Patient–Health Care Professional Communication via a Secure Web-Based Portal in Severe Mental Health Conditions: Qualitative Analysis of Secure Messages
Notice bibliographique
Résumé
BACKGROUND: Patients' web-based access to their medical records and secure messaging (SM) via patient portals is becoming increasingly prevalent worldwide. SM offers several potential benefits, including improved health outcomes and increased patient engagement. However, SM also raises concerns about effects on the therapeutic relationship and may be constrained by factors such as limited digital literacy and access to digital devices. Evidence on the use of SM in mental health is limited, and results are inconclusive. OBJECTIVE: This study aimed to examine (1) the purposes for which health care professionals (HCPs) and patients with psychiatric disorders use SM to communicate and (2) the specific use patterns associated with both patients and HCPs. METHODS: The secure messages (n=274) of 38 patients with psychiatric disorders and 4 HCPs (psychiatrists) from 3 psychiatric outpatient clinics in Brandenburg, Germany, was analyzed using thematic analysis. The data selected for this study represent a subsample from a larger study comprising a total of 116 patients. The subsample consists of the patients and HCPs who used SM. RESULTS: A total of 274 messages were analyzed: 22.3% (61/274) were initial notes from HCPs, 44.5% (122/274) were patient responses, and 33.2% (91/274) were HCP replies. Patients sent between 1 and 15 messages (mean 4.16, SD 3.42) and logged in 1 to 42 times (mean 10.78, SD 9.38). Most messages were sent during the day, although some were also sent at night and in the early morning. Regarding the purposes of SM, 4 core functions of SM were identified: reporting and feedback, interpersonal uses, intrapersonal uses, and organizational uses. Both patients and HCPs used SM to share treatment-relevant information and elicited feedback on treatment and medication. Furthermore, secure messages included expressions of gratitude by the patients, in addition to well-wishes and emotional support from the HCPs. SM allowed patients to reflect on their treatment and provide self-encouragement. Finally, secure messages were used to address organizational aspects such as scheduling, appointments, and administrative tasks. CONCLUSIONS: SM in outpatient mental health care is multifaceted and holds the potential to enhance therapeutic contact and improve access to care by enabling quick, low-threshold communication between patients and HCPs, allowing treatment-related concerns to be addressed promptly and effectively. However, the asynchronous nature of SM also poses new challenges, particularly in managing acute mental health crises and in setting boundaries to prevent HCPs from being perceived as constantly available. Therefore, specific training for HCPs-both during medical education and in clinical practice-is essential, along with clear guidelines on handling crises and managing sensitive information.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,024 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,005 | 0,006 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,001 | 0,005 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».