Lead authors Tom Delbanco, MD, and Jan Walker, RN, MBA, of Harvard University and Beth Israel Deaconess Medical Center, both in Boston, conducted an online survey in 2017 of 19,411 patients in three separate health systems who participated in the OpenNotes pilot, an initiative that provided patients access to online clinical notes about their care. Eligible survey participants were 18 years or older and had logged into their respective patient portal at least once in the last 12 months and had an ambulatory visit note available.
Of the patients surveyed, a combined 14% of patients from Beth Israel Deaconess Medical Center and Geisinger Health reported that reading their notes made them more likely to take their medications as prescribed, while 86% reported no change, according to the study published in the Annals of Internal Medicine. At the University of Washington, Seattle, 33% of patients rated notes as “extremely important” in assisting with medication regimens. (The wording and response categories used by the University of Washington were not the same as those used by the other sites.)
The majority of patients at all three sites reported that note reading helped them understand why a medication was prescribed, answered their questions, and made them feel more comfortable with and in control of their medications, according to the study.
Of patients with a primary language other than English, 75% reported that reading their clinical notes helped them understand why a medication was prescribed, compared with 64% of patients who spoke English as their primary language. Of patients with high school or less education, 74% reported that reading their notes helped answer their questions about their medications, compared with 53% of college graduates.
The researchers also found that about 8 out of 10 survey participants reported looking at their medication list on the patient portal at least once. Of those patients who checked the portal for their medications, 18% said that the list was not accurate, and 85% wanted to submit corrections online.
The authors concluded that although note sharing means a substantial change in the culture of medicine, the practice of inviting patients to review clinicians’ notes online is spreading rapidly.
“Reading visit notes may be important for sustained improvements in the use of medications over time in ambulatory care,” they noted.
SOURCE: Delbanco et. al. Ann Intern Med. 2019 May 28. doi: 0.7326/M18-3197