A Systematic Review of the Effect of Personal Health Records on Patient Activation (Preprint)

Abstract

BACKGROUND
Personal Health Records (PHRs) or Patient Portals have been on the healthcare policy agenda for many countries as a promising mechanism to support patient-centred healthcare by making medical records accessible to patients and people assisting patients in health self-management. Past work has shown PHRs conferring benefits such as convenience, a reduction in administrative costs and better health provider-patient communication. Another potential benefit touted is patient activation. This describes the knowledge, skills and confidence a person has in managing their own health and health care, and is commonly assessed through the Patient Activation Measure (PAM) and similar scales.

                OBJECTIVE
                    To systematically review the current evidence on the impact of PHRs on patient activation.

                METHODS
                    An electronic literature search was conducted for randomised controlled trials published up to December 2021 across sources including EMBASE, PsycINFO, CINAHL and PubMed. Publications were included in the study if they examined any association between PHR use and PAM or any similar measure.

                RESULTS
                    The search produced 2,941 papers for initial review, 88 full texts were screened for eligibility, 22 reviewed by two reviewers and 8 papers were identified as fully meeting the selection criteria.  Data from 8 RCTs directly assessing the effects of PHRs on patient activation and similar measures were extracted for meta-analysis. Overall, PHR use was associated with a 0.41 standardised mean difference increase (95% confidence interval 0.31-0.51) in activation. There was a high degree of heterogeneity (I2 = 98%) with much larger effect size in one paper compared to the rest.

                CONCLUSIONS
                    7 out of 8 studies showed no statistically significant differences in activation. The effect seen in one study was markedly greater than in the others. This study notably offered PHRs combined with health coaching and training to their intervention group, which may indicate an important requirement for how to get the best out of a PHR system.