Secure messaging linked to more in-person visits

Diabetic patients with co-pay-free access to their doctors through secure messaging and telephone-based communication were more likely to make in-person visits, according to a study published at the Annals of Family Medicine.

The research coincided with patient-centered medical home (PCMH) redesign in Group Health's integrated healthcare delivery system. It followed 18,486 adults with diabetes before, during and after the redesign.

The mean quarterly number of primary care contacts increased by 28 percent between the pre-PCMH baseline and the post-implementation periods, largely driven by increased secure messaging. However, overall, the number of quarterly office visits declined by 8 percent.

Despite this, the study found that a 10 percent increase in secure message threads was associated with a 1.25 percent increase in office visits; a 10 percent increase in telephone encounters was associated with a 2.74 percent increase in office visits.

"Although secure messaging and telephone encounters may facilitate patients' self-management of diabetes, they cannot fully substitute for clinical tasks such as in-person foot and eye examinations and physical examinations," the authors wrote.

Group Health had offered these modes of communication for several years, including a patient portal, before the study, and the patients were universally insured and of relatively high socioeconomic status, which leads the authors to warn about generalizing from the study.

They urge further research, for example on whether telephone and secure messaging encounters can reduce or delay use of emergency and inpatient services.

Research at the Mayo Clinic found that use of patient portals and electronic visits had no significant impact on the frequency of face-to-face primary care visits among adults.

Patients' communication preferences are evolving, according to a survey from Catalyst Healthcare. It found that patients are particularly interested in email--and one in four would choose a doctor who charged $25 per episode for it.

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