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Working conditions
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High demand, low support
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Supportive working environment
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Stress, high work load
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Support by nurses
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Limited resources
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Support by interns/students
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Strained relationships with patients
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Patient management
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Low patient adherence to the PHR
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High patient adherence to the PHR
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New PHRs are handed out to the same patient multiple times
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Encouraging patients to retrieve their PHR in case they have forgotten
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Patients do not receive appropriate information about the PHR
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Patients receive appropriate information about the PHR and understand the relevance for their medical treatment
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Local PHR practices
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Low physician adherence to the PHR
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High physician adherence to the PHR
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Physicians receive no or insufficient information about the PHR before implementation
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Strong involvement by nurses, e.g. preparing the PHR prior to the consultation
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Documenting in multiple paper-based or electronic health records
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Printing electronic PHR and storing it in the patient-held PHR’s document pocket to lower workload
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Illegible handwriting
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Using the PHR as a folder for all relevant documents
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Potential benefit of a patient-held PHR
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Low perceived benefit in settings of low fragmentation
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High perceived benefit in settings of high fragmentation
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Well-established electronic PHR accessible to all health care providers in the facility
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Absence of electronic PHR or more than one electronic PHR system
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Small number of personnel
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Large number of personnel
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Close collaboration and personal communication with external doctors prior to PHR introduction
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Dissatisfaction with availability of medical history and communication with external doctors prior to PHR introduction
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Mono-disciplinary care settings
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Different professions and medical specialties involved in care provision
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