Supplementary key findings
| Finding | Study type | Country | Reference |
|---|---|---|---|
| Users of these services were more likely to be female (OR 1.15), middle aged or older, with much greater morbidity than non-users (OR 5.6) | Cohort with match controls, cross-sectional cohort study | US | 39, 40 |
| People with Medicaid cover were less likely to use these services (OR 0.8) than people with commercial insurance | Cross-sectional cohort study | US | 40 |
| African–American, other non-white ethnicities, and females with lower socioeconomic classification were less likely to use the services | Randomised control trial, randomised control pilot study | US | 29, 37 |
| 70% of clinicians felt that online access strengthened relationships, enhanced trust, and improved decision making | Quasi-experimental non-randomised design | US | 45 |
| Patients who used online access to test results were more satisfied than those who did not | Cluster randomised control trial | US | 44 |
| Use of a secure messaging tool improved patient satisfaction with care from 48% to 59% (P = 0.04) | Randomised control trial | US | 35 |
| Patients felt themselves better able to express their concerns in writing (34%), to communicate about difficult topics (36%), and to send psychosocial information when using online tools versus telephone | Randomised control trials (and interviews) | US, US | 34, 35 |
| Online systems saved patients time, telephone calls, and clinic visits | Randomised control trials (and interviews) | Norway, US | 34, 35 |
| About half of US patients were willing to pay for online access, and 21% were unwilling. Of those who were willing, the median value assigned was $2 per message | Randomised control trials, randomised control pilot study | Norway, US, US | 33, 35, 37 |
| Patients given online access to their records identified more than twice as many medication list discrepancies with potential for severe harm than those who did not | Cluster-randomised trial | US | 43 |
| Users of online services received 84% of preventive care services compared with 68% of controls, including influenza vaccine (22% versus 14%) and mammography (49% versus 30%); children whose parents used online services received 96% of immunisations versus 87% in controls. Online services also facilitated health maintenance/appointment reminders | Cluster randomised control trial | US | 42 |
| Randomised control trials | UK, US | 32, 36 | |
| Only 1–8% of patients say that viewing their record online caused confusion, worry, or offence | Quasi-experimental non-randomised design | US | 45 |
| The impact of online record access on patient use of face-to-face services and telephone calls was unclear | Randomised control trial (and interviews), cohort with match controls, quasi-experimental non-randomised design | Norway, US, US | 34, 39, 45 |
| Randomised control trial, randomised control trial (and interviews), cohort and matched-control study, cluster randomised control trial | Norway, Norway, US, US | 30, 34, 41, 42 | |
| Clinicians had concerns about the additional burden and workload from online access but found their fears only partly realised | Randomised control trial (and patient survey), three-part cohort study, quasi-experimental non-randomised design | US, US, US | 31, 38, 45 |
OR = odds ratio.