Patient and Physician
Surveys
Original Research:
Improving Patient Care
Annals of Internal
Medicine
By Jan Walker, RN, MBA;
Suzanne G. Leveille, PhD, RN; Long Ngo, PhD; Elisabeth Vodicka, BA; Jonathan D.
Darer, MD, MPH; Shireesha Dhanireddy, MD; Joann G. Elmore, MD, MPH; Henry J.
Feldman, MD; Marc J. Lichtenfeld, PhD; Natalia Oster, MPH; James D. Ralston,
MD, MPH; Stephen E. Ross, MD; and Tom Delbanco, MD
Abstract
Background: Little is
known about what primary care physicians (PCPs) and patients would expect if
patients were invited to read their doctors' office notes.
Objective: To explore
attitudes toward potential benefits or harms if PCPs offered patients ready
access to visit notes.
Design: The PCPs and
patients completed surveys before joining a voluntary program that provided
electronic links to doctors' notes.
Setting: Primary care
practices in 3 U.S. states.
Participants: Participating
and nonparticipating PCPs and adult patients at primary care practices in
Massachusetts, Pennsylvania, and Washington.
Measurements: Doctors'
and patients' attitudes toward and expectations of open visit notes, their
ideas about the potential benefits and risks, and demographic characteristics.
Results: 110 of 114
participating PCPs (96%), 63 of 140 nonparticipating PCPs (45%), and
37 856 of 90 203 patients (42%) completed surveys. Overall, 69% to
81% of participating PCPs across the 3 sites and 92% to 97% of patients thought
open visit notes were a good idea, compared with 16% to 33% of nonparticipating
PCPs. Similarly, participating PCPs and patients generally agreed with
statements about potential benefits of open visit notes, whereas
nonparticipating PCPs were less likely to agree. Among participating PCPs, 74%
to 92% anticipated improved communication and patient education, in contrast to
45% to 67% of nonparticipating PCPs. More than one half of participating PCPs
(50% to 58%) and most nonparticipating PCPs (88% to 92%) expected that open
visit notes would result in greater worry among patients; far fewer patients
concurred (12% to 16%). Thirty-six percent to 50% of participating PCPs and 83%
to 84% of nonparticipating PCPs anticipated more patient questions between
visits. Few PCPs (0% to 33%) anticipated increased risk for lawsuits. Patient
enthusiasm extended across age, education, and health status, and 22%
anticipated sharing visit notes with others, including other doctors.
Limitations: Access
to electronic patient portals is not widespread, and participation was limited
to patients using such portals. Response rates were higher among participating
PCPs than nonparticipating PCPs; many participating PCPs had small patient
panels.
Conclusion: Among
PCPs, opinions about open visit notes varied widely in terms of predicting the
effect on their practices and benefits for patients. In contrast, patients
expressed considerable enthusiasm and few fears, anticipating both improved
understanding and more involvement in care. Sharing visit notes has broad
implications for quality of care, privacy, and shared accountability.
Primary Funding Source: The
Robert Wood Johnson Foundation's Pioneer Portfolio, Drane Family Fund, and
Koplow Charitable Foundation.
The entire story is here.
Thanks to Ken Pope for
this story.