Online services were offered in all General Practices (GPs) of England since 2015. The services provide patients with access to an online patient portal enabling GP appointment booking, medical record viewing and repeat prescription ordering. Studies from countries other than England show that patient portal registration could have an impact on healthcare utilisation patterns affecting healthcare quality and patient experience. There are no studies to date that examine healthcare utilisation outcomes related to patient portal registration in NHS GPs.
This study will investigate which patients in England are registered to the online services patient portal and what kind of healthcare utilisation outcomes are influenced by registering to the patient portal. We will use anonymous GP patient records from England to track monthly patient portal registrations and evaluate if primary care healthcare utilisation outcomes in NHS GPs change for patients before and after registration on the patient portal. We will also examine patient characteristics associated with the patient portal registration in this context. Since the COVID-19 pandemic is likely to affect patients’ need to use remote services such as online repeat prescriptions ordering, we will also conduct a sub-study focusing on the patient portal registration rates during this period.
Since 2015, the National Health Service (NHS) offered patient portals with functionalities to book appointments, request repeat prescriptions, and view GP record in all NHS England General Practices (GP). There are no current studies describing healthcare utilisation outcomes of patients registered to the portals in this context.
Research Questions: What are the monthly patient portal registration patterns during the study period?, What patient characteristics at index date (at patient portal registration) are associated with registration to a patient portal in NHS GPs?, Is there a difference in healthcare utilisation outcomes (appointment booking, consultations attended, repeat prescription requests) for patients before and after their registration to the online patient portal on a practice level?, What are the COVID-19 pandemic implications on patient portal registration on a practice level?, What are the COVID-19 pandemic implications on some healthcare utilisation measures (appointment booking, consultations attended, repeat prescription requests) for patients registered to the patient portal on a practice level?
Methods:
Our patient cohort will include all adult patients (≥18 years) in CPRD who have registered to the patient portal anytime from 01/04/2014 (1 year prior to universal availability of patient portals in GPs) till the latest available data of 2021. Two retrospective cohort studies will be conducted:
Study 1: Will be a time-series analysis to track patient portal registration over time. Then we will perform an autoregressive integrated moving average (ARIMA) time-series analysis to estimate the healthcare utilisation patterns before and after portal registration.
Study 2: Will be an interrupted-time series (ITS) analysis focusing on the rate of new patient portal registrations during the COVID-19 pandemic from March 2019 until the latest data received for the study compared to the pre-pandemic period. We will use the same method (ITS) to examine the rate of primary care healthcare utilisation outcomes during the pandemic period.
Outcomes:
Study 1:
Primary outcomes:
Practice-level outcomes: Monthly patient portal registrations, Monthly all-cause General Practice appointment bookings; Monthly all-cause General Practice consultations attended stratified by type of consultation (face to face, telephone, e-consultation); Monthly all-cause General Practice repeat prescription requests
Secondary outcomes:
Patient-level outcomes:
Factors associated with patient portal registration at the time of registration (e.g. age, sex, ethnicity, deprivation, multimorbidity and primary healthcare utilisation patterns associated with patient portal registration);
Practice-level outcomes:
Monthly General Practice appointment no-show; Monthly General Practice cancelled appointments.
Study 2:
Primary outcomes:
Practice-level outcomes:
Monthly new patient portal registration rate
Secondary outcomes:
Practice-level outcomes:
Monthly rate of all-cause General Practice appointment bookings; Monthly rate of all-cause General Practice consultations attended stratified by type of consultation (face to face, telephone, e-consultation); Monthly rate of all-cause General Practice repeat prescription request.
Ceire Costelloe - Chief Investigator - Imperial College London
Abrar Alturkistani - Corresponding Applicant - Imperial College London
Geva Greenfield - Collaborator - Imperial College London
Mark Cunningham - Collaborator - Imperial College London
Thomas Beaney - Collaborator - Imperial College London
2011 Rural-Urban Classification at LSOA level;Patient Level Index of Multiple Deprivation