Health Affairs: Patient-physician email improves diabetes, hypertension care

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The use of secure patient-physician email in context of a comprehensive EHR is associated with the improved care for patients with diabetes and hypertension, according to Kaiser Permanente research published in the July issue of Health Affairs.

Observing 35,423 patients with diabetes, hypertension, or both, of Kaiser Permanente Southern California members, Yi Yvonne Zhou, PhD, senior manager of health IT transformation and analytics at Kaiser Permanente in Portland, Ore., and colleagues found that the use of secure patient-physician messaging in any two-month period was associated with statistically significant improvements in HEDIS (Healthcare Effectiveness Data and Information Set) care measurements.

By April 2009, approximately 25 percent of Kaiser Permanente Southern California members were registered on the KP HealthConnect patient portal. More than 556,339 secure patient-physician email threads, containing 630,807 messages, were logged throughout the study with patients initiating 85 percent of those threads. The average thread contained 1.13 patient messages and 1.16 provider messages, the study found.

“As of December 2008, 3,092 primary care physicians have used secure messaging with at least one patient,” the authors wrote. “Physicians developed their own ways of handling secure patient-physician e-mail. Some preferred to have medical assistants triage the messages, while others preferred to review all of the messages personally.”

At the conclusion of the observation period in December 2008, the proportion of patients whose HEDIS measures improved ranged from 4 percent to 11.1 percent. Results included 2.0 percentage-points to 6.5 percentage-points improvements in glycemic, cholesterol and blood pressure screening and control, the researchers added.

Noting limitations that the study was not a randomized controlled study, the authors stated that possible mechanisms that might have improved care include the increasing continuity of care, patient-physician connectedness and supporting patient self-management.

“Continuity of care, defined as regular contact between providers and patients, affects glycemic and lipid care,” stated the researchers. “To the extent that the use of email lowers barrier to regular contact, it may promote continuity of care.”

Zhou and colleagues concluded further research is needed to confirm the potential of email use as an important new modality for primary care.