Access Study: Realist evaluation of patient access to electronic medical test results services in general practice in England.

Problem

In April 2020 GP service contracts in England will be updated so all registered patients will receive full online access to their electronic health record. This change demonstrates the ongoing commitment by NHS England to deliver world-class healthcare in the 21st century, with an emphasis on personalised medicine, increased autonomy and digital enablement of primary care. With over 300 million patient consultations in general practices annually, introducing digital tools to provide patients with their medical test results electronically has the potential to support self-management and deliver cost-effective improvements across a range of healthcare outcomes. Currently there is limited empirical evidence about either the positive or negative consequences associated with such services. Our study aims to evaluate the provision of electronic medical test result services in general practices across England to understand “what works, for whom, in what circumstances and why”.

Approach

Using a realist evaluation approach to explore the delivery of electronic medical test result services in general practices in England. The study has three phases: i) a questionnaire survey to assess electronic medical test result service provision (approx. 450 practices), ii) retrospective patient data collection to determine if patients who access their results electronically differ from those patients who do not (approx. 7 practices), and iii) qualitative work with patients and staff to ascertain experiences and opinions of using (or not) electronic medical test result service (approx. 7 practices).

Findings

A total of 439 completed questionnaires were received from general practices across England. 70% of practices already offered electronic test result services, though only 14% monitored patient usage of services. 72% of respondents felt using electronic test result services was ‘easy’ or ‘very easy’ for GPs at the practice, but 18% of practices said safety issues had been raised concerning adult patients receiving or accessing electronic test results. Evidence from the survey informed the subsequent retrospective patient data extraction and qualitative workstreams, which are due to be completed in Feb 2020.

Consequences

Evidence from the Access study will be directly fed back to the Department of Health and Social Care in order to inform future policy decisions, commissioning and provision of electronic medical test results service in general practice across England in the future.