Patient access to complex chronic disease records on the internet

Background: Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine) available to patients over the Internet in a project involving more than half of renal units in the UK. Methods: Content and presentation of the Renal PatientView (RPV) system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrolments and usage were extracted from the webserver. Results: By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (<10 to >90 yrs) but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling. Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enrol each patient. Conclusions: Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular, providing an increased sense of empowerment and understanding, with no serious identified negative consequences. Security concerns were present but rarely prevented participation. These are powerful reasons to make this type of access more widely available

The effect of a brief motivational intervention on community psychiatric patients' attitudes to their care, motivation to change, compliance and outcome: A case control study

Background: Individuals referred to psychiatric services are often ambivalent about service involvement. Aims: The aim of this study was to assess the impact of a brief motivational intervention during initial consultation with community psychiatric patients. Method: 45 patients referred to a Community Mental Health Team received an initial consultation followed by a feedback letter, both of which drew on the principles of motivational interviewing. These users were compared with matched controls who received a standard psychiatric assessment. The impact of the initial consultation, with or without motivational enhancement, on users' attitudes to their care, motivation to change, compliance and outcome was assessed at one month post-consultation and 3-4 months later. Results: After initial consultation, patients in both groups had similar problem severity ratings. Those patients who had received the intervention were more motivated to change, and had more positive attitudes to their consultation and care. Attitudinal differences tended to persist up to 3-4 months follow-up. Conclusions: A brief motivational intervention has at least short-term effects on motivation, and it improves attitude to car

The Inverted Relationship: Constitutive Theory of Law and the Enforcement of Orthodoxy in Book XVI of the Theodosian Code

status: publishe