Impact of patient use of an online patient portal on diabetes outcomes.

OBJECTIVE To assess the effect of patient use of an online patient portal on diabetes outcomes. METHODS Patients included were those with diabetes who were newly referred to a Vancouver-based tertiary care diabetologist between April 2008 and October 2012. Each patient was assessed by the diabetologist, received initial diabetes education and was referred, as necessary, for further education and self-management training. All patients who provided an e-mail address at registration were invited to open an online patient portal account. The portal provided access to diabetes education material, personal laboratory values and a messaging system allowing communication with the diabetologist and staff. Patients who logged in 1 or more times were defined as portal users (n=50); patients who never logged in to the portal were defined as non-users (n=107). A1C was measured at 2 time points: at baseline (i.e. initial, in-clinic visit) and at last follow up (visit no less than 6 months and no more than 2 years after the initial visit). Because usership is self-selected, propensity score matching was used to create comparable user/non-user groups based on available baseline covariates. RESULTS Compared to non-users, a higher proportion of users achieved A1C ≤7% at follow up (56% vs. 32%) (p=0.031). CONCLUSION Accessing an online patient portal is associated with improved glycemic control.

[1]  L. Egede,et al.  Associations between health literacy, diabetes knowledge, self-care behaviors, and glycemic control in a low income population with type 2 diabetes. , 2011, Diabetes technology & therapeutics.

[2]  R. Ryckman,et al.  Provider-patient interaction in diabetes care: effects on patient self-care and outcomes. A systematic review. , 2003, Patient education and counseling.

[3]  Chen-Tan Lin,et al.  Qualitative assessment of Diabetes-STAR: a patient portal with disease management functions. , 2007, AMIA ... Annual Symposium proceedings. AMIA Symposium.

[4]  Betty A Levine,et al.  Web-based care management in patients with poorly controlled diabetes. , 2005, Diabetes care.

[5]  S. Anker,et al.  Absence of obesity paradox in patients with chronic heart failure and diabetes mellitus: a propensity‐matched study , 2011, European journal of heart failure.

[6]  M Varroud-Vial,et al.  Improving diabetes management with electronic medical records. , 2011, Diabetes & Metabolism.

[7]  E. Steyerberg Clinical Prediction Models , 2008, Statistics for Biology and Health.

[8]  J. Knottnerus,et al.  Effect of lifestyle intervention for people with diabetes or prediabetes in real-world primary care: propensity score analysis , 2011, BMC family practice.

[9]  M. Ravid,et al.  Treatment of high-risk patients with diabetes: motivation and teaching intervention: a randomized, prospective 8-year follow-up study. , 2005, Journal of the American Society of Nephrology : JASN.

[10]  Gary King,et al.  Matching as Nonparametric Preprocessing for Reducing Model Dependence in Parametric Causal Inference , 2007, Political Analysis.

[11]  John Hsu,et al.  Outpatient Electronic Health Records and the Clinical Care and Outcomes of Patients With Diabetes Mellitus , 2012, Annals of Internal Medicine.

[12]  P. Austin An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies , 2011, Multivariate behavioral research.

[13]  Robert Nguyen,et al.  Social disparities in internet patient portal use in diabetes: evidence that the digital divide extends beyond access , 2011, J. Am. Medical Informatics Assoc..

[14]  Arleen F. Brown,et al.  Competing Demands for Time and Self-Care Behaviors, Processes of Care, and Intermediate Outcomes Among People With Diabetes , 2011, Diabetes Care.

[15]  Stephanie J Fonda,et al.  Changes in Diabetes Distress Related to Participation in an Internet-Based Diabetes Care Management Program and Glycemic Control , 2009, Journal of diabetes science and technology.

[16]  S. Zickmund,et al.  Interest in the Use of Computerized Patient Portals: Role of the Provider–Patient Relationship , 2007, Journal of General Internal Medicine.

[17]  Gary King,et al.  MatchIt: Nonparametric Preprocessing for Parametric Causal Inference , 2011 .

[18]  Rachel Hess,et al.  Exploring challenges and potentials of personal health records in diabetes self-management: implementation and initial assessment. , 2007, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[19]  T. Bodenheimer,et al.  Patient self-management of chronic disease in primary care. , 2002, JAMA.

[20]  M. Funnell,et al.  Patient Empowerment: Results of a randomized controlled trial , 1995, Diabetes Care.

[21]  Thomas Bodenheimer,et al.  Improving primary care for patients with chronic illness: the chronic care model, Part 2. , 2002, JAMA.

[22]  R. K. Pollom,et al.  Utilization of a Multidisciplinary Team for Inpatient Diabetes Care , 2004, Critical care nursing quarterly.

[23]  Robert Nguyen,et al.  The Literacy Divide: Health Literacy and the Use of an Internet-Based Patient Portal in an Integrated Health System—Results from the Diabetes Study of Northern California (DISTANCE) , 2010, Journal of health communication.

[24]  Russell E. Glasgow,et al.  Self-Efficacy, Problem Solving, and Social-Environmental Support Are Associated With Diabetes Self-Management Behaviors , 2010, Diabetes Care.

[25]  Mark Atkinson,et al.  Estimating the Cost of Type 1 Diabetes in the U.S.: A Propensity Score Matching Method , 2010, PloS one.

[26]  P-Y Benhamou,et al.  Improving diabetes management with electronic health records and patients' health records. , 2011, Diabetes & metabolism.