Patient access to medical records and healthcare outcomes: a systematic review

Objectives

We conducted a systematic review to determine the effect of providing patients access to their medical records (electronic or paper-based) on healthcare quality, as defined by measures of safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.

Methods

Articles indexed in PubMed from January 1970 to January 2012 were reviewed. Twenty-seven English-language controlled studies were included. Outcomes were categorized as measures of effectiveness (n=19), patient-centeredness (n=16), and efficiency (n=2); no study addressed safety, timeliness, or equity.

Results

Outcomes were equivocal with respect to several aspects of effectiveness and patient-centeredness. Efficiency outcomes in terms of frequency of in-person and telephone encounters were mixed. Access to health records appeared to enhance patients’ perceptions of control and reduced or had no effect on patient anxiety.

Conclusion

Although few positive findings generally favored patient access, the literature is unclear on whether providing patients access to their medical records improves quality.     

Personal health records and hypertension control: a randomized trial

Purpose

To examine the impact of a personal health record (PHR) in patients with hypertension measured by changes in biological outcomes, patient empowerment, patient perception of quality of care, and use of medical services.

Methods

A cluster-randomized effectiveness trial with PHR and no PHR groups was conducted in two ambulatory clinics. 453 of 1686 (26.4%) patients approached were included in the analyses. A PHR tethered to the patient''s electronic medical record (EMR) was the primary intervention and included security measures, patient control of access, limited transmission of EMR data, blood pressure (BP) tracking, and appointment assistance. BP was the main outcome measure. Patient empowerment was assessed using the Patient Activation Measure and Patient Empowerment Scale. Quality of care was assessed using the Clinician and Group Assessment Score (CAHPS) and the Patient Assessment of Chronic Illness Care. Frequency of use of medical services was self-reported.

Results

No impact of the PHR was observed on BP, patient activation, patient perceived quality, or medical utilization in the intention-to-treat analysis. Sub-analysis of intervention patients self-identified as active PHR users (25.7% of those with available information) showed a 5.25-point reduction in diastolic BP. Younger age, self-reported computer skills, and more positive provider communication ratings were associated with frequency of PHR use.

Conclusions

Few patients provided with a PHR actually used the PHR with any frequency. Thus simply providing a PHR may have limited impact on patient BP, empowerment, satisfaction with care, or use of health services without additional education or clinical intervention designed to increase PHR use.

Clinical trial registration number

http://ClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT01317537","term_id":"NCT01317537"}}NCT01317537.     

Impact of personal protective equipment on patient safety and health care workers

BackgroundThe study aims to assess the effect of personal protective equipment (PPE) on the physical and psychological well-being of health care workers (HCWs) and its impact on patient safety.MethodsAfter ethical approval, a 14-point questionnaire was circulated offline and online among the HCWs of ours institute, who were involved in performing invasive procedures while wearing a PPE. The responses were analysed using the SPSS software version 26.ResultsOf 198 responses, the mean duration of PPE use was 4.6 ± 1.52 h. Seventy percent of respondents suggested <4 h of continuous use of PPE. Seventy-seven percent found difficulties during the procedures while wearing PPE and agreed to errors while performing a procedure. Poor visibility (95.5%), fogging (84.9%), communication difficulty (75.3%), sweating (74.2%), posture-related discomfort (56.1%) and poor concentration (51%) were major causes. Anxiety (39.9%) and fear of spreading an infection to the family (42.9%) were major psychological effects. Eighty percent of HCWs raised concern over the quality of PPE, N95 mask and eye protector. The HCWs felt the need to improve the quality of PPEs, use extra padding around the ears, sealing the N95 mask with adhesive tape, besides using sign language for communication for more safety. Fifty percent graded the procedure-related difficulty level >6 on a Likert scale of 1–10.ConclusionPPE-related discomfort is common among the HCWs and could contribute to errors during an invasive procedure. Efforts to alleviate the physical and psychological well-being of the HCWs will be essential for reducing procedural error while wearing a PPE.     

应用健康教育路径对住院糖尿病患者服药依从性的影响

目的探讨应用健康教育路径对住院糖尿病患者服药依从性的影响。方法选取160例住院糖尿病患者并将其随机分为两组,80例采用传统健康教育的患者作为对照组,80例应用健康路径进行健康教育的患者作为观察组,观察比较两组患者健康教育前后对糖尿病相关知识掌握程度、服药依从性及血糖控制的情况。结果两组患者健康教育前糖尿病相关知识掌握比较,差异无统计学意义(P>0.05),但观察组患者健康教育后各项知识评分均明显高于对照组(P<0.05);两组患者健康教育前服药依从性比较,差异无统计学意义(P>0.05),但出院后6个月内,观察组患者62例(77.50%)服药依从性佳,对照组45例(56.25%)服药依从性佳,两组比较差异有统计学意义(P<0.05)。两组患者健康教育前空腹血糖及餐后2 h血糖比较差异无统计学意义(P>0.05),观察组出院后6个月空腹血糖及餐后2 h血糖明显低于对照组,两组差异有统计学意义(P<0.05)。结论应用健康教育路径对住院糖尿病患者进行健康教育,可提高患者对糖尿病知识掌握程度,提高服药依从性,从而使血糖得到更好的控制。     

个体化健康教育对精神分裂症患者服药依从性的作用

目的探讨个体化健康教育对精神分裂症患者服药依从性的影响。方法选择60例精神分裂症患者,按照入组标准分为观察组(n=30)和对照组(n=30),分别给予个体化健康教育和常规健康教育。结果入院后1个月、3个月,观察组自知力与治疗态度问卷(ITAQ)评分高于对照组,完全服药依从性亦明显高于对照组(P0.05)。结论对精神分裂症患者采用个体化健康教育,可明显提高其服药依从性。     

护理安全管理对干部病房老年患者的临床效果评价

目的：探讨护理安全管理对干部病房老年患者的治疗及护理工作中的临床效果。方法：通过对护理工作人员进行专业的护理安全管理培训,继而护理工作人员能够对患者做出准确的安全风险评估,同时针对其风险因素制定相应的护理安全管理制度和措施,并实施到位。结果：在老年干部病房实施护理安全管理后,患者及护理工作人员的满意度得到提高,护理工作质量评分也显著提高。结论：在临床上,实施护理安全管理可提高患者和护理工作人员的满意度,并对提升护理工作的质量起到至关重要的促进作用。     

左乙拉西坦治疗成人癫(疒间)临床疗效和安全性的随机对照试验

目的 评价左乙拉西坦治疗成人癫(痌)的临床疗效和安全性.方法 采用随机、双盲、双模拟、阳性药物平行对照试验设计方案,将纳入研究的120例癫(痌)受试者随机分为试验组和对照组,每组各60例.试验组给予左乙拉西坦片+丙戊酸钠缓释模拟片治疗;对照组给予丙戊酸钠缓释片+左乙拉西坦模拟片治疗.两组疗程均为26周,治疗结束后随访3个月.评定两组受试者在治疗后(治疗结束后1～3 d)及随访3个月时的总有效率、癫(痌)每周发作频率、癫(痌)发作持续时间、生活质量(QOLIE-31评分量表)及药物相关的不良反应.结果 治疗前,两组受试者的癫(痌)每周发作频率、癫(痌)发作持续时间和QOLIE-31评分比较差异均无统计学意义.治疗后及随访3个月时,试验组受试者的总有效率为95.0％(57/60)和91.7％(55/60),均分别高于对照组[71.7％(43/60),63.3％(38/60);P＜0.01].治疗后及随访3个月时,两组受试者的癫(痌)每周发作频率、癫(痌)发作持续时间和QOLIE-31评分与同组治疗前相比差异均有统计学意义(P＜0.01),两组间差异也有统计学意义(P＜0.01).治疗后两组受试者的不良反应差异无统计学意义.结论 左乙拉西坦治疗成人癫(痌)的临床疗效优于丙戊酸钠缓释片,不良反应轻微,可作为临床治疗成人癫(痌)的首选药物.     

国外居民电子健康档案共享服务体系建设及启示

居民电子健康档案与区域卫生信息网络在全世界范围内正在成为医疗卫生信息化的前沿阵地。而区域卫生信息网络的核心是居民电子健康档案服务的共享。本文从组织机构、政策法规制定、数据共享标准和重视数据安全与隐私保护四方面介绍国外主要国家居民电子健康档案的共享服务体系建设,以期为我国共享服务体系建设提供借鉴。     

Effects of an online personal health record on medication accuracy and safety: a cluster-randomized trial

Objective

To determine the effects of a personal health record (PHR)-linked medications module on medication accuracy and safety.

Design

From September 2005 to March 2007, we conducted an on-treatment sub-study within a cluster-randomized trial involving 11 primary care practices that used the same PHR. Intervention practices received access to a medications module prompting patients to review their documented medications and identify discrepancies, generating ‘eJournals’ that enabled rapid updating of medication lists during subsequent clinical visits.

Measurements

A sample of 267 patients who submitted medications eJournals was contacted by phone 3 weeks after an eligible visit and compared with a matched sample of 274 patients in control practices that received a different PHR-linked intervention. Two blinded physician adjudicators determined unexplained discrepancies between documented and patient-reported medication regimens. The primary outcome was proportion of medications per patient with unexplained discrepancies.

Results

Among 121 046 patients in eligible practices, 3979 participated in the main trial and 541 participated in the sub-study. The proportion of medications per patient with unexplained discrepancies was 42% in the intervention arm and 51% in the control arm (adjusted OR 0.71, 95% CI 0.54 to 0.94, p=0.01). The number of unexplained discrepancies per patient with potential for severe harm was 0.03 in the intervention arm and 0.08 in the control arm (adjusted RR 0.31, 95% CI 0.10 to 0.92, p=0.04).

Conclusions

When used, concordance between documented and patient-reported medication regimens and reduction in potentially harmful medication discrepancies can be improved with a PHR medication review tool linked to the provider''s medical record.

Trial registration number

This study was registered at ClinicalTrials.gov ({"type":"clinical-trial","attrs":{"text":"NCT00251875","term_id":"NCT00251875"}}NCT00251875).     

Brief communication: Scalable Collaborative Infrastructure for a Learning Healthcare System (SCILHS): Architecture

We describe the architecture of the Patient Centered Outcomes Research Institute (PCORI) funded Scalable Collaborative Infrastructure for a Learning Healthcare System (SCILHS, http://www.SCILHS.org) clinical data research network, which leverages the $48 billion dollar federal investment in health information technology (IT) to enable a queryable semantic data model across 10 health systems covering more than 8 million patients, plugging universally into the point of care, generating evidence and discovery, and thereby enabling clinician and patient participation in research during the patient encounter. Central to the success of SCILHS is development of innovative ‘apps’ to improve PCOR research methods and capacitate point of care functions such as consent, enrollment, randomization, and outreach for patient-reported outcomes. SCILHS adapts and extends an existing national research network formed on an advanced IT infrastructure built with open source, free, modular components.     

基于KABP模式的健康指导对肾移植术后接受免疫抑制剂治疗的患者服药依从性的影响

目的 研究肾移植术后接受免疫抑制剂治疗的患者通过基于知信行（KABP）模式的健康指导对服药依从性的影响。方法 选取本院于2018 年9 月至2020 年9 月收治的肾移植术后接受免疫抑制剂治疗的患者共96 例,将其依照双盲随机法分为对照组（实施一般化健康指导方式）与观察组（在对照组基础上实施基于KABP 模式的健康指导）,每组各48 例。观察比较两组患者的肾移植认知度、SF-36 评分、服药依从性等。结果 两组护理前肾移植认知度评分比较,差异无统计学意义（P＞0.05）,观察组肾移植术后接受免疫抑制剂治疗的患者护理后的肾移植认知度评分高于对照组,差异有统计学意义（P＜0.05）。观察组肾移植术后接受免疫抑制剂治疗患者的服药总依从率为95.83%,明显高于对照组的83.33%,差异有统计学意义（P<0.05）。观察组肾移植手术患者的社会功能、活力、身体疼痛与心理状态评分高于对照组,差异有统计学意义（P<0.05）。结论 基于KABP 模式的健康指导对于增强患者对肾移植术的认知度、提高服药依从性等有重要的意义。     

健康教育在高血压患者中的应用效果

目的:观察健康教育在高血压患者中的应用效果。方法:选取86例高血压患者为研究对象,按照随机数字表法分为观察组和对照组,每组43例。对照组接受常规门诊指导,观察组组接受健康教育。比较两组护理前后简明健康状况调查表(SF-36)各维度评分,以及护理后的服药依从率。结果:护理前,两组SF-36量表各维度评分比较,差异均无统计学意义(P>0.05);护理后,两组SF-36量表各维度评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组服药依从率为95.3%(41/43),高于对照组的81.4%(35/43),差异有统计学意义(P<0.05)。结论:健康教育应用于高血压患者可提高生命质量评分和服药依从率,优于常规门诊指导效果。     

Survey of medication documentation at hospital discharge: implications for patient safety and continuity of care

Background  Medication discrepancies at the time of hospital discharge are common and can result in error, patient/carer inconvenience or patient harm. Providing accurate medication information to the next care provider is necessary to prevent adverse events. Aims  To investigate the quality and consistency of medication details generated for such transfer from an Irish teaching hospital. Methods  This was an observational study of 139 cardiology patients admitted over a 3 month period during which a pharmacist prospectively recorded details of medication inconsistencies. Results  A discrepancy in medication documentation at discharge occurred in 10.8% of medication orders, affecting 65.5% of patients. While patient harm was assessed, it was only felt necessary to contact three (2%) patients. The most common inconsistency was drug omission (20.9%). Conclusions  Inaccuracy of medication information at hospital discharge is common and compromises quality of care.     

术后病人自控镇痛应用与临床用药安全性分析

目的:探讨术后病人自控镇痛(PCA)用药的安全性。方法:调查100例患者在60h的观察期内PCA用药情况与其他用药情况,分析讨论术后应用PCA与临床用药安全性的关系。结果:患者在60h内用药共计80个品种,累计2008例次,人均用药20.08例次;PCA应用期间观察到明显不良反应10例。结论:PCA可缓解患者疼痛,减少术后并发症,有利于提高手术成功率,但PCA用药与手术其他用药的相互影响带给患者术后潜在的不安全因素应予以重视。     

健康教育对农村精神分裂症患者服药依从性及复发率的影响

目的对农村精神分裂症患者实施健康教育,观察其对患者的服药依从性及复发率的影响。方法收集来我院进行住院治疗的农村精神分裂症患者136例,将其随机分为观察组和对照组各68例;观察组患者给予健康教育,对照组患者给予普通的护理。观察比较两组患者的服药依从性及其复发率。结果健康教育后观察组的复发率显著低于对照组（P〈0．05）。在健康教育前两组患者的服药依从性差异较小,无统计学意义（P〉0．05）,而健康教育实施后第6个月和第12个月比较．观察组的服药依从性明显优于对照组（P〈0．05）。结论对农村精神分裂症患者实施健康教育使患者的服药依从性得以提高．疾病的复发率得以降低,可以在农村推广使用。     

社区护理干预对脑梗死患者他汀类药物服药依从性的影响

目的：探讨社区护理干预对脑梗死患者他汀类药物服药依从性的影响及l临床效果。方法：将107例脑梗死患者随机分为干预组和对照组,干预组在药物治疗的基础上给予积极护理干预,对照组只给予药物治疗,观察社区护理干预对他汀类药物服药依从性、生活满意度和生理指标、日常生活能力、生活质量的影响。结果：1年后干预组与对照组比较,服药依从性、各项生理指标的变化等方面,差异均有显著性。结论：护理干预有利于提高缺血性脑血管病患者的服药依从性,积极应用他汀类药物,能有效调降血脂,减少脑血管事件的发生。     

门诊病人个人因素对其满意度影响探析

目的探索门诊病人满意度的影响因素。方法以山东、河北、天津、东北三省一年内就诊过的人员为调查对象,采用问卷调查的方法,以面访的形式回收问卷195份,有效问卷134份。采用独立样本检验、单因素方差分析、相关分析和回归分析对数据进行了分析。结果发现门诊病人的性别对其满意度影响不显著,患者所处的年龄段和学历对就诊满意度有显著性影响,随着年龄的增长和学历的升高,病人综合满意度有升高的趋势。     

Impact of a web-based personally controlled health management system on influenza vaccination and health services utilization rates: a randomized controlled trial

Objective

To assess the impact of a web-based personally controlled health management system (PCHMS) on the uptake of seasonal influenza vaccine and primary care service utilization among university students and staff.

Materials and methods

A PCHMS called Healthy.me was developed and evaluated in a 2010 CONSORT-compliant two-group (6-month waitlist vs PCHMS) parallel randomized controlled trial (RCT) (allocation ratio 1:1). The PCHMS integrated an untethered personal health record with consumer care pathways, social forums, and messaging links with a health service provider.

Results

742 university students and staff met inclusion criteria and were randomized to a 6-month waitlist (n=372) or the PCHMS (n=370). Amongst the 470 participants eligible for primary analysis, PCHMS users were 6.7% (95% CI: 1.46 to 12.30) more likely than the waitlist to receive an influenza vaccine (waitlist: 4.9% (12/246, 95% CI 2.8 to 8.3) vs PCHMS: 11.6% (26/224, 95% CI 8.0 to 16.5); χ²=7.1, p=0.008). PCHMS participants were also 11.6% (95% CI 3.6 to 19.5) more likely to visit the health service provider (waitlist: 17.9% (44/246, 95% CI 13.6 to 23.2) vs PCHMS: 29.5% (66/224, 95% CI: 23.9 to 35.7); χ²=8.8, p=0.003). A dose–response effect was detected, where greater use of the PCHMS was associated with higher rates of vaccination (p=0.001) and health service provider visits (p=0.003).

Discussion

PCHMS can significantly increase consumer participation in preventive health activities, such as influenza vaccination.

Conclusions

Integrating a PCHMS into routine health service delivery systems appears to be an effective mechanism for enhancing consumer engagement in preventive health measures.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12610000386033. http://www.anzctr.org.au/trial_view.aspx?id=335463.     

社区卫生服务满意度对结核病患者遵医行为影响调查

目的调查结核病患者对社区卫生服务满意度与遵医行为的关系,为改善社区卫生服务,降低结核病患者不遵医行为提供依据。方法封闭式问卷调查438例结核病患者,对社区卫生满意度和遵医情况进行统计描述,分析结核患者对社区卫生服务不满意的原因以及满意度对遵医行为的影响。结果结核病患者对社区卫生服务整体满意度较高;不满意原因主要是就诊不方便、医务人员技术水平低、诊疗环境差;结核病患者不遵医行为率为22.55%;文化程度较高者遵医行为好于文化程度低者（P〈0.05）;对社区卫生服务满意度高的结核病患者,不遵医行为发生率低（P﹤0.01）。结论加强社区卫生服务机构能力建设,可提高结核病患者的满意度,降低不遵医行为的发生率。     

药物副反应主观体验对精神分裂症服药依从性的预测作用

目的 检验抗精神病药物副反应主观体验对精神分裂症患者服药依从性的预测价值.方法 选择2019年3-6月温州市第七人民医院收治的123例精神分裂症患者,在出院时完成格拉斯哥精神病药物副反应评定量表(Glasgow antipsychotics side-effect scale,GASS)评分.在患者出院后的4～5周,完...