Effects of the Proactive Interdisciplinary Self-Management (PRISMA) Program on Online Care Platform Usage in Patients with Type 2 Diabetes in Primary Care: A Randomized Controlled Trial

Abstract

Online care platforms can support patients with type 2 diabetes (T2DM) in managing their health. However, in the use of eHealth, a low participation rate is common. The Proactive Interdisciplinary Self-Management (PRISMA) program, aimed at improving patients’ self-management skills, was expected to encourage patients to manage their disease through the use of an online platform. Therefore, the objective of the current study was to investigate whether a group education program can improve the use of an online care platform in patients with T2DM treated by primary care providers in the Netherlands. In a randomized controlled trial, patients with T2DM received either PRISMA with usual care or usual care only. During a six-month follow-up period in 2014-2015, usage (number of log-ons and time spent per session) of an online care platform (e-Vita) aimed at improving T2DM self-management was assessed. A training about the functionalities of e-Vita was offered. The sample consisted of 203 patients. No differences were found between the intervention and control groups in the number of patients who attended the platform training (interested patients) (X21=0.58; p=0.45), and the number of patients who logged on at least once (platform users) (X21=0.46; p=0.50). In addition, no differences were found between the groups in the type of users—patients who logged on twice or more (active users) or patients who logged on once (nonactive users) (X21=0.56; p=0.45). The PRISMA program did not change platform usage in patients with T2DM. In addition, only a small proportion of the patients logged on twice or more. Patients probably need other encouragements to manage their condition using an online platform.

Digital Facilitation to Support Patient Access to Web-Based Primary Care Services: Scoping Literature Review

“…Although evidence from these studies suggests that the impact of some education and assistance sessions may be long lasting, there is contradicting evidence from other studies indicating that initial training or introductory educational sessions have little impact on use after the initial sign-up [41,43,66]. For example, a study entailed clinical staff providing a 10-minute training session to prospective patient portal users on using and installing a phone app to access the portal, including troubleshooting issues during the training session and providing a pamphlet with further information on the patient portal.…”

“…Training and education may also promote the uptake and use of digital services, both by helping patients acquire technical skills to use web-based services and by helping them understand what features of a web-based service can be most helpful [39]. In the literature we reviewed, training was delivered on the web through videos [40] or offline through in-person support [41,42], presentations, or seminars [43] and was delivered either in a single session [40] or over several sessions [43]. Training and education were commonly combined with helping patients initially sign up for a specific web-based service, such as a patient portal [41,42].…”

“…• There is mixed evidence from RCTs and quantitative studies on whether initial assistance in registering and logging into digital services is effective in increasing uptake and use [41][42][43]45]. There is qualitative evidence suggesting patients and providers feel this type of assistance would be useful [78,79]; however, the weight of the evidence suggests that it is likely ineffective and that additional continued support is needed to encourage continued use of digital services.…”

“…Similarly, an RCT regarding the effectiveness of an initial 10-minute standardized personal information session on internet-based depression interventions found that these sessions were ineffective in increasing adherence in an inpatient and outpatient rehabilitation setting for diabetes care [45]. Furthermore, an RCT from the Netherlands showed that initial group education sessions for patients with type 2 diabetes to help them set goals and use web-based platforms were ineffective in increasing the use of the service [43].…”

“…Several studies pointed to the importance of ongoing human support [53] and training on both the technical aspects of digital services and general digital literacy skills for older patients [48]. Several studies included subgroup analyses, which revealed that patients with lower health literacy or disabilities were less likely than others to use digital services even after facilitation efforts [43,66,106].…”