Ross Stephen E, Moore Laurie A, Earnest Mark A, Wittevrongel Loretta, Lin Chen-Tan
Division of General Internal Medicine, University of Colorado Health Sciences Center, Aurora, Colorado, USA.
J Med Internet Res. 2004 May 14;6(2):e12. doi: 10.2196/jmir.6.2.e12.
It is possible to provide patients with secure access to their medical records using the Internet. Such access may assist patients in the self-management of chronic diseases such as heart failure.
To assess how a patient-accessible online medical record affects patient care and clinic operations. The SPPARO (System Providing Access to Records Online) software consisted of a web-based electronic medical record, an educational guide, and a messaging system enabling electronic communication between the patient and staff.
A randomized controlled trial was conducted in a specialty practice for patients with heart failure. Surveys assessing doctor-patient communication, adherence, and health status were conducted at baseline, 6 months, and 1 year. Use of the system, message volume, utilization of clinical services, and mortality were monitored.
One hundred and seven patients were enrolled (54 intervention and 53 controls). At 12 months, the intervention group was not found to be superior in self-efficacy (KCCQ self-efficacy score 91 vs. 85, p=0.08), but was superior in general adherence (MOS compliance score 85 vs. 78, p=0.01). A trend was observed for better satisfaction with doctor-patient communication. The intervention group had more emergency department visits (20 vs. 8, p=0.03), but these visits were not temporally related to use of the online medical record. There were no adverse effects from use of the system.
Providing patients with congestive heart failure access to an online medical record was feasible and improved adherence. An effect on health status could not be demonstrated in this pilot study.
利用互联网为患者提供安全访问其医疗记录的途径是可行的。这种访问可能有助于患者对诸如心力衰竭等慢性病进行自我管理。
评估患者可访问的在线医疗记录如何影响患者护理和诊所运营。SPPARO（在线记录访问系统）软件由基于网络的电子病历、一份教育指南以及一个使患者与工作人员能够进行电子通信的消息系统组成。
在一家针对心力衰竭患者的专科诊所进行了一项随机对照试验。在基线、6个月和1年时进行了评估医患沟通、依从性和健康状况的调查。监测了系统的使用情况、消息量、临床服务的利用率以及死亡率。
共招募了107名患者（54名干预组和53名对照组）。在12个月时，未发现干预组在自我效能方面更优（堪萨斯城心肌病问卷自我效能得分91对85，p = 0.08），但在总体依从性方面更优（医疗结局研究依从性得分85对78，p = 0.01）。观察到在医患沟通满意度方面有更好的趋势。干预组有更多的急诊科就诊（20次对8次，p = 0.03），但这些就诊与在线医疗记录的使用在时间上并无关联。使用该系统没有产生不良影响。
为充血性心力衰竭患者提供在线医疗记录访问是可行的，并提高了依从性。在这项试点研究中未能证明对健康状况有影响。
