Patients' perceptions of their doctors' notes and after‐visit summaries: A mixed methods study of patients at safety‐net clinics

Abstract

BackgroundPatients are increasingly offered electronic access to their doctors' notes, and many consistently receive paper After‐Visit Summaries. Specific feedback from patients about notes and summaries are lacking, particularly within safety‐net settings.DesignA mixed methods studySetting and ParticipantsPatients with poorly controlled diabetes attending two urban safety‐net primary care clinics in Washington State.MethodsPatients read their own most recent clinic note and After‐Visit Summary, then completed a brief survey followed by a focus group discussion (3 groups in a large general medicine teaching clinic and 1 in an HIV/AIDS clinic) about their perceptions of the clinic note and After‐Visit Summary.ResultsTwenty‐seven patients participated; 70% were male, 41% were Black, 48% were unemployed or disabled, 56% reported fair/poor health, and 37% had accessed the electronic patient portal. A majority of patients felt their note content was useful (89%); a minority reported that their notes were not accurate (19%), had too much medical jargon (29%), or were too long (26%). Themes identified from the discussions included reliance on the provider to explain confusing content; a desire for more rather than less detail; and perceived inaccuracies, particularly in heavily templated notes. In each focus group, one or more portal users were enthusiastically willing to teach other patients.ConclusionsThe majority of focus group participants at this safety‐net site had not accessed the electronic patient portal, but those who had were willing to promote the portal benefits and assist others. Patients identified specific opportunities to improve clinic notes and After‐Visit Summaries.

Empowering patients and reducing inequities: is there potential in sharing clinical notes?

“…Similarly, 47% (120/253) of black patients and 54% (190/354) of Hispanic patients reported strengthened goal alignment with their clinician after accessing their notes, compared with 39% (2611/6763) of white patients 3. Qualitative research also suggests that reading their clinical notes can help patients feel listened to, validated and understood 16…”

“…For example, in a recent qualitative survey involving predominantly minority patients at a safety net clinic, participants reported appreciating reading the detail in their clinicians’ notes and described using open notes as a reference for medication information and follow-up plans. As one patient noted: “ I like my summaries because I can go back and revisit them ” 16. While open notes may not help all patients, such as those with very reduced reading skills, they may help some patients with marginal and limited literacy.…”

Creation of a Patient-Centered Journey Map to Improve the Patient Experience: A Mixed Methods Approach

“…Patients perceive the after-visit summary tool to have useful content, but they also note that they may require more explanation of confusing or contradicting information often found in these scripted documents. 25 The present thematic analysis showed us that patients have varying needs based on the context of their health and psychosocial condition. Research has found that patient needs vary based on health contexts of chronic illness vs acute medical situations, and longitudinal primary care vs specialty care.…”

Helpfulness of Clinical Visit Summary Content From Multi-Specialty Care: A Mixed-Methods Assessment

“…7 Clinical visit summaries, constructed under the premise of Meaningful Use, are offered after office visits to engage patients in their health and improve care coordination in the outpatient setting; this has generally been viewed as having a high degree of utility. 8 - 15 However, they vary widely in format and included content and may be hard to use for some patients and caregivers. Patients have reported that information on medications and follow-up appointments are the most important knowledge enhancers of a clinical visit, however, these findings are reported from primary care or single specialty settings.…”

“…Patients have reported that information on medications and follow-up appointments are the most important knowledge enhancers of a clinical visit, however, these findings are reported from primary care or single specialty settings. 8 - 10 , 12 , 15 , 16 A standard for providing summary information across specialties does not exist, and the perceived benefit and essential components of clinical visit summaries for patients receiving care from multiple specialties has not been defined.…”