Email improved care for diabetics
URAC seeks comments on new Patient Centered Health Care Home toolkits
Email between patients and primary care physicians was associated with more effective care and control of glycemia, cholesterol and blood pressure, according to a study of Kaiser Permanente practices.
The study included 35,000 Southern California patients who had diabetes, hypertension or both. Data were collected on patients' use of email and their performance on Healthcare Effectiveness Data and Information Set (HEDIS) measures. The patients who used email were matched to non-emailing controls who were similar based on HEDIS measures, age, sex, primary care clinician and diagnostic cost group score. HEDIS scores for overall effectiveness of care and specific diabetes and hypertension measures were compared for the two months after patients began emailing.
After the two months, statistically significant differences were found between diabetic emailers and non-emailers for HbA1c screening and control, cholesterol screening and control, retinopathy and nephropathy screening and blood pressure control. The performance of non-emailing patients on these measures declined over the study period, while emailing patients made small gains. Little difference was seen among the groups of hypertension patients whether they emailed or didn't email. The study also found that multiple email threads—more than one message and response between the patient and physician—were associated with better performance on HEDIS measures.
Study authors acknowledged that their research was limited by the possibility of self-selection bias among patients who chose to use the email system, despite the effort at matching controls. It was also unclear what portion of the findings could have been due to resources in the online patient portal other than email, which included appointment reminders and online access to instructions and test results. The researchers proposed several possible mechanisms for the improvement found by the study, including increased continuity of care, patient-physician connectedness and support for patient self-management.
The study authors called for further research to confirm the potential of email to improve primary care, and noted that better insurance reimbursement for emailing could provide an impetus for physicians to offer this service to their patients. The study appears in the July Health Affairs.
ACP Internist recently covered advice on using email in practice.