%0期刊文章%@ 1438- 8871% I JMIR出版物%V 23卡塔尔世界杯8强波胆分析% N 4% P e25333% T与初级保健电子健康记录集成的基于互联网的心血管疾病管理干预:A Coorey,Genevieve %A Peiris,David %A Scaria,Anish %A Mulley,John %A Neubeck,Lis %A Hafiz,Nashid %A Redfern,Julie +乔治全球卫生研究所，悉尼，澳大利亚，新镇，国王街1号，悉尼，2042，澳大利亚，61 80524644，gcoorey@georgeinstitute.org.au %K电子健康%K电子健康记录%K网络干预%K实施保真度%K用户参与%K混合方法%K心血管疾病%K初级卫生保健%K手机%D 2021 %7 26.4.2021 %9原始论文%J J医学互联网Res %G英文%X背景:越来越多的证据支持电子健康干预的益处，以提高患者参与和改善一系列疾病的结果。然而，无效的项目交付和使用减员限制了这些干预措施的暴露，并可能降低其有效性。目的:本研究旨在评估电子健康干预的交付保真度，描述使用模式，比较低用户和高用户之间的结果，并确定干预交付和接收的中介因素。方法:这是一项基于互联网干预的混合方法研究，在随机对照试验(RCT)中评估其有效性。干预措施包括从初级保健电子健康记录(EHR)上传的药物和心血管疾病(CVD)风险数据;交互式、个性化的心血管疾病风险评分评估;目标设定和自我监控;互动社交论坛; and optional receipt of heart health messages. Fidelity was assessed over 12 months. Trial outcomes were compared between low and high users. Data sources included program delivery records, web log data, trial data, and thematic analysis of communication records. Results: Most participants in the intervention group (451/486, 93%) had an initial training session conducted by telephone (413/447, 92.4% of participants trained), with a mean duration of 44 minutes (range 10-90 minutes). Staff conducted 98.45% (1776/1804) of the expected follow-ups, mostly by telephone or email. Of the 451 participants who commenced log-ins, 46.8% (211) were categorized as low users (defined as at least one log-in in 3 or fewer months of follow-up), 40.4% (182) were categorized as high users (at least one log-in in more than 3 months of follow-up), and 12.8% (58) were nonadopters (no log-ins after their training session). The mean log-in frequency was 3-4 per month in ongoing users. There was no significant difference between the groups in the primary trial outcome of adherence to guideline-recommended medications (P=.44). In unadjusted analyses, high users had significantly greater eHealth literacy scores (P=.003) and were more likely to meet recommended weekly targets for fruit (P=.03) and fish (P=.004) servings; however, the adjusted findings were not significant. Interactive screen use was highest for goal tracking and lowest for the chat forum. Screens with EHR-derived data held only an early interest for most users. Fidelity measures (reach, content, dose delivered, and dose received) were influenced by the facilitation strategies used by staff, invisible qualities of staff-participant communication, and participants’ responsiveness to intervention attributes. Conclusions: A multifeature internet-based intervention was delivered with high fidelity to the RCT protocol and was regularly used by 40.4% (182/451) of users over 12 months. Higher log-in frequency as an indicator of greater intervention exposure was not associated with statistically significant improvements in eHealth literacy scores, lifestyle changes, or clinical outcomes. Attributes of the intervention and individualized support influenced initial and ongoing use. %M 33900204 %R 10.2196/25333 %U //www.mybigtv.com/2021/4/e25333 %U https://doi.org/10.2196/25333 %U http://www.ncbi.nlm.nih.gov/pubmed/33900204