Patient portal registration and healthcare utilisation outcomes of patients in the NHS General Practice.

Date of Approval
Application Number
21_000411
Technical Summary

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.

Health Outcomes to be Measured

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.

Collaborators

Ceire Costelloe - Chief Investigator - Imperial College London
Abrar Alturkistani - Corresponding Applicant - Imperial College London
Geva Greenfield - Collaborator - Imperial College London
Thomas Beaney - Collaborator - Imperial College London

Linkages

2011 Rural-Urban Classification at LSOA level;Patient Level Index of Multiple Deprivation