How do opt-in versus opt-out settings nudge patients toward electronic health record adoption? An exploratory study of facilitators and barriers in Austria and France.

BACKGROUND: Electronic health records (EHR) are becoming an integral part of the health system in many developed countries, though implementations and settings vary across countries. Some countries have adopted an opt-out policy, in which patients are enrolled in the EHR system following a default nudge, while others have applied an opt-in policy, where patients have to take action to opt into the system. While opt-in systems may exhibit lower levels of active user requests for access, this contrasts with opt-out systems where a notable percentage of users may passively retain access. Thus, our research endeavor aims to explore facilitators and barriers that contribute to explaining EHR usage (i.e., actively accessing the EHR system) in two countries with either an opt-in or opt-out setting, exemplified by France and Austria. METHODS: A qualitative exploratory approach using a semi-structured interview guideline was undertaken in both countries: 1) In Austria, with four homogenously composed group discussions, and 2) in France, with 19 single patient interviews. The data were collected from October 2020 to January 2021. RESULTS: Influencing factors were categorized into twelve subcategories. Patients have similar experiences in both countries with regard to all facilitating categories, for instance, the role of health providers, awareness of EHR and social norms. However, we highlighted important differences between the two systems regarding hurdles impeding EHR usage, namely, a lack of communication as well as transparency or information security about EHR. CONCLUSION: Implementing additional safeguards to enhance privacy protection and supporting patients to improve their digital ability may help to diminish the perception of EHR-induced barriers and improve patients' health and commitment in the long term. PRACTICAL IMPLICATIONS: Understanding the differences and similarities will help to develop practical implications to tackle the problem of low EHR usage rates in the long run. This problem is prevalent in countries with both types of EHR default settings.

Do personal health concerns and trust in healthcare providers mitigate privacy concerns? Effects on patients' intention to share personal health data on electronic health records.

RATIONALE: Health digitalization raises important challenges for personal health-data management. Particularly, the advantages underlying the implementation of Electronic Health Record (EHR) remain limited in many countries due to patients' privacy concerns. OBJECTIVE: Drawing on the privacy calculus theory, the objective of this research is to introduce personal health concerns and trust in healthcare providers as new predictors, beyond the constituent variables of the privacy calculus model - the perceived benefits and risk. We propose and test a conceptual model that investigates simultaneously the effects of these four variables on patients' privacy concerns and intention to share personal health-data on EHR. METHOD: A cross-sectional study using an on online survey was administered from December 2019 to February 2020 in France to both users and non-users of EHR. A structural equation modelling was used to assess the reliability and validity of the measurement as well as to test the research hypotheses. RESULTS: The results confirm the positive effects of personal health concerns and trust in healthcare providers on (a) the intention to create an EHR and (b) to share personal health-data. In the same vein, we do not find any significant effect of patients' privacy concerns on the intention to create an EHR and intention to share personal health-data. Furthermore, the patients' perceived benefits outweigh the perceived risks for EHR using. CONCLUSIONS: This research provides a more holistic understanding of patients' privacy concerns. Particularly, we highlight the key role of personal health concerns and trust in healthcare providers with the intention to create an EHR and to share personal health data. Empirical evidence underlines the importance to involve all the stakeholders in the implementation process. Findings are discussed according to existing literature and practical guidelines are suggested to the health policymakers and healthcare providers.

Investigating the healthcare pathway through patients' experience and profiles: implications for breast cancer healthcare providers.

BACKGROUND: Healthcare systems are facing many changes. Particularly, patients are more engaged in the care process. The medical perspective of the process is insufficient to provide patients with high quality care and service personalisation. This research presents an attempt to complete this medical perspective through an experiential perspective, especially for chronic diseases such as cancer. We investigated patients' experiences and profiles to reach a deeper understanding of their needs and expectations when they confront the disease. The objectives of this research were to model the key stages underling the patient pathway and to identify the challenging touch points of the interactions between patients and healthcare providers. Bringing together findings of patient experience, pathway, and profiles would help all the stakeholders involved to develop better practices for the healthcare process. METHODS: A qualitative observational nethnography on a French specialized forum for breast cancer patients "les Impatientes" was conducted. A total of 967 reviews were collected over a complete year period from all over France. Thematic and lexicometric content analysis were performed according to the experience dimensions, the pathway stages and touch points, as well as the patients' profiles. RESULTS: Data analysis shows that the healthcare pathway experienced by the patients is built around three stages. The discovery stage is closely related to the emotional dimension regarding the patient and physician relationship. The examination stage is characterized by a more technical and informational needs for the types of treatments. The follow-up and survivorship stage illustrates the patients' need to assess the treatments' effectiveness and the quality of the follow-up. Moreover, three profiles of patients were identified. The newcomers, the altruists and the autonomous are characterized by different attitudes depending on the stage of the healthcare pathway they were living. CONCLUSIONS: Our research presents an original modelling of the patient pathway and profiles beyond the medical process. It gives practical tracks to improve the healthcare pathway. Patients expect healthcare providers to integrate and strengthen several challenging touch points in order to create satisfactory patient experiences and high quality service.

Chemical compounds from Phoenician juniper berries (Juniperus phoenicea).

Natural chemical compounds are a widely researched topic worldwide because of their potential activity against cerebrovascular diseases. Chemicals from Juniperus phoenicea berries are reported in this study. Lipids (11%) from seeds are mainly unsaturated (86%). Minerals are also quantified like Na (63.8 mg per 100 g DW) or K (373.9 mg per 100 g DW). Total reduced sugars are ca 192.6 mg g(-1) DW. Polyphenols and flavonoids from berries are highly present with an average of 1764 ± 174.3 mg gallic acid per 100 g DW and 890 ± 47.6 mg rutin per 100 g DW, respectively. Mean free radical scavenging activities, determined by DPPH and ABTS, are 1337 ± 126.2 mM TEAC per 100 g DW and 1105.7 ± 95.9 mM TEAC per 100 g DW, respectively. All findings improve the possible presence of biologically active fractions in phytocomplex that could be used as such and/or extracted for the formulation of supplements and/or ingredients for the pharmaceutical industry.