Physicians viewed diabetes management through use of a patient portal less favorably than patients in a Canadian study published last week in the Journal of Medical Internet Research.
The research involved open-ended interviews with 17 diabetes patients and with 64 healthcare providers, including general practitioners, nurses, dietitians, diabetes educators and others.
Overall, the patients said the portal improved their knowledge of their disease and helped them better manage it. However, patients used the portal primarily to log blood-sugar readings and rarely accessed other features, such as the health library.
Providers expressed concern that patients who believed they were managing their disease well enough would skip necessary appointments or fail to alert a provider of a high blood sugar reading. They noted that those who reliably recorded their readings might have done so even without the portal.
Interestingly enough, a recent study from Kaiser Permanente Colorado found that patients with online access to their medical records and email communication with clinicians used more medical services, not less.
Patients and providers alike viewed content available on the portal positively, but both expressed frustration with the portal interface and reported difficulty in navigating and accessing the information. Both liked the graphs showing the patient's blood-sugar readings over time. The portal was considered especially helpful for new diabetics.
As with other studies, use of the portal decreased over time. And while patients indicated they would like to have more communication with their physician, most of their interactions took place with a nurse, dietitian, or other health professional who was monitoring the data. Physicians expressed concern that the portal would cut into the time they had to spend with patients.
Both patients and providers expressed the need for an online tutorial for the portal that would allow them to use it at their own pace and go back to the instructions, since they couldn't remember everything from their initial introduction to it. Other barriers included inadequate ongoing support, poor Internet connections (dial-up versus high-speed Internet), poor orientation, slow data entry, access and usability issues, including being able to find what they were looking for.
A study from Sweden proposed making physicians stakeholders in creation of the patient portal for young diabetics, finding that those involved in its content would be more likely to recommend it to their patients.
Research from the Palo Alto Medical Foundation in California found that a nurse-led, multidisciplinary health team working through an online disease management program helped Type 2 diabetes patients achieve better A1C results at six month, though there was little difference when compared with a control group at 12 months. The Canadian study did not measure whether the portal actually improved patient readings, only patient perceptions about whether it did.
To learn more:
- read the study