Impact of patient-accessible electronic medical records in rheumatology: use, satisfaction and effects on empowerment among patients

Abstract

BackgroundTo measure the use, satisfaction and impact of a web portal which provides patients with rheumatoid arthritis home access to their electronic medical records (EMR).MethodsA pretest-posttest study was conducted among 360 patients. Questionnaires assessed socio-demographics, health literacy, Internet use, disease characteristics, patient-provider relationship and empowerment before and after launching a hospital-based patient web portal. To measure the impact of the portal, patients’ satisfaction with care, trust in their rheumatologist, self-efficacy in patient-provider communication, illness perceptions, and medication adherence were assessed. The post-test included questions on portal use, satisfaction, and self-perceived impact due to portal use.Results54% of respondents with Internet access had viewed their EMR. Respondents were positive about the ease of use and usefulness of the portal and reported very few problems. Age (P = .03), amount of Internet use (P = .01) and self-perceived Internet skills (P = .03) significantly predicted portal use. Of the respondents who had logged in, 44% reported feeling more involved in their treatment and 37% felt they had more knowledge about their treatment. Significant differences over time were not found on the empowerment-related instruments.ConclusionsThe current portal succeeded in offering patients access to their EMR in a usable and understandable way. While its true impact is difficult to grasp, a relevant portion of the patients felt more involved in their treatment due to the web portal. Offering patients home EMR access, therefore, appears to be a valuable addition to the care process.

Instrumentos de avaliação do letramento em saúde: revisão de literatura

“…Randomized clinical trials -studies that present higher levels of scientific evidence -totaled only 4 occurrences (14.8%) (19,23,33,34) , and 2 of them were multi-center studies (7.4%) (33,34) . Only 1 study presented a pretest/posttest design (3.7%) (13) . Among the instrument validation studies, 3 (60.0%) translated and adapted health literacy assessment tests to local languages in Serbia and Brazil: TOFHLA and STOFHLA to Serbian (22) ; STOFHLA to Portuguese (37) ; SAHLSA (test in Spanish adapted from REALM) to Portuguese, originating SAHLPA-50 and SAHLPA-18 (26) .…”

“…The other 2 studies (40.0%) proposed to develop new health literacy assessment instruments, both in the United States: Health LiTT (31) and METER (which includes many words from REALM) (32) . Health literacy was considered an explanatory variable in the majority of the articles (n=16, 59.3%) (11)(12)(13)16,(18)(19)(20)(23)(24)(25)(28)(29)(30)(33)(34)(35) . The articles that considered health literacy the response variable (n=11, 40.7%) (14,15,17,21,22,26,27,31,32,36,37) include the 5 instrument validation studies (18.5%) (22,26,31,32,37) , 4 population-based studies (14.8%) -2 in Taiwan (14,15) , 1 in Finland (27) and 1 intercontinental study (17) , -and 2 studies with diabetic patients (7.4%), carried out in Japan (21,36) .…”

“…The other 6 instruments (46.2%) (13,14,21,30,36) were considered as indirect health literacy assessments and approached the following themes: patient's feeling of trust in the interaction with the physician (1 instrument related to communicative health literacy) (13) ; health-promoting behaviors in adults (14) ; patient's perception of their own participation in health assistance (36) ; patient's perception of the physician's explanation (36) ; patient's perception of the clarity of medical explanations (21) ; and individual's distrust of the healthcare system (30) (5 instruments related to functional, communicative and critical health literacy).…”

“…In 14 articles (51.9%) (11,13,(17)(18)(19)(20)(21)23,24,28,30,33,34,36) , general and specific health literacy assessment instruments were used in an associated form, and the approached specialties were: Rheumatology (13,19) Endocrinology (21,36) , Surgery (33,34) (each area approached in 2 articles, 7.4%), Ophthalmology (11) , Pharmacy (17) , Cardiology (18) , Nutrition and Physical Education (20) , Pneumology (23) , Urology and Urogynecology (24) , Speech-Language Pathology and Audiology (28) , Orthopedics and Physiotherapy (30) (each area approached in 1 article, 3.7%). The main characteristics of the health literacy assessment instruments most frequently used in the selected articles are presented on Chart 2.…”

“…Five of these articles used the full version (18.6%) (11,25,(32)(33)(34) , 1 of them used the short version (3.7%) (12) , and 1 used the reviewed version (3.7%) (30) . Of these 8 studies, 1 (3.7%) used SAHLPA (Short Assessment of Health Literacy for Portuguese-speaking Adults) (26) , a version (13,21,29,36) in Japan and the Netherlands, and SBSQ (Set of Brief Screening Questions), in 2 articles (7.4%) (16,17) : a study that performed assessments in 15 European countries (16) and a study that involved countries in Europe, Oceania, North and South America (17) . Each one of the other 13 health literacy assessment instruments that were identified in the study was used by 1 article (3.7%).…”