Association of Mobile Patient Portal Access With Diabetes Medication Adherence and Glycemic Levels Among Adults With Diabetes.
Association of Mobile Patient Portal Access With Diabetes Medication Adherence and Glycemic Levels Among Adults With Diabetes.
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DOI：
10.1001/jamanetworkopen.2019.21429
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发表时间：
2020-02-05
影响因子：
13.8
通讯作者：
Reed ME
中科院分区：
文献类型：
--
作者：
Graetz I;Huang J;Muelly ER;Fireman B;Hsu J;Reed ME
在线患者门户网站支持自我管理，移动设备扩展了门户网站的访问，但这是否转化为糖尿病结局的改善尚不清楚。研究增加移动患者门户与糖尿病药物依从性和成人糖尿病患者血糖水平的关系。这项回顾性队列研究纳入了2015年4月1日至2017年12月31日在大型综合医疗服务系统Kaiser Permanente Northern California接受治疗的糖尿病患者。纳入标准为基线时口服糖尿病处方且未使用胰岛素的成人糖尿病患者。数据分析时间为2018年3月至2019年3月。2015年4月至2017年12月每个日历月的患者门户访问状态，分类为从未使用、仅从计算机使用、仅从移动设备使用或同时从计算机和移动设备使用。药物依从性（以每月覆盖天数百分比（PDC）衡量）和血糖水平（以糖化血红蛋白（HbA1c）水平变化衡量）。通过基线HbA1c水平分层，采用线性回归方法评估门静脉通路与研究结果的关系，并对患者水平的固定效应和随时间变化的变量进行调整。在纳入的111463例患者（平均[SD]年龄63.79[12.93]岁；男性59 918[53.76%]）中，通过计算机和移动设备同时使用门户网站的患者数量从2015年4月的38 371例（34.42%）增加到2017年12月的57 920例（61.71%）。患者没有门户访问之前,添加电脑只门户访问与PDC的增加为1.16 (95% CI, 0.63 - 1.70)百分比和改变−0.06 (95% CI, 0.08−−0.03)百分比在糖化血红蛋白水平,并添加两个手机和电脑门户访问PDC的增加为1.67 (95% CI, 1.10 - 2.23)百分比和改变−0.13 (95% CI, 0.16−−0.10)百分比在糖化血红蛋白水平。在基线HbA1c水平较高（bbb8.0%）的患者中，从没有门静脉通道到同时有计算机和移动通道的改变与PDC增加5.09 （95% CI， 3.78至6.40）个百分点和HbA1c水平变化- 0.19 （95% CI, - 0.27至- 0.15）个百分点相关。这些发现表明，为患者提供计算机患者门静脉通道并将其与移动患者门静脉通道相结合，可显著改善糖尿病药物依从性和血糖控制，对临床需求更大的患者有更大的益处。通过移动设备方便地访问门户网站自我管理工具可以显著改善糖尿病管理。
Online patient portals support self-management, and mobile devices expand portal access, but whether this translates to improvements in diabetes outcomes is unclear. To examine the association of adding mobile patient portal access with diabetes medication adherence and glycemic levels among adults with diabetes. This retrospective cohort study included patients with diabetes treated at Kaiser Permanente Northern California, a large, integrated health care delivery system, from April 1, 2015, to December 31, 2017. Inclusion criteria were adults with diabetes with an oral diabetes prescription at baseline and no insulin use. Data were analyzed from March 2018 to March 2019. Patient portal access status for each calendar month from April 2015 to December 2017, categorized as never used, used from a computer only, used from a mobile device only, or used from both computer and mobile device. Medication adherence, measured by monthly percentage of days covered (PDC), and glycemic levels, measured by changes in glycated hemoglobin A1c (HbA1c) levels. The association of portal access with study outcomes was assessed using linear regression with patient-level fixed effects and adjusting for time-changing variables, stratified by baseline HbA1c level. Among 111 463 included patients (mean [SD] age, 63.79 [12.93] years; 59 918 [53.76%] men), the number of patients using the portal from both a computer and mobile device increased over time from 38 371 patients (34.42%) in April 2015 to 57 920 patients (61.71%) in December 2017. Among patients with no prior portal access, adding computer-only portal access was associated with an increase in PDC of 1.16 (95% CI, 0.63 to 1.70) percentage points and a change of −0.06 (95% CI, −0.08 to −0.03) percentage points in HbA1c level, and adding both mobile and computer portal access was associated with an increase in PDC of 1.67 (95% CI, 1.10 to 2.23) percentage points and a change of −0.13 (95% CI, −0.16 to −0.10) percentage points in HbA1c level. Among patients with higher baseline HbA1c level (>8.0%), changing from no portal access to both computer and mobile access was associated with an increase in PDC of 5.09 (95% CI, 3.78 to 6.40) percentage points and a change of −0.19 (95% CI, −0.27 to −0.15) percentage points in HbA1c level. These findings suggest that providing patients with computer patient portal access and combining it with mobile patient portal access are associated with significantly improved diabetes medication adherence and glycemic control, with greater benefits among patients with more clinical need. Convenient access to portal self-management tools through a mobile device could significantly improve diabetes management.
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影响因子：
7.4
作者：
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通讯作者：
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作者：
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DOI：
10.1093/jamia/ocy129
发表时间：
2019-01-01
影响因子：
6.4
作者：
Graetz, Ilana;Huang, Jie;Reed, Mary E.
通讯作者：
Reed, Mary E.