Expectations of patients and physicians regarding patient-accessible medical records.
Expectations of patients and physicians regarding patient-accessible medical records.
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DOI：
10.2196/jmir.7.2.e13
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发表时间：
2005-05-24
影响因子：
7.4
通讯作者：
Lin, Chen-Tan
中科院分区：
文献类型：
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作者：
Ross, Stephen E;Todd, Jamie;Moore, Laurie A;Beaty, Brenda L;Wittevrongel, Loretta;Lin, Chen-Tan
中产阶级人口支持共享医疗记录，包括互联网访问的医疗记录。低收入人群和医生的态度不太清楚。 本研究的目的是比较（1）社区卫生中心的社会经济弱势患者，（2）初级保健办公室的保险患者和（3）门诊实践中的广泛医生对共享门诊病历的态度。 在科罗拉多大都市丹佛地区的六个初级保健诊所的候诊室，向患者提供了书面问卷。三个做法是社区卫生中心，三个做法是一个学术医疗中心的初级保健诊所。调查报告也被邮寄给了科罗拉多州的初级保健医生。 患者调查的回复率为79%（返回601份调查），医生调查的回复率为53%（返回564份调查）。学术医疗中心和社区卫生中心的患者同样可能赞同共享医疗记录（94%对96%）和互联网访问记录（54%对57%）。社区卫生中心的患者比学术医疗中心的患者更有可能预期共享医疗记录的好处（预期好处的平均数= 7.9比7.1，P <0.001），他们也更有可能预期共享记录的问题。患者认可互联网可访问记录的重要预测因素是以前使用互联网（OR = 2.45，CI 1.59-3.79），预期获益数（OR = 1.12/单位，CI 1.03-1.21），预期访视之间会提出更多问题（OR = 1.73，CI 1.18-2.54），预期会发现医生的记录是混乱的（OR = 1.50，CI 1.01-2.22）。医生比患者更有可能预期访问记录会导致问题。医生预期获益的可能性明显低于患者（预期获益的平均数= 4.2 vs 7.5，P <0.001）。 对共享医疗记录感兴趣的并不局限于白色中产阶级人群。共享医疗记录几乎得到了广泛的种族和社会经济群体的普遍认可。大多数患者也对互联网可访问的记录感兴趣，但也有相当多的少数人不感兴趣。支持互联网访问记录的主要决定因素不是年龄、种族或教育水平;相反，它们是以前使用互联网的经验和患者对阅读他们的医疗记录的好处和缺点的期望。医生对共享医疗记录有更多担忧，并且认为受益的潜力较小。病人和医生的态度可能需要协调，以实现广泛采用共享医疗记录。
Middle class populations have supported shared medical records, including Internet-accessible medical records. The attitudes of lower income populations, and of physicians, are less clear. The objective of this study was to compare the attitudes toward shared outpatient medical records among (1) socioeconomically disadvantaged patients in community health centers, (2) insured patients in primary care offices, and (3) a broad range of physicians in outpatient practice. Written questionnaires were provided to patients in the waiting rooms of six primary care practices in the metropolitan Denver, Colorado area. Three practices were community health centers, and three practices were primary care clinics of an academic medical center. Questionnaires were also mailed to primary care physicians in the state of Colorado. There was a 79% response rate for patient surveys (601 surveys returned) and a 53% response rate for physician surveys (564 surveys returned). Academic medical center patients and community health center patients were equally likely to endorse shared medical records (94% vs 96%) and Internet-accessible records (54% vs 57%). Community health center patients were more likely than academic medical center patients to anticipate the benefits of shared medical records (mean number of expected benefits = 7.9 vs 7.1, P < .001), and they were also somewhat more likely to anticipate problems with shared records. Significant predictors of patient endorsement of Internet-accessible records were previous use of the Internet (OR = 2.45, CI 1.59–3.79), the number of expected benefits (OR = 1.12 per unit, CI 1.03–1.21), anticipation of asking more questions between visits (OR = 1.73, CI 1.18–2.54), and anticipation of finding the doctors' notes to be confusing (OR = 1.50, CI 1.01–2.22). Physicians were significantly more likely than patients to anticipate that access to records would cause problems. Physicians were significantly less likely than patients to anticipate benefits (mean number of expected benefits = 4.2 vs 7.5, P < .001). Interest in shared medical records is not confined to a white, middle class population. Shared medical records are almost universally endorsed across a broad range of ethnic and socioeconomic groups. A majority of patients are also interested in Internet-accessible records, but a substantial minority is not. The primary determinants of support of Internet-accessible records are not age, race, or education level; rather, they are previous experience with the Internet and patients' expectations of the benefits and drawbacks of reading their medical records. Physicians have more concerns about shared medical records and see less potential for benefit. The attitudes of patients and physicians may need to be reconciled for widespread adoption of shared medial records to be achieved.