The authors investigated use of the internet-based patient portal, kp.org, among a well-characterized population of adults with diabetes in Northern California. Among 14,102 diverse patients, 5671 (40%) requested a password for the patient portal. Of these, 4311 (76%) activated their accounts, and 3922 (69%), logged on to the patient portal one or more times; 2990 (53%) participants viewed laboratory results, 2132 (38%) requested medication refills, 2093 (37%) sent email messages, and 835 (15%) made medical appointments. After adjustment for age, gender, race/ethnicity, immigration status, educational attainment, and employment status, compared to non-Hispanic Caucasians, African-Americans and Latinos had higher odds of never logging on (OR 2.6 (2.3 to 2.9); OR 2.3 (1.9 to 2.6)), as did those without an educational degree (OR compared to college graduates, 2.3 (1.9 to 2.7)). Those most at risk for poor diabetes outcomes may fall further behind as health systems increasingly rely on the internet and limit current modes of access and communication.
Background
Online patient portals are being widely implemented, but their impact on health behaviors are not well-studied.
Objective
To determine whether statin adherence improved after initiating use of the portal refill function.
Research Design
Observational cohort study within an integrated healthcare delivery system.
Subjects
Diabetes patients on statins who had registered for online portal access by 2010. 8,705 subjects initiated online refill function use within the study window, including “exclusive” and “occasional” users (i.e., requesting all vs. some refills online, respectively). Using risk-set sampling, we temporally matched 9,055 reference group patients who never used online refills.
Measures
We calculated statin adherence before and after refill function initiation, assessed as % time without medications (non-adherence defined as gap >20%). Secondary outcome was dyslipidemia (LDL ≥100). Difference-in-differences regression models estimated pre-post changes in non-adherence and dyslipidemia, comparing refill function users to the reference group and adjusting for age, sex, race/ethnicity, medications, frequency of portal use, and outpatient visits.
Results
In unadjusted examinations, non-adherence decreased only among patients initiating occasional or exclusive use of the refill function (26 to 24%, and 22 to 15%, respectively). In adjusted models, non-adherence declined by an absolute 6% (95% CI: 4–7%) among exclusive users, without significant changes among occasional users. Similar LDL decreases were also seen among exclusive users.
Conclusions
Compared to portal users who did not refill medications online, adherence to statin medications and LDL levels improved among diabetes patients who initiated and exclusively used the patient portal for refills, suggesting that wider adoption of online refills may improve adherence.
In a well-controlled examination of diabetes patients' behavior when using a new online feature for their healthcare management, patient portals were linked to better medication adherence across all racial/ethnic groups.
Statistical errors are common in many biomedical fields. 1-5 We believe the nature and impact of these errors to be great enough in sports science and medicine to warrant special attention. 6-14 Poor methodological and statistical practices have led to calls for change in other fields, such as psychology. 15-18 We believe that a similar call to action is needed in sports science and medicine. Specifically, we see two pressing needs: (1) to increase collaboration between researchers and statisticians, and (2) to increase statistical training within the exercise science/medicine/physiotherapy (PT) discipline. Our call to action extends the work of those who have previously called for increased statistical collaboration in sports medicine and sports injury research.
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