DesRoches Catherine M, Salmi Liz, Dong Zhiyong, Blease Charlotte
Division of Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2021 Dec;69(12):3497-3506. doi: 10.1111/jgs.17406. Epub 2021 Aug 17.
We examine the experiences with and perceptions of the effect of reading clinical outpatient visit notes on patients with multiple chronic conditions at three healthcare organizations with significant experience sharing clinical notes with patients.
A cross-sectional survey was conducted via patient portals at three diverse healthcare organizations in the United States: Beth Israel Deaconess Medical Center (Boston, MA), UW Medical Center (Seattle, WA), and Geisinger Health System (Danville, PA). Participants were aged 65 and older patient portal users who read at least one clinical note over the 12 months before the survey. We examined the effect of note reading on patient engagement and managing medications.
The majority of respondents had read two or more clinical notes in the 12 months before the survey. Patients with more than two chronic conditions were more likely than those with fewer or none to report that reading their notes helped them remember their care plan, take their medications as prescribed, and understand and feel more in control of their medications. Very few patients reported feeling worried or confused about their health or medications due to reading their notes.
Older patients with chronic conditions are particularly vulnerable to misremembering and mismanaging their care and medication plans. Findings from this study suggest that these patients and their care partners could receive important benefits from accessing their notes. Healthcare organizations should work to maximize patient's engagement with their health information both through the patient portal and through other methods to ensure that patients and the healthcare systems reap the full benefit of the increased transparency of medical records.
我们考察了在三个在与患者共享临床记录方面有着丰富经验的医疗机构中,患有多种慢性病的患者阅读临床门诊记录的经历以及对其效果的看法。
在美国三个不同的医疗机构通过患者门户网站进行了一项横断面调查:贝斯以色列女执事医疗中心(马萨诸塞州波士顿)、华盛顿大学医学中心(华盛顿州西雅图)和盖辛格医疗系统(宾夕法尼亚州丹维尔)。参与者为65岁及以上的患者门户网站用户,他们在调查前的12个月内阅读了至少一份临床记录。我们考察了阅读记录对患者参与度和药物管理的影响。
大多数受访者在调查前的12个月内阅读了两份或更多的临床记录。患有两种以上慢性病的患者比患有较少或没有慢性病的患者更有可能报告说,阅读他们的记录有助于他们记住护理计划、按规定服药,以及理解并更好地掌控自己的药物。极少数患者报告说因为阅读记录而对自己的健康或药物感到担忧或困惑。
患有慢性病的老年患者在记错和管理护理及药物计划方面特别容易出错。这项研究的结果表明,这些患者及其护理伙伴可以从查阅他们的记录中获得重要益处。医疗机构应努力通过患者门户网站和其他方法,最大限度地提高患者对其健康信息的参与度,以确保患者和医疗系统充分受益于医疗记录透明度的提高。