Should Patients Get Direct Access to Their Laboratory Test Results? An Answer With Many Questions

Baylor College of Medicine, Houston, Texas, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 11/2011; 306(22):2502-3. DOI: 10.1001/jama.2011.1797
Source: PubMed
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    • "Therefore, institutional policies and procedures should be strengthened to clarify test result notification responsibilities for physicians as well as address responsibility aspects of direct notification [21]. Our study has several limitations. "
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    ABSTRACT: To determine physician perspectives about direct notification of normal and abnormal test results. We conducted a cross-sectional survey at five clinical sites in the US and Australia. The US-based study was conducted via web-based survey of primary care physicians and specialists between July and October 2012. An identical paper-based survey was self-administered between June and September 2012 with specialists in Australia. Of 1417 physicians invited, 315 (22.2%) completed the survey. Two-thirds (65.3%) believed that patients should be directly notified of normal results, but only 21.3% were comfortable with direct notification of clinically significant abnormal results. Physicians were more likely to endorse direct notification of abnormal results if they believed it would reduce the number of patients lost to follow-up (OR=4.98, 95%CI=2.21-1.21) or if they had personally missed an abnormal test result (OR=2.95, 95%CI=1.44-6.02). Conversely, physicians were less likely to endorse if they believed that direct notification interfered with the practice of medicine (OR=0.39, 95%CI=0.20-0.74). Physicians we surveyed generally favor direct notification of normal results but appear to have substantial concerns about direct notification of abnormal results. Widespread use of direct notification should be accompanied by strategies to help patients manage test result abnormalities they receive. Published by Elsevier Ireland Ltd.
    Full-text · Article · Feb 2015 · Patient Education and Counseling
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    • "42 Furthermore, the Department of Health and Human Services recently proposed a rule43 allowing patients to access test results directly from the laboratory upon patient request (ie, bypassing the provider). However, providers’ interpretation of test results within the context of the patient's other clinical conditions remains essential.44 Because most PCPs receive hundreds of test results a week,31 one area for potential improvement is PCPs’ resources to facilitate patient notification. "
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    ABSTRACT: Context Failure to notify patients of test results is common even when electronic health records (EHRs) are used to report results to practitioners. We sought to understand the broad range of social and technical factors that affect test result management in an integrated EHR-based health system. Methods Between June and November 2010, we conducted a cross-sectional, web-based survey of all primary care practitioners (PCPs) within the Department of Veterans Affairs nationwide. Survey development was guided by a socio-technical model describing multiple inter-related dimensions of EHR use. Findings Of 5001 PCPs invited, 2590 (51.8%) responded. 55.5% believed that the EHRs did not have convenient features for notifying patients of test results. Over a third (37.9%) reported having staff support needed for notifying patients of test results. Many relied on the patient's next visit to notify them for normal (46.1%) and abnormal results (20.1%). Only 45.7% reported receiving adequate training on using the EHR notification system and 35.1% reported having an assigned contact for technical assistance with the EHR; most received help from colleagues (60.4%). A majority (85.6%) stayed after hours or came in on weekends to address notifications; less than a third reported receiving protected time (30.1%). PCPs strongly endorsed several new features to improve test result management, including better tracking and visualization of result notifications. Conclusions Despite an advanced EHR, both social and technical challenges exist in ensuring notification of test results to practitioners and patients. Current EHR technology requires significant improvement in order to avoid similar challenges elsewhere.
    Full-text · Article · Dec 2012 · Journal of the American Medical Informatics Association
    • "Further, there are major obstacles which hinder the involvement of patients. These include a lack of access to clinical information and a lack of appropriate tools, educational aids and decision support aids that can help them to understand and engage in their own care[39]. For this reason, the development of person-centred care will need to be informed by evidence about what enhances or blocks patient engagement and involvement, along with research about the effect on patient out- comes[42]. "
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    ABSTRACT: Modern information technology is changing and provides new challenges to health care. The emergence of the Internet and the electronic health record (EHR) has brought new opportunities for patients to play a more active role in his/her care. Although in many countries patients have the right to access their clinical information, access to clinical records electronically is not common. Patient portals consist of provider-tethered applications that allow patients to electronically access health information that are documented and managed by a health care institution. Although patient portals are already being implemented, it is still unclear in which ways these technologies can influence patient care. To systematically review the available evidence on the impact of electronic patient portals on patient care. A systematic search was conducted using PubMed and other sources to identify controlled experimental or quasi-experimental studies on the impact of patient portals that were published between 1990 and 2011. A total of 1,306 references from all the publication hits were screened, and 13 papers were retrieved for full text analysis. We identified 5 papers presenting 4 distinct studies. There were no statistically significant changes between intervention and control group in the 2 randomized controlled trials investigating the effect of patient portals on health outcomes. Significant changes in the patient portal group, compared to a control group, could be observed for the following parameters: quicker decrease in office visit rates and slower increase in telephone contacts; increase in number of messages sent; changes of the medication regimen; and better adherence to treatment. The number of available controlled studies with regard to patient portals is low. Even when patient portals are often discussed as a way to empower patients and improve quality of care, there is insufficient evidence to support this assumption.
    No preview · Article · Nov 2012 · Journal of Medical Internet Research
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