J. Med. Internet Res. - The effect of a patient portal with electronic messaging on patient activation among chronically ill patients: controlled before-and-after study.

Tópicos

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Resumo

CKGROUND: It has been suggested that providing patients with access to their medical records and secure messaging with health care professionals improves health outcomes in chronic care by encouraging and activating patients to manage their own condition.OBJECTIVES: The aim was to evaluate the effect of access to a patient portal on patient activation among chronically ill patients. Further, the relationship between temporal proximity of a severe diagnosis and patient activation were assessed.METHODS: A total of 876 chronically ill patients from public primary care were allocated to either an intervention group receiving immediate access to a patient portal that included their medical records, care plan, and secure messaging with a care team, or to a control group receiving usual care. Patient Activation Measure (PAM) at baseline and at 6-month follow-up was obtained from 80 patients in the intervention group and 57 patients in the control group; thus, a total of 137 patients were included in the final analysis.RESULTS: No significant effect of access to patient portal on patient activation was detected in this study (F1,133=1.87, P=.17, (2)=0.01). Patients starting at a lower level of activation demonstrated greater positive change in activation compared to patients starting at higher levels of activation in both the intervention and control groups. Further, patients diagnosed with a severe diagnosis during the intervention showed greater positive change in patient activation compared to patients whose last severe diagnosis was made more than 2 years ago. The results also suggest that the intervention had greatest effect on patients starting at the highest level of patient activation (difference in change of patient activation=4.82, P=.13), and among patients diagnosed within a year of the intervention (difference in change of patient activation=7.65, P=.12).CONCLUSIONS: Time since last severe diagnosis and patient activation at baseline may affect changes in patient activation, suggesting that these should be considered in evaluation of activating chronic care interventions and in the specification of possible target groups for these interventions. This may be relevant in designing services for a heterogeneous group of patients with a distinct medical history and level of activation.

Resumo Limpo

ckground suggest provid patient access medic record secur messag health care profession improv health outcom chronic care encourag activ patient manag conditionobject aim evalu effect access patient portal patient activ among chronic ill patient relationship tempor proxim sever diagnosi patient activ assessedmethod total chronic ill patient public primari care alloc either intervent group receiv immedi access patient portal includ medic record care plan secur messag care team control group receiv usual care patient activ measur pam baselin month followup obtain patient intervent group patient control group thus total patient includ final analysisresult signific effect access patient portal patient activ detect studi f p patient start lower level activ demonstr greater posit chang activ compar patient start higher level activ intervent control group patient diagnos sever diagnosi intervent show greater posit chang patient activ compar patient whose last sever diagnosi made year ago result also suggest intervent greatest effect patient start highest level patient activ differ chang patient activ p among patient diagnos within year intervent differ chang patient activ pconclus time sinc last sever diagnosi patient activ baselin may affect chang patient activ suggest consid evalu activ chronic care intervent specif possibl target group intervent may relev design servic heterogen group patient distinct medic histori level activ

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