Does Sharing Physician Notes via Internet Portal Improve Medication Adherence?

The first large-scale study of the use of an electronic web portal to give patients access to their primary care physicians (PCP) visit notes suggests that it increases medication adherence.

The retrospective comparative analysis, published in Journal of Medical Internet Research, was conducted at one site of the OpenNotes quasi-experimental trial in Danville, Pennsylvania, with primary care practices at the Geisinger Health System (GHS). Participants included 2147 patients aged 18 years or older with electronic portal access, PCPs in the GHS, with Geisinger health plan insurance, and prescriptions for at least one antihypertensive or antihyperlipidemic agent from March 2009 to June 2011.

Starting in March 2010, intervention patients (n = 756) were invited and reminded to read their PCP’s notes through a secure patient portal. Control patients (n = 1391) also had web portal access but their PCP’s notes were not made available.

Eric Wright, PharmD, MPH, and colleagues assessed adherence by using the proportion of days covered (PDC) from prescription claims. Patient characteristics at baseline were similar between the two groups, with the exception of the presence of diabetes mellitus and an elevated body mass index, both of which were slightly higher in the intervention group. Patients were 59 years of age on average, split about evenly between men and women, and overwhelmingly white.

Patients with a PDC ≥80 were considered adherent and were compared across groups using generalized linear models.

Compared with patients who did not have access to notes, patients invited to review notes were more adherent to antihypertensive medications: adherence rate was 79.7% for intervention versus 75.3% for controls (adjusted risk ratio, 1.06; 95% CI, 1.00-1.12). Adherence was similar among patients with access to notes and those without access to notes among patients taking antihyperlipidemic agents: adherence rate was 77.6% for intervention versus 77.3% for control group (adjusted risk ratio, 1.01; 95% CI, 0.95-1.07).

The study authors concluded that the availability of notes following visits with PCPs was associated with improved adherence by patients prescribed antihypertensive medications, but not antihyperlipidemic, medications. They reported that a large majority of patients chose to read their progress notes and reported feeling more in control of their health care, being more prepared for visits, and understanding their medical conditions better. “Of particular interest, they reported improving their adherence to medications.”

More and wider measurements of this important component of care are urgently needed, investigators concluded.

“As the use of fully transparent records spread, patients invited to read their clinicians’ notes may modify their behaviors in clinically valuable ways,” the authors wrote.