Sustained Use of Patient Portal Features and Improvements in Diabetes Physiological Measures

Abstract

BackgroundPersonal health records (PHRs) have the potential to improve patient self-management for chronic conditions such as diabetes. However, evidence is mixed as to whether there is an association between PHR use and improved health outcomes.ObjectiveThe aim of this study was to evaluate the association between sustained use of specific patient portal features (Web-based prescription refill and secure messaging—SM) and physiological measures important for the management of type 2 diabetes.MethodsUsing a retrospective cohort design, including Veterans with diabetes registered for the My Health e Vet patient portal who had not yet used the Web-based refill or SM features and who had at least one physiological measure (HbA1c, low-density lipoprotein (LDL) cholesterol, blood pressure) in 2009-2010 (baseline) that was above guideline recommendations (N=111,686), we assessed portal use between 2010 and 2014. We calculated the odds of achieving control of each measure by 2013 to 2014 (follow-up) by years of using each portal feature, adjusting for demographic and clinical characteristics associated with portal use.ResultsBy 2013 to 2014, 34.13% (38,113/111,686) of the cohort was using Web-based refills, and 15.75% (17,592/111,686) of the cohort was using SM. Users were slightly younger (P<.001), less likely to be eligible for free care based on economic means (P<.001), and more likely to be women (P<.001). In models adjusting for both features, patients with uncontrolled HbA1c at baseline who used SM were significantly more likely than nonusers to achieve glycemic control by follow-up if they used SM for 2 years (odds ratio—OR=1.24, CI: 1.14-1.34) or 3 or more years (OR=1.28, CI: 1.12-1.45). However, there was no significant association between Web-based refill use and glycemic control. Those with uncontrolled blood pressure at baseline who used Web-based refills were significantly more likely than nonusers to achieve control at follow-up with 2 (OR=1.07, CI: 1.01-1.13) or 3 (OR=1.08, CI: 1.02-1.14) more years of Web-based refill use. Both features were significantly associated with improvements in LDL cholesterol levels at follow-up.ConclusionsAlthough rates of use of the refill function were higher within the population, sustained SM use had a greater impact on HbA1c. Evaluations of patient portals should consider that individual components may have differential effects on health improvements.

A systematic review of studies of web portals for patients with diabetes mellitus

“…Improvements in LDL cholesterol and blood pressure have also been observed in some studies of web portals used by patients with diabetes and hypertension (7). The specific portal features that may impact quality of care or improve glycemic control (e.g., patient-provider secure messaging, online access to lab test results or instructions, other patient supports) has not been clearly distinguished by studies completed to date.…”

“…The specific portal features that may impact quality of care or improve glycemic control (e.g., patient-provider secure messaging, online access to lab test results or instructions, other patient supports) has not been clearly distinguished by studies completed to date. Secure messaging may facilitate coordination of diabetes care and make it easier for providers to refer patients to related services such as weight loss programs and advice from a dietician (7).…”

“…Type 2 diabetes requires effective patient-provider communication and patient self-management to manage side effects, monitor blood test results, and screen for potential complications (7). Studies have shown that increasing patients' knowledge about their risk factors can lead to improved clinical outcomes (8,9).…”

Patient Engagement as Measured by Inpatient Portal Use: Methodology for Log File Analysis (Preprint)

“…Log file analysis in the context of outpatient portals has been used to track the number of people using health applications and the patient portals; however, many of these studies measure only log-ins to the portal and not use of individual functions [6,8,20,21]. There has been limited research measuring the rate of use of one or two specific features of a tool, such as secure provider messaging or medication refill requests [22][23][24].…”

Designing a portal to patient-centered care? Let�s start with the patient. A cross-sectional survey. (Preprint)

“…For example, web-based prescription refills and secure messaging have an impact on some physiological measures important for the management of type 2 diabetes. [17] Patients' interest and ability to use a Patient Portal are influenced by age, health literacy and level of education. Patients are more likely to adopt a Patient Portal if its features align with the patients' information needs and with the functionalities they require.…”