Emani Srinivas, Healey Michael, Ting David Y, Lipsitz Stuart R, Ramelson Harley, Suric Vladimir, Bates David W
Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
J Med Internet Res. 2016 Apr 13;18(4):e77. doi: 10.2196/jmir.5207.
Patient portals are being used to provide a clinical summary of the office visit or the after-visit summary (AVS) to patients. There has been relatively little research on the characteristics of patients who access the AVS through a patient portal and their beliefs about the AVS.
The aim was to (1) assess the characteristics of patients who are aware of and access the AVS through a patient portal and (2) apply the Theory of Planned Behavior (TPB) to predict behavioral intention of patients toward accessing the AVS provided through a patient portal.
We developed a survey capturing the components of TPB (beliefs, attitude, perceived norm, and perceived behavioral control). Over a 6-month period, patients with a patient portal account with an office visit in the previous week were identified using our organization's scheduling system. These patients were sent an email about the study and a link to the survey via their portal account. We applied univariate statistical analysis (Pearson chi-square and 1-way ANOVA) to assess differences among groups (aware/unaware of AVS and accessed/did not access AVS). We reported means and standard deviations to depict belief strengths and presented correlations between beliefs and attitude, perceived norm, and perceived behavioral control. We used hierarchical regression analysis to predict behavioral intention toward accessing the AVS through the patient portal.
Of the 23,336 patients who were sent the survey, 5370 responded for a response rate of 23.01%. Overall, 76.52% (4109/5370) were aware that the AVS was available through the patient portal and 54.71% of those (2248/4109) accessed the AVS within 5 days of the office visit. Patients who accessed the AVS had a greater number of sessions with the portal (mean 119, SD 221.5) than those who did not access the AVS (mean 79.1, SD 123.3, P<.001); the difference was not significant for awareness of the AVS. The strongest behavioral beliefs with accessing the AVS were being able to track visits and tests (mean 2.53, SD 1.00) followed by having medical information more readily accessible (mean 2.48, SD 1.07). In all, 56.7% of the variance in intention to access the AVS through the portal was accounted for by attitude, perceived norm, and perceived behavioral control.
Most users of a patient portal were aware that the AVS was accessible through the portal. Patients had stronger beliefs about accessing the AVS with the goal of timely and efficient access of information than with engaging in their health care. Interventions to improve patient access of the AVS can focus on providers promoting patient beliefs about the value of the AVS for tracking tests and visits, and timely and efficient access of information.
患者门户网站正被用于向患者提供门诊就诊的临床总结或就诊后总结（AVS）。关于通过患者门户网站访问AVS的患者特征及其对AVS的看法，相关研究相对较少。
旨在（1）评估通过患者门户网站知晓并访问AVS的患者特征，以及（2）应用计划行为理论（TPB）预测患者访问通过患者门户网站提供的AVS的行为意图。
我们开发了一项调查，涵盖TPB的各个组成部分（信念、态度、感知规范和感知行为控制）。在6个月的时间里，使用我们机构的调度系统识别出上周有门诊就诊且拥有患者门户网站账户的患者。通过他们的门户网站账户向这些患者发送了一封关于该研究的电子邮件和调查链接。我们应用单变量统计分析（Pearson卡方检验和单因素方差分析）来评估各组之间的差异（知晓/不知晓AVS以及访问/未访问AVS）。我们报告均值和标准差以描述信念强度，并呈现信念与态度、感知规范和感知行为控制之间的相关性。我们使用层次回归分析来预测通过患者门户网站访问AVS的行为意图。
在被发送调查问卷的23336名患者中，5370名回复，回复率为23.01%。总体而言，76.52%（4109/5370）的患者知晓可通过患者门户网站获取AVS，其中54.71%（2248/4109）的患者在门诊就诊后5天内访问了AVS。访问AVS的患者使用门户网站的会话次数（均值119，标准差221.5）多于未访问AVS的患者（均值79.1，标准差123.3，P<0.001）；对于AVS的知晓情况，差异不显著。与访问AVS最强烈的行为信念是能够跟踪就诊和检查（均值2.53，标准差1.00），其次是能更便捷地获取医疗信息（均值2.48，标准差1.07）。总体而言，通过门户网站访问AVS的意图中，56.7%的变异可由态度、感知规范和感知行为控制来解释。
大多数患者门户网站用户知晓可通过门户网站访问AVS。患者对于为及时高效获取信息而访问AVS的信念，强于参与医疗保健方面的信念。改善患者访问AVS的干预措施可侧重于医疗服务提供者增强患者对于AVS在跟踪检查和就诊以及及时高效获取信息方面价值的信念。
