Title: Evaluation of patient access to medical test result services in General Practice
Funder: Department of Health and Social Care

Abstract: Background Electronic access to test results by patients is already being used in many GP practices in England and rolling these out further is strategically important for the NHS as it offers the potential for improved efficiency and accuracy of communicating results. However, there is little evidence on which to base best practice both for patients and GP practice staff. Aims The aims of our research are: (i) to describe the range of services currently being offered to provide electronic medical test results to General Practice patients in England; (ii) to understand patient and clinician experiences, attitudes and perceptions of different test result services; and (iii) to develop a framework to assess the economic impact of adopting these test results services in general practice in England. Plan of Investigation In order to meet our aims we will conduct a mixed methods realist evaluation consisting of three Phases. Phase I will identify the types of medical test result services that are currently being offered to patients by GP practices and the characteristics of the patients and practices using and not using these services. We will develop a questionnaire and send this electronically to a diverse sample of research active practices using the Clinical Research Networks; we will also send the questionnaire to a sample of non-research active practices to assess the representativeness of the research active practice sample. Additionally we will select a diverse sample of practices from those returning the questionnaires and ask them to provide selected anonymised patient data for adults at the practice for a retrospective year to determine whether patients who access medical results electronically differ to those who do not with respect to their demographics, diagnoses or conditions, frequency of consultations, and their practice characteristics. In Phase II, we will use qualitative interviews with patients and practice staff, whereby data on context, mechanisms and outcomes will be gathered and the relationships between the three explored. These data will be used to investigate what works for whom, where, and under what circumstances, as well as identifying facilitators and/or barriers associated with the implementation and effectiveness of the test results service under evaluation. This information will be gleaned from a sample of patients, general practitioners, practice nurses, practice managers, IT specialists and receptionists (and other relevant staff as required). Phase III will use the information from Phase II to identify areas of potential benefits and economic cost of different models of access to electronic results in order to develop an economic framework which could be used as a basis to undertake a full economic evaluation of patient electronic access to test results in the future. Research team The research will be conducted by an experienced team at the University of Bristol with previous collaborative links who have all undertaken primary care research and have complementary expertise in quantitative methods (Dr Christensen, Prof Hay, Dr Lasseter), qualitative methods (Dr Cabral, Dr Lasseter), ethics (Prof Huxtable, Dr Lasseter), and health economics (Dr Christensen). Impact Our research will contribute significantly to the currently limited evidence base on the benefits and costs of patient electronic access to medical test results. To disseminate our findings we will: present at conferences; publish results in peer-reviewed journals as open access papers; prepare lay summaries for participants; produce an executive summary for GP practices; and develop policy briefings for commissioners and ministers. This work will allow policy makers and the NHS, including the many practices currently not offering electronic patient access to test results, to consider how best to implement electronic access in order to benefit patients and GP practice workflow in order to improve health.

Lay abstract: Patients are increasingly being offered the opportunity to access their medical test results electronically through online access. This could benefit both patients and GP practices, by patients being able to access the information they want more quickly and reducing appointments for practices. However, it could also cause problems, if for example patients are anxious about receiving results at home or are unclear what they should do with their results. More evidence is required to fully understand what the benefits and problems could be for patients and practices. Our research will find out what kinds of electronic access to medical records patients are currently being offered by practices and how the practice and patients are finding using these systems. We will also consider how types of benefit and economic cost are affected by providing electronic services and generate a framework so that cost effectiveness can be assessed in the future. We will develop a questionnaire and send this to some of the GP practices in England to ask them what electronic access to medical test results they are currently offering patients (for example, online results, text messaging etc.). We will also ask for patient records (the patients will remain anonymous) from some practices to find out if those patients who choose to access their medical test results electronically differ from patients who do not. We will look at several factors including age, gender, what health conditions they have, and their social background. Then we will ask patients and staff who work in GP practices their views about electronic access of results for patients. We will ask them to tell us about their experience and opinions of using the electronic access (or not) offered by their practice. We will also ask them what is helpful, and what is not helpful, when using electronic access. Finally, we will bring together all the information to develop a guide which could be used to work out whether electronic access is cost-effective. Our results will be useful for policy makers and GP practices thinking about offering electronic services to patients and will help them to offer the access in the most effective way possible for the practice and their patients.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.1 ORGANISATION AND DELIVERY OF SERVICES;7.1 INDIVIDUAL CARE NEEDS
Health categories: GENERIC HEALTH RELEVANCE