Impact of providing patients access to electronic health records on quality and safety of care: a systematic review and meta-analysis

OBJECTIVE: To evaluate the impact of sharing electronic health records (EHRs) with patients and map it across six domains of quality of care (ie, patient-centredness, effectiveness, efficiency, timeliness, equity and safety). DESIGN: Systematic review and meta-analysis. DATA SOURCES: CINAHL, Cochrane, Embase, HMIC, Medline/PubMed and PsycINFO, from 1997 to 2017. ELIGIBILITY CRITERIA: Randomised trials focusing on adult subjects, testing an intervention consisting of sharing EHRs with patients, and with an outcome in one of the six domains of quality of care. DATA ANALYSIS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Title and abstract screening were performed by two pairs of investigators and assessed using the Cochrane Risk of Bias Tool. For each domain, a narrative synthesis of the results was performed, and significant differences in results between low risk and high/unclear risk of bias studies were tested (t-test, p<0.05). Continuous outcomes evaluated in four studies or more (glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and diastolic blood pressure (DBP)) were pooled as weighted mean difference (WMD) using random effects meta-analysis. Sensitivity analyses were performed for low risk of bias studies, and long-term interventions only (lasting more than 12 months). RESULTS: Twenty studies were included (17 387 participants). The domain most frequently assessed was effectiveness (n=14), and the least were timeliness and equity (n=0). Inconsistent results were found for patient-centredness outcomes (ie, satisfaction, activation, self-efficacy, empowerment or health literacy), with 54.5% of the studies (n=6) demonstrating a beneficial effect. Meta-analyses showed a beneficial effect in effectiveness by reducing absolute values of HbA1c (unit: %; WMD=-0.316; 95% CI -0.540 to -0.093, p=0.005, I 2=0%), which remained significant in the sensitivity analyses for low risk of bias studies (WMD= -0.405; 95% CI -0.711 to -0.099), and long-term interventions only (WMD=-0.272; 95% CI -0.482 to -0.062). A significant reduction of absolute values of SBP (unit: mm Hg) was found but lost in sensitivity analysis for studies with low risk of bias (WMD= -1.375; 95% CI -2.791 to 0.041). No significant effect was found for DBP (unit: mm Hg; WMD=-0.918; 95% CI -2.078 to 0.242, p=0.121, I 2=0%). Concerning efficiency, most studies (80%, n=4) found either a reduction of healthcare usage or no change. A beneficial effect was observed in a range of safety outcomes (ie, general adherence, medication safety), but not in medication adherence. The proportion of studies reporting a beneficial effect did not differ between low risk and high/unclear risk studies, for the domains evaluated. DISCUSSION: Our analysis supports that sharing EHRs with patients is effective in reducing HbA1c levels, a major predictor of mortality in type 2 diabetes (mean decrease of -0.405, unit: %) and could improve patient safety. More studies are necessary to enhance meta-analytical power and assess the impact in other domains of care. PROTOCOL REGISTRATION: http://www.crd.york.ac.uk/PROSPERO (CRD42017070092)

a comprehensive survey of medical doctor's perspectives in Portugal

Publisher Copyright: Copyright: © 2023 Pedro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Artificial Intelligence (AI) is increasingly influential across various sectors, including healthcare, with the potential to revolutionize clinical practice. However, risks associated with AI adoption in medicine have also been identified. Despite the general understanding that AI will impact healthcare, studies that assess the perceptions of medical doctors about AI use in medicine are still scarce. We set out to survey the medical doctors licensed to practice medicine in Portugal about the impact, advantages, and disadvantages of AI adoption in clinical practice. We designed an observational, descriptive, cross-sectional study with a quantitative approach and developed an online survey which addressed the following aspects: impact on healthcare quality of the extraction and processing of health data via AI; delegation of clinical procedures on AI tools; perception of the impact of AI in clinical practice; perceived advantages of using AI in clinical practice; perceived disadvantages of using AI in clinical practice and predisposition to adopt AI in professional activity. Our sample was also subject to demographic, professional and digital use and proficiency characterization. We obtained 1013 valid, fully answered questionnaires (sample representativeness of 99%, confidence level (p< 0.01), for the total universe of medical doctors licensed to practice in Portugal). Our results reveal that, in general terms, the medical community surveyed is optimistic about AI use in medicine and are predisposed to adopt it while still aware of some disadvantages and challenges to AI use in healthcare. Most medical doctors surveyed are also convinced that AI should be part of medical formation. These findings contribute to facilitating the professional integration of AI in medical practice in Portugal, aiding the seamless integration of AI into clinical workflows by leveraging its perceived strengths according to healthcare professionals. This study identifies challenges such as gaps in medical curricula, which hinder the adoption of AI applications due to inadequate digital health training. Due to high professional integration in the healthcare sector, particularly within the European Union, our results are also relevant for other jurisdictions and across diverse healthcare systems.publishersversionpublishe

A systematic review

Introduction: Surveys are a useful tool in primary care. However, low response rates can introduce selection bias, impairing both external and internal validity. The aim of this study was to assess the average response rate in surveys with Portuguese general practitioners (GPs). Method: We searched the Medline, Web of Science, Scopus, Embase, PsychInfo, SciELO, IndexRMP, RCAAP, Revista Portuguesa de Medicina Geral e Familiar, Acta Médica Portuguesa and the proceedings of conferences of general practice from incepton to December 2016. We included all postal, e-mail, telephone and personal surveys to primary care physicians without language restrictions. We did not assess risk of bias of included studies, since the main outcome was survey response rate. We performed planned subgroup analyses of the use of monetary incentives, the use of non-monetary incentives, survey delivery modes and prior contact with participants. Results: A total of 1,094 papers were identified and 37 studies were included in this review. The response rate in surveys done to Portuguese GPs was 56% (95CI 47-64%). There was substantial heterogeneity among included studies (I2=99%), but subgroup analysis did not explain this heterogeneity. Conclusion: Consistent with other published studies, the average response rate in surveys done with Portuguese GPs was 56%, with substantial variation among studies. Use of monetary incentives, one of the most effective strategies to increase response rates, was not present in any of the included studies.publishersversionpublishe

Tradução e validação do questionário de ativação do doente (Patient Activation Measure) para português, em pessoas com diabetes mellitus tipo 2

INTRODUCTION: Management of diabetes mellitus is largely dependent on patients' active participation in care. The 'Patient Activation Measure 13' assesses patients' knowledge, skills, and confidence in self-care. We aimed to translate, culturally adapt, and validate the 'Patient Activation Measure 13' to Portuguese, in people with type 2 diabetes. MATERIAL AND METHODS: The translation and cultural adaptation occurred in six phases. A convenience sample of people with type 2 diabetes was recruited from the waiting rooms of a diabetes outpatient centre in Lisbon, between March and April 2014. The questionnaire was self-administered; medical records were reviewed to obtain glycated haemoglobin levels. Main statistical analyses were based on the Rasch rating scale model. RESULTS: The response rate for the final questionnaire was 76%. Rasch analysis was conducted on 193 respondents. Respondents had a mean age of 67.1 (SD 10.1) years, 42.7% were women, and the mean patient activation measure score (0 - 100) in the sample was 58.5 (SD 10.1). The sample was low to moderate in terms of activation: 40.4% were low in activation (levels 1 and 2), 49.7% were in level 3, and 9.8% were in level 4, the highest level of activation. All items had good fit and the response categories functioned well. Item reliability was 0.97 and person reliability was between 0.77 (real) and 0.83 (model). DISCUSSION: The 'Patient Activation Measure 13' was translated and culturally adapted to European Portuguese and validated in people with diabetes, showing good psychometric properties. Future research should aim at evaluating test-retest reliability of the Portuguese 'Patient Activation Measure 13', and exploring its ability to measure changes in activation over time. CONCLUSION: The 'Patient Activation Measure 13' is now available in European Portuguese and has good psychometric properties.publishersversionpublishe

Stakeholder preferences for attributes of digital health technologies to consider in health service funding

Objectives: Health service providers are currently making decisions on the public funding of digital health technologies (DHTs) for managing chronic diseases with limited understanding of stakeholder preferences for DHT attributes. This study aims to understand the community, patient/carer, and health professionals' preferences to help inform a prioritized list of evaluation criteria. Methods: An online best-worst scaling survey was conducted in Australia, New Zealand, Canada, and the United Kingdom to ascertain the relative importance of twenty-four DHT attributes among stakeholder groups using an efficient incomplete block design. The attributes were identified from a systematic review of DHT evaluation frameworks for consideration in a health technology assessment. Results were analyzed with multinomial models by stakeholder group and latent class. Results: A total of 1,251 participants completed the survey (576 general community members, 543 patients/carers, and 132 health professionals). Twelve attributes achieved a preference score above 50 percent in the stakeholder group model, predominantly related to safety but also covering technical features, effectiveness, ethics, and economics. Results from the latent class model supported this prioritization. Overall, connectedness with the patient's healthcare team seemed the most important; with Helps health professionals respond quickly when changes in patient care are needed as the most highly prioritized of all attributes. Conclusions: It is proposed that these prioritized twelve attributes be considered in all evaluations of DHTs that manage chronic disease, supplemented with a limited number of attributes that reflect the specific perspective of funders, such as equity of access, cost, and system-level implementation considerations

Patients’ access to their medical records

Until recently, the medical record was seen exclusively as being the property of health institutions and doctors. Its great technical and scientific components, as well as the personal characteristics attributed by each doctor, have been the reasons appointed for that control. However, nowadays throughout the world that paradigm has been changing. In Portugal, since 2007 patients are allowed full and direct access to their medical records. Nevertheless, the Deontological Code of the Portuguese Medical Association (2009) explicitly states that patients’ access to their medical records should have a doctor as intermediary and that the records are each physician’s intellectual property. Furthermore, several doctors and health institutions, receiving requests from patients to access their medical records, end up requesting the legal opinion of the Commission for access to administrative documents. Each and every time, that opinion goes in line with the notion of full and direct patient access. Sharing medical records with patients seems crucial and inevitable in the current patient-centred care model, having the potential to improve patient empowerment, health literacy, autonomy, self-efficacy and satisfaction with care. With the recent technological developments and the fast dissemination of Personal Health Records, it is foreseeable that a growing number of patients will want to access their medical records. Therefore, promoting awareness on this topic is essential, in order to allow an informed debate between all the stakeholders.Até muito recentemente, o processo clínico era visto exclusivamente como propriedade das instituições de saúde ou dos médicos que o elaboravam. A sua grande componente técnica e científica, bem como com o forte cunho pessoal por parte do médico, têm sido as razões invocadas para esse controlo. Atualmente, um pouco por todo o mundo, assiste-se a uma mudança neste campo. Em Portugal, desde 2007 que os pacientes podem aceder diretamente à totalidade dos seus processos clínicos. No entanto, o Código Deontológico da Ordem dos Médicos (2009) defende que o acesso dos pacientes aos seus processos clínicos deverá ser feito através de um médico e que este último é o detentor da propriedade intelectual dos registos que elabora. Além disso, muitos médicos e instituições de saúde confrontados com os pedidos de acesso dos pacientes aos seus processos clínicos acabam por solicitar o parecer da Comissão de Acesso aos Documentos Administrativos. Esse parecer vai, invariavelmente, no sentido do acesso total e direto. A partilha dos processos clínicos com os pacientes parece fulcral e inevitável num modelo de medicina centrada na pessoa, tendo o potencial de melhorar a capacitação, a literacia em saúde, a autonomia, a autoeficácia e a satisfação dos pacientes. Com os progressivos avanços tecnológicos e a crescente disseminação dos Sistemas Personalizados de Informação de Saúde, é previsível que cada vez mais pacientes desejem aceder aos seus processos clínicos. Assim, a consciencialização sobre esta matéria é essencial, por forma a que seja possível promover o debate informado entre as várias partes envolvidas

Portuguese primary care physicians response rate in surveys: a systematic review

Introduction: Surveys are a useful tool in primary care. However, low response rates can introduce selection bias, impairing both external and internal validity. The aim of this study was to assess the average response rate in surveys with Portuguese general practitioners (GPs). Method: We searched the Medline, Web of Science, Scopus, Embase, PsychInfo, SciELO, IndexRMP, RCAAP, Revista Portuguesa de Medicina Geral e Familiar, Acta Médica Portuguesa and the proceedings of conferences of general practice from inception to December 2016. We included all postal, e-mail, telephone and personal surveys to primary care physicians without language restrictions. We did not assess the risk of bias of included studies since the main outcome was surveyed response rate. We performed planned subgroup analyses of the use of monetary incentives, the use of non-monetary incentives, survey delivery modes and prior contact with participants. Results: A total of 1,094 papers were identified and 37 studies were included in this review. The response rate in surveys done to Portuguese GPs was 56% (95CI 47-64%). There was substantial heterogeneity among included studies (I2=99%), but subgroup analysis did not explain this heterogeneity. Conclusion: Consistent with other published studies, the average response rate in surveys done with Portuguese GPs was 56%, with substantial variation among studies. Use of monetary incentives, one of the most effective strategies to increase response rates, was not present in any of the included studies.info:eu-repo/semantics/publishedVersio

General practitioners’ perceptions of using virtual primary care during the COVID-19 pandemic: An international cross-sectional survey study

With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs’ perspectives on the main benefits and challenges of using digital virtual care. GPs across 20 countries completed an online questionnaire between June–September 2020. GPs’ perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patients’ preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital virtual care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions and support the long-term development of platforms that are more technologically robust and secure

Person-centered health care and information and communication technologies : current and future perspectives [editorial]

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