title: Sharing Physician Notes Through an Electronic Portal is Associated With Improved Medication Adherence: Quasi-Experimental Study.
abstract: BACKGROUND
  In surveys, interviews, and focus groups, patients taking medications and offered Web portal access to their primary care physicians' (PCPs) notes report improved adherence to their regimens. However, objective confirmation has yet to be reported.
  
  
  OBJECTIVE
  To evaluate the association between patient Internet portal access to primary care physician visit notes and medication adherence.
  
  
  METHODS
  This study is a retrospective comparative analysis at one site of the OpenNotes quasi-experimental trial. The setting includes primary care practices at the Geisinger Health System (GHS) in Danville, Pennsylvania. Participants include patients 18 years of age or older with electronic portal access, GHS primary care physicians, and Geisinger health plan insurance, and taking at least one antihypertensive or antihyperlipidemic agent from March 2009 to June 2011. Starting in March 2010, intervention patients were invited and reminded to read their PCPs' notes. Control patients also had Web portal access throughout, but their PCPs' notes were not available. From prescription claims, adherence was assessed by using the proportion of days covered (PDC). Patients with a PDC ≥.80 were considered adherent and were compared across groups using generalized linear models.
  
  
  RESULTS
  A total of 2147 patients (756 intervention participants, 35.21%; 1391 controls, 64.79%) were included in the analysis. Compared to those without access, patients invited to review notes were more adherent to antihypertensive medications-adherence rate 79.7% for intervention versus 75.3% for control group; adjusted risk ratio, 1.06 (95% CI 1.00-1.12). Adherence was similar among patient groups taking antihyperlipidemic agents-adherence rate 77.6% for intervention versus 77.3% for control group; adjusted risk ratio, 1.01 (95% CI 0.95-1.07).
  
  
  CONCLUSIONS
  Availability of notes following PCP visits was associated with improved adherence by patients prescribed antihypertensive, but not antihyperlipidemic, medications. As the use of fully transparent records spreads, patients invited to read their clinicians' notes may modify their behaviors in clinically valuable ways.
authors.affiliation: Geisinger Health System, Center for Health Research, Danville, PA, United States. eawright@geisinger.edu.
authors.forename: Eric
authors.identifier: http://orcid.org/0000-0003-1721-4104
authors.initials: E
authors.lastname: Wright
authors.forename: Jonathan
authors.identifier: http://orcid.org/0000-0001-6481-6699
authors.initials: J
authors.lastname: Darer
authors.forename: Xiaoqin
authors.identifier: http://orcid.org/0000-0001-7749-692X
authors.initials: X
authors.lastname: Tang
authors.forename: Jason
authors.identifier: http://orcid.org/0000-0001-6981-2881
authors.initials: J
authors.lastname: Thompson
authors.forename: Lorraine
authors.identifier: http://orcid.org/0000-0002-9091-8178
authors.initials: L
authors.lastname: Tusing
authors.forename: Alan
authors.identifier: http://orcid.org/0000-0001-9537-5304
authors.initials: A
authors.lastname: Fossa
authors.forename: Tom
authors.identifier: http://orcid.org/0000-0001-6755-9333
authors.initials: T
authors.lastname: Delbanco
authors.forename: Long
authors.identifier: http://orcid.org/0000-0002-8903-9352
authors.initials: L
authors.lastname: Ngo
authors.forename: Jan
authors.identifier: http://orcid.org/0000-0001-9366-1200
authors.initials: J
authors.lastname: Walker
mesh_terms: D000328:Adult; D000368:Aged; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D058007:Physicians, Primary Care / Q000941:ethics*; D016903:Drug Monitoring
keywords: adherence; hyperlipidemia; hypertension; patient portal; progress notes