Access to Notes Boosts Adherence

The secret to medication adherence might be found in doctors’ notes, if patients are given online access to those notes, says a study in which three health systems offer expanded transparency. Beth Israel Deaconess Medical Center in Massachusetts, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Washington offered patients online access to notes taken by their primary care physicians. (The three had three different starting and ending points; the shortest lasted a year and the longest lasted 19 months.)

By law, patients are entitled to such access. In practice, they rarely ask and physicians rarely remind them. That should perhaps change, says “Inviting Patients to Read Their Doctors’ Notes: A Quasi-Experimental Study and Look Ahead,” published in the October 2 issue of the Annals of Internal Medicine.

In the study, patients “received e-mails when a doctor’s note was signed and posted to their portal, but whether to open the note was up to the patient.”

The study included 105 primary care physicians with 13,564 patients. Of 5,391 patients who opened at least one note and completed a post-intervention survey, “77 percent to 87 percent across the three sites reported that open notes helped them feel more in control of their care; 60 percent to 78 percent of those taking medications reported increased medication adherence....”

At the end of the study period, 99 percent of patients wanted access to notes to continue and not one doctor asked that the service be stopped. The study says that “a remarkable number [of patients] reported becoming more likely to take medications as prescribed. In contrast to the fears of many doctors, few patients reported being confused, worried, or offended by what they read.”