Research Critique And Picot Statement Final Draft ASSIGNMENT

Diabetes can be a debilitating chronic disease if not effectively managed. Due to the far-reaching effects of diabetes, including heart problems, effective management is vital, and patients should be closely monitored. Effective diabetes management necessitates a continuous collaboration between patients and. Health information technology tools such as patient portals play an integral role in promoting engagement, supporting patient-provider communication, and enhance clinical outcomes in managing diabetes (Portz et al., 2019). However, their use among the elderly population has not reached the desired levels. Portz et al. (2019) found that the level of technology literacy among the elderly is low, discouraging them from using patient portals maximally. The main reason for researching this topic is because practical interventions are necessary to address fears associated with patient portals, change perception, and improve literacy. In health practice, patient education is used to impart information to patients to alter their behaviors and can improve literacy among different patient groups to improve the use of patient portals.

PICO Question and Relevance to the Topic

PICOT Question: In adults with diabetes (P), can education on using patient portals (I) compared to no patient education (C) improve patient-provider engagement (O) in three months (T)?

The PICO question examines how education can be utilized as an intervention to promote technology use in the health practice. It is an evidence-based practice approach since it allows the clinical application of research to improve patient outcomes (McNiff & Petrick, 2018). The PICO question also shows the outcome targeted by educating adults on using patient portals to address barriers that limit their application to achieve the desired levels of patient-provider engagement. The qualitative and quantitative studies explored analyze user experience, challenges impeding the use of patient portals such as perception, strategies to improve engagement through portals, and other elements where outcomes can be improved through patient education as a nursing intervention.

Background

From a research viewpoint, the is an area of concern, purpose represents the goal of the study, and the research question addresses the research problem through analysis and data interpretation (McNiff & Petrick, 2018). Sieck et al. (2018) were concerned about the connection between patients’ experience, perception, and use of patient portals. This study is centered on the premise that experience affects perception, which further determines how adult patients use patient portals. Accordingly, the use of patient portals can be maximized if factors that motivate users can be known. The study was significant in examining perspectives on patient portal use for collaboration and engagement among experienced users. The research question was about elements that motivate patients to use patient portals to manage care and improve relationships with providers. Portz et al. (2019) explored the use of patient portals in health care settings qualitatively. As the research problem, barriers to portal adoption among older adults are widespread and hamper effective use. The study was needed since user interface and experience are common barriers that should be addressed in nursing practice to improve portal adoption. The research question was whether patient portals’ user experience affects their use among elderly patients with chronic illnesses.

Reed et al. (2019) examined the impact of portal access on critical elements such as the number of outpatient and emergency visits and preventable hospitalizations. The article’s research question was the effect of patient portal access on patient visits, addressing unmet clinical needs, and health events leading to emergency and hospital care. The significance of the study is that many patients with diabetes and other complex comorbidities were able to manage their conditions better and take a more active role in their health because of access to patient portals. Greysen et al. (2018) conducted a study based on the premise that educational interventions improve literacy levels and improve clinical outcomes. In this context, the study’s primary purpose was to evaluate the efficacy of a patient-centered, tablet-based educational intervention on increasing patient engagement with their patient portals during hospitalization and after discharge. The research question was how a patient-centered, tablet-based educational intervention affects patient-portal engagement.

Method of Study

Portz et al. (2019) and Sieck et al. (2018) studies were grounded theory research. McNiff and Petrick (2018) defined grounded theory research as collecting and analyzing data from interviews and/or observation.  Portz et al. (2019) primarily relied on focus groups (semi-structured), while Sieck et al. (2018) used semi-structured interviews. In a focus group, a skilled moderator facilitates a discussion with the selected group of participants. Semi-structured interviews are characterized by the researcher asking more open-ended questions to the participants instead of following a strictly formalized list of questions. One of the main benefits of focus groups is that the researcher can clarify pre-conceived notions. However, opinions can be biased since participants may not provide honest and personal views about the issue of interest. On the other hand, semi-structured interviews provide more in-depth information through open-ended responses. However, the method is time-consuming since a significant number of participants must be interviewed to enable the researcher to draw valid conclusions and make comparisons. A better understanding of customs and habits was important to get insight on how they can be changed or improved through patient education.

Quantitative research is important when examining portal use and importance of education among adults since it enables the researcher to use deductive reasoning to develop an idea (McNiff & Petrick, 2018). Greysen et al. (2018) conducted a randomized controlled trial of adult patients to test the efficacy of a bedside educational intervention (97 participants- 50 intervention; 47 control). Patients in the control group received minimal assistance registering and logging in if they were new to the portal system. No other instruction was provided to the control group. Patients in the intervention group received extensive assistance, education on how to operate the portal, view medications, request refills, and how to verify personal information. This study is experimental as it occurs in a highly controlled environment. One or more of the variables is/are manipulated to determine the effect on the other variables, and the assignment was random (McNiff & Petrick, 2018). Randomization eliminates population bias in a study but the sample population may not represent the whole population. Reed et al. (2019) used an observational study to compare patients’ visits rates with and without portal access. An observational study allows the researcher(s) to watch and record participants’ behavior as it unfolds in a natural setting. This type of study is descriptive research as it describes a situation, behavior, or phenomenon as it occurs in a natural setting, and there is no manipulation of the variables (McNiff & Petrick, 2018). The sample population for this study was 165,447 patients with diabetes defined using clinical registries. The study was conducted within an integrated delivery system that services over four million patient members.

Results of Study

Portz et al. (2019) found that challenges to log-ins user interface design and some portals’ specific features were common hindrances to effective portal use for patient-provider engagement and health knowledge.  Sieck et al. (2018) found that portals’ features such as enabling patients to track their health information, communication, and better communication motivated them to use portals. Psychological benefits motivating patients to use portals included a greater sense of collaboration in care, increased trust in providers, and enhanced engagement in health care activities (Sieck et al., 2018).  Greysen et al. (2018) found a significant difference between patients receiving the educational intervention and those not receiving as far as the using patient portals are concerned. Patient education was found to be instrumental in improving patient engagement and post-discharge use of portals. Reed et al. (2019) found that using a patient portal supports self-management and coordination of care services. Patient portals were also found to impact the frequency of in-person health care visits depending on the level of access.

On practice implications, the current nursing practice is highly dependent on technology, and patients should be encouraged to use technology to enhance health outcomes. Engaging and educating patients via patient portals improve health outcomes to a huge extent. Accordingly, health care providers should improve all mechanisms that increase patient engagement in health care. In agreement with Portz et al. (2019), providers should be keen on promoting usefulness and ease of use as far as patient portals are concerned. Greysen et al. (2018) showed the importance of improving literacy through educational interventions that address the limiting factors reducing the use of portals among patients with diabetes. Reed et al. (2019) showed the importance of promoting access to patient portals. Accordingly, health care providers should be willing to interact with adults to change their perceptions about the importance of patient portals in engagement and health management.

Ethical Considerations

Health research should comply with the set ethical guidelines. Common ethical considerations when conducting research include human subjects’ protection, informed consent and beneficence. On participants’ protection, McNiff and Petrick (2018) stated that the critical consideration elements include privacy, anonymity and confidentiality, protection from harm and discomfort and fair selection and treatment. Informed consent means that participants should participate in the research freely with full information about the implications of participating in the research. Beneficence has all to do with keeping participants free from harm. When conducting research, the researchers adhered to these principles. Participants are treated autonomously and informed on what it meant to engage in research. Researchers also sought approval from the relevant authorizing bodies before commencing their research. All participants were of sound mind and children excluded. Children are viewed as legally incompetent to provide valid consent, and including them in research can be emotionally or mentally harmful (Rentala, 2018).

Outcomes Comparison- Conclusion

The PICOT question states that “In adults with diabetes (P), can education on using patient portals (I) compared to no patient education (C) improve patient-provider engagement (O) in three months (T)?” The anticipated outcome is a scenario where adults with diabetes are more engaged in illness management via patient portals after patient education. The patient education will change their perception and improve their knowledge on patient portals’ use. The outcomes of the articles correspond to my anticipated outcome since their general objective and recommendation is to make adults more receptive to technology by addressing their knowledge gaps and access to patient portals. Overall, this research enables me to become a safer, kinder, and more compassionate nurse since it enables me to be centrally involved in addressing population health problems through evidence-based nursing interventions. It also provides an opportunity to connect compassionately with patient-related concerns and addressing them to enhance patient safety and care quality.

 

 

 

References

Greysen, S. R., Harrison, J. D., Rareshide, C., Magan, Y., Seghal, N., Rosenthal, J., … & Auerbach, A. D. (2018). A randomized controlled trial to improve engagement of hospitalized patients with their patient portals. Journal of the American Medical Informatics Association, 25(12), 1626-1633. https://doi.org/10.1093/jamia/ocy125

McNiff, P., & Petrick, M. (2018). Nursing research: Understanding methods for best practice. .

Portz, J. D., Bayliss, E. A., Bull, S., Boxer, R. S., Bekelman, D. B., Gleason, K., & Czaja, S. (2019). Using the technology acceptance model to explore user experience, intent to use, and use behavior of a patient portal among older adults with multiple chronic conditions: descriptive qualitative study. Journal of Medical Internet Research, 21(4), e11604. doi: 

Reed, M. E., Huang, J., Brand, R. J., Neugebauer, R., Graetz, I., Hsu, J., … & Grant, R. (2019). Patients with complex chronic conditions: Health care use and clinical events associated with access to a patient portal. PLoS One, 14(6), e0217636.

Rentala, S. (2018). Basics in nursing research and biostatistics. Jaypee Brothers Medical Publishers.

Sieck, C. J., Hefner, J. L., & McAlearney, A. S. (2018). Improving the patient experience through patient portals: Insights from experienced portal users. Patient Experience Journal, 5(3), 47-54. doi: https://doi.org/10.35680/2372-0247.1269