Title: InPAct - Increasing Patient Activation by encouraging and enhancing online records access in primary care
Funder: Department of Health and Social Care

Abstract: Research question How can we improve patient online access to their GP record to enhance patient activation, care, and health outcomes? Background GP contracts in England state practices must offer patients online access to their primary care record. Systematic reviews demonstrate that online access benefits both patients and clinicians, for example by improving patients' feelings of autonomy and increasing uptake of preventive services. Challenges include resistance from clinicians, and concerns about data security or increasing patient anxiety. Previous research has focussed on potential benefits/problems associated with online access, how patients interact with their record, and barriers/facilitators to doing so. There is little on patients' views, and a paucity of theory-driven work on how online health records access can best be designed and enhanced to maximise potential beneficial health impacts. Aims and objectives The overall aim of the project is to develop and test improvements to the online patient record platform (an enhanced online portal), and to ascertain the feasibility of a trial testing the impact of this on patient activation and health outcomes. Key objectives are: To identify the issues, needs and challenges that an enhanced online portal must address. To identify guiding principles that will steer design of the enhanced online portal. To develop and optimize platform improvements and design an intervention based on these. To assess the feasibility of evaluating an intervention containing an enhanced online portal, in order to test if this could lead to enhanced patient activation and improved health outcomes.Methods and timelines for delivery We will employ mixed methods, use the person-based approach (9), and adhere to MRC guidance on complex interventions (10). Timelines are laid out below. Plan of investigation Stage 1: Planning (by month 12) To identify key issues, needs, and challenges that platform improvements must address. This will include a review of current usage data, qualitative work with stakeholders, a synthesis of relevant evidence, and an exemplar case study. Stage 2: Design (by month 22) To define the 'guiding principles' to help guide the design of the enhanced online portal to address the findings from stage 1, employ theoretical modelling and intervention mapping from established behaviour change techniques, and user-centred design to create personas, scenarios and use cases. Stage 3: Development (by month 32) To develop the enhanced online portal and optimise it from a user perspective, using 'think-aloud' techniques, iterative modification, and prototype development through user-centred design. Stage 4: Feasibility testing (by month 46) To ascertain the feasibility of testing the enhanced online portal in primary care and conduct a process evaluation (11) with patients and staff. Anticipated Impact and Dissemination Findings will inform the development of an RCT to assess the impact of a primary care based complex intervention built around an enhanced online portal. Findings will be disseminated via our collaborators at NHSx, presented at public engagement events, in scientific journals, conferences, distributed to relevant stakeholders, and posted on the study website.

Lay abstract: Aims It is now possible for people to view their GP health record online (online access). We want to find out how to make the best use of this service. We want to improve what's available, and design a study to test if these changes improve peoples' health. Background to the research Research shows there are benefits to online access - for example, people feel more in control of their care and more able to communicate with healthcare staff. There are also some down sides, including some professionals not being keen on the idea, or people not understanding what they see in their record. Research has mainly looked at the positives and negatives of online access, and at what helps, or gets in the way of using it. More research is needed to improve what people see when they use online access and how to present this in a way that helps them stay healthy or manage health problems. We need to understand more about what people want and what support they need. We will involve patients, carers, healthcare professionals, computer programmers, and NHS decision makers at all stages. We also need to make sure that online access does not increase the differences in health between the well off and the less well off.Design and methods We will split the project into four stages: Stage 1: Planning We will find out what is currently happening. For example, how many people can only book appointments or order repeat prescriptions, and how many can see what their GP wrote in their notes during their last visit? We will interview patients, carers, GP surgery staff, computer programmers, and decision-makers in the NHS to find out more about what they think of online access. We will summarise previous research, look at what features of online access have worked well in other studies, and spend time in GP surgeries where patients have different levels of online access. Stage 2: Design We will work with the groups mentioned above to come up with the best ideas for improving what is already available. Experts like psychologists and computer programmers will work together with patients, carers, and healthcare staff to find ways to turn these ideas into reality. Stage 3: Development We will work with computer experts to create 'mock-ups' of improvements to what people currently see, and what they can do when they use online access. We will ask people to try these out and tell us what they think as they go along. We will use what people say about the improvements to make the service even better. Stage 4: Testing We will examine the best way to find out if the improvements from the previous stages can have a positive impact on peoples' experience of using online access. We will speak to people who have used the improvements, and to GP surgery staff. We will use this information to design a study to test if these changes can improve people's health. Patient and public involvement We will ensure that patients and the public are involved at all stages. We gathered the views of members of the public and involved them in writing this funding application. Their insight and enthusiasm has greatly improved our ideas, for example by encouraging us to include carers and carry out some work before this project, asking patients what they want from online access to their health record. Dissemination Findings will be presented at public events locally and nationally, in scientific journals, at conferences, sent to participants, relevant charities and medical groups, and posted on NHS websites.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE