Sustained Use of Patient Portal Features and Improvements in Diabetes Physiological Measures.
Sustained Use of Patient Portal Features and Improvements in Diabetes Physiological Measures.
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DOI：
10.2196/jmir.5663
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发表时间：
2016-07-01
影响因子：
7.4
通讯作者：
Houston TK
中科院分区：
文献类型：
--
作者：
Shimada SL;Allison JJ;Rosen AK;Feng H;Houston TK
个人健康记录（PHR）有可能改善患者对糖尿病等慢性疾病的自我管理。然而，关于PHR的使用和改善的健康结果之间是否存在关联，证据是混合的。本研究的目的是评估持续使用特定的患者门户功能（基于Web的处方续药和安全消息-SM）和对2型糖尿病管理重要的生理措施之间的关联。使用回顾性队列设计，包括在My Health e Vet患者门户注册的糖尿病退伍军人，他们尚未使用基于Web的再填充或SM功能，并且至少有一项生理测量2009-2010年（HbA 1c、低密度脂蛋白（LDL）胆固醇、血压）（基线）高于指南建议（N= 111，686），我们评估了2010年至2014年之间的门户网站使用情况。我们计算了在2013年至2014年（随访）之前，通过使用每个门户功能的年份，调整与门户使用相关的人口统计学和临床特征，实现控制每个指标的几率。到2013年至2014年，34.13%（38，113/111，686）的队列使用基于网络的再填充，15.75%（17，592/111，686）的队列使用SM。使用者略年轻（P<.001），不太可能有资格获得基于经济手段的免费护理（P<.001），更可能是女性（P<.001）。在调整两个特征的模型中，基线时HbA 1c不受控制的使用SM的患者，如果使用SM 2年（比值比-OR =1.24，CI：1.14-1.34）或3年或更长时间（OR=1.28，CI：1.12-1.45），则在随访时实现血糖控制的可能性显著高于未使用SM的患者。然而，基于网络的补充使用和血糖控制之间没有显著的关联。基线时血压不受控制的使用基于网络的再填充物的患者比非使用者更有可能在随访时获得控制，使用基于网络的再填充物2年（OR=1.07，CI：1.01-1.13）或3年（OR=1.08，CI：1.02-1.14）。这两个特征与随访时LDL胆固醇水平的改善显著相关。尽管人群中使用补充功能的比率较高，但持续使用SM对HbA 1c的影响更大。对患者门户的评估应考虑各个组成部分可能对健康改善有不同的影响。
Personal 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. The 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. Using 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. By 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. Although 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.