Patients' continuing use of an online health record: a quantitative evaluation of 14,000 patient years of access data.

BACKGROUND: Online access to all or part of their health records is widely demanded by patients and, where provided in form of patient portals, has been substantially used by at least subgroups of patients, particularly those with chronic disease. However, little is reported regarding the longer-term patient use of patient-accessible electronic health record services, which is important in allocating resources. Renal PatientView (RPV) is an established system that gives patients with chronic kidney disease access to live test results and information about their condition and treatment. It is available in most UK renal units with up to 75% of particular patient groups registered in some centers. We have analyzed patient use out to 4 years and investigated factors associated with more persistent use. OBJECTIVE: Our aim was to investigate RPV use by patients over time from initial registration in order to understand which patients choose to access RPV and the endurance of its appeal for different patient groups. METHODS: We analyzed an anonymized extract of the database underlying RPV containing information on patient registration and events including patient access and the arrival of new blood test results or letters that patients might wish to view. RESULTS: At the time of the extract, there were 11,352 patients registered on RPV for 0-42 months (median 17). More than half of registrants became persistent users, logging in a median of 2.0 times each month over post-registration intervals of up to 42 months (median 18.9). Provision of assistance with first logon was strongly associated with becoming a persistent user, even at 3 years. Logons by persistent users occurred around the time of consultations/tests, strongly suggestive of patient engagement. While indices indicative of greater deprivation were the strongest determinants of non-participation, they had negligible influence on drop-out rates among established users. CONCLUSIONS: In this mature patient portal system, a large proportion of patients made regular use of their online health records over protracted periods. The patterns and timing of use indicate strong patient interest in detailed information such as recent test results and clinic letters. Supporting patients through the first steps of establishing access to their online records is associated with much higher rates of long-term use of RPV and likely would increase use of other electronic health records provided for patients with chronic disease.

Implementing an innovative, patient-centered approach to day case arthroplasty: improving patient outcomes through remote preoperative pharmacist consultations.

OBJECTIVE: Elective surgery suffered significant loss of capacity during the COVID-19 pandemic. To address this, hip and knee arthroplasties are being conducted as day case procedures. Pre-admission pharmacist consultations were introduced (the intervention) for these patients. This consultation aimed to address perioperative medicines issues, promote patient empowerment, improve prescribing quality and contribute to reduction in length of stay (LoS). METHODS: All patients listed for a total/unicompartmental knee replacement (TKR/UKR) or total hip replacement (THR) at an ambulatory care hospital were identified by a pharmacist prescriber 1-2 weeks before the operation. Pharmacist consultations were conducted remotely with discharge prescriptions written electronically and dispensed before admission. Prescribing data were collected for both pre-intervention (n=80) and post-intervention (n=129) groups along with all interventions undertaken during consultations. Staff opinion was sought via online questionnaire and patient opinion was gathered via post-discharge telephone calls. RESULTS: A total of 115 interventions took place during 129 patient consultations and >75% of interventions were of a significance expected to improve patient care. Prescribing standards were improved in the intervention group compared with patients whose arthroplasty was before the introduction of this service. The pharmacy service would have produced a different prescription in 38.8% of the pre-intervention group. Staff and patient feedback was extremely positive and all patients with previous surgical experience in the health board reported an improved experience. There was a statistically significant reduction in post-discharge healthcare encounters (such as general practitioner (GP) visits) in the intervention group. CONCLUSION: This novel remote preoperative pharmacist consultation improved prescribing standards, enhanced the patient's surgical experience and reduced the burden on post-discharge healthcare systems.

The use of joints of meat as phantoms for ultrasound-guided needling skills: a prospective blinded study.

BACKGROUND: Needle visualisation during ultrasound-guided procedures is a skill that can be difficult to practise, with commercially available phantoms being expensive and often unrealistic. Our aim was to find an inexpensive, reproducible model that could be used to assist in developing this skill. METHODS: Pork shoulder, beef brisket, and lamb shoulder joints were compared to a standard blue ultrasound phantom. Five 'chunky' yarn pieces were twisted together and threaded through each joint to simulate hyperechoic nerves. Participants were instructed to ultrasound each specimen and insert a needle close to a nerve like structure. Using a visual analogue scale, specimens were scored based on realism of appearances of ultrasound images and 'feel' of needling. RESULTS: 38 people participated. All specimens of meat scored significantly higher than the blue phantom (p = 0.01). There was no significant difference between the different types of meat. CONCLUSIONS: Pork, beef and lamb joints are an effective model to use for simulation training for needling skills. They have limited lifespan, but due to its relatively low cost, it is feasible to discard the meat after each training workshop. We hope the use of inexpensive meat products will make ultrasound simulation training simpler to organise and more effective.