Osborn Chandra Y, Mayberry Lindsay Satterwhite, Wallston Kenneth A, Johnson Kevin B, Elasy Tom A
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-8300, United States.
J Med Internet Res. 2013 Jul 3;15(7):e133. doi: 10.2196/jmir.2589.
The Internet can be leveraged to provide disease management support, including medication adherence promotion that, when tailored, can effectively improve adherence to medications. The growing adoption of patient portals represents an opportunity to support medication management and adherence more broadly, but virtually no data exist about the real and potential impact of existing portals on these outcomes.
We sought to (1) understand who uses an existing patient portal and reasons for use and nonuse, (2) understand how portal users are using a portal to manage their medications, and (3) explore participants' ideas for improving portal functionality for medication management and adherence support.
A total of 75 adults with type 2 diabetes participated in a mixed-methods study involving focus groups, a survey, and a medical chart review. We used quantitative data to identify differences between portal users and nonusers, and to test the relationship between the frequency of portal use and glycemic control among users. We used qualitative methods to understand how and why participants use a portal and their ideas for improving its medication management functionality.
Of the enrolled participants, 81% (61/75) attended a focus group and/or completed a survey; portal users were more likely than nonusers to participate in that capacity (Fisher exact test; P=.01). Users were also more likely than nonusers to be Caucasian/white (Fisher exact test; P<.001), have higher incomes (Fisher exact test; P=.005), and be privately insured (Fisher exact test; P<.001). Users also tended to have more education than nonusers (Mann-Whitney U; P=.05), although this relationship was not significant at P<.05. Among users, more frequent use of a portal was associated with better A1C (Spearman rho =-0.30; P=.02). Reasons for nonuse included not knowing about the portal (n=3), not having access to a computer (n=3), or having a family member serve as an online delegate (n=1). Users reported using the portal to request prescription refills/reauthorizations and to view their medication list, and they were enthusiastic about the idea of added refill reminder functionality. They were also interested in added functionality that could streamline the refill/reauthorization process, alert providers to fill/refill nonadherence, and provide information about medication side effects and interactions.
Although there are disparities in patient portal use, patients use portals to manage their medications, are enthusiastic about further leveraging portals to support medication management and adherence, and those who use a portal more frequently have better glycemic control. However, more features and functionality within a portal platform is needed to maximize medication management and adherence promotion.
互联网可用于提供疾病管理支持，包括促进药物依从性，经过定制的促进措施可有效提高药物依从性。患者门户网站的日益普及为更广泛地支持药物管理和依从性提供了契机，但几乎没有关于现有门户网站对这些结果的实际和潜在影响的数据。
我们试图（1）了解使用现有患者门户网站的人群及其使用和不使用的原因，（2）了解门户网站用户如何使用门户网站来管理他们的药物，以及（3）探讨参与者对于改进门户网站药物管理和依从性支持功能的想法。
共有75名2型糖尿病成年人参与了一项混合方法研究，该研究包括焦点小组、一项调查和一次病历审查。我们使用定量数据来确定门户网站用户和非用户之间的差异，并测试门户网站使用频率与用户血糖控制之间的关系。我们使用定性方法来了解参与者如何以及为何使用门户网站，以及他们对于改进其药物管理功能的想法。
在登记的参与者中，81%（61/75）参加了焦点小组和/或完成了调查；门户网站用户比非用户更有可能以这种身份参与（Fisher精确检验；P = 0.01）。用户也比非用户更有可能是白种人/白人（Fisher精确检验；P < 0.001），收入更高（Fisher精确检验；P = 0.005），并且有私人保险（Fisher精确检验；P < 0.001）。用户的受教育程度也往往高于非用户（曼-惠特尼U检验；P = 0.05），尽管这种关系在P < 0.05时并不显著。在用户中，更频繁地使用门户网站与更好的糖化血红蛋白水平相关（Spearman相关系数=-0.30；P = 0.02）。不使用的原因包括不知道有该门户网站（n = 3）、无法使用电脑（n = 3）或让家庭成员作为在线代理人（n = 1）。用户报告使用门户网站来请求处方续开/重新授权并查看他们的药物清单，他们对增加续开提醒功能的想法很感兴趣。他们还对可以简化续开/重新授权流程、提醒提供者注意漏开/未按时续开以及提供有关药物副作用和相互作用信息的附加功能感兴趣。
尽管在患者门户网站的使用方面存在差异，但患者使用门户网站来管理他们的药物，热衷于进一步利用门户网站来支持药物管理和依从性，并且那些更频繁使用门户网站的患者血糖控制更好。然而，需要在门户网站平台内增加更多功能，以最大限度地促进药物管理和依从性。
