The feasibility of sharing digital audio-recordings of clinic visits online with older adults in primary care settings: A multisite trial

Paul J Barr¹, Meredith Masel², Reed W Bratches³, Elizabeth Carpenter-Song⁴, A James O'Malley⁵, Martha L Bruce⁶, James S Goodwin⁷, Sunil Kripalani⁸, Susan Tarczewski⁹, Sonya Williams¹⁰, Isamar Ortiz¹¹, Adam Wright¹², Mukaila A Raji¹¹, Hyunouk Hong¹³, Parul M Goyal¹⁴, Kerri L Cavanaugh¹⁵

Affiliations

¹ The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; The Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. Electronic address: Paul.j.barr@dartmouth.edu.
² Oliver Center for Patient Safety and Quality Healthcare, The University of Texas Medical Branch, Galveston, TX, USA; Department of Population Health & Health Disparities, UTMB School of Public & Population Health, Galveston, TX, USA; Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA.
³ The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; The Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Division of Nursing, The University of Alabama, Birmingham, AL, USA.
⁴ The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Anthropology, Dartmouth College, Hanover, NH, USA.
⁵ The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
⁶ The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Psychiatry, Geisel School of Medicine at Dartmouth and Dartmouth Health, Lebanon, NH, USA.
⁷ Department of Population Health & Health Disparities, UTMB School of Public & Population Health, Galveston, TX, USA.
⁸ Vanderbilt Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
⁹ The Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
¹⁰ Vanderbilt Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA.
¹¹ Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA.
¹² Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
¹³ Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
¹⁴ Department of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁵ Vanderbilt Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Nephrology & Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

PMID: 39642632
PMCID: PMC11701810 (available on 2026-02-01)
DOI: 10.1016/j.pec.2024.108574

Randomized Controlled Trial

The feasibility of sharing digital audio-recordings of clinic visits online with older adults in primary care settings: A multisite trial

Paul J Barr et al. Patient Educ Couns. 2025 Feb.

. 2025 Feb:131:108574.

doi: 10.1016/j.pec.2024.108574. Epub 2024 Nov 29.

Authors

Affiliations

¹ The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; The Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. Electronic address: Paul.j.barr@dartmouth.edu.
² Oliver Center for Patient Safety and Quality Healthcare, The University of Texas Medical Branch, Galveston, TX, USA; Department of Population Health & Health Disparities, UTMB School of Public & Population Health, Galveston, TX, USA; Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA.
³ The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; The Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Division of Nursing, The University of Alabama, Birmingham, AL, USA.
⁴ The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Anthropology, Dartmouth College, Hanover, NH, USA.
⁵ The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
⁶ The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Psychiatry, Geisel School of Medicine at Dartmouth and Dartmouth Health, Lebanon, NH, USA.
⁷ Department of Population Health & Health Disparities, UTMB School of Public & Population Health, Galveston, TX, USA.
⁸ Vanderbilt Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
⁹ The Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
¹⁰ Vanderbilt Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA.
¹¹ Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA.
¹² Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
¹³ Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
¹⁴ Department of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁵ Vanderbilt Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Nephrology & Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

PMID: 39642632
PMCID: PMC11701810 (available on 2026-02-01)
DOI: 10.1016/j.pec.2024.108574

Abstract

Objective: The objective of this trial was to determine the feasibility, acceptability, and preliminary effectiveness of sharing audio recordings of primary care visits with older adults with multimorbidity.

Methods: We used a two-arm, randomized, controlled, feasibility trial with 3-month follow-up. Patients aged ≥ 65 years-with diabetes and hypertension-were recruited from academic primary care settings in New Hampshire, Tennessee, and Texas. Patients were randomized to receive online access to audio recordings of scheduled visits for three-months or care as usual (after visit summaries). Primary outcomes were acceptability and feasibility assessed using several indicators: acceptabilityrecruitment of 90 patients; recording use; and the Appropriateness of Intervention Measure (AIM; >3), feasibility- retention rate; protocol adherence; and the Feasibility of Intervention Measure (FIM; >3). Interviews were conducted with clinicians (n = 14) and patients (n = 19). Exploratory outcomes included patient activation, satisfaction, adherence, and quality of life.

Results: We met recruitment (n = 91) and retention (98 %) targets and exceeded feasibility (Median FIM 4; IQR 3 - 4) and acceptability (Median AIM 4; IQR 3 - 4) metrics. Fidelity to protocol was high (92 %), and 40 of 45 patients (85 %) accessed their recordings. Interviewees noted the benefits of visit recording, including greater recall, understanding, and family engagement. Recording had little perceived impact on the visit interaction, and concerns about visit recording were minimal. Exploratory outcomes revealed better PROMIS Mental Health Scores for patients receiving Audio compared to Usual Care at 3 months: 51.5 (SD 7.7) vs. 47.7 (SD 9.9), P = 0.04.

Conclusions: Sharing visit recordings online with older adults is feasible and acceptable. A larger trial is needed to determine the impact of sharing recordings on patient health outcomes.

Practice implications: Recording is a highly scalable approach to supporting older adults and their care partners in managing care. Advances in natural language processing may unlock further opportunities for this innovative strategy.

Keywords: Older adults; Patient centered communication; Technology.

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Conflict of interest statement

Declaration of Competing Interest The authors have no conflicts of interest to declare. HealthPAL is software developed with NIH funding (R01LM012815) by Dr. Barr and is freely available at GITHUB https://github.com/openrecordings/healthpal; HealthPAL has not been commercialized and Dr. Barr receives no financial incentives or income related to its use.

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The feasibility of sharing digital audio-recordings of clinic visits online with older adults in primary care settings: A multisite trial

Affiliations

The feasibility of sharing digital audio-recordings of clinic visits online with older adults in primary care settings: A multisite trial

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous