Use of an Electronic Patient Portal Among the Chronically Ill: An Observational Study

Riippa, Iiris; Linna, Miika; Rönkkö, Ilona; Kröger, V.

doi:10.2196/jmir.3722

Cited by 24 publications

(15 citation statements)

References 29 publications

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“…Number of internet/ email devices 1 73 1 89 : Hypertension, hyperlipidemia, cerebrovascular disease, peripheral vascular disease, chronic kidney disease stage, nephrolithiasis (no) 94 : having depression 100 : Psychiatric history 102 : bipolar disorder 107 : Hepatitis C, depression (+ve), hepatitis B (no) 108 : Type 1 or 2 diabetes, hypercholesterolemia (no) 110 : Diabetes or elevated lipids 113 : Type 1 Diabetes 114 : Type of diabetes 115 : Chronic diseases, or cancer 118 : HIV, hyperlipidemia, hypertension, posttraumatic stress disorder, traumatic brain injury, spinal cord injury, depression and anxiety (+ve) complex chronic medical conditions (CHD, CHF, Schizophrenia) (-ve) 128 :…”

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confidence: 99%

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Factors that affect the use of electronic personal health records among patients: A systematic review

Abd‐Alrazaq

Bewick

Farragher

et al. 2019

International Journal of Medical Informatics

110

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ReuseThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) licence. This licence only allows you to download this work and share it with others as long as you credit the authors, but you can't change the article in any way or use it commercially. More information and the full terms of the licence here: https://creativecommons.org/licenses/ TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. AbstractBackground: Electronic personal health records (ePHRs) are web-based tools that enable patients to access parts of their medical records and other services. In spite of the potential benefits of using ePHRs, their adoption rates remain very low. The lack of use of ePHRs among patients leads to implementation failures of these systems. Many studies have been conducted to examine the factors that influence patients' use of ePHRs, and they need to be synthesised in a meaningful way.Objective: The current study aimed to systematically review the evidence regarding factors that influence patients' use of ePHRs.Methods: The search included: 42 bibliographic databases (e.g. Medline, Embase, CINHAL, and PsycINFO), hand searching, checking reference lists of the included studies and relevant reviews, contacting experts, and searching two general web engines. Study selection, data extraction, and study quality assessment were carried out by two reviewers independently. The quality of studies was appraised using the Mixed Methods Appraisal Tool. The extracted data were synthesised narratively according to the outcome: intention to use, subjective measures of use, and objective measures of use. The identified factors were categorised into groups based on Or and Karsh's conceptual framework.Results: Of 5225 citations retrieved, 97 studies were relevant to this review. These studies examined more than 150 different factors: 59 related to intention to use, 52 regarding subjectively-measured use, and 105 related to objectively-measured use. The current review was able to draw definitive conclusions regarding the effect of only 18 factors. Of these, only three factors have been investigated in connection with every outcome, which are: perceived usefulness, privacy and security concerns, and internet access. Conclusion: Of the numerous factors examined by the included studies, this review concluded the effect of 18 factors: 13 personal factors (e.g. gender, ethnicity, and income), four humantechnology factors (e.g. perceived usefulness and ease of use), and one organisational factor (facilitating conditions). These factors should be taken into account by stakeholders for the successful implementation of these systems. For example, patients should be assured that the system is secure and no one can access their records without their permission in order to decrease their concerns about the privacy and security. Fur...

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confidence: 99%

“…Visual acuity 1 100 1 Risk factor for HIV (gay) 1 107 1 Having kidney transplant 1 89 1 Length of membership in the healthcare setting 1 81 Health plan duration 1 107 1 Dipstick proteinuria (≥1+) 1 89 1 Serum creatinine level 1 89 1 Having ≥1 HbA1C measurement 1 108 1…”

mentioning

confidence: 99%

Factors that affect the use of electronic personal health records among patients: A systematic review

Abd‐Alrazaq

Bewick

Farragher

et al. 2019

International Journal of Medical Informatics

110

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“…A previous study published on this topic found that the portal had the greatest effect on activation among patients starting at the highest level of patient activation [ 18 ]. It has also been reported previously [ 47 ] that previous care received by the patient, rather than state of health, age, gender, or patient activation, is an important factor predicting the attractiveness of electronic patient portal use. Among patients with similar disease burden, those who chose not to use the portal had received more services from primary care in the previous year than those who had used the portal [ 47 ].…”

Section: Discussionmentioning

confidence: 64%

A Patient Portal With Electronic Messaging: Controlled Before-and-After Study

Riippa¹,

Linna²,

Rönkkö³

2015

J Med Internet Res

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BackgroundPatients’ access to their medical records, along with electronic messaging, offers an efficient means of information transition between patients and their caregivers. Easier access to information and interaction with health care professionals may reduce use of other services while increasing patients’ activation in the management of their own health. Patient portals may therefore have a favorable impact on the cost-effectiveness of care.ObjectiveThe aim was to assess the benefits and risks of providing electronic messaging services to patients with chronic conditions. Using cost-effectiveness analysis, the outcomes and costs of providing access to an electronic patient portal were evaluated in a real-life treatment process in primary care.MethodsA total of 876 chronically ill patients from public primary care were allocated to either an intervention group receiving immediate access to a patient portal that included their medical records, care plan, and secure messaging with a care team, or to a control group receiving standard care. Incremental direct heath care costs, health status based on the Short-Form Health Survey, version 2 (SF-36v2), and patient activation based on the short form of the Patient Activation Measure (PAM13) were compared to standard care in a 6-month follow-up. Incremental cost-effectiveness ratios were calculated using a sample of 80 patients in the intervention group and 57 patients in the control group; thus, a total of 137 patients were included in the final analysis. Propensity-score matching was used to assess the sensitivity of the results to the possible attrition bias.ResultsPatient activation improved more in the intervention group but the effect was not statistically significant. The effect on cost of care was ambiguous; costs decreased by an average of €91 in the unadjusted model, but increased by €48 in the adjusted model. Due to the controversial results on cost, the unadjusted analysis showed an 89% probability of cost-effectiveness with no willingness to pay for increased patient activation, whereas in the adjusted sample, the probability of the portal being more cost-effective than care as usual exceeded 50% probability at a willingness to pay €700 per clinically significant increase in patient activation score. There was no marked short-term impact on health status based on the SF-36v2 measure.ConclusionsOffering the possibility to substitute health care visits with less costly contacts using self-management tools did not seem to compromise the health status or treatment of chronic care patients. Patient activation increased, and this could be achieved with moderate costs in a short-term experiment. In the long term, increased activation is proposed to lead to better health outcomes and eventually cut down resource use. Future studies should assess the long-term effects of patient portals on patients’ health status and cost of care.

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“…Articles reporting on portals with a medium number of functionalities (five to eight) differentiated between outcomes on design and development of a patient portal [26,28,29,30], positive effects on health-related issues [31,32] or creating awareness and self-management among patients [33,34,35]. Surprisingly, the group of articles with the fewest items (three to four) on the Minkman model are studies that focus primarily on care coordination [36,37,38,39,40,41,42,43].…”

Section: Study Outcomementioning

confidence: 99%

In pursuit of integrated care: the contribution of patient portals (Preprint)

Zwikker¹,

Scheepers²,

Smit³

et al. 2018

Preprint

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Background: Advocates of patient portals claim that they can strengthen integrated care for patients with complex or chronic health issues. However, it remains unclear how patient portals can achieve this, since indicators of integrated care are absent in most research on the matter. Objective: This study investigates the claim that patient portals can strengthen integrated care by reviewing the current research with Minkman's model of integrated care. Methods: A systematic search of PubMed, PsycInfo and Embase was conducted on research literature about patient portals (and related search terms) that was published between 2006 and 2016. Parts of the selected texts were scored on items which contribute to or hinder clusters of the Minkman model, or were absent from the model. Results:The 22 selected studies we analyzed with the Minkman model implicitly address several clusters of integrated care. Most prevalent were patientcenteredness (55 mentions), delivery system (49 mentions) and performance management (33 mentions); the least prevalent were interprofessional teamwork (3 mentions) and commitment (2 mentions). Five studies showed ways in which portals can hinder integrated care (12 mentions), while four studies showed ways in which they can promote integrated care that is not yet present in Minkman's model. Conclusions: Since the majority of the studies described items that contribute towards clusters of the Minkman model, the claim that patient portals can strengthen integrated care appears to have some merit. Items with negative impact are few and are primarily related to the implementation of portals for users. Based on our findings, we advocate using all the clusters of the Minkman model, since it can help patient portals be designed and implemented more effectively.

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Use of an Electronic Patient Portal Among the Chronically Ill: An Observational Study

Cited by 24 publications

References 29 publications

Factors that affect the use of electronic personal health records among patients: A systematic review

Factors that affect the use of electronic personal health records among patients: A systematic review

A Patient Portal With Electronic Messaging: Controlled Before-and-After Study

In pursuit of integrated care: the contribution of patient portals (Preprint)

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