***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Therapist-delivered online cognitive-behavioural therapy ( CBT ) has been found to be effective for depression in primary care . AIMS To determine the cost-effectiveness of online CBT compared with usual care . METHOD Economic evaluation at 8 months alongside a r and omised controlled trial . Cost to the National Health Service ( NHS ) , personal costs , and the value of lost productivity , each compared with outcomes based on the Beck Depression Inventory and quality -adjusted life-years ( QALYs ) . Incremental analysis indicated the NHS cost per QALY gain . RESULTS Online CBT was more expensive than usual care , although the outcomes for the CBT group were better . Cost per QALY gain based on complete case data was £ 17,173 , and £ 10,083 when missing data were imputed . CONCLUSIONS Online CBT delivered by a therapist in real time is likely to be cost-effective compared with usual care if society is willing to pay at least £ 20,000 per QALY ; it could be a useful alternative to face-to-face CBT Background Internet-based interactive websites for patient communication ( patient portals ) may improve communication between patients and their clinics and physicians . Objective The aim of the study was to assess the impact of a patient portal on patients ’ satisfaction with access to their clinic and clinical care . Another aim was to analyze the content and volume of email messages and telephone calls from patients to their clinic . Methods This was a r and omized controlled trial with 606 patients from an academic internal medicine practice . The intervention “ portal ” group used a patient portal to send secure messages directly to their physicians and to request appointments , prescription refills , and referrals . The control group received usual care . We assessed patient satisfaction at the end of the 6-month trial period and compared the content of telephone and portal communications . Results Portal group patients reported improved communication with the clinic ( portal : 77/174 [ 44 % ] “ a little better ” or “ a lot better ; ” control : 18/146 [ 12 % ] ; χ2 = 38.8 , df = 1 , P < .001 ) and higher satisfaction with overall care ( portal : 103/174 [ 59 % ] “ very good ” or “ excellent ; ” control : 78/162 [ 48 % ] ; χ2 = 4.1 , df = 1 , P = .04 ) . Portal group patients also reported higher satisfaction with each of the portal ’s services . Physicians received 1 portal message per day for every 250 portal patients . Total telephone call volume was not affected . Patients were more likely to send informational and psychosocial messages by portal than by phone . Of all surveyed patients , 162/341 ( 48 % ) were willing to pay for online correspondence with their physician . Of those willing to pay , the median amount cited was US $ 2 per message . Conclusions Portal group patients demonstrated increased satisfaction with communication and overall care . Patients in the portal group particularly valued the portal ’s convenience , reduced communication barriers , and direct physician responses . More online messages from patients contained informational and psychosocial content compared to telephone calls , which may enhance the patient-physician relationship Background Electronic mail ( email ) has the potential to improve communication between physicians and patients . Methods We conducted two research studies in a family practice setting : 1 ) a brief , anonymous patient survey of a convenience sample to determine the number of clinic patients receptive to communicating with their physician via email , and 2 ) a r and omized , controlled pilot study to assess the feasibility of providing health education via email to family practice patients . Results Sixty-eight percent of patients used email  , and the majority of those ( 80 % ) were interested in using  email  to communicate with the clinic . The majority also reported that their email address changed less frequently than their home address ( 65 % , n = 173 ) or telephone number ( 68 % , n = 181 ) . Forty-two percent were willing to pay an out-of-pocket fee to have email access to their physicians . When evaluating email initiated by the clinic , 26 % of otherwise eligible patients could not participate because they lacked email access ; those people were more likely to be black and to be insured through Medicaid . Twenty-four subjects agreed to participate , but one-third failed to return the required consent form by mail . All participants who received the intervention emails said they would like to receive  health education emails  in the future . Conclusion Our survey results show that patients are interested in  email communication  with the family practice clinic . Our feasibility study also illustrates important challenges in physician-initiated electronic communication . The ' digital divide ' – decreased access to electronic technologies in lower income groups – is an ethical concern in the use of email for patient-physician communication Despite the common use of electronic communication in other aspects of everyday life , its use between patients and health care providers has been slow to diffuse . Possible explanations are security issues and lack of payment mechanisms . This study investigated how patients value secure electronic access to their general practitioner ( GP ) . One hundred and ninety-nine patients were asked an open-ended willingness-to-pay ( WTP ) question as part of a r and omised controlled trial . We compared the WTP values between two groups of respondents ; one group had had the opportunity to communicate electronically with their GP for a year and the other group had not . Fifty-two percent of the total sample was willing to pay for electronic GP contact . The group of patients with access revealed a significantly lower WTP than the group without such access . Possible explanations are that the system had fewer benefits than expected , a presence of hypothetical bias or simply a preference for face-to-face encounters Abstract Objective : To determine whether a decision aid on benign prostatic hypertrophy influences decision making , health outcomes , and re source use . Design : R and omised controlled trial . Setting : 33 general practice s in the United Kingdom . Participants : 112 men with benign prostatic hypertrophy . Intervention : Patients ' decision aid consisting of an interactive multimedia programme with booklet and printed summary . Outcome measures : Patients ' and general practitioners ' perceptions of who made the decision , decisional conflict scores , treatment choice and prostatectomy rate , American Urological Association symptom scale , costs , anxiety , utility , and general health status . Results : Both patients and general practitioners found the decision aid acceptable . A higher proportion of patients ( 32 % v 4 % ; mean difference 28 % , 95 % confidence interval 14 % to 41 % ) and their general practitioners ( 46 % v 25 % ; 21 % , 3 % to 40 % ) perceived that treatment decisions had been made mainly or only by patients in the intervention group compared with the control group . Patients in the intervention group had significantly lower decisional conflict scores than those in the control group at three months ( 2.3 v 2.6 ; −0.3 , −0.5 to −0.1 , P<0.01 ) and this was maintained at nine months . No differences were found between the groups for anxiety , general health status , prostatic symptoms , utility , or costs ( excluding costs associated with the video disc equipment ) . Conclusions : The decision aid reduced decisional conflict in men with benign prostatic hypertrophy , and the patients played a more active part in decision making . Such programmes could be delivered cheaply by the internet , and there are good arguments for coordinated investment in them , particularly for conditions in which patient utilities are important . What is already known on this topic Patients want more information about their condition and treatment options , and many want to play an active part in decision making Decision aids improve patients ' knowledge of their conditions and treatment options What this study adds The decision aid was highly acceptable to both the patients and their general practitioners Decisional conflict was reduced in the intervention group Patients who viewed the programme played a more active part in the decision making process and were less anxious than control patients Such aids could be introduced throughout the NHS at relatively low cost by using the OBJECTIVE : To determine the effect of the Ischemic Heart Disease Shared Decision-Making Program ( IHD SDP ) an interactive videodisc design ed to assist patients in the decision-making process involving treatment choices for ischemic heart disease , on patient decision-making . DESIGN : R and omized , controlled trial . SETTING : The Toronto Hospital , University of Toronto , Toronto , Ontario , Canada . PARTICIPANTS : Two hundred forty ambulatory patients with ischemic heart disease amenable to elective revascularization and ongoing medical therapy . MEASUREMENTS AND MAIN RESULTS : The primary outcome was patient satisfaction with the decision-making process . This was measured using the 12-item Decision-Making Process Question naire that was developed and vali date d in a r and omized trial of the benign prostatic hyperplasia SDP . Secondary outcomes included patient knowledge ( measured using 20 questions about knowledge deemed necessary for an informed treatment decision ) , treatment decision , patient-angiographer agreement on decision , and general health scores . Outcomes were measured at the time of treatment decision and /or at 6 months follow-up . Shared decision-making program scores were similar for the intervention and control group ( 71 % and 70 % , respectively ; 95 % confidence interval [ CI ] for 1 % difference , −3 % to 7 % ) . The intervention group had higher knowledge scores ( 75 % vs 62 % ; 95 % CI for 13 % difference , 8 % to 18 % ) . The intervention group chose to pursue revascularization less often ( 58 % vs 75 % for the controls ; 95 % CI for 17 % difference , 4 % to 31 % ) . At 6 months , 52 % of the intervention group and 66 % of the controls had undergone revascularization ( 95 % CI for 14 % difference , 0 % to 28 % ) . General health and angina scores were not different between the groups at 6 months . Exposure to the IHD SDP result ed in more patient-angiographer disagreement about treatment decisions . CONCLUSIONS : There was no significant difference in satisfaction with decision-making process scores between the IHD SDP and usual practice groups . The IHD SDP  patients were more knowledgeable , underwent less revascularization ( interventional therapies ) , and demonstrated increased patient decision-making autonomy without apparent impact on quality of life OBJECTIVE To determine whether patient access to secure patient-physician messaging affects annual adult primary care office visit and documented telephone contact rates . STUDY DESIGN Retrospective cohort and matched-control studies with pre-post analysis . METHODS The cohort study sample included 4686 adult members of Kaiser Permanente Northwest ( KPNW ) who had been registered KP HealthConnect Online users longer than 13 months and had used at least 1 feature . The matched-control study sample included 3201 r and omly selected controls matched by age/sex , selected chronic conditions , and primary care physician to 3201 registered users . We calculated the difference in primary care office visit and documented telephone contact rates in the pre- and post-periods ( defined , respectively , as 3 - 14 months before and 2 - 13 months after registration for KP HealthConnect Online ) . Paired t tests were used to assess significance . RESULTS Annual office visit rates decreased by 0.23 ( -9.7 % ) visits per member in the cohort study . Annual office visit rates for users in the matched-control study decreased by 0.25 ( -10.3 % ) ; the corresponding decrease for the controls was 0.08 ( -3.7 % ) . This 0.17 ( -6.7 % ) reduction was significant ( P < .003 ) . Annual documented telephone contact rates for users in the matched-control design increased by 0.32 ( 16.2 % ) contacts per member ; the corresponding rate for the control group was 0.52 ( 29.9 % ) . This 0.20 ( 13.7 % ) difference was significant ( P < .01 ) . CONCLUSION Patient access to the secure messaging feature of KP HealthConnect Online was associated with decreased rates of primary care office visits and telephone contacts Background : Failure to attend appointments compromises health service efficiency . Despite considerable interest in using novel technologies to improve attendance , evidence from rigorously conducted controlled studies is lacking . Aim : To evaluate the effectiveness of texting appointment reminders to patients who persistently fail to attend appointments . Design : R and omised controlled study . Setting : Inner city general practice in Lothian , Scotl and . Method : We included 415 appointments made by patients ( n = 173 ) who had failed to attend two or more routine appointments in the preceding year . Patients whose appointments were r and omised to the intervention group received a text message reminder of the appointment . Patients whose appointments were in the control group received no reminder . Our primary outcome measure was non-attendance rates . We undertook an intention-to-treat analysis and multi-level analysis to take account of the lack of independence of the outcomes of repeated appointments for the same patient . Results : Of the 418 appointments originally included in the study , three were excluded due to clerical error ; 189 were r and omised to the intervention group and 226 to the control group . Twenty-two appointments ( 12 % ) were not attended in the intervention group compared with 39 ( 17 % ) in the control group . A chi-square analysis , considering the outcome of appointments as independent from one another , gave a non-significant difference of 5 % ( 95 % CI of difference −1.1 to 12.3 % , p = 0.13 ) . Multilevel analysis applied to the binary outcome data on non-attendance gave an odds ratio for non-attendance in the intervention group compared with the control group of 0.63 ( 95 % CI 0.36 to 1.1 , p = 0.11 ) . Conclusion : Although the intervention showed promise , we failed to demonstrate significant reduction in non-attendance rates , as a result of texting appointment reminders to patients who persistently fail to attend their general practice appointments OBJECTIVE To determine the effects of a personal health record (PHR)-linked medications module on medication accuracy and safety . DESIGN From September 2005 to March 2007 , we conducted an on-treatment sub- study within a cluster-r and omized trial involving 11 primary care practice s that used the same PHR . Intervention practice s received access 
    Output:
    
Patients reported improved satisfaction with online access and services compared with st and ard provision , improved self-care , and better communication and engagement with clinicians .
Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services .
Provision of online record access and services result ed in a moderate increase of e-mail , no change on telephone contact , but there were variable effects on face-to-face contact .
However , other tasks were necessary to sustain these services , which impacted on clinician time .
There were no reports of harm or breaches in privacy .
While the RoB scores suggest many of the studies were of low quality , patients using online services reported increased convenience and satisfaction .
These services positively impacted on patient safety , although there were variations of record access and use by specific ethnic and socioeconomic groups .
Professional concerns about privacy were unrealised and those about workload were only partly so