Seniors open to PCEHR with GP oversight

A survey of the views of a group of older people in Bendigo about their willingness to accept the concept of the PCEHR showed that while the majority think it is a good idea, they still think GPs should oversee their records.

The study, carried out in 2011 before the PCEHR was introduced by Paresh Kerai and colleagues from the School of Pharmacy and Applied Science at La Trobe University, involved taking the views of a group of people with an average age of 71 on the idea of the PCEHR, its perceived benefits and its drawbacks.

The study also inquired into where seniors would be most likely to access the PCEHR, and which healthcare professionals they would share the information with.

It found that elderly people were generally in favour of the concept and felt it would have a positive benefit for their health, but that there were some security fears about electronic information. In addition to viewing the PCEHR at home, they would be amendable to viewing it in their doctor's office.

It also found that a function that allowed the information to be printed out easily would be welcomed by older people, as many would prefer to view the information on paper rather than electronically.

Most older people would be willing to share the information with their GPs, specialists and other medical and emergency personnel, but were less willing to share it with family members, pharmacists and allied health practitioners, and few were willing to share it with carers.

Study co-author Pene Wood, an associate lecturer in clinical pharmacy at La Trobe, said the role of carers was not defined in the study and so incorporated both formal and informal carers.

The authors state that the main limitation of the study was that the sample may not be representative of the wider population, as the participants were recruited from Probus, a club for business and professional retirees who are known to be active in the community.

Sixty-two per cent were female and 38 per cent male, with the majority aged between 70 and 79. Three-quarters had access to a computer at home, with 70 per cent having internet access. Sixty per cent used a computer regularly, including the internet and email, but usage of internet banking and shopping was quite low. A third never or rarely used a computer.

The authors write that respondents were asked general questions about their own health records, which could be either paper-based or electronic. The vast majority knew that they had a right to see their own records and believed that they should have that right, but they also said they preferred that their records should be managed by their GP's practice.

“More than half of the respondents strongly or partly agreed that having access to their own records would provide for better understanding of their own health (65%) or planning for questions during an appointment (60%),” the authors write.

“A little over half (53%) thought it would be easy to understand their own records, and just under half felt that having access to their records would make it easier for them to make decisions

“Errors in health records were identified as a concern by nearly one third of respondents (31%), with one respondent stating that ‘ensuring the accuracy of records is paramount’. A minority of respondents (16%) did not want to see their records at all, however the majority (65%) strongly or partly disagreed with this statement.”

The vast majority (85 per cent) thought the idea of the PCEHR was a good one, and three-quarters of those people would like to have had a look at their PCEHR if it had been available.

While they indicated that home or their doctor's surgery was the most likely places they would view their PCEHR online, 60 per cent said they would prefer to see a print-out of their records rather than see them on the computer. A similar percentage said they had some security concerns about the PCEHR.

“[It] was identified that some respondents prefer paper copies of their health records,” the authors write. “To meet the needs of these particular patients authorities may need to make provisions for printing the information in PCEHR whilst ensuring that a PCEHR of these consumers is still available for accurate and timely access by their health professionals.”

The survey respondents had mixed opinions about sharing their PCEHR with other people, with 95 per cent saying they were willing to provide their usual GP full access to their PCEHR. Most also indicated their willingness to share the information with specialists, hospital medical staff and emergency personnel.

“Approximately half of the respondents felt that family members (53%), diagnostic laboratories (48%), staff at pathology (46%), allied health professionals1(45%) and pharmacists (44%) also should have full access, and the carer attracted the lowest number of respondents (29%).

“Of those who did not select full access, limited access was the most common choice.”

Ms Wood, who also practices as a community pharmacist in Bendigo, said the reluctance to share information with pharmacists saddened her.

“I don't think it's to do with them seeing a pharmacist in a social role – I believe it is more to do with what role they see the pharmacist has,” she said.

“I think that consumers don't always fully understand what it is we actually do. I think a lot believe that we just put stickers on a box and that's it. They look at it with a silo point of view – the pharmacist gives me my medication, they don't need to know about my medical conditions and blood test results.

“This is often apparent when you ask them questions about their medical conditions or results or even offer them a Medscheck to make sure their medications are going ok and doing what they are supposed to.

“The response is, 'no it's fine my doctor looks after that...' If you ever query anything it's 'my doctor knows what he is doing or I'll have to ask the doctor first' especially with the elderly.

“It appears that they don't really value the pharmacist as a member of the healthcare team and perhaps that's due to the fact that often we are situated in a retail setting.”

The authors conclude that while the respondents were in favour of the PCEHR concept, “there were still some concerns about the security of the PCEHR suggesting further reassurance may be required.”

Measures such as providing computer access points at general practices and print-out facilities may need to be considered.

The study was part of Mr Kerai's honours project in pharmacy, in which he is now qualified.

Ms Wood said she hoped to have another honours student undertake further research this year now that the PCEHR has been rolled out.

The study was published in the International Journal of Medical Informatics.

Posted in Australian eHealth

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