Palo Alto Medical Foundation Research Institute, Palo Alto, CA
Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA.
Diabetes Care. 2017 Oct;40(10):1342-1348. doi: 10.2337/dc17-0140. Epub 2017 Aug 14.
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 how messaging is associated with use and clinical quality measures 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.
Patients with diabetes who were enrolled in an online portal of an outpatient health care organization in 2011-2014 were studied ( = 37,762 patient-years). Messages from/to primary care physicians or diabetes-related specialists for medical advice were considered. We estimated the association of messaging with diabetes quality measures, adjusting for patient and provider characteristics and patient-level clustering.
Most patients (72%) used messaging, 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 HbA target of <8% (64 mmol/mol) (odds ratio [OR] 0.83 [95% CI 0.77, 0.90]). Among message users, additional messages (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 patient-initiated messages.
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.
通过患者门户实现医患之间基于互联网的安全信息传递，这在现代医学实践中已很常见。但有关信息传递与 2 型糖尿病患者的就诊次数和临床质量指标之间关系的证据有限。我们研究了向医生咨询医疗建议的信息传递是否与就诊次数减少和更好的糖尿病管理有关。
对 2011-2014 年间参加在线门诊医疗组织门户的糖尿病患者（=37762 患者年）进行了研究。考虑了来自/发往初级保健医生或糖尿病相关专家的用于医疗咨询的信息。我们根据患者和提供者特征以及患者水平聚类调整了信息传递与糖尿病质量指标的关系。
大多数患者（72%）使用了信息传递，就诊次数多的患者也更有可能使用信息传递。考虑到就诊频率，与未发送（vs.任何）信息相比，发送信息（vs.任何）与 HbA<8%（64mmol/mol）目标达标率较低显著相关（比值比[OR]0.83[95%CI0.77，0.90]）。在信息使用者中，与发送 1 条信息相比，发送更多信息（每增加 2 条信息：OR1.17[95%CI1.06，1.28]；每增加 3 条信息：1.38[1.25，1.53]；每增加 4 条信息：1.55[1.43，1.69]）与更好的结果显著相关。对于非胰岛素使用者，这种关系更强。信息传递频率也与过程指标（如眼部检查）呈正相关，但程度较小。医生发起的信息与患者发起的信息具有相似的效果。
除了常规就诊外，糖尿病患者还经常使用安全信息传递来获取医疗建议。在大型社区门诊实践中，信息传递与更好的糖尿病管理呈正相关。
