Patient interaction with medical record boosts prevention service use

By Sarah Guy

The use of patient-centered interactive health records can improve the delivery and uptake of preventive services, including cancer screening and vaccinations, show the results of a US study.

The interactive preventive health record (IPHR), which gives patients access to their clinicians' health records, displays tailored recommendations, educational resources, and generates individualized reminders.

Significantly more study participants who signed up to the IPHR were up to date with preventive services after 16 months compared with study participants who received usual preventive care (controls), with the benefit greatest among those who signed up and who were actively using it.

"Americans receive only one-half of recommended preventive services," remark Alex Krist (Virginia Commonwealth University, Richmond) and colleagues.

"One proposed solution is to harness the power of information technology, especially personal health records… assessing patients' needs by applying the latest evidence-based guidelines and incorporating personal medical data to derive individualized recommendations," they suggest.

Furthermore, an automated prevention process would ease the burden on clinicians and move interaction outside of the clinical encounter, writes the team in the Annals of Family Medicine.

During 66 weeks of follow up, 16.8% of 2250 invited patients from eight practices established an account with the IPHR and received prevention recommendations. Users were older and more likely to be male, non-Hispanic, and college-educated than were nonusers, which could compromise the ability to generalize results across populations, acknowledge the researchers.

At 4 and 16 months, the percentage of patients who received the IPHR who were up to date with all indicated preventive services (composite analysis) increased by a significant 2.1% and 3.8%, respectively. Conversely, there was no change in the proportion of up-to-date control patients (n=2250) at these time points.

The change in overall delivery of specific indicated preventive services (eg, colorectal and breast cancer screening) did not change significantly between IPHR patients and control patients during the study.

However, in subgroup analysis of users and nonusers of the IPHR, the percentage of indicated preventive services increased overall by 5.2% and 3.5% in users at 4 and 16 months, but did not change, and indeed decreased (by 2.4%) among nonusers at these time points, respectively.

Some "striking" improvements were seen in uptake of certain services among users and nonusers of the IPHR, note Krist et al. At 4 months, colorectal, breast, and cervical cancer screening increased by 15.3%, 12.3%, and 11.3%, all significant changes compared with nonusers.

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