Survey: Access to Physician Notes Helps Medication Adherence

Marcia Frellick

May 28, 2019

Giving patients access to physician notes may help them better manage, understand, and adhere to their medications, results of an online survey of patients indicate.

Catherine M. DesRoches, DrPH, associate professor of medicine at Harvard Medical School and executive director of OpenNotes at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues surveyed patients at the three centers included in the original OpenNotes pilot about their use of medications and their engagement in updating their medications since the project began in 2010.

Findings were published online today in Annals of Internal Medicine.

In addition to Beth Israel, the other two centers in the pilot were Geisinger Health System in Pennsylvania and the University of Washington Medical Center in Seattle. Of 136,815 patients invited to take the survey in 2017, more than 29,500 (22%) responded.

Of the responders, 19,411 patients had read their visit notes and said they had taken or been prescribed medications in the past year; 14% in that group who were associated with Beth Israel and Geisinger reported that reading the notes made them more likely to follow doctors' orders on prescriptions. Eighty-six percent said reading the notes did not affect their adherence.

Similarly, "At practices associated with the University of Washington, where the survey used different wording and response categories, 33% of such patients rated notes as extremely important in assisting with their regimens," the authors write.

Reports of benefit went up substantially with qualifying patients whose primary language was not English and with patients who had a high school education or less.

Of the 1420 respondents who said their primary language was not English, 1064 (75%) said reading the notes helped answer questions about their medications. In comparison, 64% of the 16,966 primary English speakers answered that way.

Of the 1239 responders who had a high school education or less, 74% reported that reading the notes helped answer questions about their medications, compared with the 53% of the 12,839 college graduates who gave that response.

The results are particularly important because, "As many as half of Americans with chronic illness do not take their medications as prescribed, which contributes to poorer health outcomes and up to $300 billion annually in avoidable health care costs," the researchers write.

They acknowledge that limitations of this study include a low response rate, that the responders were mostly white and well-educated, and that they relied on patients to self-report.

Very few patients who responded to the survey said the notes added worry or confusion.

Additionally, about 80% of the respondents said they looked at their list of medications through their portal at least once; of those, about 18% said they found inaccuracies and wanted to be able to correct the list online.

Study Reaffirms Lack of Adverse Effects

In an accompanying editorial, David Blumenthal, MD, and Melinda K. Abrams, MS, president and vice president, respectively, of The Commonwealth Fund in New York City, a nonprofit foundation that provides grants for healthcare research, write that this study and others before it show no adverse effects of sharing clinical documents with patients.

"Transparency is no longer the distant, radical vision it was when the pioneering OpenNotes team began their work. Rather, it is a fact of clinical life, mandated by federal law and policy," they write.

Under the 21st Century Cures Act, enacted in December 2016, patients are entitled to a comprehensive summary of their health information, including visit notes, if they request it.

However, Blumenthal and Abrams write that physicians need much better preparation for sharing the information and that should start at the undergraduate level.

That education, they say, should include how to keep information private and safe and how to work with patients to make sense of their health information; in short, teach patients how to use it to help them stay healthier.

The authors say The Commonwealth Fund is developing a system called "OurNotes" that enables patients to edit their visit notes in collaboration with their physicians in order to make them more useful.

"The viability and consequences of this idea remain to be demonstrated," they write, "but it builds on evidence showing that engaged patients often have better health care outcomes."

The study is supported by the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, the Cambia Foundation, and the Peterson Center on Healthcare. DesRoches reports grants from the Gordon and Betty Moore Foundation, Cambia Foundation, Peterson Center on Healthcare, and the Robert Wood Johnson Foundation during the conduct of the study. Multiple coauthors report disclosures; the full list of these can be found with the original article. Editorialists Blumenthal and Abrams have disclosed no relevant financial relationships.

Ann Intern Med. Published online May 28, 2019. Abstract, Editorial

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