Petersson Lena, Erlingsdóttir Gudbjörg
Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden.
JMIR Ment Health. 2018 Jun 21;5(2):e10521. doi: 10.2196/10521.
This is the second of two papers presenting the results from a study of the implementation of patient online access to their electronic health records (here referred to as Open Notes) in adult psychiatric care in Sweden. The study contributes an important understanding of both the expectations and concerns that existed among health care professionals before the introduction of the Open Notes Service in psychiatry and the perceived impact of the technology on their own work and patient behavior after the implementation. The results from the previously published baseline survey showed that psychiatric health care professionals generally thought that Open Notes would influence both the patients and their own practice negatively.
The objective of this study was to describe and discuss how health care professionals in adult psychiatric care in Region Skåne in southern Sweden experienced the influence of Open Notes on their patients and their own practice, and to compare the results with those of the baseline study.
We distributed a full population Web-based questionnaire to psychiatric care professionals in Region Skåne in the spring of 2017, which was one and a half years after the implementation of the service. The response rate was 27.73% (699/2521). Analyses showed that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between health professional groups and attitudes to the Open Notes Service.
A total of 41.5% (285/687) of the health care professionals reported that none of their patients stated that they had read their Open Notes. Few health care professionals agreed with the statements about the potential benefits for patients from Open Notes. Slightly more of the health care professionals agreed with the statements about the potential risks. In addition, the results indicate that there was little impact on practice in terms of longer appointments or health care professionals having to address patients' questions outside of appointments. However, the results also indicate that changes had taken place in clinical documentation. Psychologists (39/63, 62%) and doctors (36/94, 38%) in particular stated that they were less candid in their documentation after the implementation of Open Notes. Nearly 40% of the health care professionals (239/650, 36.8%) reported that the Open Notes Service in psychiatry was a good idea.
Most health care professionals who responded to the postimplementation survey did not experience that patients in adult psychiatric care had become more involved in their care after the implementation of Open Notes. The results also indicate that the clinical documentation had changed after the implementation of Open Notes. Finally, the results indicate that it is important to prepare health care professionals before an implementation of Open Notes, especially in medical areas where the service is considered sensitive.
本文是两篇论文中的第二篇，介绍了瑞典成人精神病护理中患者在线访问其电子健康记录（以下简称“开放病历”）实施情况的研究结果。该研究有助于深入了解在精神病学领域引入开放病历服务之前，医疗保健专业人员的期望和担忧，以及该技术在实施后对他们自身工作和患者行为的感知影响。先前发表的基线调查结果表明，精神科医疗保健专业人员普遍认为开放病历会对患者及其自身的实践产生负面影响。
本研究的目的是描述和讨论瑞典南部斯科讷地区成人精神病护理中的医疗保健专业人员如何体验开放病历对其患者及其自身实践的影响，并将结果与基线研究结果进行比较。
2017年春季，我们向斯科讷地区的精神科护理专业人员发放了一份基于网络的全人群调查问卷，此时该服务已实施一年半。回复率为27.73%（699/2521）。分析表明，受访者代表了全体工作人员。一项统计分析研究了医疗专业人员群体与对开放病历服务态度之间的关系。
共有41.5%（285/687）的医疗保健专业人员报告称，他们的患者中没有人表示读过自己的开放病历。很少有医疗保健专业人员同意关于开放病历对患者有潜在益处的说法。略多一些的医疗保健专业人员同意关于潜在风险的说法。此外，结果表明，在预约时间延长或医疗保健专业人员必须在预约之外回答患者问题方面，对实践几乎没有影响。然而，结果也表明临床记录发生了变化。特别是心理学家（39/63，62%）和医生（36/94，38%）表示，在实施开放病历后，他们在记录中不再那么坦诚。近40%的医疗保健专业人员（239/650，36.8%）报告称，精神病学中的开放病历服务是个好主意。
大多数对实施后调查做出回应的医疗保健专业人员没有体验到在成人精神病护理中，实施开放病历后患者更多地参与到自己的护理中。结果还表明，实施开放病历后临床记录发生了变化。最后，结果表明在实施开放病历之前，对医疗保健专业人员进行准备很重要，尤其是在该服务被认为敏感的医疗领域。
