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Personal Health Records :

Personal Health Records :. Is there an impact on patient’s health ?. Introdução à Medicina Turma 11 2009/2010. Key-words. Personal Health Records; Personal Child Health Records; PHR; Health Impact. Personal Health Records – PHRs .

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Personal Health Records :

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  1. PersonalHealthRecords: Isthereanimpactonpatient’shealth? Introdução à Medicina Turma 11 2009/2010

  2. Key-words Personal Health Records; Personal Child Health Records; PHR; Health Impact.

  3. Personal Health Records – PHRs • An electronic application through which individuals can access, manage and share their health information in a private, secure and confidential environment.

  4. PHRs • They differ from electronic health records because the main manager is the patient himself, instead of health care professionals or health institutions [1]. [1] Tang, P., et al., Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Association, 2006. 13(2): p. 121-126.

  5. [3] Pagliari, C., D. Detmer, and P. Singleton, Potential of electronic personal health records. British Medical Journal, 2007. 335(7615): p. 330. [4] Johnston, D., et al. A framework and approach for assessing the value of personal health records (PHRs). 2007: American Medical Informatics Association.

  6. Background • Need for clinical history of the patient for more accurate diagnosis or treatment-related decisions . • They can help prevent medical error and improve doctor/patient relationship [5]. • Perceived as the tool to empower consumers to become active decision-makers of their healthcare [2, 8]. [2] Ball, M., N. Carla Smith, and R. Bakalar, Personal health records: empowering consumers. Journal of Healthcare Information Management—Vol. 21(1): p. 77. [5] George, J. and P. Bernstein, Using electronic medical records to reduce errors and risks in a prenatal network. Current Opinion in Obstetrics and Gynecology, 2009. 21: p. 000-000. [8] Raisinghani, M. and E. Young, Personal health records: key adoption issues and implications for management. International Journal of Electronic Healthcare, 2008. 4(1): p. 67-77.

  7. Background Personal Personal [6] [6] Akber, A. and T. Gough, TeleHealth paradigm for Kuwait's healthcare. Logistics Information Management, 2003. 16(3/4): p. 229-245.

  8. Background [11] Wright, A. and D. Sittig, Encryption characteristics of two USB-based personal health record devices. Journal of the American Medical Informatics Association, 2007. 14(4): p. 397-399. [12]Lober, W., et al. Barriers to the use of a personal health record by an elderly population. 2006: American Medical Informatics Association. [13] Wuerdeman, L., et al. How Accurate is Information that Patients Contribute to their Electronic Health Record? 2005: American Medical Informatics Association.

  9. Justification PHRs are becoming an increasingly important research subject in medical informatics. The PHRs in use or in development today support a myriad of different functions, advantages and disadvantages and consequently offer different value propositions [4]. [4] Johnston, D., et al. A framework and approach for assessing the value of personal health records (PHRs). 2007: American Medical Informatics Association.

  10. The increasing mobility of the population and their health care providers, allied to the current complexity of care delivered, make PHRs valuable in the development of health care. Justification

  11. Research question "Does the use of PHRs improve the health of their users?"

  12. Aim • Comprehend the impact of PHR on patient’s health, according to variables such as • Study type • PHR’s characteristics • Patient’s description, health status, opinion and response • Costs • Doctor-patient communication

  13. Methods • Studyparticipants • Original articles that evaluate the impact of PHRs

  14. Methods • Study Design: SystematicReview

  15. Methods • Data collectionmethods No hand search of references was performed.

  16. Methods

  17. Methods • Limits

  18. Methods

  19. Methods • ExclusionCriteria • Datedbefore 1990 • Withoutanavailableabstractorfulltext • Aboutelectronicsystemsofhealthcareproviders • Aboutelectronichealthrecords • Notwritten in EnglishorPortuguese

  20. Methods The search was performed and the results of all the databases gathered in an Endnote file, the articles ordered by title. Those repeated were eliminated, which meant cutting down from 698 articles to 371. An additional set of 13 articles were excluded, due to being older than 1990.

  21. Methods The 358 articles were split in 5 groups of 2 students each that preformed a primitive selection by reading titles and abstracts and applying the inclusion and exclusion criteria. 119 articles were included and 155 excluded, the remaining underwent further selection. Whenever the group disagreed on the inclusion/exclusion of a certain article, a third reviser would be the judge. During this stage, 43 articles were excluded and 39 were included, resulting in a sample of 158 articles to be fully read.

  22. Methods Therefore, of a total of 362 articles, the revisers agreed in 268, leading 94 articles to a third scrutiny. K0,48

  23. Methods The 158 articlesobtainedwere confronted with a number of parameters which aided us in assessing the real impact of PHRs on patients’ health.

  24. Methods While reading the full-texts, further exclusion took place, due to factors such as the language, the study type (some were reviews, which were excluded) and the inability to answer our variables. Some full-texts were unavailable, even after contacting the article’s author. Therefore, our final sample of articles was reduced to 45.

  25. Methods • Impactvariables

  26. Methods

  27. Methods • Statisticanalysis • SPSS®version 17 • We obtained the frequencies of all variables created • Several one sample t-tests were performed to evaluate how close to reality were these frequencies. We considered as statistically significant results with p<0,05. • In order to study the association between our variables, we applied chi-square tests. Again, results with p<0,05 were reckoned as statistically significant.

  28. Results • We got results from 45 papers, within a group of 158 researched. • The median of participants in each paper was 165, with an interquartil range of 50 to 610.

  29. Results • Variable: Study characteristics

  30. Results • Variable: PHR’ characteristics – Data and PHR access

  31. Results • Variable: PHR’ characteristics – PHR’s tools

  32. Results • Variable: PHR’ characteristics – Emergency access

  33. Results • Variable: PHR’ characteristics – Data re-use

  34. Results • Variable: PHR’ characteristics – Health entities

  35. Results • Variable: PHR’ characteristics - Illnesses

  36. Results • Variable: Patients’ description

  37. Results • Variable: Patients’ health status

  38. Results • Variable: Patients’ health status

  39. Results • Variable: Patients’ opinion

  40. Results • Variable: Patients’ response

  41. Results • Variable: Costs

  42. Results • Variable: Communication

  43. Results Number of articles that quote each type of PHR in developed countries and countries in development. The results are statistically significant (p<0,05). N=29.

  44. Results Association between the patients that start managing their health or not and the changes on health status. The results are statistically significant (p<0,05). N=13.

  45. Discussion • The results obtained allow us to conclude that PHRs, in fact, improve the health of their users. In spite of the low number of statistically significant results, those which are so (as well as the tendencies represented by the other values) confirm this belief, , leading us to affirm that further research on this theme would be important.

  46. Discussion Studycharacteristics • We observed that this is a topic increasingly discussed in the scientific community, as the number of papers increased exponentially since 2005 (32 of 44 articles). This is probably due to the increasing concern with the power of technologies to easy our tasks or to improve our quality of life.

  47. Discussion PHR’scharacteristics • Internet PHRs are the most used, followed by paper-based and USB-pen ones. The persistency of paper-based PHRs might be caused by problems of Internet security and accessibility. • Internet PHRs are the most used, especially on developed countries.

  48. Discussion PHR’scharacteristics • We also found a majority of PHRs free of charge, perhaps because this technology is not yet well known, thus needing of some good publicity to gather users. • We had twice as many examples of PHRs supported by medical entities than those without support, which shows the importance given to this technology.

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