Use of the Refill Function Through an Online Patient Portal is Associated With Improved Adherence to Statins in an Integrated Health System

Sarkar, Urmimala; Lyles, Courtney R.; Parker, Melissa M.; Allen, Jill Y.; Nguyen, Robert; Moffet, Howard H.; Schillinger, Dean; Karter, Andrew J.

doi:10.1097/mlr.0000000000000069

Cited by 113 publications

(93 citation statements)

References 35 publications

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“…While the evidence is far from conclusive, studies do suggest that patient portals can improve processes of care and adherence. 3,4 Technology is also thought to benefit health through improved patient activation and selfmanagement achieved via access to online health information and peer support. 5,6 However, clear and consistent evidence related to health disparities is lacking.…”

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confidence: 99%

Health Literacy, Vulnerable Patients, and Health Information Technology Use: Where Do We Go from Here?

Lyles

Sarkar

2015

J GEN INTERN MED

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In the past few years, the rapid adoption of health information technology (HIT) in the US has been very apparent, largely driven by the more than $25 billion in incentives for "Meaningful Use" of HIT provided to date as a part of healthcare reform in the Health Information Technology for Economic and Clinical Health (HITECH) Act. As we move into Stage 2 of the Meaningful Use program with new metrics for patient engagement, healthcare leaders are now shifting their focus from implementation to understanding patient needs and preferences for health technology use. The article by Levy et al. 1 in this issue highlights an important issue in this landscape: the intersection of vulnerable populations and HIT use.At the national level, the Pew Research Center's Internet and American Life Project estimates that the gaps in technology use (that is, the "digital divide") are shrinking. In 2014, 87 % of US adults accessed the Internet including 81 % of African Americans, 83 % of Hispanics/Latinos, and 77 % of those making less than $30,000 annually.2 Thus, many view HIT as a mechanism to reach diverse populations to engage in health.Despite this, there is not much evidence about how HIT use will affect health outcomes or address existing health disparities. The underlying assumption behind incentives to encourage health systems to implement patient portals is that these portals will improve health. While the evidence is far from conclusive, studies do suggest that patient portals can improve processes of care and adherence. 3,4 Technology is also thought to benefit health through improved patient activation and selfmanagement achieved via access to online health information and peer support. 5,6 However, clear and consistent evidence related to health disparities is lacking.In this issue of JGIM, Levy et al. have honed in on an important subgroup where the digital divide persists: those aged 65 years or older, only 57 % of whom are Internet users. Within this older group, the authors were able to explore additional predictors of Internet use-namely, health literacy, which has been previously shown to predict online portal use. 7They also explored patterns of searching for health information online as opposed to simply noting the presence or absence of any Internet use. The results aren't surprising when examining the barriers of age and health literacy simultaneously: only 32 % of older adults used the Internet to get health information and only 10 % of older adults with limited health literacy did so. This was after adjustment for the major potential confounder of cognitive ability.This pattern is also likely to hold within other subgroups not specifically examined in this study, such as income and race/ethnicity. It is clear from national data that older adults with lower income or from racial/ethnic minority groups are least likely to use the Internet. 8 For example, only 25 % of low-income older adults use the Internet at all, 9 compared to more than 50 % of older adults overall. Furthermore, not only are health li...

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confidence: 99%

Health Literacy, Vulnerable Patients, and Health Information Technology Use: Where Do We Go from Here?

Lyles

Sarkar

2015

J GEN INTERN MED

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“…[6][7][8] One study suggested that patient use of an online portal with refill function increased adherence to statin medications for those with diabetes receiving care in an integrated health system. 9,10 Studies also report that low education, income, and Internet access are associated with lower online use of an SMR, though socioeconomic status (SES) alone does not account for lower SMR use by racial-ethnic minorities. 11 African Americans and Latinos are less likely to use an online SMR system that has options to request medication refills.…”

Section: Introductionmentioning

confidence: 99%

Disparities in the Use of Internet and Telephone Medication Refills among Linguistically Diverse Patients

et al. 2015

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BACKGROUND: Health systems are increasingly implementing remote telephone and Internet refill systems to enhance patient access to medication refills. Remote refill systems may provide an effective approach for improving medication non-adherence, but more research is needed among patients with limited English proficiency with poor access to remote refill systems. OBJECTIVE: To compare the use of remote medication refill systems among limited-English-proficiency (LEP) and English-proficient (EP) patients with chronic conditions. METHODS: Cross-sectional survey in six languages/ dialects (English, Cantonese, Mandarin, Korean, Vietnamese, and Spanish) of 509 adults with diabetes, hypertension, or hyperlipidemia. Primary study outcomes were self-reported use of 1) Internet refills, 2) telephone refills, and 3) any remote refill system. LEP was measured by patient self-identification of a primary language other than English and a claims record of use of an interpreter. Other measures were age, gender, education, years in the U.S., insurance, health status, chronic conditions, and number of prescribed medications. Analyses included multivariable logistic regression weighted for survey non-response. RESULTS: Overall, 33.1 % of patients refilled their medications by telephone and 31.6 % by Internet. Among LEP patients (n=328), 31.5 % refilled by telephone and 21.2 % by Internet, compared with 36.7 % by telephone and 52.7 % by Internet among EP patients (n=181). Internet refill by language groups were as follows: English (52.7 %), Cantonese (34.9 %), Mandarin (17.4 %), Korean (16.7 %), Vietnamese (24.4 %), and Spanish (12.6 %). Compared to EP patients, LEP patients had lower use of any remote refill system (adjusted odds ratio [AOR] 0.18; p<0.001), CONCLUSIONS: LEP patients are significantly less likely than EP patients to use any remote medication refill system. Increased reliance on current systems for remote medication refills may increase disparities in health outcomes affecting LEP patients with poor access to telephone and Internet medication refills.

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“…174 The impact of patient portals on health is largely unknown, but in one report, use was associated with greater adherence to statins and lower low-density lipoprotein levels. 175 Together, these new technologies and new approaches reveal a shift in our appreciation for the value of patientcollected data obtained outside the conventional clinic setting. In addition, there is growing recognition among funders that research into this area is needed.…”

Section: Patient-reported Informationmentioning

confidence: 99%

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

Maddox¹,

Albert²,

Borden³

et al. 2017

Circulation

118

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ABSTRACT:The learning healthcare system uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery. To achieve these goals, the learning healthcare system requires systematic redesign of the current healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture. This scientific statement provides an overview of how these learning healthcare system domains can be realized in cardiovascular disease care. Current cardiovascular disease care innovations in informatics, data uses, patient engagement, continuous learning culture, and incentives are profiled. In addition, recommendations for next steps for the development of a learning healthcare system in cardiovascular care are presented.H ealth care has never been more complex. Clinicians and patients must make decisions that integrate the continually evolving scientific evidence base with hundreds of individual data points such as patients' vital signs, symptoms, comorbidities, medications, test results, and preferences. Furthermore, once these decisions are made, little information is available about their impact, limiting the ability to learn from and ultimately improve care delivery. This inability of the healthcare system to learn from its operation results in significant inefficiencies, substantial costs, and suboptimal health outcomes.The creation of a learning healthcare system (LHS) can potentially address these issues. The LHS uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery 1,2 (Figure 1). Thus, the LHS enables rapid, iterative learning in which "evidence informs practice, and practice informs evidence." 2 The authors argued that recent advances in information processing and connectivity, healthcare organizational design, and reimbursement policies centered on quality rather than quantity of care provided the necessary tools for the creation of the LHS. Accordingly, they called for systematic redesign of the healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture.

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Use of the Refill Function Through an Online Patient Portal is Associated With Improved Adherence to Statins in an Integrated Health System

Cited by 113 publications

References 35 publications

Health Literacy, Vulnerable Patients, and Health Information Technology Use: Where Do We Go from Here?

Health Literacy, Vulnerable Patients, and Health Information Technology Use: Where Do We Go from Here?

Disparities in the Use of Internet and Telephone Medication Refills among Linguistically Diverse Patients

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

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