Keywords: health services research, medical records, general practitionners,nurse clinicians, physician assistants

Background:

Demographic aging and chronic diseases have profoundly reshaped healthcare needs. Care coordination and multidisciplinary primary care practices have emerged over recent decades. The French healthcare system transformed lately with the addition of new healthcare professionals (HP) particularly. Besides, implementation of the French shared medical record (SMR) has been challenging, despite strong national promotion since 2022.

Research questions:

An action research study was conducted in a multidisciplinary primary care practice to contribute to the SMR by creating up-to-date clinical summaries for regular multimorbid patients through interprofessional collaboration.

Method:

The study combined an initial focus group with HP, informal exchanges, regular interviews with HP, and a monitoring of contributions over four months. A consensual protocol structured the patient pathway and defined professional roles. A final focus group with HP assessed the intervention, and results were analysed using the Consolidated Framework for Implementation Research.

Results:

Among 1,947 registered patients, 73 agreed to activate their SMR. 49 benefited from activation, and 23 SMR received a medical summary. Initially, HP expressed ethical and technical concerns, particularly regarding software interfaces. Over time, they reported improved patient trust, enhanced interprofessional exchanges, and a better continuity of care.

Conclusions:

Despite professional engagement, the low number of contributions highlighted persistent barriers. The protocol was complex, and SMR updates remained an additional workload. HP access rights, software interoperability, and adaptation to interprofessional practice remained challenges. Strategies inspired by other European healthcare systems must be implemented.

Points for discussion:

Simplification of protocol

Experience of European collegues

Patient input into interprofessional protocols