Acceptance and use of patient-carried health records

1. Learning points from paper
1. 1.1. Alternatives evaluated
2. 1.2. Results
2. Critique of paper
3. Other comments
4. Citation and Abstract

Learning points from paper

One of the earliest cases of paper PHRs was from the University of Vermont in 1973. (See: The patient and his problem-oriented record. In: Implementing the problem-oriented system.)
In the USA, one radical example comes from Dr. Schade. In his practice, the complete record is held by the patient. The physician retains only a summary and patients are expected to bring their records whenever they seek medical treatment. Dr. Schade reported that the records stimulated his patients to take more responsibility for their health. He did not report any problems with lost records, continuity of care, or malpractice suits. (See: Schade HI. My patients take their medical records with them. Medical Economics 1976;March 8:75-81.)
A Personal Life Health Plan (PLHP) specifically designed to provide information to both physicians and patients. The PLHP does not replace the medical record and is maintained by the patients themselves, with some advice from medical personnel. (See: Giglio RJ, Spears BM, Rumpf DL, et al. Encouraging behaviour changes by use of client-held records. Med Care 1978;9:757.)
Health Hazard Appraisal (HHA) relates an individual's behaviors, such as diet and exercise, hereditary factors and environment, to his expected life span. The developers believe that their approach offers some indi-
viduals an incentive to take preventive measures. An HHA was included as a section of the PLHP. (See: Emery M, Gilbert N, Hall J, et al. The case for doing health hazard appraisals. Patient Care, October 1974; Clendenin J, Cowan S, Emory M, et al. How four practitioners are using health hazard appraisals. Patient Care, October 1974. Sadusk JF, Robbins LC. Proposal for health hazard appraisal and comprehensive health care. JAMA 1968;16:106.)
Altman studied patients who had specifically asked to see their records while in a hospital. Compared to the
average patient in that hospital, those who requested records were much younger, much more likely to have a medically related job, and much more likely to exhibit what was termed "paranoid" or "hysterical" behavior. The authors felt "it unlikely that the patient who trusts the staff and has a working alliance with the physician will feel a need to read the medical record. .. ." (See: Altman JH. Patients who read their hospital charts: sounding board. N Eng J Med 1980;75:302.)

Alternatives evaluated

1. A small, compact card that can be folded to wallet-size containing a brief problem list, and information on allergies, inoculations, and major health problems. This record was designed to help maintain continuity of care when visiting a different facility.

2. A passport-size record. Compared to the wallet record, the problem list in this record was expanded, the record was easier for the patient to write in and there was a section for a health plan.

3. A folder containing xerox copies of materials in the medial chart to provide problem lists and information on allergies. It was hypothesized that possessing this information could help the patient feel more a part of the medical process and possibly improve compliance.

4. Personal Life Health Plan. This record contains most of what is in a medical record, plus a number of sections which deal with health maintenance, behavior changes and the use of the health care system. The PLHP is a participatory record designed to be maintained by the patient with the help of initial instructions and continued reinforcement from providers. In addition to being a repository of information, such a record was designed to be an aid to communication between providers and patients, as well as between providers. In this regard, a participatory record such as the PLHP differs from the others in that it involves both a document and a process for modifying typical healthcare delivery practices so as to most effectively use the record.

Results

Table.01.Participation rates.png

Table.02.Reasons for refusing.png

Table.03.Acceptance by physicians.png

Table.04.Patient percentage carrying record.png

Table.05.Patient-initiated entries.png

Table.06.Summary results.png

Critique of paper

Instructions (to be deleted): Explain any problems with the paper's methods or findings

Other comments

Instructions (to be deleted): Any other comments (can be left blank).

Citation and Abstract

J Am Med Rec Assoc. 1987 May;58(5):32-6. Acceptance and use of patient-carried health records. Giglio RJ, Papazian B.

The ultimate goals of providing health records to patients are to improve continuity of care, to improve patient understanding of instructions, and to encourage patients to take a more active role in maintaining their health. In the current study, four types of patient-carried health records were evaluated in a hospital-based outpatient service to determine whether records would be accepted and used, to estimate the cost of the process, and to obtain patient and provider reactions. Records were provided at moderate cost and the primary determinants in record acceptance and use were physicians' support of the process, the type of record, and the employment status of the patient. A small record which could be carried in a wallet seemed suited to most patients; other more elaborate participatory records appeared to have benefits for selected patients. More extensive use of participatory records appears to require changes in the way health care would be delivered.

PMID: 10282199 [PubMed - indexed for MEDLINE]