Currently submitted to: Journal of Participatory Medicine
Date Submitted: Apr 3, 2020
Open Peer Review Period: Apr 3, 2020 - May 29, 2020
(currently open for review)
Beyond Known Barriers – Assessing physician perspectives and attitudes towards introducing Open Records in Germany: Qualitative study
Having access to medical records can improve patients’ health literacy, self-care, treatment adherence, and can facilitate the doctor-patient-communication. Approaches based on the Open Record concept aim at achieving these goals. In Germany, patients are entitled by law to have access to their medical records. However, while Open Record projects have been successfully implemented in primary care in the USA, they remain an exception in Germany. So far, research has been focused on organizational implementation barriers. However, little is known about factors that might influence physicians’ attitude, support, or reluctance towards opening records in German primary care.
This qualitative study aims to provide a better understanding of attitudes towards opening records in primary care in Germany. To expand the knowledgebase future implementation programs could draw from, it focuses on professional self-conception as an influencing factor regarding the approval for Open Records. As professional self-conception might change from generation to generation and biographically, perspectives and attitudes of practicing primary care physicians and advanced medical students were to be explored.
Data were collected through semi-structured guide-based interviews with general practitioners and advanced medical students. Participants were asked to share their perspectives on Open Records in German general practices, as well as perceived implications, their expectations for future medical records, and the conditions for a potential implementation. Data were pseudonymized, audiotaped, and transcribed verbatim. Themes and subthemes were identified through thematic analysis. Data were organized and coded by using MAXQDA Standard 2018 (Release 18.2.0). Participant characteristics were analyzed descriptively by using Microsoft Excel (Release 16.28).
Barriers and potential advantages were reported by 7 GPs and 7 medical students (n=14). The barriers (1) data security, (2) increased workload, (3) costs, (4) the patients’ limited capabilities, and (5) the physicians’ restraints were identified. As advantages, (1) patient education and empowerment, (2) positive impact on the practice, and (3) improved quality of care were mentioned in the interviews. GPs’ professional self-conception influenced their approval for Open Records: GPs considered their aspiration for professional autonomy and freedom from external control to be threatened and their knowledge-based support of patients to be obstructed by Open Records. Conversely, medical students emphasized the chance of encouraging patients and achieving shared decision making through Open Records. While students expected the implementation in Germany to be realistic in the near future, GPs were more hesitant and voiced a strong resistance towards sharing personal notes. Reliable technical conditions, the participants’ consent, and a joint development of the implementation project to meet the GPs’ interests were requested.
Open Records was proven beneficial before and can be a chance to improve health care. Although the medical students’ positive attitude towards the concept provides an optimistic view for a future implementation, the GPs’ professional values have to be respected and complied with. Further research and a broad support of decision makers is crucial to realize the opportunities related to giving patients access to their records in Germany.
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