I f you need a bit of prodding from your physician to make positive changes, the nudge may be as close as your computer, provided you have electronic medical records and an online personal health record.
Using your medical record, your doctor can make personalized recommendations for exercise, vaccinations or medications.
These are effective, whether the advice is given in person, electronically or by mail, according to the results of several recent studies.
Getting a health message can be very powerful coming from a physician’s office, according to Dr. Grant M. Greenberg, assistant professor and associate chair for information management and quality in the Department of Family Medicine at the University of Michigan
In a study of a new program, Exercise as a Vital Sign, overweight adult patients were asked how many days a week and how many minutes per session they exercised during routine outpatient visits at four Kaiser Permanente centers in Northern California (Other centers had yet to track exercise.).
The responses were entered in the patients’ electronic records, next to the vital signs.
Asking the question had a positive effect, according to Dr. Richard W. Grant, research scientist with the Kaiser Permanente Division of Research.
“People lost a little more weight when asked,” says Dr. Grant, lead author the study.
Those patients did slightly better at weight loss and blood glucose control (if they had diabetes) than comparable patients who hadn’t provided the information. The addition of the exercise component in patients’ health records also can remind physicians to discuss physical activity with their patients, according to Dr. Grant.
Raising awareness also is effective when it comes to vaccinations or medications.
Although adults age 60 or older are more likely to get shingles and experience severe pain and blistering skin, the vaccination rates are extremely low (less than 5 percent among Medicare enrollees from the period of 2007 to 2009, according to a study in PLOS Medicine).
A team led by Stuart Beatty at the College of Pharmacy at The Ohio State University conducted a study on improving those numbers.
The researchers used electronic medical records to identify more than 2,500 patients over age 60 who didn’t have a documented shingles vaccination (A few had been vaccinated but that wasn’t included in their records.).The patients were divided into groups.
Some patients received information about shingles through an email linked to their online personal health record; others got a mailed postcard and still others received no special alert.
The pharmacists then reviewed the electronic medical records of those who received information to identify eligible vaccine candidates and sent them vaccination prescriptions along with a list of pharmacies they could visit.
Patients who actively used their health records and received emails were most likely to sign up. Receiving written information by postcard also led to more vaccinations. People who pay attention to their records may already be concerned with their health and more likely to become vaccinated, according to Dr. Neerai Tayal of the Ohio State Wexner Medical Center, general internist on the research team.
The collaboration between clinical pharmacies and physicians using electronic health records has been successful in other campaigns as well, according to Dr.Tayal.
“We’ve done that with people with osteoporosis. We identified patients who were not being treated but should be and we also identified people who had been treated long enough,” he says.
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