JMIR Publications

ABSTRACT

Background:

Patients with long-term needs for health services are often expected to participate actively in specialized outpatient care, regardless of their condition or digital skills. Health literacy and digital literacy are seen as requisites for active participation to exploit the potential of digital outpatient services. However, associations between participation in a digital outpatient care service and health literacy remain unclear.

Objective:

The objective of the current study was to evaluate whether digital outpatient care for 6 months resulted in improved health literacy, health-related quality of life (HRQL), digital/eHealth literacy and utilization of healthcare services compared with usual care.

Methods:

We conducted a multicenter nonrandomized trial with one intervention arm and one control arm. Patients were allocated 1:2 in favor of the intervention arm. Eligible patients were aged 18 years or older and receiving outpatient care in the pain, lung, neurology, or cancer departments at two Norwegian university hospitals. Patients in the intervention arm received digital outpatient care utilizing a tailored combination of patient reported outcome (PRO) measures, self-monitoring, and chats for timely contact with the outpatient clinic. Patient responses were assessed by healthcare workers, via a dashboard that included a traffic light system to draw attention to the most urgent patient reports. The control group received care as usual. The data were collected at enrollment/baseline and after 3 and 6 months. The primary outcome was the change in health literacy according to the Health Literacy Questionnaire (HLQ) domain “Understanding health information well enough to know what to do” at 6 months. The secondary outcomes were four additional domains from HLQ, seven domains of digital/eHealth literacy, HRQL, acceptability of the digital intervention, and health service use. The data were analyzed using SPSS, with univariate methods.

Results:

A total of 162 patients were recruited, with 55 allocated to the control arm and 107 to the intervention arm. After 6 months of follow up, data were available for 135 individuals (attrition rate 17.3%). There was no statistically significant change in the primary outcome, “Understanding health information well enough to know what to do” at 6 months. After 3 months, the health literacy domains “Actively managing my own health”, and “Understanding health information well enough to know what to do,” as well as both physical and mental HRQL, improved in the digital outpatient intervention group compared with the control group. Overall, the participants in digital outpatient care had a high satisfaction rate when evaluating the digital outpatient care platform.

Conclusions:

The present study explored digital outpatient care comprising PRO measures, asynchronous messaging, and remote monitoring on clinical indications for patients with chronic pain, ILD, epilepsy, or cancer. Although no significant differences were observed in patients’ health literacy regarding their understanding of health information after 6 months, our data indicate an improvement in health literacy domains and HRQL at 3 months. Despite our mixed results, the participants reported high satisfaction with the digital outpatient care intervention, and our findings highlight the potential of digital interventions in outpatient care. Clinical Trial: NCT05068869 https://clinicaltrials.gov/ct2/show/NCT05068869 International Registered Report Identifier (IRRID): DERR1-10.2196/46649