Electronic medical test results services in general practices across England: what works, for whom, in what circumstances and why?

Problem

GP Online Services allow patients to access their medical records; book appointments; request prescriptions; and view medical test results. Patients are increasingly offered medical test results electronically, yet there remains a paucity of evidence on the benefits of these services. This study used a realist evaluation approach to explore electronic test result services (ETRSs) being offered by general practices in England to understand what worked, for whom, and in what circumstances.

Approach

Between February-September 2019, we surveyed GP practices across England to explore ETRSs provision. From survey responders, six representative case study practices were selected to participate in: i) retrospective data analysis of registered patients and ii) general practice-based interviews.

Findings

In total 562 GP practices were invited and 457 (81.3%) responded to the online survey, of which 339 (74.2%) were providing ETRSs. Of those providing ETRSs, 93.5% (n=317/339) allowed patients to access results online; 41.9% (n=142/339) offered ETRSs to receive results (e.g., text messaging, emails); and 35.7% (n=121/339) provided both. A quarter (25.7%) of practices providing ETRSs allowed patients to retrieve all types of results electronically. Most of these practices (74.0%) asked patients to register for ETRSs when joining the practice. Yet in some practices certain types of patients were less likely to be offered ETRSs (i.e., children, carers of patients, non-English speaking patients, or patients in a perceived coercive relationship). The retrospective analysis of 11,676 registered patient from three SystmOne practices providing ETRSs showed that patients aged 30-39 years were most, and patients aged ≥70 least likely, to sign up to ETRSs. Patients with face-to-face GP consultations during the 12-month study period were more likely to be signed up to ETRSs than other adult patients with a test result during the study period. Interviews were conducted with 29 individuals (8 patients and 21 staff). Most patients were keen to use ETRSs, however some were unaware that their practices offered this service. For the few that had used ETRSs, they reported easier access to results by reducing telephone waiting times or visits to their practice. General practice staff talked about the extra work needed to introduce and maintain ETRSs, but once set up, they believed it simplified and reduced workload.

Consequences

Considerable variation was found in the implementation, integration, and delivery of ETRSs across general practices in England. Overall, potential benefits of ETRSs remain largely unrealised and unquantified, as these services simply have not been implemented well enough to generate sufficient measurable impact. The next challenge is to encourage reluctant adopters to embrace ETRSs and to provide additional resources and guidance to help support the contractually required provision these services, while ensuring any potential benefits are fully realised.