Health Information Technology

Electronic patient-provider messaging is linked to good diabetes control

Debate continues over the value, usefulness, and privacy concerns of electronic patient-provider messaging. A recent study looked at what happens when patients with diabetes are given the option to communicate with their provider by E-mail. The patients who established an E-mail relationship with their care providers were more likely to have their diabetes well controlled than the group who chose not to E-mail their providers. The E-mailing patients also made more in-person visits to their providers.

Over a 15-month period, researchers analyzed electronic patient-provider messaging at Group Health Cooperative, which operates in Washington and Idaho. Patients with diabetes had the option to use electronic messaging to communicate with their care providers over a secure Web site. In addition to measuring message threads, the researchers also measured three diabetes-related quality-of-care indicators. These were hemoglobin A1c (a marker of glucose control), blood pressure, and LDL-cholesterol ("bad" cholesterol). A total of 2,924 patients (19 percent) with diabetes used the secure messaging option on the Web site. Each user participated in an average of 5.3 message threads consisting of 11.8 individual messages.

The vast majority (86.9 percent) of message threads were started by the patient. The rate of A1c at or below 7 percent (which indicates good glycemic control) was 36 percent higher in patients who had the highest rate of secure messaging use (defined as 12 or more threads per year) compared with nonmessaging patients. Electronic messaging, however, was not strongly associated with adequate blood pressure control or lower LDL cholesterol. High messaging users also made 32 percent more primary care visits than nonusers, which was surprising. High messaging users also had more outpatient specialty and emergency care visits.

Patients who use electronic messaging may be more proactive with providers both online and in person, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS14625).

See "Diabetes quality of care and outpatient utilization associated with electronic patient-provider messaging: A cross-sectional analysis," by Lynne T. Harris, Sebastien J. Haneuse, Ph.D., Diane P. Martin, M.A., Ph.D., and James D. Ralston, M.D., M.P.H., in the July 2009 Diabetes Care 32(7), 1182-1187.

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