Patient portals in the National Health Service general practice (GP) practices: a systematic review and analysis of GP patient surveys and clinical practice research datalink

Abstract

Introduction: Patient portals are online platforms for accessing healthcare records, prescriptions, and appointments, and are available in all General Practice (GP) practices providing National Health Service (NHS) services in England. This thesis aims to study the use and associations of patient portals in this context and explore healthcare-related outcomes, offering clinical and policy recommendations. Methods: A systematic review was performed to determine health and healthcare utilisation outcomes associated with patient portals among patients with diabetes. An analysis of the GP Patient Surveys (GPPS) of 2018-2020 was performed to explore characteristics associated with patient portal use in England. An analysis of Clinical Practice Research Datalink (CPRD), was performed to evaluate the number of consultations and statin prescription ordering adherence before and after patient portal registration. Results: The systematic review concluded that patient portal use is associated with health and healthcare utilisation outcomes. Analyses of the GPPS surveys indicated that respondents with long-term conditions (compared to those without), of the age groups 16 years old until 84 years old (compared to those aged 85 years and older), and of the lowest deprivation level (compared to those in the highest level) were more likely to use patient portals. The exploration of health utilisation indicated a reduced number of face-to-face consultations (incidence rate ratio (IRR): 0.93, 95% confidence interval (CI): 0.93, 0.94), but an increased number of remote consultations after portal registration (IRR: 1.16, 95% CI: 1.15, 1.18). Additionally, there was a reduction in statin prescription ordering adherence (of at least 80%) after portal registration (IRR: 0.84, 95% CI: 0.81, 0.86). Conclusion: Patient portals are useful tools, but there is a need to further explore and address any existing inequalities, and unintended outcomes associated with their use. Future research could explore inequalities and the mechanisms between patient portal use and outcomes.