The Promise of Patient Portals for Individuals Living With Chronic Illness: Qualitative Study Identifying Pathways of Patient Engagement

Abstract

Background Patients play a critical role in managing their health, especially in the context of chronic conditions like diabetes. Electronic patient portals have been identified as a potential means to improve patient engagement; that is, patients’ involvement in their care. However, little is known about the pathways through which portals may help patients engage in their care. Objective Our objective is to understand how an electronic patient portal facilitates patient engagement among individuals with diabetes. Methods This qualitative study employed semistructured telephone interviews of 40 patients living with diabetes since at least 2011, who had experienced uncontrolled diabetes, and had used secure messaging through a portal at least 4 times over 18 months. The interviews were recorded, transcribed, coded, and analyzed using primarily an inductive approach to identify how patients living with diabetes use an online health portal to support diabetes self-management. Results Overall, patients who used the portal reported feeling engaged in their health care. We identified four pathways by which the portal facilitates patient engagement and some challenges. The portal provides a platform that patients use to (1) better understand their health by asking questions about new symptoms, notes, or labs, (2) prepare for medical appointments by reviewing labs and notes, (3) coordinate care between VA (Veterans Affairs) and non-VA health care teams, and (4) reach out to providers to request help between visits. Several patients reported that the portal helped improve the patient-provider relationship; however, aspects of the portal design may hinder engagement for others. Patients reported challenges with both secure messaging and access to medical records that had negative impacts on their engagement. Benefits for patient engagement were described by many types of portal users with varying degrees of diabetes control. Conclusions Patient portals support engagement by facilitating patient access to their health information and by facilitating patient-provider communication. Portals can help a wide range of users engage with their care.

The Causal Relationship Between Portal Usage and Self-Efficacious Health Information–Seeking Behaviors: Secondary Analysis of the Health Information National Trends Survey Data

“…Although we should be cautious in interpreting the relationship between using patient portals and self-efficacy as causal, we did observe a co-occurrence of better outcomes and increased patient portal usage intensity. Despite the benefits of patient portals being well documented [ 39 , 40 ], rates of usage remain low [ 41 ], and increasing the adoption of patient portals would provide more patients a trusted source of personalized information. Because patients can be easily misinformed by the large amount of inaccurate information online [ 42 ], using patient portals allows patients and their caregivers to stay connected with their providers.…”

Classification of patient‐ and clinician‐generated secure messages using a theory‐based taxonomy

“…Rather, we focused on secure messaging because it improves patients' access to their clinicians by offering a convenient mechanism for patient‐clinician communication for patients comfortable with this communication modality 1 . Further, both clinicians and patients support secure messaging as a useful and valuable communication modality 3,6,84‐92 . Given that secure messaging accounts for a growing and significant portion of patient‐clinician outpatient encounters, 4,5 the application of our taxonomy provides important insights into (1) patients' use of this modality to self‐manage their condition and address their uncertainty, and (2) how clinicians' responses to patients through this mechanism incorporate communication functions associated with promoting patients' indirect and health outcomes 93 …”

“…40,41 Research has found that relationship building is possible through technology-mediated communication like secure messaging. 6,[42][43][44][45]…”

“…4,5 In one study, patients reported that use of secure messaging helped reduce anxiety and coordinate care between different clinicians. 6 Elsewhere, however, patients noted that some secure message communication could reduce their trust in their clinicians and increase uncertainty. 3 Having a standard coding system-a taxonomy-that supports quantification of content in patients' and clinicians' messages will permit analyses on the types of content associated with patients' outcomes.…”

“…Research demonstrates secure messaging accounts for a significant and growing form of communication between patients and clinicians 4,5 . In one study, patients reported that use of secure messaging helped reduce anxiety and coordinate care between different clinicians 6 . Elsewhere, however, patients noted that some secure message communication could reduce their trust in their clinicians and increase uncertainty 3 .…”