Can a Patient Web-Based Health Portal Improve T2D Self-Management?

Patients with chronic diseases like type 2 diabetes require continuous, coordinated care to support self-management and communication between clinic visits so that treatment can be better tailored and managed individually. Personal health records and patient Web-based portals are technologies that may be able to increase patient self-management and communication with clinical healthcare teams.

A recent study, published in the Journal of Medical Internet Research, of the Department of Veterans Affairs’ Web-based patient portal, My HealtheVet (MHV), which allows patients to refill VA prescriptions and send secure messages (SM) to providers, finds a small, statistically significant and potentially meaningful improvement in diabetes-related physiologic measures among patients who started and sustained use of the MHV’s web-based refills or SM or both. Furthermore, where significant associations were found, use of SM was associated with higher odds of improved outcomes than use of Web-based refills.

Stephanie L. Shimada, PhD, of the Center for Healthcare Organization and Implementation Research at Edith Nourse Rogers Memorial Veterans Hospital in Bedford, MA, and colleagues examined whether diabetes outcomes were improved for patients who initiated use of key features of the MHV compared with similar patients with type 2 diabetes who were registered for the portal but did not initiate use of any of these features.

Patients in the study had at least one uncontrolled diabetes-related physiologic measure (hemoglobin A1C [HbA1c], low-density lipoprotein [LDL] cholesterol, and blood pressure) at the beginning of the study in 2009-2010. Researchers collected data on whether the patients who used the portal’s Web-based prescription refills or SM features for the first time between 2010 and 2013 were more likely than nonusers to achieve control at follow up in 2013 to 2014.

A total of 50,482 patients (45.20%) used the SM and/or prescription refills at least twice per year and 61,204 (54.8%) did not use either technology. Uncontrolled blood glucose was defined as average HbA1c greater than or equal to 7.0% at baseline and uncontrolled LDL cholesterol at baseline was greater than or equal to 100 mg/dL. Uncontrolled blood pressure at baseline was defined as average systolic pressure 140 mmHg or higher or average diastolic pressure of 80 mmHg or higher.

Overall, the investigators found that between 2010 and 2014 there was increasing activity on the MHV patient portal. The rate of use and increase in use was greater for Web-based prescription refills than for SM. Those with uncontrolled blood pressure who used Web-based refills were significantly more likely than nonusers to achieve control at follow-up with 2 or 3 more years of Web-based refill use. Both features were significantly associated with improvements in LDL cholesterol levels at follow up.

Patients who used Web-based refill reminders or SM were slightly younger, more likely to be female, and less likely to be eligible for free VA care based on low economic means. There were significant differences in race or ethnicity between users and nonusers, with African American, Asian, and patients of unknown race less likely than white patients to be users of the portal.