Mobile Access To A Diabetes Portal Tied To Improved Patient Outcomes

In patients with diabetes, mobile access to a self-management portal was associated with improved medication adherence and glycemic control, a retrospective study reveals.

"Making patient portals easy to use from a mobile device, either with an app or mobile-optimized website, puts access to portal functions literally in the patient's pocket and can improve outcomes for patients with diabetes," Dr. Ilana Graetz from Emory University's Rollins School of Public Health in Atlanta told Reuters Health by email.

"I was surprised that patients who saw the most improvement in blood sugar levels were the ones that started with higher HbA1c and no portal use and gained only mobile access to the portal," she said.

"Previously, we found that patients who accessed the portal only from mobile devices were more likely to belong to racial and ethnic minorities, live in lower socioeconomic status neighborhoods, or have lower medication adherence," she noted. (http://bit.ly/2ThUXN4)

Dr. Graetz and colleagues analyzed Kaiser Permanente Northern California data on 111,463 patients (mean age, 63.79; 54% men) with an oral diabetes prescription, no insulin use and patient portal access.

As reported in JAMA Network Open, the number of patients using the portal from both a computer and mobile device increased from 38,371 (34.42%) in April 2015 to 57,920 (61.71%) in December 2017.

Among patients with no prior portal access, adding computer-only access was associated with an increase in medication adherence, as measured by percentage of days covered (PDC) increase of 1.16 percentage points and a −0.06 percentage point drop in HbA1c.

Further, adding both mobile and computer portal access for this group was associated with a PDC increase of 1.67 percentage points and a −0.13 percentage point reduction in HbA1c.

Among patients with higher baseline HbA1c (>8.0%), changing from no portal access to both computer and mobile access was associated with a PDC increase of 5.09 percentage points and a decrease of −0.19 percentage points in HbA1c.

Dr. Graetz said, "The fact that patients with a higher clinical need who gained only mobile access to the portal experienced the most improvement in blood sugar levels suggests that adding mobile portal access can be an easy way for practices to improve care for vulnerable patients who may face barriers to engaging with healthcare."

Dr. Joshua Miller, Medical Director of Diabetes Care at Stony Brook Medicine in New York, commented by email, "As a diabetologist, I rely on electronic portal access for countless patients to communicate on...topics ranging from simple needs such as prescription refills and appointment changes to complex needs such as changes to insulin or medication regimens. With so many demands placed on our time, electronic access can substantially improve access to medical care and support... (and avoid) wait times associated with traditional phone calls and voice messaging."

Many patients share their data electronically from anywhere in the world via the electronic portal, he told Reuters Health. "This opportunity for communication with our diabetes team provides another layer of support and encouragement for patients, outside of the brick and mortar walls of a diabetes center. Between-visit communication can also help to address 'therapeutic inertia' that can sometimes develop over time in between traditional visits with the care team."

"As a person living for over 20 years with type 1 diabetes, I rely on a patient portal to communicate with my physicians on a regular basis," he said. "As recently as last week, I was able to discuss medication changes and appointment information with my own endocrinologist many miles away, never having had to pick up the phone."

Challenges that still need to be addressed, he added, include "information safety and security, and setting ground rules for safe/proper portal engagement—i.e., when phone call/visitation is a must. On a systems level, physician reimbursement needs to evolve to support out-of-office patient engagement, and telemedicine is evolving to support this functionality."

—Marilynn Larkin

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