Sharing Physician Notes Through an Electronic Portal is Associated With Improved Medication Adherence: Quasi-Experimental Study

Abstract

BackgroundIn surveys, interviews, and focus groups, patients taking medications and offered Web portal access to their primary care physicians’ (PCPs) notes report improved adherence to their regimens. However, objective confirmation has yet to be reported.ObjectiveTo evaluate the association between patient Internet portal access to primary care physician visit notes and medication adherence.MethodsThis study is a retrospective comparative analysis at one site of the OpenNotes quasi-experimental trial. The setting includes primary care practices at the Geisinger Health System (GHS) in Danville, Pennsylvania. Participants include patients 18 years of age or older with electronic portal access, GHS primary care physicians, and Geisinger health plan insurance, and taking at least one antihypertensive or antihyperlipidemic agent from March 2009 to June 2011. Starting in March 2010, intervention patients were invited and reminded to read their PCPs' notes. Control patients also had Web portal access throughout, but their PCPs' notes were not available. From prescription claims, adherence was assessed by using the proportion of days covered (PDC). Patients with a PDC ≥.80 were considered adherent and were compared across groups using generalized linear models.ResultsA total of 2147 patients (756 intervention participants, 35.21%; 1391 controls, 64.79%) were included in the analysis. Compared to those without access, patients invited to review notes were more adherent to antihypertensive medications—adherence rate 79.7% for intervention versus 75.3% for control group; adjusted risk ratio, 1.06 (95% CI 1.00-1.12). Adherence was similar among patient groups taking antihyperlipidemic agents—adherence rate 77.6% for intervention versus 77.3% for control group; adjusted risk ratio, 1.01 (95% CI 0.95-1.07).ConclusionsAvailability of notes following PCP visits was associated with improved adherence by patients prescribed antihypertensive, but not antihyperlipidemic, medications. As the use of fully transparent records spreads, patients invited to read their clinicians’ notes may modify their behaviors in clinically valuable ways.

Engaging patients through open notes: an evaluation using mixed methods

“…Although percentages of patients reading their notes may differ, study results indicate that patients both value and benefit from online access to clinical notes, and adherence for some medications may indeed improve. 52 Patients can read their notes at home or wherever they want, that is, asynchronously and repeatedly, and can readily share their notes with people of their choice by downloading them and forwarding them, or by inviting others to read them on a computer, tablet or smartphone. Some users now have 5 years of experience with open notes, and many patients have become frequent users.…”

Patient and caregiver perspectives on decision support for symptom and quality of life management during cancer treatment: Implications for eHealth

“…This finding underscores the potential usefulness of patient access to electronic medical records through Web‐based, personal health record (PHR) portals. Personal health record usage has been explored in primary care and was associated with improved communication with clinicians and improvement in medication adherence . Cahill and colleagues examined the use of PHR and the relationship among PHR usage, symptom severity, uncertainty, and mood in 186 patients with brain tumors.…”

“…Personal health record usage has been explored in primary care and was associated with improved communication with clinicians and improvement in medication adherence. [15][16][17] Cahill and colleagues 18 examined the use of PHR and the relationship among PHR usage, symptom severity, uncertainty, and mood in 186 patients with brain tumors. The investigators found that at least 60% of patients accessed PHR at least once (range, 0-126).…”

A Decade of Veteran Voices: Examining Patient Portal Enhancements Through the Lens of User-Centered Design (Preprint)

“…Evidence indicates that such access improves communication and trust, patient safety, and potentially patient outcomes. [20][21][22][23][24] Two large integrated healthcare systems that launched tethered patient portals in 2003 with significant patient adoption and sustained use are Kaiser Permanente and the Department of Veterans Affairs (VA). Kaiser Permanente's (KP) portal, My Health Manager, is used by more than 5 million members, representing about 70% of adult KP members.…”