The Promise of Patient Portals for Individuals Living With Chronic Illness: Qualitative Study Identifying Pathways of Patient Engagement

Maureen T Stewart, Timothy P Hogan, Jeff Nicklas, Stephanie A Robinson, Carolyn M Purington, Christopher J Miller, Varsha G Vimalananda, Samantha L Connolly, Hill L Wolfe, Kim M Nazi, Dane Netherton, Stephanie L Shimada, Maureen T Stewart, Timothy P Hogan, Jeff Nicklas, Stephanie A Robinson, Carolyn M Purington, Christopher J Miller, Varsha G Vimalananda, Samantha L Connolly, Hill L Wolfe, Kim M Nazi, Dane Netherton, Stephanie L Shimada

Abstract

Background: Patients play a critical role in managing their health, especially in the context of chronic conditions like diabetes. Electronic patient portals have been identified as a potential means to improve patient engagement; that is, patients' involvement in their care. However, little is known about the pathways through which portals may help patients engage in their care.

Objective: Our objective is to understand how an electronic patient portal facilitates patient engagement among individuals with diabetes.

Methods: This qualitative study employed semistructured telephone interviews of 40 patients living with diabetes since at least 2011, who had experienced uncontrolled diabetes, and had used secure messaging through a portal at least 4 times over 18 months. The interviews were recorded, transcribed, coded, and analyzed using primarily an inductive approach to identify how patients living with diabetes use an online health portal to support diabetes self-management.

Results: Overall, patients who used the portal reported feeling engaged in their health care. We identified four pathways by which the portal facilitates patient engagement and some challenges. The portal provides a platform that patients use to (1) better understand their health by asking questions about new symptoms, notes, or labs, (2) prepare for medical appointments by reviewing labs and notes, (3) coordinate care between VA (Veterans Affairs) and non-VA health care teams, and (4) reach out to providers to request help between visits. Several patients reported that the portal helped improve the patient-provider relationship; however, aspects of the portal design may hinder engagement for others. Patients reported challenges with both secure messaging and access to medical records that had negative impacts on their engagement. Benefits for patient engagement were described by many types of portal users with varying degrees of diabetes control.

Conclusions: Patient portals support engagement by facilitating patient access to their health information and by facilitating patient-provider communication. Portals can help a wide range of users engage with their care.

Keywords: chronic disease; diabetes; patient engagement; patient portal; secure messaging; veterans.

Conflict of interest statement

Conflicts of Interest: None declared.

©Maureen T Stewart, Timothy P Hogan, Jeff Nicklas, Stephanie A Robinson, Carolyn M Purington, Christopher J Miller, Varsha G Vimalananda, Samantha L Connolly, Hill L Wolfe, Kim M Nazi, Dane Netherton, Stephanie L Shimada. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 17.07.2020.

References

    1. Barello S, Graffigna G, Vegni E. Patient engagement as an emerging challenge for healthcare services: mapping the literature. Nurs Res Pract. 2012;2012:905934. doi: 10.1155/2012/905934. doi: 10.1155/2012/905934.
    1. James J. Health Policy Brief: Patient Engagement. Health Affairs. 2013 Feb 14;PMID:1–6.
    1. World Health Organization . Technical Series on Safer Primary Care. Geneva: World Health Organization; 2016. Dec, [2020-06-15]. Patient Engagement: Technical Series on Safer Primary Care. .
    1. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004 Aug;39(4 Pt 1):1005–26. doi: 10.1111/j.1475-6773.2004.00269.x.
    1. Carman KL, Dardess P, Maurer M, Sofaer S, Adams K, Bechtel C, Sweeney J. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Aff (Millwood) 2013 Feb;32(2):223–31. doi: 10.1377/hlthaff.2012.1133.
    1. Irizarry T, Shoemake J, Nilsen ML, Czaja S, Beach S, DeVito Dabbs A. Patient portals as a tool for health care engagement: a mixed-method study of older adults with varying levels of health literacy and prior patient portal use. J Med Internet Res. 2017 Mar 30;19(3):e99. doi: 10.2196/jmir.7099.
    1. Ricciardi L, Mostashari F, Murphy J, Daniel JG, Siminerio EP. A national action plan to support consumer engagement via e-health. Health Aff (Millwood) 2013 Feb;32(2):376–84. doi: 10.1377/hlthaff.2012.1216.
    1. Irizarry T, DeVito Dabbs A, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res. 2015 Jun 23;17(6):e148. doi: 10.2196/jmir.4255.
    1. Kuo A, Dang S. Secure messaging in electronic health records and its impact on diabetic clinical outcomes: a systematic review. Telemed J E Health. 2016 Sep;22(9):769–77. doi: 10.1089/tmj.2015.0207.
    1. Lau M, Campbell H, Tang T, Thompson DJS, Elliott T. Impact of patient use of an online patient portal on diabetes outcomes. Can J Diabetes. 2014 Feb;38(1):17–21. doi: 10.1016/j.jcjd.2013.10.005.
    1. McMahon GT, Gomes HE, Hickson Hohne Sara, Hu TM, Levine BA, Conlin PR. Web-based care management in patients with poorly controlled diabetes. Diabetes Care. 2005 Jul;28(7):1624–9. doi: 10.2337/diacare.28.7.1624.
    1. Osborn CY, Mayberry LS, Mulvaney SA, Hess R. Patient web portals to improve diabetes outcomes: a systematic review. Curr Diab Rep. 2010 Dec;10(6):422–35. doi: 10.1007/s11892-010-0151-1.
    1. Pillemer F, Price RA, Paone S, Martich GD, Albert S, Haidari L, Updike G, Rudin R, Liu D, Mehrotra A. Direct release of test results to patients increases patient engagement and utilization of care. PLoS One. 2016;11(6):e0154743. doi: 10.1371/journal.pone.0154743.
    1. Barello S, Triberti S, Graffigna G, Libreri C, Serino S, Hibbard J, Riva G. eHealth for patient engagement: a systematic review. Front Psychol. 2015;6:2013. doi: 10.3389/fpsyg.2015.02013. doi: 10.3389/fpsyg.2015.02013.
    1. Robinson SA, Zocchi MS, Netherton D, Ash A, Purington CM, Connolly SL, Vimalananda VG, Hogan TP, Shimada SL. Secure messaging, diabetes self-management, and the importance of patient autonomy: a mixed methods study. J Gen Intern Med. 2020 May 21;:1–8. doi: 10.1007/s11606-020-05834-x.
    1. Etingen B, Hogan TP, Martinez RN, Shimada S, Stroupe K, Nazi K, Connolly SL, Lipschitz J, Weaver FM, Smith B. How do patients with mental health diagnoses use online patient portals? An observational analysis from the Veterans Health Administration. Adm Policy Ment Health. 2019 Sep;46(5):596–608. doi: 10.1007/s10488-019-00938-x.
    1. Hogan TP, Nazi KM, Luger TM, Amante DJ, Smith BM, Barker A, Shimada SL, Volkman JE, Garvin L, Simon SR, Houston TK. Technology-assisted patient access to clinical information: an evaluation framework for blue button. JMIR Res Protoc. 2014 Mar 27;3(1):e18. doi: 10.2196/resprot.3290.
    1. US Department of Veterans Affairs, Office of Rural Health VHA and ORH Adopt New System to Define "Rural". US Department of Veterans Affairs. 2014. [2020-06-15]. .
    1. Schmitt A, Gahr A, Hermanns N, Kulzer B, Huber J, Haak T. The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control. Health Qual Life Outcomes. 2013 Aug 13;11:138. doi: 10.1186/1477-7525-11-138.
    1. Lorig K, Ritter PL, Villa FJ, Armas J. Community-based peer-led diabetes self-management: a randomized trial. Diabetes Educ. 2009;35(4):641–51. doi: 10.1177/0145721709335006.
    1. Rosen AK, Wagner TH, Pettey WBP, Shwartz M, Chen Q, Lo J, O'Brien WJ, Vanneman ME. Differences in risk scores of veterans receiving community care purchased by the Veterans Health Administration. Health Serv Res. 2018 Dec;53 Suppl 3:5438–5454. doi: 10.1111/1475-6773.13051.
    1. Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004 Sep;36(8):588–94.
    1. Lune H, Berg L. Qualitative Research Methods for the Social Sciences, Ninth Edition. Boston: Pearson Education, Inc; 2017.
    1. Latulippe K, Hamel C, Giroux D. Social health inequalities and eHealth: a literature review with qualitative synthesis of theoretical and empirical studies. J Med Internet Res. 2017 Apr 27;19(4):e136. doi: 10.2196/jmir.6731.
    1. Sarkar U, Karter AJ, Liu JY, Adler NE, Nguyen R, López A, Schillinger D. Social disparities in internet patient portal use in diabetes: evidence that the digital divide extends beyond access. J Am Med Inform Assoc. 2011 May 01;18(3):318–21. doi: 10.1136/jamia.2010.006015.
    1. Zickmund SL, Hess R, Bryce CL, McTigue K, Olshansky E, Fitzgerald K, Fischer GS. Interest in the use of computerized patient portals: role of the provider-patient relationship. J Gen Intern Med. 2008 Jan;23 Suppl 1:20–6. doi: 10.1007/s11606-007-0273-6.

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