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

Formålet med dette studie er at undersøge den videnskabelige evidens for effekter ved implementering af patientportaler og sammenholde den med forventningerne til MyChart i Sundhedsplatformen i Region Hovedstaden. Vi gennemførte et systematisk litteraturreview (december 2015–januar 2016) i PubMed, Embase, Cinahl, Lista, Scopus og Web of Science med PRISMA-P/PRISMA som ramme. Studier publiceret fra 2010 og frem på dansk, svensk, norsk eller engelsk blev inkluderet; brugbarhedsstudier og ikke-interaktive portaler blev ekskluderet. I alt blev 1.820 titler screenet, 205 fuldtekster vurderet, og 43 studier inkluderet. Efter reviewet interviewede vi en politiker, en læge og en patient med tæt relation til implementeringen af MyChart; fund fra litteratur og interviews blev syntetiseret narrativt. Evidensstyrken blev vurderet som samlet set middel (GRADE-inspireret). Rapportere­de effekter fordelte sig på kliniske outcomes, ressourceforbrug, adherence/compliance, patient-sundhedsprofessionel kommunikation, patientempowerment, patienttilfredshed og sundhedsøkonomi; klinikertilfredshed blev tilføjet under syntesen. Patientempowerment (44%) og patienttilfredshed (42%) var hyppigst rapporteret, kliniske outcomes i 35% af studierne, lavere ressourceforbrug i 14% og sundhedsøkonomiske effekter i 7%. Risiko for ulighed blev nævnt i 45% af studierne. Interviewpersonerne havde mere positive forventninger til ressource- og økonomiske effekter end evidensen understøtter, mens der var større overensstemmelse om kliniske outcomes, compliance og tilfredshed; risiko for ulighed blev generelt ikke tillagt stor betydning. Konklusionen er, at evidensen for positive effekter af patientportaler er relativt svag, og dokumenterede økonomiske gevinster er sjældne; der er behov for mere forskning i de økonomiske effekter, og beslutningstagere bør tage ulighedsrisikoen alvorligt for at undgå at udelukke patienter med lav e-sundhedskompetence.

This study examines the scientific evidence for the effects of implementing patient portals and compares it with expectations for MyChart within the Sundhedsplatformen in Denmark’s Capital Region. We conducted a systematic literature review (December 2015–January 2016) across PubMed, Embase, Cinahl, Lista, Scopus, and Web of Science, guided by PRISMA-P/PRISMA. Publications from 2010 onward in Danish, Swedish, Norwegian, or English were included; usability studies and non-interactive portals were excluded. In total, 1,820 titles were screened, 205 full texts reviewed, and 43 studies included. We then interviewed a politician, a physician, and a patient closely involved in the MyChart implementation; findings from the literature and interviews were synthesized narratively. Overall strength of evidence was assessed as medium (GRADE-inspired). Reported effects clustered around clinical outcomes, resource use, adherence/compliance, patient–provider communication, patient empowerment, patient satisfaction, and health economics; clinician satisfaction was added during synthesis. Patient empowerment (44%) and patient satisfaction (42%) were most frequently reported, clinical outcomes appeared in 35% of studies, lower resource use in 14%, and health economic effects in 7%. Risk of inequality was noted in 45% of studies. Interviewees expressed more optimistic expectations regarding resource and economic gains than the evidence supports, with greater alignment on clinical outcomes, adherence, and satisfaction; inequality risk was generally not seen as important. We conclude that evidence for positive effects of patient portals is relatively weak and documented economic benefits are rare; more research on economic outcomes is needed, and decision makers should address inequality risks to avoid excluding patients with low e-health 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)