Access to doctors’ notes ‘gives patients more control’

By Caroline Price, Senior medwireNews Reporter

Giving patients access to their primary care doctors' notes makes them feel more in control of their care and more likely to adhere to medication, suggests a US study.

Of 13,564 patients invited to view their notes via a secure internet portal, 11,797 opened at least one note over the year-long study and 5391 of these completed a survey about their perceptions. Around four-fifths said that being able to read their notes helped them to feel more in control of their care, while around two-thirds who were taking medications reported increased adherence to those medications.

The study was conducted across three primary care practices, including 105 primary care physicians. Importantly, the authors report, the doctors themselves experienced "no more than a modest effect on their work lives."

Jan Walker (Harvard Medical School, Boston, Massachusetts) and colleagues report in the Annals of Internal Medicine that the proportion of patients saying they felt more in control of their care ranged from 77% to 87% across the three sites, while rates of increased medication adherence ranged from 60% to 78%.

Between 1% and 8% of patients reported that the notes caused them confusion, while a more substantial minority, between 26% and 36%, had privacy concerns, and 20% to 42% reported sharing notes with others.

Few doctors reported longer visits (0-5%) or more time addressing patients' questions outside of visits (0-8%) after access was given. But between 3% and 36% reported changing the content of notes and up to a fifth took more time writing them.

Nevertheless, doctors seemed positive about the impact of the open notes. Asked what the greatest advantage of opening up notes had been, the most frequent response was a strengthening of relationships with some of their patients. Doctors also noted quite often that some patients seemed more activated or empowered.

"The patients in this large-scale trial reported striking benefits and presented a clear mandate to continue open notes. The doctors encountered few problems, and we hope that the problems that exist can be overcome with further analysis, education, and experimentation," write the authors, who also say they believe that "open notes seem worthy of widespread adoption".

A patient who took part in the study, Michael Meltsner (Northeastern University School of Law, Boston, Massachusetts), comments in a related editorial that he is grateful to have had complete access to the information about his own serious illness, including the available options, his response to treatment, and what he could do to increase his chances of survival.

He notes that "passivity robs patients of a wide range of steps that they, and only they, can take toward improved well-being."

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