Experiences and opinions of general practitioners with patient online record access: an online survey in England.
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ABSTRACT: Objective
To describe the experiences and opinions of general practitioners (GPs) in England regarding patients having access to their full online GP health records.Design
Convenience sample, online survey.Participants
400 registered GPs in England.Main outcome measures
Investigators measured GPs' experiences and opinions about online record access (ORA), including patient care and their practice.Results
A total of 400 GPs from all regions of England responded. A minority (130, 33%) believed ORA was a good idea. Most GPs believed a majority of patients would worry more (364, 91%) or find their GP records more confusing than helpful (338, 85%). Most GPs believed a majority of patients would find significant errors in their records (240, 60%), would better remember their care plan (280, 70%) and feel more in control of their care (243, 60%). The majority believed they will/already spend more time addressing patients' questions outside of consultations (357, 89%), that consultations will/already take significantly longer (322, 81%) and that they will be/already are less candid in their documentation (289, 72%) after ORA. Nearly two-thirds of GPs believed ORA would increase their litigation (246, 62%).Conclusions
Similar to clinicians in other countries, GPs in our sample were sceptical of ORA, believing patients would worry more and find their records more confusing than helpful. Most GPs also believed the practice would exacerbate work burdens. However, the majority of GPs in this survey also agreed there were multiple benefits to patients having online access to their primary care health records. The findings of this survey also contribute to a growing body of contrastive research from countries where ORA is advanced, demonstrating clinicians are sceptical while studies indicate patients appear to derive multiple benefits.
SUBMITTER: Blease CR
PROVIDER: S-EPMC10806584 | biostudies-literature | 2024 Feb
REPOSITORIES: biostudies-literature
Publications
Experiences and opinions of general practitioners with patient online record access: an online survey in England.
Blease Charlotte R CR Kharko Anna A Dong Zhiyong Z Jones Ray B RB Davidge Gail G Hagglund Maria M Turner Andrew A Turner Andrew A DesRoches Catherine C McMillan Brian B
BMJ open 20240201 1
<h4>Objective</h4>To describe the experiences and opinions of general practitioners (GPs) in England regarding patients having access to their full online GP health records.<h4>Design</h4>Convenience sample, online survey.<h4>Participants</h4>400 registered GPs in England.<h4>Main outcome measures</h4>Investigators measured GPs' experiences and opinions about online record access (ORA), including patient care and their practice.<h4>Results</h4>A total of 400 GPs from all regions of England respo ...[more]
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Project description:BackgroundIn 2022, NHS England announced plans to ensure that all adult primary care patients in England would have full online access to new data added to their general practitioner (GP) record. However, this plan has not yet been fully implemented. Since April 2020, the GP contract in England has already committed to offering patients full online record access on a prospective basis and on request. However, there has been limited research into UK GPs' experiences and opinions about this practice innovation.ObjectiveThis study aimed to explore the experiences and opinions of GPs in England about patients' access to their full web-based health record, including clinicians' free-text summaries of the consultation (so-called "open notes").MethodsIn March 2022, using a convenience sample, we administered a web-based mixed methods survey of 400 GPs in the United Kingdom to explore their experiences and opinions about the impact on patients and GPs' practices to offer patients full online access to their health records. Participants were recruited using the clinician marketing service Doctors.net.uk from registered GPs currently working in England. We conducted a qualitative descriptive analysis of written responses ("comments") to 4 open-ended questions embedded in a web-based questionnaire.ResultsOf 400 GPs, 224 (56%) left comments that were classified into 4 major themes: increased strain on GP practices, the potential to harm patients, changes to documentation, and legal concerns. GPs believed that patient access would lead to extra work for them, reduced efficiency, and increased burnout. The participants also believed that access would increase patient anxiety and incur risks to patient safety. Experienced and perceived documentation changes included reduced candor and changes to record functionality. Anticipated legal concerns encompassed fears about increased litigation risks and lack of legal guidance to GPs about how to manage documentation that would be read by patients and potential third parties.ConclusionsThis study provides timely information on the views of GPs in England regarding patient access to their web-based health records. Overwhelmingly, GPs were skeptical about the benefits of access both for patients and to their practices. These views are similar to those expressed by clinicians in other countries, including Nordic countries and the United States before patient access. The survey was limited by the convenience sample, and it is not possible to infer that our sample was representative of the opinions of GPs in England. More extensive, qualitative research is required to understand the perspectives of patients in England after experiencing access to their web-based records. Finally, further research is needed to explore objective measures of the impact of patient access to their records on health outcomes, clinician workload, and changes to documentation.
| S-EPMC9996425 | biostudies-literature
Project description:AimIncreasingly at GP practices, patients appear who are extremely worried as a result of health information researched online and consequently affected by doubts and concerns. The study highlights GP attitudes and experiences with regard to this patient group. Moreover, it identifies strategies adopted by GPs to respond appropriately to worried or scared patients.Subject and methodsIn the German federal states of Baden-Württemberg, Rhineland-Palatinate and Saarland, 2532 GPs were surveyed between June and August 2022. Owing to the explorative nature of the study, a descriptive analysis was conducted.ResultsOf the total respondents, 77% deemed the current problem of internet-related health concerns to be a major challenge in everyday practice. The implications affect patients' mental stability and expectations towards the doctor (esp. demand for further instrumental diagnosis, 83%). One doctor in five (20%) has experienced the termination of patient contact because the relationship with the patient was no longer possible due to the patient's uncontrolled online information behaviour. To respond to worried or scared patients, the respondents generally ask certain patient groups about online research (39%) and take this into account in the doctor-patient discussion (23%). Furthermore, the respondents use a detailed explanation of the diagnosis and/or treatment (65%) and recommend websites that they consider reputable (66%). Some of the doctors prefer a joint examination of the information researched by the patient (55%) as well as to explain the benefits and risks of online research (43%).ConclusionMany GPs demonstrate a high level of awareness and sensitivity with regard to extensive online research and potentially worried patients. It seems advisable to actively address the online search for information in the patient consultation to prevent possible negative effects on the doctor-patient relationship and to actively involve the patient. In this respect, it would also be worth considering expanding the medical history to include the dimension of online searching.Supplementary informationThe online version contains supplementary material available at 10.1007/s10389-023-01909-1.
| S-EPMC10096108 | biostudies-literature
Project description:BackgroundThe growth in the volume of online patient feedback, including online patient ratings and comments, suggests that patients are embracing the opportunity to review online their experience of receiving health care. Very little is known about health care professionals' attitudes toward online patient feedback and whether health care professionals are comfortable with the public nature of the feedback.ObjectiveThe aim of the overall study was to explore and describe general practitioners' attitudes toward online patient feedback. This paper reports on the findings of one of the aims of the study, which was to explore and understand the concerns that general practitioners (GPs) in England have about online patient feedback. This could then be used to improve online patient feedback platforms and help to increase usage of online patient feedback by GPs and, by extension, their patients.MethodsA descriptive qualitative approach using face-to-face semistructured interviews was used in this study. A topic guide was developed following a literature review and discussions with key stakeholders. GPs (N=20) were recruited from Cambridgeshire, London, and Northwest England through probability and snowball sampling. Interviews were transcribed verbatim and analyzed in NVivo using the framework method, a form of thematic analysis.ResultsMost participants in this study had concerns about online patient feedback. They questioned the validity of online patient feedback because of data and user biases and lack of representativeness, the usability of online patient feedback due to the feedback being anonymous, the transparency of online patient feedback because of the risk of false allegations and breaching confidentiality, and the resulting impact of all those factors on them, their professional practice, and their relationship with their patients.ConclusionsThe majority of GPs interviewed had reservations and concerns about online patient feedback and questioned its validity and usefulness among other things. Based on the findings from the study, recommendations for online patient feedback website providers in England are given. These include suggestions to make some specific changes to the platform and the need to promote online patient feedback more among both GPs and health care users, which may help to reduce some of the concerns raised by GPs about online patient feedback in this study.
| S-EPMC4704896 | biostudies-literature
Project description:BackgroundIn 2020, Portugal had high levels of unmet health care needs. Primary Care was reported as the main source of unmet needs.ObjectivesTo describe face-to-face and remote access to GPs in Portugal during the COVID-19 pandemic. To discover patient experiences and attitudes to access to care. To identify determinants of access to care.MethodsA survey of a random sample of 4,286 adults registered in a group of Family Practices was conducted in 2021. Paper questionnaires were sent by post to patients who had no e-mail address registered with the practice. Patients with an e-mail address were sent a link to an online questionnaire. Outcomes were reported waiting times for face-to-face and remote contacts with GPs, dichotomized to ascertain compliance with standards. Associations between participant characteristics and outcome variables were tested using logistic regression.ResultsWaiting times for face-to-face consultations with GPs during the pandemic often exceeded the maximum waiting times (MWT) set by the National Health Service. Remote contacts were mostly conducted within acceptable standards. Waiting times for speaking with the GP over the phone were rated as 'poor' by 40% and 27% reported requests for these calls as unmet. The odds of getting care over MWT increased for participants who reported poorer digital skills. Participants were less likely to get non-urgent consultations over MWT if they found it easy to use the online patient portal to book appointments (odds ratio 0.24; 99% confidence intervals 0.09-0.61), request prescriptions (0.18; 0.04-0.74) or insert personal data (0.18; 0.04-0.95).ConclusionPatient reported access to GPs during the pandemic was uneven in Portugal. Obtaining non-urgent consultations and remote contacts over MWT affected mainly those patients with poor digital skills. Telephone access to GPs received the worse ratings. Access through traditional pathways must remain available, to prevent the widening of inequities.
| S-EPMC10204959 | biostudies-literature
Project description:ObjectiveGiven recent concerns regarding general practitioner (GP) workforce capacity, we aimed to describe GPs' career intentions, especially those which might impact on GP workforce availability over the next 5 years.DesignCensus survey, conducted between April and June 2016 using postal and online responses , of all GPs on the National Health Service performers list and eligible to practise in primary care. Two reminders were used as necessary.SettingSouth West England (population 3.5 million), a region with low overall socioeconomic deprivation.ParticipantsEligible GPs were 2248 out of 3370 (67 % response rate).Main outcome measuresReported likelihood of permanently leaving or reducing hours spent in direct patient care or of taking a career break within the next 5 years and present morale weighted for non-response.ResultsResponders included 217 7 GPs engaged in patient care. Of these, 863 (37% weighted, 95% CI 35 % to 39 %) reported a high likelihood of quitting direct patient care within the next 5 years. Overall, 1535 (70% weighted, 95% CI 68 % to 72 %) respondents reported a career intention that would negatively impact GP workforce capacity over the next 5 years, through permanently leaving or reducing hours spent in direct patient care, or through taking a career break. GP age was an important predictor of career intentions; sharp increases in the proportion of GPs intending to quit patient care were evident from 52 years. Only 305 (14% weighted, 95% CI 13 % to 16 %) reported high morale, while 1195 ( 54 % weighted, 95% CI 52 % to 56 %) reported low morale. Low morale was particularly common among GP partners. Current morale strongly predicted GPs' career intentions; those with very low morale were particularly likely to report intentions to quit patient care or to take a career break.ConclusionsA substantial majority of GPs in South West England report low morale. Many are considering career intentions which, if implemented, would adversely impact GP workforce capacity within a short time period.Study registrationNIHR HS&DR - 14/196/02, UKCRN ID 20700.
| S-EPMC5719652 | biostudies-literature
Project description:BackgroundThe ability for patients to directly view their radiology images through secure electronic portals is rare in the American health care system. We previously surveyed patients within our health system and found that a large majority wanted to view their own radiology images online, and we have since implemented this new feature.ObjectiveWe aim to understand patient experiences, opinions, and actions taken after viewing their own radiology images online.MethodsWe emailed a web-based survey to patients who recently viewed their radiology images via our electronic patient portal.ResultsWe sent 1825 surveys to patients and received 299 responses (response rate 16.4%). Patients reported a favorable experience (258/299, 86.3% agree) viewing their radiology images online. Patients found value in reading their radiology reports (288/299, 96.3% agree) and viewing their images (267/299, 89.3% agree). Overall, patients felt that accessing and viewing their radiology images online increased their understanding of their medical condition (258/299, 82.9%), made them feel more in control and reassured (237/299, 79.2% and 220/299, 73.6%, respectively), and increased levels of trust (214/299, 71.6%). Only 6.4% (19/299) of the patients indicated concerns with finding errors, 6.4% (19/299) felt that viewing their images online made them worry more, and 7% (21/299) felt confused when viewing their images online. Of patients who viewed their images online, 45.2% (135/299) took no action with their images, 32.8% (98/299) saved a copy for their records, 25.4% (76/299) shared them with their doctor, and 14.7% (44/299) shared them with another doctor for a second opinion. A total of 9 patients (3%) shared their radiology images on Facebook, Instagram, or both, primarily to inform family and friends. Approximately 10.4% (31/299) of the patients had questions about their radiology images after viewing them online, with the majority (20/31, 65%) seeking out a doctor, and far fewer (5/31, 16%) choosing to ask a family member about their images. Finally, respondents viewed their images online using 1 or more devices, including computers, smartphones, tablets, or a combination of these devices. Approximately 26.7% (103/385) of the responses noted technical difficulties, with the highest incidence rate occurring with smartphones.ConclusionsWe report the first known survey results from patients who viewed their own radiology images through a web-based portal. Patients reported high levels of satisfaction and increased levels of trust, autonomy, reassurance, and medical understanding. Only a small minority of patients expressed anxiety or confusion. We suggest that patient access to radiology images, such as patient access to radiology reports, is highly desired by patients and is operationally practical. Other health care institutions should consider offering patients access to their radiology images online in the pursuit of information transparency.
| S-EPMC9086874 | biostudies-literature
Project description:BackgroundOnline record access (ORA) is being increasingly implemented internationally. Despite reported benefits for patients, health care professionals (HCPs) have raised concerns about potential disadvantages. To date, no review has examined the empirical evidence on whether and how documentation changes following the introduction of patients' ORA.ObjectiveThis scoping review aimed to examine potential subjective and objective changes in HCPs' documentation after using patients' ORA.MethodsA scoping review was conducted using a methodological framework for scoping reviews and data from 4 electronic databases. Studies examining objective and subjective changes in clinical documentation following the implementation of ORA, specifically those related to actual use experiences (rather than previous expectations), up to July 2023, were included. We used the Mixed Methods Appraisal Tool to assess the quality of the included studies. The narrative synthesis and reporting of findings were guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews).ResultsOf the 3143 papers screened, 42 (1.34%) were included in this review. The included studies mainly used qualitative methods and were predominantly published after 2016 in the United States. The included studies were conducted in different settings (inpatient and outpatient) and clinical areas (somatic, mental health, and other). In total, 8 studies analyzed clinical notes, while the remaining studies focused on the experiences of patients, HCPs, and other stakeholders with ORA. Objectively, a decrease in complexity, an increase in readability, and a change in the emotional tone of the clinical notes were observed. The length of the clinical notes was observed to change both objectively and subjectively, although the direction of this change was inconclusive. However, many HCPs also reported writing notes that were less open and more restrictive to protect sensitive or hypothetical information. While for some HCPs the implementation of ORA made the clinical notes a less efficient and valuable working tool, others perceived that ORA opened up new therapeutic opportunities through direct contact with patients.ConclusionsThe question of whether an inherently uniform clinical note can meet the diverse needs of different health care stakeholders remains unresolved, highlighting the challenges of standardizing practices in this complex sector. While ORA may encourage HCPs to make their clinical notes more patient friendly, it may also compromise the integrity of documentation by omitting sensitive findings and expert judgment, which can put patients at risk and lead to errors that increase the risk of malpractice. Given the limitations of digital documentation in fostering trust, it is imperative to prioritize meaningful patient-HCP interactions. The use of compensatory measures, such as parallel documentation and restricted access to clinical notes, indicates systemic problems and suggests that current practices are suboptimal.International registered report identifier (irrid)RR2-10.2196/46722.
| S-EPMC11888084 | biostudies-literature
Project description:ObjectivesInvolving general practitioners (GPs) in the commissioning/purchasing of services has been an important element in English health policy for many years. The Health and Social Care Act 2012 handed responsibility for commissioning of the majority of care for local populations to GP-led Clinical Commissioning Groups (CCGs). In this paper, we explore GP attitudes to involvement in commissioning and future intentions for engagement.Design and settingSurvey of a random sample of GPs across England in 2015.MethodThe Eighth National GP Worklife Survey was distributed to GPs in spring 2015. Responses were received from 2611 respondents (response rate = 46%). We compared responses across different GP characteristics and conducted two sample tests of proportions to identify statistically significant differences in responses across groups. We also used multivariate logistic regression to identify the characteristics associated with wanting a formal CCG role in the future.ResultsWhile GPs generally agree that they can add value to aspects of commissioning, only a minority feel that this is an important part of their role. Many current leaders intend to quit in the next 5 years, and there is limited appetite among those not currently in a formal role to take up such a role in the future. CCGs were set up as 'membership organisations' but only a minority of respondents reported feeling that they had 'ownership' of their local CCG and these were often GPs with formal CCG roles. However, respondents generally agree that the CCG has a legitimate role in influencing the work that they do.ConclusionCCGs need to engage in active succession planning to find the next generation of GP leaders. GPs believe that CCGs have a legitimate role in influencing their work, suggesting that there may be scope for CCGs to involve GPs more fully in roles short of formal leadership.
| S-EPMC5734491 | biostudies-literature
Project description:BackgroundEmergency Care and Treatment Plans are recommended for all primary care patients in the United Kingdom who are expected to experience deterioration of their health. The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was developed to integrate resuscitation decisions with discussions about wider goals of care. It summarises treatment recommendations discussed and agreed between patients and their clinicians for a future emergency situation and was designed to meet the needs of different care settings. Our aim is to explore GPs' experiences of using ReSPECT and how it transfers across the primary care and secondary care interface.MethodsWe conducted five focus groups with GPs in areas being served by hospitals in England that have implemented ReSPECT. Participants were asked about their experience of ReSPECT, how they initiate ReSPECT-type conversations, and their experiences of ReSPECT-type recommendations being communicated across primary and secondary care. Focus groups were transcribed and analysed using Thematic Analysis.ResultsGPs conceptualise ReSPECT as an end of life planning document, which is best completed in primary care. As an end of life care document, completing ReSPECT is an emotional process and conversations are shaped by what a 'good death' is thought to be. ReSPECT recommendations are not always communicated or transferable across care settings. A focus on the patient's preferences around death, and GPs' lack of specialist knowledge, could be a barrier to completion of ReSPECT that is transferable to acute settings.ConclusionConceptualising ReSPECT as an end of life care document suggests a difference in how general practitioners understand ReSPECT from its designers. This impacts on the transferability of ReSPECT recommendations to the hospital setting.
| S-EPMC8224258 | biostudies-literature
Project description:ObjectiveThe standard data-collection procedure in the Norwegian national patient experience survey programme is post-discharge mail surveys, which include a pen-and-paper questionnaire with the option to answer electronically. A purely electronic protocol has not previously been explored in Norway. The aim of this study was to compare response rates, background characteristics, data quality and main study results for a survey of patient experiences with general practitioners (GPs) administered by the standard mail data-collection procedure and a web-based approach.DesignCross-sectional survey.SettingGP offices in Norway.ParticipantsThe sample consisted of 6999 patients aged 16 years and older registered with a GP in November 2018.InterventionBased on a three-stage sampling design, 6999 patients of GPs aged 16 or older were randomised to one of two survey administration protocols: Group A, who were mailed an invitation with both a pen-and-paper including an electronic response option (n=4999) and Group B, who received an email invitation with electronic response option (n=2000).Main outcome measuresResponse rates, background characteristics, data quality and main study results.ResultsThe response rate was markedly higher for the mail survey (42.6%) than for the web-based survey (18.3%). A few of the background variables differed significantly between the two groups, but the data quality and patient-reported experiences were similar.ConclusionsWeb-based surveys are faster and less expensive than standard mail surveys, but their low response rates and coverage problems threaten their usefulness and legitimacy. Initiatives to increase response rates for web-based data collection and strategies for tailoring data collection to different groups should be key elements in future research.
| S-EPMC7554501 | biostudies-literature