Use of text messaging in general practice: a mixed methods investigation on GPs' and patients' views.

BACKGROUND: Text messaging has become more prevalent in general practice as a tool with which to communicate with patients. AIM: The main objectives were to assess the extent, growth, and perceived risks and benefits of text messaging by GPs to communicate with patients, and assess patients' attitudes towards receiving text messages from their GP. DESIGN AND SETTING: A mixed methods study, using surveys, a review, and a focus group, was conducted in both urban and rural practices in the south-west of Ireland. METHOD: A telephone survey of 389 GPs was conducted to ascertain the prevalence of text messaging. Subsequently, the following were also carried out: additional telephone surveys with 25 GPs who use text messaging and 26 GPs who do not, a written satisfaction survey given to 78 patients, a review of the electronic information systems of five practices, and a focus group with six GPs to ascertain attitudes towards text messaging. RESULTS: In total, 38% (n = 148) of the surveyed GPs used text messaging to communicate with patients and 62% (n = 241) did not. Time management was identified as the key advantage of text messaging among GPs who used it (80%; n = 20) and those who did not (50%; n = 13). Confidentiality was reported as the principal concern among both groups, at 32% (n = 8) and 69% (n = 18) respectively. Most patients (99%; n = 77) were happy to receive text messages from their GP. The GP focus group identified similar issues and benefits in terms of confidentiality and time management. Data were extracted from the IT systems of five consenting practices and the number of text messages sent during the period from January 2013 to March 2016 was generated. This increased by 40% per annum. CONCLUSION: Collaborative efforts are required from relevant policymakers to address data protection and text messaging issues so that GPs can be provided with clear guidelines to protect patient confidentiality.

Implementing registries and results databases of clinical trials: is there a side effect?

Many parts of the world are currently witnessing a controversial discussion concerning the appropriate design of the environment for clinical trials. The catalyst of this debate has been a number of highly publicized cases in which pharmaceutical firms are accused of having selectively disclosed evidence on marketed drugs. Many participants in the discussion promote greater transparency in clinical trials and support the introduction of mandatory clinical trials registries and results databases. This report draws upon prior work by the authors analyzing the effects of these regulations on a pharmaceutical firm's incentives to conduct clinical trials. Our findings add a new dimension to the discussion since they show the existence of a trade-off - as intended, registries and databases have the potential to increase transparency in clinical trials but they are likely to reduce the incentives to carry out clinical trials. This does not imply that these regulations are undesirable but it underlines the need for more research to be conducted on the incentive effects of these policies, because an informed policy choice must take into account all likely consequences of regulatory action and balance conflicting goals.

Trials, tricks and transparency: how disclosure rules affect clinical knowledge.

Scandals of selective reporting of clinical trial results by pharmaceutical firms have underlined the need for more transparency in clinical trials. We provide a theoretical framework which reproduces incentives for selective reporting and yields three key implications concerning regulation. First, a compulsory clinical trial registry complemented through a voluntary clinical trial results database can implement full transparency (the existence of all trials as well as their results is known). Second, full transparency comes at a price. It has a deterrence effect on the incentives to conduct clinical trials, as it reduces the firms' gains from trials. Third, in principle, a voluntary clinical trial results database without a compulsory registry is a superior regulatory tool; but we provide some qualified support for additional compulsory registries when medical decision-makers cannot anticipate correctly the drug companies' decisions whether to conduct trials.