Study: Integrated PHRs encourage patients to seek preventive care

Patients on average receive only one-half of recommended preventive services, but health IT possesses the power to change that. Inviting patients to use an interactive personal health record (PHR) linked to their clinicians’ EHRs increased their likelihood of receiving preventive care, according to research published in the July/August issue of the Annals of Family Medicine.

“Patients need evidence-based information about what is recommended, tailored to their individual risk factors and presented in an understandable format,” wrote corresponding author Alex H. Krist, MD, MPH, of the Virginia Commonwealth University’s department of family medicine. “They need reminders when services are due, guidance to deal with inconsistent recommendations and access to decision aids for choices that require shared decision making.”

To test whether meeting these needs would affect a patient’s decision to seek preventive care, Krist and his colleagues conducted a randomized controlled trial involving 4,500 patients from eight primary care practices in northern Virginia, inviting half to receive usual care and the other half to use a PHR addressing 18 preventive care services.

In the following 16 months, 16.8 percent of the intervention patients accepted invitations to use a PHR. While the proportion of up-to-date preventive services did not change for the whole intervention group, the group performed better than the control group, which saw a 2.2 percent decrease in preventive services. Among the intervention group, 25.1 percent of PHR users were up-to-date on all recommended services after 16 months compared to 13.9 percent of those who did not accept an invitation to use the PHR.

Based on the results, researchers believe that integrating intelligent PHRs into clinical practice and encouraging patients to use them would positively affect preventive care rates. In addition, an effective system could reduce burdens on providers by removing preventive care from clinical environments and reducing time necessary for administrative tasks like scheduling.

“The next generation of PHRs could offer higher functionality, assessing patients' needs by applying the latest evidence-based guidelines and incorporating personal medical data to derive individualized recommendations,” Krist et al wrote. “Taken further, they could link guidance with personalized evidence-based educational resources and decision aids, community services, logistical details and reminder systems. Automating this process eases the burden on clinicians and moves much of the preventive process outside the confines of the clinical environment.”