Patient portal engagement and diabetes management among new portal users in the Veterans Health Administration

Zocchi, Mark S.; Robinson, Stephanie A.; Ash, Arlene S.; Vimalananda, Varsha G; Wolfe, Hill L.; Hogan, Timothy P.; Connolly, Samantha L.; Stewart, Maureen T.; Am, Linda; Netherton, Dane; Shimada, Stephanie L.

doi:10.1093/jamia/ocab115

Cited by 15 publications

(8 citation statements)

References 42 publications

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“… 7 Aside from the benefits patients perceive, a growing body of research has shown that use of specific portal tools is positively related to certain health-related outcomes. Among patients living with diabetes, more months of portal use was related to improved hemoglobin A1c (HbA1c) and low-density lipoproteins control, 8 with earlier research showing that sustained use of the secure messaging tool among patients was related to controlled HbA1c among those who had uncontrolled HbA1c at baseline. 9 Similarly, in a sample of patients living with HIV (PLWH), use of the prescription refill tool was associated with changes in viral load from unsuppressed to suppressed over time.…”

Section: Introductionmentioning

confidence: 73%

Relationship Between Patient Portal Tool Use and Medication Adherence and Viral Load Among Patients Living with HIV

Midboe,

Cave,

Shimada

et al. 2024

J GEN INTERN MED

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Background Patient portals play an increasingly critical role in engaging patients in their health care. They have the potential to significantly impact the health of those living with chronic diseases, such as HIV, for whom consistent care engagement is both critical and complex. Objective The primary aim was to examine the longitudinal relationships between individual portal tool use and health-related outcomes in patients living with HIV. Design Retrospective cohort study using electronic health record data to examine the relationship between patient portal tool use and key HIV-specific, health-related outcomes in patients engaged in care in the Veterans Health Administration (VA) through the application of marginal structural models. Participants A national sample of patients living with HIV (PLWH) active in VA care who were registered to use the VA’s patient portal, My HealtheVet (MHV; n = 18,390) between 10/1/2012 and 4/1/2017. Main Measures The MHV tools examined were prescription refill (including prescription refill of an antiretroviral (ART) medication and any medication), secure messaging, view appointments, and view labs. Primary outcomes were viral load test receipt, viral load suppression, and ART medication adherence (measured as proportion of days covered). Key Results The use of prescription refill for any medication or for ART was positively associated with ART adherence. Secure messaging was positively associated with ART adherence but not with viral load test receipt or viral load suppression. The use of view appointments was positively associated with ART adherence and viral load test receipt but not viral load suppression. The use of view labs was positively associated with viral load suppression but not ART adherence or viral load test receipt. Conclusions These findings highlight the valuable role patient portals may play in improving health-related outcomes among PLWH and have implications for patients living with other types of chronic disease.

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Section: Introductionmentioning

confidence: 73%

Relationship Between Patient Portal Tool Use and Medication Adherence and Viral Load Among Patients Living with HIV

Midboe,

Cave,

Shimada

et al. 2024

J GEN INTERN MED

View full text Add to dashboard Cite

show abstract

“…We used data collected for a larger study performed between 2017 and 2020 examining patient portal use in diabetes management [ 5 , 12 , 13 ]. Participants included veterans with type 2 diabetes who had uncontrolled blood glucose (2012 mean HbA 1c >8.0% and less than 25% of the year with HbA 1c <8.0%), as well as repeated and current use of key portal features.…”

Section: Methodsmentioning

confidence: 99%

Secure Messaging for Diabetes Management: Content Analysis

Robinson¹,

Zocchi²,

Purington³

et al. 2023

JMIR Diabetes

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Background Secure messaging use is associated with improved diabetes-related outcomes. However, it is less clear how secure messaging supports diabetes management. Objective We examined secure message topics between patients and clinical team members in a national sample of veterans with type 2 diabetes to understand use of secure messaging for diabetes management and potential associations with glycemic control. Methods We surveyed and analyzed the content of secure messages between 448 US Veterans Health Administration patients with type 2 diabetes and their clinical teams. We also explored the relationship between secure messaging content and glycemic control. Results Explicit diabetes-related content was the most frequent topic (72.1% of participants), followed by blood pressure (31.7% of participants). Among diabetes-related conversations, 90.7% of patients discussed medication renewals or refills. More patients with good glycemic control engaged in 1 or more threads about blood pressure compared to those with poor control (37.5% vs 27.2%, P=.02). More patients with good glycemic control engaged in 1 more threads intended to share information with their clinical team about an aspect of their diabetes management compared to those with poor control (23.7% vs 12.4%, P=.009). Conclusions There were few differences in secure messaging topics between patients in good versus poor glycemic control. Those in good control were more likely to engage in informational messages to their team and send messages related to blood pressure. It may be that the specific topic content of the secure messages may not be that important for glycemic control. Simply making it easier for patients to communicate with their clinical teams may be the driving influence between associations previously reported in the literature between secure messaging and positive clinical outcomes in diabetes.

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“…Study population, disease, controlled? Country, setting Author, year 0 (0) 7 ( 4) 30 (10) [76], 2021 a All studies are listed once in Tables 2-5 and are reported in the disease category of the condition that is most prominently investigated. We have included only the functionalities that the authors have reported in their articles.…”

Section: Study Design Burden Bmentioning

confidence: 99%

Patient-Centered Digital Health Records and Their Effects on Health Outcomes: Systematic Review

Brands¹,

Gouw²,

Beestrum³

et al. 2022

J Med Internet Res

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Background eHealth tools such as patient portals and personal health records, also known as patient-centered digital health records, can engage and empower individuals with chronic health conditions. Patients who are highly engaged in their care have improved disease knowledge, self-management skills, and clinical outcomes. Objective We aimed to systematically review the effects of patient-centered digital health records on clinical and patient-reported outcomes, health care utilization, and satisfaction among patients with chronic conditions and to assess the feasibility and acceptability of their use. Methods We searched MEDLINE, Cochrane, CINAHL, Embase, and PsycINFO databases between January 2000 and December 2021. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible studies were those evaluating digital health records intended for nonhospitalized adult or pediatric patients with a chronic condition. Patients with a high disease burden were a subgroup of interest. Primary outcomes included clinical and patient-reported health outcomes and health care utilization. Secondary outcomes included satisfaction, feasibility, and acceptability. Joanna Briggs Institute critical appraisal tools were used for quality assessment. Two reviewers screened titles, abstracts, and full texts. Associations between health record use and outcomes were categorized as beneficial, neutral or clinically nonrelevant, or undesired. Results Of the 7716 unique publications examined, 81 (1%) met the eligibility criteria, with a total of 1,639,556 participants across all studies. The most commonly studied diseases included diabetes mellitus (37/81, 46%), cardiopulmonary conditions (21/81, 26%), and hematology-oncology conditions (14/81, 17%). One-third (24/81, 30%) of the studies were randomized controlled trials. Of the 81 studies that met the eligibility criteria, 16 (20%) were of high methodological quality. Reported outcomes varied across studies. The benefits of patient-centered digital health records were most frequently reported in the category health care utilization on the “use of recommended care services” (10/13, 77%), on the patient-reported outcomes “disease knowledge” (7/10, 70%), “patient engagement” (13/28, 56%), “treatment adherence” (10/18, 56%), and “self-management and self-efficacy” (10/19, 53%), and on the clinical outcome “laboratory parameters,” including HbA1c and low-density lipoprotein (LDL; 16/33, 48%). Beneficial effects on “health-related quality of life” were seen in only 27% (4/15) of studies. Patient satisfaction (28/30, 93%), feasibility (15/19, 97%), and acceptability (23/26, 88%) were positively evaluated. More beneficial effects were reported for digital health records that predominantly focus on active features. Beneficial effects were less frequently observed among patients with a high disease burden and among high-quality studies. No unfavorable effects were observed. Conclusions The use of patient-centered digital health records in nonhospitalized individuals with chronic health conditions is potentially associated with considerable beneficial effects on health care utilization, treatment adherence, and self-management or self-efficacy. However, for firm conclusions, more studies of high methodological quality are required. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews) CRD42020213285; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=213285

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Patient portal engagement and diabetes management among new portal users in the Veterans Health Administration

Cited by 15 publications

References 42 publications

Relationship Between Patient Portal Tool Use and Medication Adherence and Viral Load Among Patients Living with HIV

Relationship Between Patient Portal Tool Use and Medication Adherence and Viral Load Among Patients Living with HIV

Secure Messaging for Diabetes Management: Content Analysis

Patient-Centered Digital Health Records and Their Effects on Health Outcomes: Systematic Review

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