The results of a year-long “quasi-experimental” OpenNotes trial found that patients who are given access to their primary care physicians’ notes were more engaged in care and saw better outcomes.
San Francisco, CA -- (SBWIRE) -- 10/09/2012 -- According to the study’s results recently published in the Annals of Internal Medicine, OpenNotes looked at portal use and electronic messaging by more than 13,000 primary care patients who were provided digital links to their doctors' notes at Beth Israel Deaconess Medical Center in Boston, Harborview Medical Center in Seattle and the Geisinger Health System in central and northeastern Pennsylvania.
Patients also took surveys that focused on their perceptions of behaviors, benefits and negative consequences. According to the study’s authors, the majority of the participants who frequently accessed notes on their visits indicated they wanted to continue the practice: "In response to a relatively simple intervention, the patients in this large-scale trial reported striking benefits and presented a clear mandate to continue open notes," the authors wrote.
"The doctors encountered few problems, and … since reviewing their individual results as documented in this report, the three participating institutions have each decided to broaden patient access to their clinicians' notes. Despite important limitations … our findings suggest that expanding such transparency is the right thing to do."
Before implementation of the study, many physicians expressed concerns about opening their notes up to patients. They worried that patients would become worried or offended by what they read. In fact, the opposite proved true as the study showed that a vast majority of participants reported an increased sense of control over their health and healthcare, as well as a better understanding of related medical issues.
Many patients also felt better prepared for future visits. The results of the study also indicates that “a remarkable number” of participants stated that open access to their doctors’ notes increased their likelihood to take medications as prescribed.
“We were excited to see that more than half of patients who received medications reported improved adherence, consistent with findings about general adherence from another open-records study" the authors wrote. They also stated, “Although self-reports fall short of objective data, open notes may prove to be a simple intervention that has an important effect on medication adherence.”
Although a sizable minority of doctors in the study changed how they addressed substance abuse, mental health issues, cancer and obesity, many of the comments researchers received suggested that doctors were surprised at the minimal effect opening their notes had on their work level. The authors found that "[s]everal wondered whether the intervention had been implemented. . .One comment may best summarize their collective experience: ‘My fears: Longer notes, more questions and messages from patients. In reality, it was not a big deal.’ ”
The researchers found that the patients in the study inevitably found relief, rather than anxiety, when reviewing their health providers’ and doctors’ notes: “We suspect that fear or uncertainty of what is in the doctor's 'black box' may engender far more anxiety than what is actually written, and patients who are especially likely to react negatively to notes may self-select not to read them.”
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