患者对在线获取全科医疗记录的看法的影响：纵向调查研究。

The Effects of Online Access to General Practice Medical Records Perceived by Patients: Longitudinal Survey Study.

机构信息

School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.

出版信息

J Med Internet Res. 2023 Jun 2;25:e47659. doi: 10.2196/47659.

DOI:10.2196/47659

PMID:37266981

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10276325/

Abstract

BACKGROUND

Patient online access to medical records is assumed to facilitate patient empowerment and advance patient-centered health care. However, to date, the actual effects of online access to medical records perceived by patients and other outcomes are insufficiently empirically tested.

OBJECTIVE

This study aimed to investigate the effects of online access to medical records on patient empowerment, informed decision-making, and the patient-provider relationship perceived by patients.

METHODS

A nationwide, 2-wave, longitudinal survey study was conducted among Dutch adults (N=2402). Linear regression analyses were performed. In model 1, the perceived effects of online access to medical records (measured at T1 [first measurement; July 2021]) on 16 outcomes (measured at T2 [second measurement; January 2022]), which were associated with the use of online access to general practice medical records in previous research, were investigated. Model 2 included sociodemographic factors and patient characteristics as confounders.

RESULTS

Users indicated more strongly than nonusers that online access to medical records would increase their participation in health care, improve the relationship with their general practitioner, and support informed decision-making. These results were robust when adjusted for the influence of confounders. Effect sizes were very small, with unstandardized regression coefficients (B) ranging between -0.39 and 0.28. Higher digital and health literacy were associated with higher ratings of almost all effects.

CONCLUSIONS

Online access to medical records has the potential to empower patients and foster informed decision-making among patients. The effects in this study were small but might grow over time. Other factors, such as the attitude of general practitioners toward online access to medical records, might moderate these effects. The results indicate that the potential benefits of online access to medical records might be unevenly distributed. We suggest future exploration of the conditions under which online access to medical records can improve health care system functioning and efficiency without increasing health inequality.

摘要

背景

人们认为，患者在线访问病历可以增强患者的能力并推动以患者为中心的医疗保健。然而，迄今为止，患者感知的在线访问病历的实际效果和其他结果尚未得到充分的经验验证。

目的

本研究旨在调查在线访问病历对患者能力、知情决策和患者感知的医患关系的影响。

方法

在荷兰成年人中进行了一项全国性的 2 波纵向调查研究（N=2402）。采用线性回归分析。在模型 1 中，调查了在线访问病历（在 T1 时测量[第一次测量；2021 年 7 月]）对 16 项结果（在 T2 时测量[第二次测量；2022 年 1 月]）的感知效果，这些结果与之前关于在线访问一般实践病历的研究中使用在线访问病历相关。模型 2 包括社会人口统计学因素和患者特征作为混杂因素。

结果

与非用户相比，用户更强烈地表示，在线访问病历将增加他们参与医疗保健的程度，改善与他们的全科医生的关系，并支持知情决策。当调整混杂因素的影响时，这些结果是稳健的。效应大小非常小，未标准化回归系数（B）范围在-0.39 到 0.28 之间。更高的数字和健康素养与几乎所有效果的更高评价相关。

结论

在线访问病历有可能增强患者的能力并促进患者的知情决策。本研究中的效果虽然较小，但随着时间的推移可能会增加。其他因素，如全科医生对在线访问病历的态度，可能会调节这些效果。结果表明，在线访问病历的潜在好处可能分配不均。我们建议未来探索在线访问病历在不增加健康不平等的情况下如何改善医疗保健系统的功能和效率的条件。