Effect of Electronic Messaging on Glucose Control and Hospital Admissions Among Patients with Diabetes

Petullo, Brian; Noble, Byron; Dungan, Kathleen

doi:10.1089/dia.2016.0105

Cited by 20 publications

(20 citation statements)

References 13 publications

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“…Thus, it does not describe the effectiveness of secure messaging in community-based outpatient settings. In a study conducted in an academic setting with a small number of patients, messaging was associated with improved HbA 1c control but increasing the frequency of messaging was not associated with better control (17). This study did not account for a nonlinear dose-response relationship, however.…”

Section: Discussionmentioning

confidence: 91%

“…Messaging with providers could be used as a substitute for traditional office visits and thus be cost saving for patients and payers (5). Studies of patients with diabetes found that increased use of outpatient and inpatient care (13)(14)(15) improved diabetes care processes and outcomes (16)(17)(18)(19)(20) associated with the use of patient portal or secure messaging with providers. However, these studies were conducted mainly as clinical trials of messaging linked with diabetes management programs or in integrated delivery organizations, which may not be representative of how messaging is used in community settings.…”

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confidence: 99%

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Can Secure Patient-Provider Messaging Improve Diabetes Care?

et al. 2017

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OBJECTIVEInternet-based secure messaging between patients and providers through a patient portal is now common in the practice of modern medicine. There is limited evidence on how messaging is associated with use and clinical quality measures among patients with type 2 diabetes. We examine whether messaging with physicians for medical advice is associated with fewer face-to-face visits and better diabetes management. RESEARCH DESIGN AND METHODSPatients with diabetes who were enrolled in an online portal of an outpatient health care organization in 2011-2014 were studied (N = 37,762 patient-years). Messages from/to primary care physicians or diabetes-related specialists for medical advice were considered. We estimated the association of messaging with diabetes quality measures, adjusting for patient and provider characteristics and patient-level clustering. RESULTSMost patients (72%) used messaging, and those who made frequent visits were also more likely to message. Given visit frequency, no (vs. any) messaging was negatively associated with the likelihood of meeting an HbA 1c target of <8% (64 mmol/mol) (odds ratio [OR] 0.83 [95% CI 0.77, 0.90]). Among message users, additional messages (vs. 1) were associated with better outcome (two more messages: OR 1.17 [95% CI 1.06, 1.28]; three more messages: 1.38 [1.25, 1.53]; four more messages: 1.55 [1.43, 1.69]). The relationship was stronger for noninsulin users. Message frequency was also positively associated, but to a smaller extent, with process measures (e.g., eye examination). Physician-initiated messages had effects similar to those for patientinitiated messages. CONCLUSIONSPatients with diabetes frequently used secure messaging for medical advice in addition to routine visits to care providers. Messaging was positively associated with better diabetes management in a large community outpatient practice.

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Section: Discussionmentioning

confidence: 91%

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confidence: 99%

Can Secure Patient-Provider Messaging Improve Diabetes Care?

et al. 2017

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“… 20 ICT has been shown to improve self-management and satisfaction of care in various settings, with evidence of improved health outcomes in chronic disease populations. 21 - 23 More recently, ICT has spread to the dialysis population with the advent of online self-management support tools and advances in telemedicine technologies. 24 - 26 …”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a Web-Based eHealth Portal for Delivery of Care to Home Dialysis Patients: A Single-Arm Pilot Study

Kiberd

Stockman

Radhakrishnan

et al. 2018

Can J Kidney Health Dis

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BackgroundImproving a patient’s experience with their care through an online interface for communication (an eHealth patient portal) has been shown to be beneficial in some studies of chronic disease populations. However, little is known about the effectiveness of an eHealth portal for delivery of care to home dialysis patients.ObjectivesPrimary: To determine whether an eHealth portal is effective at improving a patient’s experience with their home dialysis care. Secondary: (1) To determine whether an eHealth portal improves health-related quality of life for home dialysis patients, (2) to assess patient satisfaction with an eHealth portal and perceived impact on aspects of their home dialysis therapy and health, (3) to determine the acceptability of the eHealth portal software, and (4) to determine the change in telephone usage for communication after patient adoption of an eHealth portal.DesignSingle-arm pilot trial with recruitment over a 4-month period.SettingThe multidisciplinary home dialysis clinic in Halifax Nova Scotia Canada.PatientsAdults (>18 years) receiving either home hemodialysis or peritoneal dialysis.MeasurementsConsumer quality index (CQI), health-related quality of life using the EuroQol Five Dimensions Questionnaire (EQ-5D), acceptability of the eHealth portal software (using the Acceptability E-scale), and satisfaction/perceived impact (using a modified questionnaire).MethodsA web-based application (McKesson, Canada, RelayHealth®) allowed patients and health care workers to communicate through a secure, password-protected online portal that permitted visualization of the messaging history by patient and provider. Patients and the home dialysis health care team had the ability to send messages related to patient care at any time including proposed changes to medication, instructions after a clinic visit, times of new appointments, upcoming investigations, or questions about care. Patient experience with home dialysis care using the CQI, health-related quality of life using the EQ-5D, acceptability of the eHealth portal software, and satisfaction/perceived impact were assessed at baseline, 6, and 12 months of follow-up (where applicable). Total minutes of telephone communication was assessed prior to and after adoption of the portal.ResultsOf the 41 patients who consented to join the portal, 27 (66%) created an online account. At baseline, patients had a positive experience for the care and communication provided by their nephrologist (CQI: 3.63, 95% confidence interval [CI]: 3.50-3.76) and this did not change significantly over the study period. Similar results were observed for the care provided by other nephrology health care team members. Health-related quality of life using the EQ-5D score was 0.80 (interquartile range [IQR]: 0.71-0.83) at baseline and this also did not significantly change over the study period. Patients were satisfied with the eHealth portal (mean Likert scale score of 6.5 ± 0.6 in overall satisfaction, scale ranging from 1 completely dissatisfied to 10 completely satis...

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“…In particular, secure messaging is a unique aspect within patient portals that may facilitate patient self-management, shared decision making, and patient satisfaction by allowing patients more opportunities to communicate with providers [9]. Secure messaging has been associated with favorable clinical outcomes, specifically in studies examining diabetes management, in which patients who engage in secure messaging have lower hemoglobin A 1c values [1,8,10-15].…”

Section: Introductionmentioning

confidence: 99%

Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study

Ukoha¹,

Feinglass²,

Yee³

2019

J Med Internet Res

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BackgroundElectronic patient portals are websites that provide individuals access to their personal health records and allow them to engage through a secure Web-based platform. These portals are becoming increasingly popular in contemporary health care systems. Patient portal use has been found to be beneficial in multiple specialties, especially in the management of chronic disease. However, disparities have been identified in portal use in which racial and ethnic minorities and individuals with lower socioeconomic status have been shown to be less likely to enroll and use patient portals than non-Hispanic white persons and individuals with higher socioeconomic status. Electronic patient portal use by childbearing women has not been well studied, and data on portal use during pregnancy are limited.ObjectiveThis study aimed to quantify the use of an electronic patient portal during pregnancy and examine whether disparities related to patients’ demographics or clinical characteristics exist.MethodsThis was a retrospective cohort study of women who received prenatal care at an academic medical center from 2014 to 2016. Clinical records were reviewed for portal use and patient data. Patients were considered enrolled in the portal if they had an account at the time of delivery, and enrollees were compared with nonenrollees. Enrollees were further categorized based on the number of secure messages sent during pregnancy as active (≥1) or inactive (0) users. Bivariable chi-square and multivariable Poisson regression models were used to calculate the incidence rate ratio of portal enrollment and, if enrolled, of active use based on patients’ characteristics.ResultsOf the 3450 women eligible for inclusion, 2530 (73.33%) enrolled in the portal. Of these enrollees, 72.09% (1824/2530) were active users. There was no difference in portal enrollment by maternal race and ethnicity on multivariable models. Women with public insurance (adjusted incidence rate ratio; aIRR 0.60, 95% CI 0.49-0.84), late enrollment in prenatal care (aIRR 0.78, 95% CI 0.69-0.89 for second trimester and aIRR 0.50, 95% CI 0.39-0.64 for third trimester), and high-risk pregnancies (aIRR 0.82, 95% CI 0.75-0.89) were significantly less likely to enroll. Conversely, nulliparity (aIRR 1.10, 95% CI 1.02-1.20) and having more than 8 prescription medications at prenatal care initiation (aIRR 1.19, 95% CI 1.06-1.32) were associated with greater likelihood of enrollment. Among portal enrollees, the only factor significantly associated with active portal use (ie, secure messaging) was nulliparity (aIRR 1.11, 95% CI 1.01-1.23).ConclusionsAmong an obstetric population, multiple clinical and socioeconomic factors were associated with electronic portal enrollment, but not subsequent active use. As portals become more integrated as tools to promote health, efforts should be made to ensure that already vulnerable populations are not further disadvantaged with regard to electronic-based care.

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Effect of Electronic Messaging on Glucose Control and Hospital Admissions Among Patients with Diabetes

Cited by 20 publications

References 13 publications

Can Secure Patient-Provider Messaging Improve Diabetes Care?

Can Secure Patient-Provider Messaging Improve Diabetes Care?

Effectiveness of a Web-Based eHealth Portal for Delivery of Care to Home Dialysis Patients: A Single-Arm Pilot Study

Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study

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