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Personal Health Record implementation in rural primary care: A descriptive exploratory study using RE-AIM framework.

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Personal health records (PHRs) offer a comprehensive health story and improved communication. However, challenges with interoperability, patient agency, and provider support hindered widespread adoption and maintenance in rural settings.

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Area of Science:

  • Health Informatics
  • Patient Engagement
  • Rural Health

Background:

  • Personal health records (PHRs) are emerging as patient-centric tools for shared decision-making and healthcare data management.
  • Rural healthcare settings face unique challenges in adopting new digital health technologies.

Purpose of the Study:

  • To explore rural patients' and providers' perceptions of PHR implementation using the RE-AIM framework.
  • To evaluate the reach, effectiveness, adoption, implementation, and maintenance of a PHR in a rural context.

Main Methods:

  • A mixed-methods approach including pre-/post-intervention patient surveys, provider interviews, and administrative data.
  • Focus groups were conducted with patients and providers to gather pre- and post-implementation perspectives.
  • The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework guided the evaluation.

Main Results:

  • PHRs were perceived to enhance communication and provide a comprehensive health narrative, with patients prioritizing health promotion data and providers favoring clinical data.
  • Evaluation indicated limited patient reach (16%), neutral patient satisfaction, and no significant changes in quality of life or self-efficacy.
  • Clinic adoption was moderate (44%), favoring public clinics in smaller, more remote communities. Key barriers included lack of interoperability and implementation challenges exacerbated by the COVID-19 pandemic.
  • All participating clinics discontinued PHR use within the study period due to significant barriers.

Conclusions:

  • The RE-AIM framework provides a comprehensive evaluation of PHR impact in rural settings.
  • Critical obstacles to successful PHR implementation include achieving system interoperability, ensuring patient agency and control, and providing adequate provider training and support.
  • Future PHR initiatives must address these barriers to improve patient engagement and healthcare data management in rural communities.