Open Notes May Help Older Adults — If They Actually Read Them

Jake Remaly

September 08, 2021

Older patients who read their clinicians' notes online may find that the notes help them remember their care plan and take their medications as prescribed, new research suggests.

And the more chronic conditions a patient has, the more helpful the notes appear to be.

Among adults aged 65 years and older who had read a clinic note in a patient portal in the past year and who completed a survey about their experience, those with more than two chronic conditions were more likely to find the notes helpful, compared with those with fewer chronic conditions, according to a study published online in the Journal of the American Geriatrics Society.

Patients with more chronic conditions also were more likely to have been encouraged by a clinician to access their notes.

For fewer than 5% of the respondents, the notes could be confusing or cause them to worry more about their health, the survey data show. But for about 29%, accessing the notes made them less worried.

Despite the potential benefits of accessing personal medical information online, which US healthcare organizations have been required to provide since April 5, older patients are less likely to be told about, register for, and use online patient portals, the study authors note. Providing personalized health information on paper and in lay terms, as well as online, could engage patients, they suggest.

"There is a central paradox here in terms of the digital divide," senior author Charlotte Blease, PhD, told Medscape Medical News. "We know that elderly persons, those from racial minorities, or persons with a low income are more likely to suffer from chronic conditions, but these populations are less likely to use health portals."

Blease is a researcher with OpenNotes at Beth Israel Deaconess Medical Center (BIDMC), Boston, Massachusetts. The OpenNotes organization conducts studies of and advocates for the sharing of clinicians' notes and transparent medical records.

For the current study, Catherine M. DesRoches, DrPH, executive director of OpenNotes, and colleagues analyzed data from people who completed surveys via patient portals at BIDMC, the University of Washington Medical Center, in Seattle, Washington, and the Geisinger Health System, in Danville, Pennsylvania.

Their analysis focused on 7688 respondents aged 65 years or older; 4190 (55%) were women, and 4018 (52%) were 65 to 70 years old. Most were White, had at least a high school education, and rated their health as good or better.

Some of the participants had chronic conditions, such as hypertension, high cholesterol, arthritis, ischemic heart disease, diabetes, chronic kidney disease, heart failure, depression, Alzheimer's disease and dementia, and chronic obstructive pulmonary disease.

About 73% of the patients said that notes were very important for taking care of themselves.

Approximately 66% of patients with three or more conditions reported that note reading helped them remember their care plan; among respondents with one or two conditions, 63% said the notes helped them remember their plan; and among patients with no chronic conditions, 62% said so.

Some people wondered whether older patients might find clinic notes too confusing or upsetting, but "what we see in our data is sort of the opposite," DesRoches told Medscape Medical News.

Not all patients read their notes, and some may not need to. "But for patients who want the notes, they are now available to them," DesRoches said.

Peter J. Kaboli, MD, with the Iowa City VA Healthcare System, has studied similar issues, such as the effects of secure messaging between patients and practitioners in the Department of Veterans Affairs.

In one study that included patients whose average age was 65 years, secure messaging led to more care via telephone and less in-person care. Offering another way to access care "is likely a good thing," Kaboli said.

"Open notes are here to stay, and the evidence is conclusive that they provide more potential benefit than harm," he said. "The fact that so few elderly patients with chronic illnesses reported negative impressions of their open note experience suggests that even this population benefits."

It makes sense that open notes could be especially beneficial for older patients with chronic conditions, Blease said. During a 10-minute clinic visit, patients might be dealing with anxieties, memory impairment, or overwhelming amounts of information about multiple chronic illnesses.

"When patients rely only on that pressurized visit to concentrate on, understand, and to remember what their doctor tells them, for a variety of reasons this information may not stick," Blease said. By reading the information later in the patient portal, "they get the chance to pore over their notes, digest the information, and better understand what the doctor was telling them," Blease said.

Now that open notes are here, Kaboli is encouraging efforts to unlock their potential.

"The open notes genie is out of the bottle, so we should all keep working to improve the experience for patients and make it as easy as possible," he said.

The study was funded by the Cambia Health Foundation, the Gordon and Betty Moore Foundation, a Keane Scholar Award, the Peterson Center on Healthcare, and the Robert Wood Johnson Foundation. The study authors and Kaboli have disclosed no relevant financial relationships.

J Am Geriatr Soc. Published online August 17, 2021. Abstract

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