| 1. |
- Hägglund, Maria, Lektor, 1975-, et al.
(författare)
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The Future of Online Video Consultations in Primary Care : A Qualitative Study
- 2023
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Ingår i: Caring is Sharing - Exploiting the Value in Data for Health and Innovation - Proceedings of MIE 2023. - : IOS Press. - 0926-9630 .- 1879-8365. - 9781643683881 - 9781643683898 ; 302, s. 942-946
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Konferensbidrag (refereegranskat)abstract
- The COVID-19 pandemic has significantly increased the use of remote services such as video consultations (VCs). In Sweden, private healthcare providers offering VCs have grown substantially since 2016 and have been controversial. Few studies have focused on physicians' experiences of providing care in this context. Our overall aim was to study physicians' experiences of VCs, here focusing on their suggestions for future improvements. Twenty-two semi-structured interviews were performed with physicians working for an online healthcare provider in Sweden, and analyzed through inductive content analysis. Two themes emerged related to desired future improvements of VCs; blended care and technical innovation.
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| 2. |
- Scandurra, Isabella, 1973-, et al.
(författare)
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When do people read their health record? analysis of usage data of a national eHealth service giving patients access to their electronic health record
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: eHealth services for citizens provide support for patients and families, as well as for healthcare professionals. In Sweden different eHealth services have been developed since the late 1990s and they are now used by millions of users. One of the national eHealth services that provides opportunities for increased participation in care is the Patient Accessible Electronic Health Record (PAEHR). To date (February 2017) over one million citizens (of 10 million inhabitants) have accessed their own electronic health record (EHR). In this study, we describe current usage by analysing log-data from the service. Who are the users, and how and when do they use the service?Method: Data collection of routinely captured usage data was administered by Inera AB, owner of all Swedish national eHealth services. Data was analyzed through IBM SPSS in accordance with the declaration of Helsinki. Queries for this quantitative study were created based on previously published results regarding concerns often expressed by healthcare professionals (HCP) as well as routinely captured log-data. Descriptive usage statistics were analysed towards such HCP concerns, e.g. increased workload due to worried patients reading but not understanding the PAEHR content.Results: Current status of the Swedish PAEHR is presented, e.g. number of users, demographic data (age, gender) in relation to log-in statistics. Regarding log-ins, first-time users and unique hits show that attention by national media has an impact a news cast resulted in 31,000 logged in compared to a week day average of 20,000. To date more than 1 million citizens have chosen to log in and the numbers are increasing. A newly connected region (Örebro) has an average of 500 new users a day. This can be compared to the first region (Uppsala) which during the first year (2012- 2013) had approx. 100 new users a day, although the strategy then was not to advertise the service. In total 10,000 to 13,000 new users log in every day nationally. More women than men log in and their mean age are 23-32 years. The older the users get the less they use the PAEHR, however some users are older than 93 years. During weekends the activity decreases, as opposed to HCP expectations. More often, users log in on week days, e.g. on Monday morning.Discussion: Usage statistics were related to concerns of HCP, which seem to have little resemblance to reality. One concern was that the service would not provide benefit for patients, here contradicted by the increasing number of both first-time and recurrent users. However, such indicators need to be further analysed. Paper records and PAEHR usage are difficult to compare, due to lack of statistics regarding printout reading. Usage comparisons between PAEHR solutions of different counties would however be interesting.Conclusion: Recurrent concerns of mainly HCP seem to be contradicted by actual usage by patients. This may lead to a decreased controversy of how PAEHR is experienced by patients and HCP. Knowledge about how users actually use PAEHR may also improve the service as such.
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| 3. |
- Ögmundsdóttir Michelsen, Halldóra, et al.
(författare)
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The effect of audit and feedback and implementation support on guideline adherence and patient outcomes in cardiac rehabilitation : a study protocol for an open-label cluster-randomized effectiveness-implementation hybrid trial
- 2024
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Ingår i: Implementation Science. - : BioMed Central (BMC). - 1748-5908. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundProviding secondary prevention through structured and comprehensive cardiac rehabilitation programmes to patients after a myocardial infarction (MI) reduces mortality and morbidity and improves health-related quality of life. Cardiac rehabilitation has the highest recommendation in current guidelines. While treatment target attainment rates at Swedish cardiac rehabilitation centres is among the highest in Europe, there are considerable differences in service delivery and variations in patient-level outcomes between centres. In this trial, we aim to study whether centre-level guideline adherence and patient-level outcomes across Swedish cardiac rehabilitation centres can be improved through a) regular audit and feedback of cardiac rehabilitation structure and processes through a national quality registry and b) supporting cardiac rehabilitation centres in implementing guidelines on secondary prevention. Furthermore, we aim to evaluate the implementation process and costs.MethodsThe study is an open-label cluster-randomized effectiveness-implementation hybrid trial including all 78 cardiac rehabilitation centres (attending to approximately 10 000 MI patients/year) that report to the SWEDEHEART registry. The centres will be randomized 1:1:1 to three clusters: 1) reporting cardiac rehabilitation structure and process variables to SWEDEHEART every six months (audit intervention) and being offered implementation support to implement guidelines on secondary prevention (implementation support intervention); 2) audit intervention only; or 3) no intervention offered. Baseline cardiac rehabilitation structure and process variables will be collected. The primary outcome is an adherence score measuring centre-level adherence to secondary prevention guidelines. Secondary outcomes include patient-level secondary prevention risk factor goal attainment at one-year after MI and major adverse coronary outcomes for up to five-years post-MI. Implementation outcomes include barriers and facilitators to guideline adherence evaluated using semi-structured focus-group interviews and relevant questionnaires, as well as costs and cost-effectiveness assessed by a comparative health economic evaluation.DiscussionOptimizing cardiac rehabilitation centres’ delivery of services to meet standards set in guidelines may lead to improvement in cardiovascular risk factors, including lifestyle factors, and ultimately a decrease in morbidity and mortality after MI.
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| 4. |
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| 5. |
- Blease, Charlotte, et al.
(författare)
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COVID-19 and Open Notes : A New Method to Enhance Patient Safety and Trust
- 2021
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Ingår i: JMIR Mental Health. - : JMIR Publications. - 2368-7959. ; 8:6
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Tidskriftsartikel (refereegranskat)abstract
- From April 5, 2021, as part of the 21st Century Cures Act, all providers in the United States must offer patients access to the medical information housed in their electronic records. Via secure health portals, patients can log in to access lab and test results, lists of prescribed medications, referral appointments, and the narrative reports written by clinicians (so-called open notes). As US providers implement this practice innovation, we describe six promising ways in which patients' access to their notes might help address problems that either emerged with or were exacerbated by the COVID-19 pandemic.
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| 6. |
- Blease, Charlotte, et al.
(författare)
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Does Patient Access to Clinical Notes Change Documentation?
- 2020
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Ingår i: Frontiers In Public Health. - : Frontiers Media SA. - 2296-2565. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Open, honest, and trustworthy communication is crucial to ensure the effective responses of citizens. Paralleling transparency in the arena of public health are new practice policies that are set to transform the transmission of information at the level of doctors and patients. While patients have legally been entitled to obtain copies of their records for many years, in March 2020 federal legislation in the United States (U.S.) mandated that health providers offer all patients rapid and secure online access to their clinical notes via patient portals (“open notes”) (1). Similar developments are underway in the United Kingdom (U.K.) where in April 2020 it was announced that patients in NHS England will be granted online access, albeit prospectively, to their full general practitioners' notes (2). Worldwide, open notes have already been enacted in more than ten countries including Sweden, Estonia, and Norway (3).A variety of surveys have been conducted into patients' and doctors' experiences of open notes but much less is understood about the objective changes in documentation that may arise as a result of patient access (4–7). We review current research into open notes including clinicians' reports on how they have modified their notes as a result of implementing the practice. Highlighting the potentially beneficial and harmful effects that different types of documentation changes might have on the therapeutic relationship and on patient outcomes, we argue that more research is needed to investigate objective changes in notes as a result of patient access.
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| 7. |
- Blease, Charlotte, et al.
(författare)
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Experiences and opinions of general practitioners with patient online record access : an online survey in England
- 2024
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the experiences and opinions of general practitioners (GPs) in England regarding patients having access to their full online GP health records.DESIGN: Convenience sample, online survey.PARTICIPANTS: 400 registered GPs in England.MAIN OUTCOME MEASURES: Investigators measured GPs' experiences and opinions about online record access (ORA), including patient care and their practice.RESULTS: A total of 400 GPs from all regions of England responded. A minority (130, 33%) believed ORA was a good idea. Most GPs believed a majority of patients would worry more (364, 91%) or find their GP records more confusing than helpful (338, 85%). Most GPs believed a majority of patients would find significant errors in their records (240, 60%), would better remember their care plan (280, 70%) and feel more in control of their care (243, 60%). The majority believed they will/already spend more time addressing patients' questions outside of consultations (357, 89%), that consultations will/already take significantly longer (322, 81%) and that they will be/already are less candid in their documentation (289, 72%) after ORA. Nearly two-thirds of GPs believed ORA would increase their litigation (246, 62%).CONCLUSIONS: Similar to clinicians in other countries, GPs in our sample were sceptical of ORA, believing patients would worry more and find their records more confusing than helpful. Most GPs also believed the practice would exacerbate work burdens. However, the majority of GPs in this survey also agreed there were multiple benefits to patients having online access to their primary care health records. The findings of this survey also contribute to a growing body of contrastive research from countries where ORA is advanced, demonstrating clinicians are sceptical while studies indicate patients appear to derive multiple benefits.
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| 8. |
- Blease, Charlotte, et al.
(författare)
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Generative Language Models and Open Notes : Exploring the Promise and Limitations
- 2024
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Ingår i: JMIR Medical Education. - : JMIR Publications. - 2369-3762. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Patients’ online record access (ORA) is growing worldwide. In some countries, including the United States and Sweden, access is advanced with patients obtaining rapid access to their full records on the web including laboratory and test results, lists of prescribed medications, vaccinations, and even the very narrative reports written by clinicians (the latter, commonly referred to as “open notes”). In the United States, patient’s ORA is also available in a downloadable form for use with other apps. While survey studies have shown that some patients report many benefits from ORA, there remain challenges with implementation around writing clinical documentation that patients may now read. With ORA, the functionality of the record is evolving; it is no longer only an aide memoire for doctors but also a communication tool for patients. Studies suggest that clinicians are changing how they write documentation, inviting worries about accuracy and completeness. Other concerns include work burdens; while few objective studies have examined the impact of ORA on workload, some research suggests that clinicians are spending more time writing notes and answering queries related to patients’ records. Aimed at addressing some of these concerns, clinician and patient education strategies have been proposed. In this viewpoint paper, we explore these approaches and suggest another longer-term strategy: the use of generative artificial intelligence (AI) to support clinicians in documenting narrative summaries that patients will find easier to understand. Applied to narrative clinical documentation, we suggest that such approaches may significantly help preserve the accuracy of notes, strengthen writing clarity and signals of empathy and patient-centered care, and serve as a buffer against documentation work burdens. However, we also consider the current risks associated with existing generative AI. We emphasize that for this innovation to play a key role in ORA, the cocreation of clinical notes will be imperative. We also caution that clinicians will need to be supported in how to work alongside generative AI to optimize its considerable potential.
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