JMIR Publications

ABSTRACT

Background:

Electronic Health Record (EHR) use can impede or augment patient-physician communication. However, little research explores patient advocacy interventions to improve patient-physician-EHR interactions.

Objective:

To evaluate the impact of an educational comic on patient EHR self-advocacy.

Methods:

We conducted a prospective observational study with adult patients and parents of pediatric patients at the University of Chicago general internal medicine (GIM) and pediatric primary care (PPC) clinics. The authors developed an educational comic highlighting EHR self-advocacy behaviors and distributed it to patients during check-in for their primary care visits between May 2017 and May 2018. Participants completed a survey immediately after their visit, which included a question on whether participants would be interested in participating in a follow-up telephone interview. Of those who expressed interest, 50 participants each from the adult and pediatric parent cohorts were selected at random for follow-up telephone interviews 8 months (range 3-12 months) post-visit.

Results:

Overall, 71% (115/162) of adult patients and 72% (224/313) of pediatric parents agreed the comic encouraged EHR involvement. African American and Hispanic participants were more likely to ask to see the screen and become involved in EHR use due to the comic (adult p=0.010, p=0.010; parent p=0.020, p=0.006 respectively). Lower educational attainment was associated with an increase in parents asking to see the screen (rs=0.18, p=0.003) and to be involved (rs=0.19, p<0.001), and adults calling for physician attention (rs=0.17, p=0.040). Female GIM patients were more likely than males to ask to be involved (median 3 vs. 4, p=0.003). During follow-up phone interviews, 90% (45/50) of adult patients and all pediatric parents (50/50) remembered the comic. Almost half of all participants [GIM 46% (23/50), PPC 42% (21/50)] recalled at least one best-practice behavior. Adult patients reported an increase in asking to see the screen at subsequent visits (median 3 vs. 4, p=0.006), and pediatric parents reported an increase in both asking to see the screen and calling for attention at subsequent visits (median 3 vs. 4 and p<0.001 for both).

Conclusions:

Our study found that an educational comic may improve patient advocacy for enhanced patient-physician-EHR engagement, with higher impacts on female, African American and Hispanic patients, and patients with low educational attainment. Clinical Trial: N/A