditions (availability of technical support and automated adherence calls), (4) social influence (support from family, friends, and trusted clinicians), and (5) habit (degree to which taking readings became automatic). Conclusions: The decline in adherence rates over time is consistent with findings from other studies. However, this study also found adherence to be the highest and most consistent over time in older age groups and progressively lower over time for younger age groups. These findings can inform the design and implementation of TM interventions that maximize patient adherence, which will enable a more accurate evaluation of impact and optimization of resources. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9911 %M 30806625 %R 10.2196/13259 %U http://mhealth.www.mybigtv.com/2019/2/e13259/ %U https://doi.org/10.2196/13259 %U http://www.ncbi.nlm.nih.gov/pubmed/30806625