My Medical Record Neuro: Identifying strategies to support widespread uptake, use and usefulness of digital care in long-term conditions
Principal Investigator: Dr Chris Kipps
Team members: John Spreadbury, Sarah Fearn.
Project Partners: University Hospital Southampton NHS Foundation Trust, NIHR CRN Wessex.
Covid-19 has changed the way we deliver care - My Medical Record offers an opportunity for remote care to support and maintain quality of care delivery.
My Medical Record (MyMR) platform is an online care platform, which offers patients more control over their healthcare.
Using MyMR patients can: Access their clinical letters and appointments in one place, message their clinical teams for advice, read clinically relevant information on their condition and monitor and share outcomes.
During the Covid and non-Covid period it has the potential to help reduce variation in care, make it more personal and integrated, identify people with higher risk of a poor outcome and promote self-management. It can support clinicians to be more efficient, freeing up time for the sickest patients.
There are now 70,000 patients enrolled, and the platform is being rolled out to support care pathways across the Hampshire and Isle of Wight region. Despite this expansion, use at an individual level, amongst patients with long-term neurological conditions (LTC), including dementia, and their treating clinicians (HCPs), has been variable. This research aims to better understand this variation in order to maximise the uptake, use and usefulness of MyMR Neuro for these groups.
Underlying concept: Normalisation process theory (NPT) helps structure understanding about the factors that may promote, or act as a barrier to, an intervention or new way of workingbecoming a routine part of care. We will use the four components of NPT to structure four workpackages (WPs):
- ‘Coherence’ (sense-making) factors: ‘Attitudes’ To understand attitudes towards digital care in general and the MyMR digital care platform for existing users and potential users
- ‘Cognitive participation’ (engagement) factors: 'Profiles’ To identify patient characteristics that influence use, including those which may lead to digital health inequality or exclusion in our population
- ‘Collective action’ (work to enable the intervention to happen): 'Strategies’ To use data from WP1 and 2 to create and assess strategies to optimise user skills, knowledge, and engagement
- ‘Reflexive monitoring’ (opportunities for feedback) factors: 'Evaluation’ To investigate how additional support, opportunities for feedback, and outcome monitoring can promote use
- We will use patient and healthcare professional interviews in WP1, surveys in WP2, workshops and other feedback mechanisms in WP3, and groups comparisons/ multiple small-scale randomised trials.
The findings will create impact through: Improved implementation of digital self-management platforms, Better knowledge informing the sustainability of digital platforms, transfer of this knowledge to other, similar platforms, Better identification of facilitators and barriers to digital supported care and self-management; and recognition of those at risk of digital healthcare exclusion