背景:通过患者门户为未成年人和监护人实施在线记录访问(ORA)的方法在国际上有所不同,随着越来越多的国家继续开发患者可访问的电子健康记录(PAEHR)系统。在青春期允许或阻止未成年人和监护人访问未成年人记录的ORA使用和国家/地区特定做法的证据(即访问控制做法)可以更广泛地了解可能的方法及其对未成年人保密性和监护人支持的影响。
目的:描述和比较瑞典和芬兰的未成年人\'和监护人代理用户\'PAEHR的使用情况。此外,调查特定国家的访问控制实践的使用情况。
方法:回顾性研究,进行了观察性案例研究。数据是从瑞典和芬兰的PAEHR管理部门收集的,并根据人口统计数据计算比例使用。采用描述性统计方法对结果进行分析。
结果:在瑞典和芬兰,从年轻到老年组,接受PAEHR的青少年比例增加,在17岁年龄组中,瑞典的比例为59.9%,芬兰的比例为84.8%.瑞典青春期早期的PAEHR访问差距可能解释了进入成年期的使用者比例较低。芬兰大约一半的监护人在2022年访问了他们未成年子女的记录(46.1%)。而瑞典监护人的使用率在2022年是新生儿中最高的(41.8%),此后减少。很少,主要是监护人,在瑞典申请扩展访问。在芬兰,在个案访问控制方法依赖于医疗保健专业人员(HCP)考虑未成年人的成熟度的情况下,95.8%的未成年人选择向监护人透露处方信息。
结论:虽然基于年龄的访问控制做法会妨碍未成年人和监护人的ORA,个案方法需要HCP资源和仔细指导,以确保患者之间的平等.监护人主要在幼儿时期访问未成年人\'记录,青少年表示愿意与父母分享他们的PAEHR。
BACKGROUND: Approaches to implementing online record access (ORA) via patient portals for minors and guardians vary internationally, as more countries continue to develop patient-accessible electronic health records (PAEHR) systems. Evidence of ORA
usage and country-specific practices to allow or block minors\' and guardians\' access to minors\' records during adolescence (i.e. access control practices) may provide a broader understanding of possible approaches and their implications for minors\' confidentiality and guardian support.
OBJECTIVE: To describe and compare minors\' and guardian proxy users\' PAEHR
usage in Sweden and Finland. Furthermore, to investigate the use of country-specific access control practices.
METHODS: A retrospective, observational
case study was conducted. Data were collected from PAEHR administration services in Sweden and Finland and proportional use was calculated based on population statistics. Descriptive statistics were used to analyze the results.
RESULTS: In both Sweden and Finland, the proportion of adolescents accessing their PAEHR increased from younger to older age-groups reaching the proportion of 59.9 % in Sweden and 84.8 % in Finland in the age-group of 17-year-olds. The PAEHR access gap during early adolescence in Sweden may explain the lower proportion of users among those who enter adulthood. Around half of guardians in Finland accessed their minor children\'s records in 2022 (46.1 %), while Swedish guardian use was the highest in 2022 for newborn children (41.8 %), and decreased thereafter. Few, mainly guardians, applied for extended access in Sweden. In Finland, where a
case-by-
case approach to access control relies on healthcare professionals\' (HCPs) consideration of a minor\'s maturity, 95.8 % of minors chose to disclose prescription information to their guardians.
CONCLUSIONS: While age-based access control practices can hamper ORA for minors and guardians,
case-by-
case approach requires HCP resources and careful guidance to ensure equality between patients. Guardians primarily access minors\' records during early childhood and adolescents show willingness to share their PAEHR with parents.