Implementering af patientportaler: Forventninger og evidens - Et litteraturstudie: Hvordan implementeres patient empowerment, så det giver positive effekter (økonomiske, outcome for patienten osv.)

Implementing patient portals: Expectations and evidence - A Systematic Literature Review

Grønvald, Liselotte ; Jensen, Henrik Gaedt ; Nobel, Charlotte

2. årgang

Master i Sundhedsinformatik (Efter- og videreuddannelse)

2016

2016-06-23

Dette projekt undersøger, hvilke effekter der er videnskabeligt dokumenteret ved implementering af patientportaler, og sammenholder dem med forventningerne til MyChart i Sundhedsplatformen i Region Hovedstaden. Vi gennemførte et systematisk litteraturstudie (december 2015–januar 2016) i PubMed, Embase, CINAHL, LISTA, Scopus og Web of Science efter PRISMA-P/PRISMA, med inklusion af online tilgængelig litteratur fra 2010 og frem på dansk, svensk, norsk eller engelsk; brugervenlighedsstudier og ikke-interaktive portaler blev ekskluderet. I alt blev 1.820 titler screenet, 205 fuldtekster gennemlæst, og 43 studier inkluderet til narrativ syntese; evidensstyrken blev vurderet som middel med et GRADE-inspireret værktøj. Effekter blev grupperet i kategorier (bl.a. kliniske outcomes, ressourceforbrug, adherence/compliance, patient–kliniker-kommunikation, patientempowerment, patienttilfredshed, sundhedsøkonomi; samt klinikertilfredshed) og en hyppigt omtalt sideeffekt var ulighed. På tværs af studierne fandtes signaler om patientempowerment (44%), patienttilfredshed (42%) og kliniske effekter (35%), mens lavere ressourceforbrug (14%) og positive sundhedsøkonomiske effekter (7%) var sjældnere; risiko for ulighed blev nævnt i 45%. Tre kvalitative interviews (politiker, læge, patient) tæt på MyChart-implementeringen viste højere forventninger til ressource- og økonomiske gevinster end evidensen understøtter, større overensstemmelse for kliniske outcomes, compliance og tilfredshed, og begrænset fokus på ulighedsrisiko. Samlet peger fundene på, at evidensen for positive effekter af patientportaler er relativt svag, særligt for økonomiske gevinster; det afspejler mangel på dokumentation snarere end bevis for manglende effekt. Vi anbefaler at prioritere forskning i de økonomiske effekter samt at tage risikoen for digital ulighed alvorligt, så patienter med lav e-sundhedskompetence ikke utilsigtet ekskluderes.

This project examines the scientific evidence for the effects of implementing patient portals and compares it with expectations for MyChart in the Sundhedsplatformen in Denmark’s Capital Region. We conducted a systematic literature review (December 2015–January 2016) in PubMed, Embase, CINAHL, LISTA, Scopus, and Web of Science following PRISMA-P/PRISMA; studies published online from 2010 onward in Danish, Swedish, Norwegian, or English were included, while usability studies and non-interactive portals were excluded. In total, 1,820 titles were screened, 205 full texts were reviewed, and 43 studies were included for narrative synthesis; using a GRADE-inspired tool, overall evidence strength was assessed as medium. Effects were grouped (including clinical outcomes, health resource use, adherence/compliance, patient–clinician communication, patient empowerment, patient satisfaction, and health economics; clinician satisfaction was also considered), and inequality emerged as a frequent side effect. Across studies, signals were observed for patient empowerment (44%), patient satisfaction (42%), and clinical outcomes (35%), whereas lower resource consumption (14%) and positive economic effects (7%) were less common; risk of inequality was reported in 45%. Three qualitative interviews (a politician, a physician, and a patient) close to the MyChart rollout revealed higher expectations for resource and economic gains than the literature supports, more alignment on clinical outcomes, compliance, and satisfaction, and limited attention to inequality. Overall, evidence for positive effects of patient portals is relatively weak, especially for economic benefits; this reflects a lack of documentation rather than proof of no effect. We recommend prioritizing research on economic outcomes and taking the risk of digital inequality seriously to avoid unintentionally excluding patients with low eHealth literacy.

[Dette resumé er genereret med hjælp fra AI direkte fra projektet (PDF)]

patientportal ; litteraturstudie ; implementering ; sundhedsplatformen

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Grønvald, Liselotte:

• Implementing patient portals: Expectations and evidence - A Systematic Literature Review (2016)

Jensen, Henrik Gaedt:

• Implementing patient portals: Expectations and evidence - A Systematic Literature Review (2016)

Nobel, Charlotte:

• Implementing patient portals: Expectations and evidence - A Systematic Literature Review (2016)