Can secure patient-provider messaging improve diabetes care?

Abstract

OBJECTIVE Internet-based secure messaging between patients and providers through a patient portal is now common in the practice of modern medicine. There is limited evidence on howmessaging is associatedwith use and clinical qualitymeasures among patients with type 2 diabetes. We examine whether messaging with physicians for medical advice is associated with fewer face-to-face visits and better diabetes management. RESEARCH DESIGN AND METHODS Patients with diabeteswhowere enrolled in an online portal of an outpatient health care organization in 2011-2014were studied (N= 37,762 patient-years).Messages from/to primary care physicians or diabetes-related specialists for medical advice were considered. We estimated the association ofmessaging with diabetes qualitymeasures, adjusting for patient and provider characteristics and patient-level clustering. RESULTS Most patients (72%) usedmessaging, and those who made frequent visits were also more likely to message. Given visit frequency, no (vs. any) messaging was negatively associated with the likelihood of meeting an HbA1c target of <8% (64 mmol/mol) (odds ratio [OR] 0.83 [95%CI 0.77, 0.90]).Amongmessage users, additionalmessages (vs. 1) were associated with better outcome (two more messages: OR 1.17 [95% CI 1.06, 1.28]; three more messages: 1.38 [1.25, 1.53]; four more messages: 1.55 [1.43, 1.69]). The relationship was stronger for noninsulin users. Message frequency was also positively associated, but to a smaller extent, with process measures (e.g., eye examination). Physician-initiated messages had effects similar to those for patientinitiated messages. CONCLUSIONS Patients with diabetes frequently used secure messaging for medical advice in addition to routine visits to care providers. Messaging was positively associated with better diabetes management in a large community outpatient practice.