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      Evaluation of the Digital Alzheimer Center: Testing Usability and Usefulness of an Online Portal for Patients with Dementia and Their Carers

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          Abstract

          Background

          Dementia is a progressive and highly disabling neurodegenerative disease that will likely become highly prevalent in the future due to the globally aging population. To improve health care efficiency and quality for dementia care, eHealth could help with, for example, an online portal, such as the Digital Alzheimer Center (DAC) of the Vrije Universiteit Medical Center Amsterdam. It provides up-to-date disease information, peer-to-peer contact, and methods for contacting the hospital and health professionals.

          Objective

          We aimed to investigate the usability and usefulness of the DAC for patients with dementia and carers to get insight into the feasibility and value of this eHealth app in dementia care and to recommend potential improvements.

          Methods

          A descriptive study among patients, carers, and health care professionals was performed. Mixed methods were used, consisting of observations (n=10, 4 people with dementia, 6 carers), an online survey (n=287; 88 patients, 199 carers), and semistructured interviews (n=18; 6 patients, 6 carers, 6 health care professionals). During the observations, participants performed a set of five different prescribed tasks on the portal. Speed, number of errors, and navigation were noted. The online survey aimed to assess users’ opinions on the portal’s usability and usefulness. Semistructured interviews were conducted in a subsample of patients, carers, and health care professionals to gain more in-depth information.

          Results

          In the usability assessment, eight categories of errors were distinguished, of which three were of critical, two of medium, and three of low severity. In the survey, 45% (40/88) of the patients and 53% (105/199) of the carers indicated they used the portal. In all, 33% (12/36) of patients and 61% (62/102) of carers found it easy to learn to work with the portal. Most considered the DAC generally useful: 65% (17/26) of patients and 78% (67/86) of carers found the DAC useful, especially for understanding dementia (patients: 64%, 16/25; carers: 62%, 53/86). In the semistructured interviews, the site was generally rated positively on usability and usefulness and being well designed. People with dementia and carers indicated it helped them to understand and deal with dementia.

          Conclusions

          To our knowledge, this is the first study investigating the usability and usefulness of an Internet portal especially designed for people with dementia and their carers. An online patient portal could be a useful means to help to support patients and carers in dealing with dementia: the majority of users positively evaluated usability and usefulness of the portal, and appreciated the information on it. However, only a minority of patients found it easy to work with the portal. Good design and frequent usability testing is essential to offer a good online portal.

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          Most cited references33

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          European citizens' use of E-health services: A study of seven countries

          Background European citizens are increasingly being offered Internet health services. This study investigated patterns of health-related Internet use, its consequences, and citizens' expectations about their doctors' provision of e-health services. Methods Representative samples were obtained from the general populations in Norway, Denmark, Germany, Greece, Poland, Portugal and Latvia. The total sample consisted of 7934 respondents. Interviews were conducted by telephone. Results 44 % of the total sample, 71 % of the Internet users, had used the Internet for health purposes. Factors that positively affected the use of Internet for health purposes were youth, higher education, white-collar or no paid job, visits to the GP during the past year, long-term illness or disabilities, and a subjective assessment of one's own health as good. Women were the most active health users among those who were online. One in four of the respondents used the Internet to prepare for or follow up doctors' appointments. Feeling reassured after using the Internet for health purposes was twice as common as experiencing anxieties. When choosing a new doctor, more than a third of the sample rated the provision of e-health services as important. Conclusion The users of Internet health services differ from the general population when it comes to health and demographic variables. The most common way to use the Internet in health matters is to read information, second comes using the net to decide whether to see a doctor and to prepare for and follow up on doctors' appointments. Hence, health-related use of the Internet does affect patients' use of other health services, but it would appear to supplement rather than to replace other health services.
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            Usability Engineering

            Written by the author of the best-selling <b>HyperText & HyperMedia,</b> this book is an excellent guide to the methods of usability engineering. The book provides the tools needed to avoid usability surprises and improve product quality. Step-by-step information on which method to use at various stages during the development lifecycle are included, along with detailed information on how to run a usability test and the unique issues relating to international usability.<br><br>* Emphasizes cost-effective methods that developers can implement immediately<br>* Instructs readers about which methods to use when, throughout the development lifecycle, which ultimately helps in cost-benefit analysis. <br>* Shows readers how to avoid the four most frequently listed reasons for delay in software projects.<br>* Includes detailed information on how to run a usability test.<br>* Covers unique issues of international usability.<br>* Features an extensive bibliography allowing readers to find additional information.<br>* Written by an internationally renowned expert in the field and the author of the best-selling HyperText & HyperMedia.
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              The Impact of Electronic Patient Portals on Patient Care: A Systematic Review of Controlled Trials

              Background Modern information technology is changing and provides new challenges to health care. The emergence of the Internet and the electronic health record (EHR) has brought new opportunities for patients to play a more active role in his/her care. Although in many countries patients have the right to access their clinical information, access to clinical records electronically is not common. Patient portals consist of provider-tethered applications that allow patients to electronically access health information that are documented and managed by a health care institution. Although patient portals are already being implemented, it is still unclear in which ways these technologies can influence patient care. Objective To systematically review the available evidence on the impact of electronic patient portals on patient care. Methods A systematic search was conducted using PubMed and other sources to identify controlled experimental or quasi-experimental studies on the impact of patient portals that were published between 1990 and 2011. A total of 1,306 references from all the publication hits were screened, and 13 papers were retrieved for full text analysis. Results We identified 5 papers presenting 4 distinct studies. There were no statistically significant changes between intervention and control group in the 2 randomized controlled trials investigating the effect of patient portals on health outcomes. Significant changes in the patient portal group, compared to a control group, could be observed for the following parameters: quicker decrease in office visit rates and slower increase in telephone contacts; increase in number of messages sent; changes of the medication regimen; and better adherence to treatment. Conclusions The number of available controlled studies with regard to patient portals is low. Even when patient portals are often discussed as a way to empower patients and improve quality of care, there is insufficient evidence to support this assumption.
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                Author and article information

                Contributors
                Journal
                JMIR Res Protoc
                JMIR Res Protoc
                ResProt
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                1929-0748
                Jul-Sep 2016
                21 July 2016
                : 5
                : 3
                : e144
                Affiliations
                [1] 1VU University Medical Center Department of Psychiatry AmsterdamNetherlands
                [2] 2VU University Medical Center Alzheimer Center; Department of Neurology; Department of Epidemiology & Biostatistics AmsterdamNetherlands
                [3] 3VU University Medical Center Alzheimer Center; Department of Neurology AmsterdamNetherlands
                Author notes
                Corresponding Author: Bart Hattink b.hattink@ 123456vumc.nl
                Author information
                http://orcid.org/0000-0002-9472-2201
                http://orcid.org/0000-0002-4812-1229
                http://orcid.org/0000-0002-0161-3656
                http://orcid.org/0000-0003-0215-8373
                http://orcid.org/0000-0002-8933-3260
                Article
                v5i3e144
                10.2196/resprot.5040
                4974452
                27444209
                46857f49-7c60-431a-bb3c-7626cd5ff1ba
                ©Bart Hattink, Rose-Marie Droes, Sietske Sikkes, Ellen Oostra, Afina W Lemstra. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 21.07.2016.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.

                History
                : 15 August 2015
                : 10 September 2015
                : 21 December 2015
                : 20 February 2016
                Categories
                Original Paper
                Original Paper

                dementia,alzheimer disease,patient portal,electronic health record,ehealth

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