Thursday, November 28, 2013

It Looks Like Patient Portals Do Not Add All That Much In Chronic Disease Care. Maybe.

This appeared a few days ago.

No evidence that messaging portals reduce costs, improve outcomes, review of studies shows

21 November, 2013
A key to the patient-centered medical home model is enhanced patient-physician communication—often through using a secure-messaging portal connected to an electronic health record. But according to a systematic review of 46 studies published over 22 years, there is insufficient evidence that portals improve outcomes or lower costs.
In the Veterans Affairs Department-funded review, researchers from VA and academic medical centers in Los Angeles and Indianapolis did find that portal use was associated with improved outcomes for patients with chronic diseases such as diabetes, hypertension and depression, but these improvements were also linked to portals used in case management. The researchers were unable to discern whether the portals themselves made a difference.
“Portals are being created as part of a movement to make patients more active participants in their care,” the researchers wrote. “Our review suggests that there are some potential barriers to achieving this goal, including disparities in who accesses these portals and instances of suboptimal patient attitudes of their worth. More widespread acceptance will require attention to overcoming these disparities and addressing usability and patient-perceived value to engage certain populations that are not readily embracing personal health-record systems.”
Lots more here:
Here is the abstract.
19 November 2013

Electronic Patient Portals: Evidence on Health Outcomes, Satisfaction, Efficiency, and Attitudes: A Systematic Review

Caroline Lubick Goldzweig, MD, MSHS; Greg Orshansky, MD; Neil M. Paige, MD, MSHS; Ali Alexander Towfigh, MD; David A. Haggstrom, MD, MAS; Isomi Miake-Lye, BA; Jessica M. Beroes, BS; and Paul G. Shekelle, MD, PhD
Ann Intern Med. 2013;159(10):677-687. doi:10.7326/0003-4819-159-10-201311190-00006
Background: Patient portals tied to provider electronic health record (EHR) systems are increasingly popular.
Purpose: To systematically review the literature reporting the effect of patient portals on clinical care.
Data Sources: PubMed and Web of Science searches from 1 January 1990 to 24 January 2013.
Study Selection: Hypothesis-testing or quantitative studies of patient portals tethered to a provider EHR that addressed patient outcomes, satisfaction, adherence, efficiency, utilization, attitudes, and patient characteristics, as well as qualitative studies of barriers or facilitators, were included.
Data Extraction: Two reviewers independently extracted data and addressed discrepancies through consensus discussion.
Data Synthesis: From 6508 titles, 14 randomized, controlled trials; 21 observational, hypothesis-testing studies; 5 quantitative, descriptive studies; and 6 qualitative studies were included. Evidence is mixed about the effect of portals on patient outcomes and satisfaction, although they may be more effective when used with case management. The effect of portals on utilization and efficiency is unclear, although patient race and ethnicity, education level or literacy, and degree of comorbid conditions may influence use.
Limitation: Limited data for most outcomes and an absence of reporting on organizational and provider context and implementation processes.
Conclusion: Evidence that patient portals improve health outcomes, cost, or utilization is insufficient. Patient attitudes are generally positive, but more widespread use may require efforts to overcome racial, ethnic, and literacy barriers. Portals represent a new technology with benefits that are still unclear. Better understanding requires studies that include details about context, implementation factors, and cost.
Primary Funding Source: U.S. Department of Veterans Affairs.
Here is the link:
It seems to me that this study may have been compromised by taking a 20 year period, or at least dividing the old from the recent studies. I suspect we might find that the richer functionality portals now in use (with messaging to docs, appointment making, repeat prescriptions etc.) might be a good deal more successful.
What this study may very well suggest is that non-functional portals (like the PCEHR) are not all that useful.
Clearly more research needed!

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