Primary Care unit (UIGP), BFM local 4091, Centre Médical Universitaire de Genève, University of Geneva, Geneva, Switzerland.
Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
J Gen Intern Med. 2021 Jul;36(7):1875-1882. doi: 10.1007/s11606-021-06753-1. Epub 2021 Apr 26.
Primary care physicians (PCPs) now widely use electronic health records (EHRs) during medical encounters. Experts in clinical communication issued recommendations for a patient-centered use of EHRs. However, they have never been validated by patients themselves.
To explore patients' preferences regarding physicians' EHR-related behaviors.
Discrete choice experiment study.
French-speaking patients waiting for a medical consultation at two outpatient clinics in Geneva, Switzerland.
We invited patients to watch videos displaying 2 or 3 variations of four specific EHR-related behaviors and asked them to indicate which one they preferred. EHR-related behaviors were (1) typing: continuous/intermittent/handwriting in biomedical or psychosocial focused consultations; (2) maintaining contact while typing: visual/verbal/both; (3) signposting the use of EHR: with/without; (4) position of physicians' hands and bust: on the keyboard and towards the patient/away from the keyboard and towards the patient/on the keyboard and towards the screen.
Three hundred thirty-six patients participated (response rate 61.4%). They preferred intermittent typing versus handwriting or continuous typing for biomedical issues (32.7%; 95% CI: 26.0-40.2% vs 31.6%; 95% CI: 24.9-39.0% or 14.9%; 95% CI: 10.2-21.1%) and psychosocial issues (38.7%; 95% CI: 31.6-46.3% vs 24.4% 95% CI: 18.4-31.5% or 17.9%; 95% CI; 12.7-24.4%). They favored visual and verbal contact (38.9%; 95% CI: 31.9-46.3%) over verbal (30.3%; 95% CI: 23.9-37.5%) or visual contact only (11.4%; 95% CI: 7.5-17.1%) while the doctor was typing. A majority preferred signposting the use of EHR versus no signposting (58.9%; 95% CI: 53.5-64.0% vs 34.8%; 95% CI: 29.9-40.1%). Finally, half of the patients (49.7%; 95% CI: 42.0-57.4%) favored the position with the physician's bust towards the patient and hands away from the keyboard.
Our study shows that patients' preferences regarding EHR-related behaviors are in line with most experts' recommendations. Such recommendations should be more consistently integrated into under- and postgraduate communication skills training.
初级保健医生（PCP）现在在医疗就诊期间广泛使用电子健康记录（EHR）。临床沟通专家针对以患者为中心的 EHR 使用提出了建议。然而，这些建议从未得到患者的验证。
探讨患者对医生 EHR 相关行为的偏好。
离散选择实验研究。
在瑞士日内瓦的两家门诊诊所等待医疗咨询的讲法语的患者。
我们邀请患者观看显示四个特定 EHR 相关行为的 2 或 3 种变化的视频，并要求他们选择自己喜欢的行为。EHR 相关行为包括：（1）打字：在生物医学或心理社会重点咨询中连续/间歇性/手写；（2）打字时保持联系：视觉/口头/两者兼有；（3）提示使用 EHR：有/无；（4）医生的手和胸部的位置：在键盘上并朝向患者/远离键盘并朝向患者/在键盘上并朝向屏幕。
336 名患者参与了研究（响应率为 61.4%）。他们更喜欢在生物医学问题上进行间歇性打字而不是手写或连续打字（32.7%；95%CI：26.0-40.2% 比 31.6%；95%CI：24.9-39.0% 或 14.9%；95%CI：10.2-21.1%）和心理社会问题（38.7%；95%CI：31.6-46.3% 比 24.4%；95%CI：18.4-31.5% 或 17.9%；95%CI：12.7-24.4%）。他们更喜欢视觉和口头接触（38.9%；95%CI：31.9-46.3%）而不是仅口头（30.3%；95%CI：23.9-37.5%）或仅视觉接触（11.4%；95%CI：7.5-17.1%），而医生在打字时。大多数人更喜欢在使用 EHR 时进行提示，而不是不进行提示（58.9%；95%CI：53.5-64.0% 比 34.8%；95%CI：29.9-40.1%）。最后，一半的患者（49.7%；95%CI：42.0-57.4%）更喜欢医生的胸部朝向患者且手远离键盘的位置。
我们的研究表明，患者对 EHR 相关行为的偏好与大多数专家的建议一致。此类建议应更一致地纳入到医学生和住院医师的沟通技巧培训中。
