medwireNews: People with diabetes who access an online self-management portal through mobile devices have better medication adherence and glycemic control than those with computer-only or no access to the portal, researchers report.
These online portals “are tethered to a complete electronic health record [and] offer patients access to web-based tools for viewing laboratory test results, communicating with their health care team, and ordering prescription refills,” explain Ilana Graetz (Emory University, Atlanta, Georgia, USA) and co-authors.
In their retrospective cohort study of people with diabetes treated at the Kaiser Permanente Northern California integrated health system, Graetz and team found that the proportion of 111,463 individuals accessing the online portal using both a computer and a mobile device increased from 34.42% in 2015 to 61.71% in 2017.
As reported in JAMA Network Open, the addition of computer-only access to the portal was associated with a significant 1.16-percentage point improvement in medication adherence – measured by monthly percentage of days covered (PDC) – among those with no prior access, while adding both computer and mobile access was associated with a 1.67-percentage point improvement in PDC.
And for people who initially had computer-only access, the addition of mobile access was associated with an improvement in PDC of 0.50 percentage points.
The researchers also observed improvements in glycemic control with use of the online portal; the addition of both mobile and computer access among patients without prior portal use was associated with a 0.13% decrease in glycated hemoglobin (HbA1c) levels, on average, and the addition of mobile access among those with prior computer-only access was associated with a 0.07% decrease.
Graetz and team note that “improvements associated with mobile portal access were greater among patients with higher clinical need at baseline,” indicated by HbA1c levels above 8.0%. These people, comprising 20.33% of the study population, experienced greater improvements in both PDC and HbA1c levels than those with better baseline glycemic control.
For instance, the improvement in PDC associated with computer and mobile use of the portal versus no use was 5.09 percentage points in patients with HbA1c levels above 8.0%, compared with just 0.63 percentage points for those with levels of 8.0% or lower. The corresponding improvements in HbA1c levels in these groups were 0.19 versus 0.10%.
“Overall, our findings suggest that convenient access to patient portal tools for self-management through a mobile device could help patients with diabetes manage their health and improve outcomes,” write the researchers, noting that “programs designed to increase access to portals should consider explicitly requiring that portals be easily accessible by a mobile device.”
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