What are patients, caregivers, and healthcare professional’s experiences of, and perspectives on, online health records access in primary care? A qualitative synthesis.
Problem
NHS England (NHSE) have announced that all adult patients in England will have full prospective access, by default, to their primary care record online. Whilst there have been several systematic reviews examining the evidence for the benefits or drawbacks or records access, no studies to date have attempted a qualitative synthesis of studies on this topic. Our qualitative synthesis examined patients, caregivers, and healthcare professional’s experiences of, and perspectives on, online health records access in primary care. We compared if various stakeholders’ priorities and concerns align or differ in respect of important factors to consider with regard to making improvements to future online health records access services.
Approach
We searched MEDLINE, Embase, PsycINFO, CINAHL, and grey literature for relevant papers published between Jan 2000 and Jan 2023. We included qualitative studies that focussed on patient online GP records access and excluded studies focussing solely on transactional functions. The target population was patients, caregivers, and/or health care professionals who interact with electronic primary care health care records. Titles and abstracts of were assessed for relevance by two researchers independently. Full texts were examined by two independent reviewers and disputes were resolved by a third reviewer. Data extraction and synthesis were undertaken using guidance set out in the Cochrane Handbook for Systematic Reviews of Interventions. Eligible studies were critically appraised by two researchers for risk of bias and methodological quality. The Critical Appraisal Skills Programme Qualitative checklist was used to inform the assignment of studies into final categories based on the qualitative research assessment framework adopted by Dixon and Woods. Data synthesis drew upon strategies employed by Thomas and Harden’s work on thematic synthesis. Searching for themes continued until no new themes were identified. Synthesis was undertaken and a sample of selected codes and themes created at each stage were checked by a second reviewer for consistency. Discrepancies were resolved through discussion with a third member of the research team. Using this three-step process we synthesised and aggregated results of included studies.
Findings
Our findings enabled us to develop an in-depth understanding of patients, caregivers and health care professionals’ perspectives and experiences of patients having access to their own electronic health record within primary care contexts. We identified barriers and facilitators of effective online records access for patients that can inform improvements to future provision of this service in England.
Consequences
Our findings will be used to develop materials to support patients and carers to benefit maximally from online access to their primary care record. We are also working with NHSE, Health Education England, and Primary Care Medical Defence Organisations to develop materials to support primary care staff navigate common challenging scenarios resulting from patients having full prospective access to their primary care record.