JMIR Publications

ABSTRACT

Background and aims: Health-IT interventions to decrease readmissions in cirrhosis may be limited by patient-associated factors. Our aim was to determine perspectives regarding adoption versus refusal of Health-IT interventions by patient-caregiver dyads.

Methods:

Inpatients with cirrhosis and their caregivers were approached to participate in a randomized trial of health-IT interventions requiring daily contact with research teams via the PatientBuddy App. This App focuses on ascites, medications and hepatic encephalopathy (HE) over 30 days. Regression analyses for acceptance were analyzed. For those who declined, a semi-structured interview with themes focused on caregivers, protocol, transport/logistics and technology demands and privacy was performed.

Results:

349 patient-caregiver dyads were approached (191 VCU, 56 VA and 102 Mayo) of which 87 dyads (25%) agreed to participate. On regression, dyads agreeing were likely to have a male patient (OR: 2.08, P=0.01), GI bleeding (OR: 2.3, P =0.006) or HE admission (OR: 2.0, P =0.01) while opioid use (OR 0.46, P =0.03) and alcohol-related etiology (OR: 0.54, P =0.02) were associated with refusal. Race, study site, and other admission reasons were not contributory. In the 262 dyads who declined randomization caregiver reluctance (43%), perceived burden (31%), technology-related issues (14%), transportation/logistics (10%) and others (4%), but not privacy, were major concerns.

Conclusions:

Patients with cirrhosis admitted with HE and GI bleeding without opioid use or alcohol-related etiologies were likely to participate in a Health-IT intervention focused on preventing readmissions. Caregiver and study burden but not privacy were major reasons to decline participation. Reducing perceived patient-caregiver burden and improving communication may improve participation.